Dr. Kay Durairaj 0:00
Kay,

Dr. Kay Durairaj 0:15
well, hello, hello, guys. You're listening to beauty bites with Dr Kay, secrets of a plastic surgeon, and I have some secrets for you. Today. We're going to talk about the microbiome and why it is a hot topic. We have a really amazing expert, Kieran Krishnan, came on the podcast date, maybe it was about two years ago. Blew my mind, and the science has exploded so much since then. Kieran is a research microbiologist, health and wellness expert, entrepreneur and educator. He spent two decades, the last two decades, translating this complex science of microbiomes into like strategies you could actually use. He co founded microbiome labs. He has published research, scientific textbooks and global patents in the microbiome space. So today we'll talk about skin microbiome. What is the acid mantle and why is it so important? How microbes help your skin barrier? And what about skin dysbiosis? How does that lead to all these problems we have, like dermatitis, allergies, food problems, probably even aging. Welcome to the podcast, Karen,

Speaker 1 1:18
thank you so much for having me. It's wonderful to be back.

Dr. Kay Durairaj 1:21
Shall I call you Dr Krishnan, or shall we stick with Karen?

Speaker 1 1:24
No, Karen is perfect. Okay,

Dr. Kay Durairaj 1:26
you're going to have a little chat. So for listeners who are new to the whole entire concept of skin microbiome in general, why should they care about it?

Speaker 1 1:35
You know? It's, it's, it's a really profound concept, right? So we've all known, for example, we just take the skin itself, forget the gut microbiome for a moment, which is really complex and very impactful in your overall health. But let's look at the skin. The skin is known to be the largest organ in the body. We've always thought of it as just this barrier that that prevents things from going out and things from going in from the outside world. But now we come to know that the skin is much more dynamic than that, right? There's this neuro, immune endocrine axis related to the skin. The skin is really an amazing sensory and signaling organ that indicates to the inside of your body all of these things that are going on on the outside, and then and your immune system response, your hormones response to it, and so on. And at the end of the day, all of those things, all of those functions, are dictated in large part by the microbes that are present on the skin. It's a 35 to one ratio of skin cells to microbes on the skin. And we're talking about bacteria, viruses, fungus and so on, and all of those microbes play a very important role in how the skin is structured, how it functions, and then also how it affects your overall health. So we have to consider what's going on with the ecosystem on the surface of our body.

Dr. Kay Durairaj 2:56
I think that people don't know what the acid mantle is, but that's one of the most important features healthy skin. Can you explain? What's the acid mantle? Why is that foundational?

Speaker 1 3:07
Yeah, you know, and you hear about pH of the skin quite a bit in in cosmetic products, right? They talk about products that are pH balanced. And then as we're digging into this further, we go, okay, what? What is going on with the acid mantle of the skin? Number one, you start to realize that it's a very narrow range, right? The optimum range for the for the acidity of the skin is between a pH of 4.5 and 5.2 which is a relatively narrow range, right? And then the question becomes, how is that maintained? Right? That's external. We everyone knows that the stomach, for example, produces stomach acid, and stomach acid is incredibly important, but we've got glands in the stomach that produce hydrochloric acid that we need, but we don't have acid production on the skin. So how is this pH maintained? So well? Then you start to realize, well, your seat, your your your oils that are secreted come out in triglyceride form, and so on, and then you've got a mix of some minerals from sweat, and all of that actually gets metabolized by microbes on the skin to release fatty acids. And it is those fatty acids that actually acidify and maintain that very narrow pH range of the skin, and we know that if the pH goes off that narrow range, things start to fall apart, right? So we we start to look at the first barrier feature of the skin, and that is the pH of the skin, and that is one of the most important things to keep in mind as we're thinking about the health of the skin. Thinking

Dr. Kay Durairaj 4:43
about the health of the

Dr. Kay Durairaj 4:43
skin. Should I be testing my patient's skin pH? Could you do that with like regular pH strips, or do you have to use specialized like iontophoresis type equipment?

Speaker 1 4:54
Yeah, I think you you can. You can utilize strips to get a pretty strong idea of. How off the pH may be. But there's some, there's some, really, you know, clear examples of what happens, right? So, for example, you can assume that the pH of the skin is off when your patients are showing up with increased sensitivity or reactivity of the skin, right? That is one of the key features of dismantle pH within the skin if it's too high or if it's too low, skin increases its sensitivity and reactivity, and we can explain why that is. You start to see an increase in redness and chronic low grade inflammation on the skin. So those patients that show up with the redness in the skin and that hyper reactivity right? The immune response on the skin that is typically starts with a pH imbalance. You also start to see patients that tend to get breakouts that are atypical in nature, right? And then you start to see dryness in the skin. So most people that struggle with a significant amount of dryness, that is an issue of the pH of the skin as one of the driving factors. And then another piece of evidence is slower recovery. You know, repair of the skin, the function of the keratinocytes and the matrix metalloproteinases and all that to facilitate repair is pH dependent, right? And in fact, the lipid layer. So you know, the ceramide layer that protects the skin, that acts as kind of the mortar between the skin cells, that prevents moisture from evaporating. The maturation of the ceramides are dependent on on pH, and so you don't get the PA, if you're not within that pH range, you don't get proper maturation the ceramides. And then you end up with much more dry, flaky skin. And then most of the enzymatic function on the skin to activate and repair the skin. Most of those enzymes function in that neuroph as well, which is why, when the pH is off, you get lots of barrier function issues. And one last big thing when the pH is off, especially if the pH is elevated, you get fungal overgrowth. That's that's a that's a foundational driver of fungal overgrowth in people. And then we know all of the problems that that can relate to.

Dr. Kay Durairaj 7:14
And then you need to acidify the skin if that's happening

Speaker 1 7:18
exactly, yeah,

Dr. Kay Durairaj 7:19
testing would be interesting. I saw a patient yesterday, and her skin was just red inflammatory acne. You could just tell something's wrong in her gut and her diet. Even quizzed her about, what do you like to eat? She's like, I'm a pescatarian, but I do like spicy. And then, well, maybe I do like carbs, but I only eat sourdough. And then I'm like, I don't even know where to start with the dietary corrections for that. But I, you know, of course, I told her, have prebiotic, probiotic, yeah, supplement with acromancy. But like, where would you start with the diet advice? Because this visible problem on the skin, don't we need to start with diet? Or do we start with barrier repair?

Speaker 1 7:57
Yeah, I would. I would do absolutely both the gut skin connection. The gut skin axis is a very powerful influencer on the skin. And in fact, ceramides, for example, that she would need to improve the barrier function in the skin. Those ceramides actually come from the diet. They come from sources called Phytoceramides, which come from rice bran and other fiber sources. So one of the things that she probably really needs is an increase in fiber intake, and then the ability to convert that fiber into a particular type of short chain fatty acid called acetate. Acetate that's made in the gut actually ends up in the skin and other areas distal from the gut and in the skin, for example, one of the things acetate does is it repairs damaged cells. It helps facilitate damaged cell repair, and it dampens down immune responses as well. It acts as a strong anti inflammatory. And so I would in her case, she should remove gluten. She should likely remove dairy, if she's likely sensitive to it. A lot of people with with sensitive skin tend to have casein and other sensitivity. So she can remove gluten and dairy for a period of time, and then increase her fiber intake, increase her polyphenol intake, and then utilizing a probiotic, like a spore based probiotic, which converts the fiber into the short chain fatty acids. That will be a brilliant start for her from the gut side and then from the topical side. I would use a serum that can help balance the skin microbiome to bring back the growth of the of the organisms that manage the pH and manage the acid mantle, you know, like the SIB serum, for example, SIV, that can help do that as well.

Dr. Kay Durairaj 9:47
When is the sim serum? I haven't heard of

Speaker 1 9:50
that. Yeah. So that's a, that's one that that I worked on with the group and creating to help rebalance the skin microbiome. It's, it's called SIV, you. Used to stand for skin IV, but now it's called SIV. We've done studies on it, on eczema, on dermatitis, on acne, a number of examples of inflamed, broken barrier of the skin. We've done skin microbiome swabs to see how it actually changes the skin microbiome, and as a result of that, completely changes the barrier function, and thereby the inflammatory pathologies on the skin as well. So something like that could be very beneficial for her.

Dr. Kay Durairaj 10:28
That's so interesting. You mentioned the spore based prebiotic. So what do you mean by that?

Speaker 1 10:36
Yeah, so there's a there's a type of probiotic out there called megaspore biotic. These are spore organisms only. So these are bacillus Endospores versus your conventional lactobacillus and biffrobacteria, which you find in lots of different probiotics. Now the advantage of the spores is there's the studies that are published that show that the spores do a really great job of facilitating the metabolization of fiber and prebiotics into short chain fatty acids, right? And ultimately, that's what we want out of the fiber and the prebiotics. We want the conversion to short chain fatty acid. So somebody that already has a bit of a messed up gut like this patient likely does, they simply won't convert enough of their fiber into short chain fatty acids. So you want to add the spore probiotic in there to facilitate that one study. Actually, I was one of the authors on this study. We published we saw that we can increase the conversion of short chain fatty acids to by 150% just by adding in the spores. That facilitates that. That reaction.

Dr. Kay Durairaj 11:42
Is there a brand that you typically favor or recommend? We can mention brands because we're I'm all about the learning.

Speaker 1 11:48
Yeah, absolutely. So the easy to access brand is one called just thrive. Just thrive. Yeah, and it's one I use myself, and then for clinicians, it's megaspore biotic, but just thrive. Does exactly the same thing. It's fantastic.

Dr. Kay Durairaj 12:05
Okay, perfect. And then do the bacteria. One of the things I want to impress on the audience is you can take a probiotic every day, but it kind of just washes right through. How do we increase these kind of Keystone commensal bacterias that live in us and with us and be become part of our, you know, Flora and our background.

Dr. Kay Durairaj 12:28
Yeah.

Speaker 1 12:28
How do we get them up and have them in high

Dr. Kay Durairaj 12:31
Ed live there and yeah, the good ones need to take up house, live there and be like, you know, existing with us.

Speaker 1 12:37
Yeah, the biggest driver of that is diet. So so most of the keystone species, especially the most important ones, like, say, akramansia or bifida, bacterium longum or Fe Kayli bacteria prosnitzsi, all of these organisms feed off of polyphenols and fiber. And when it comes to fiber, we want a diversity of fiber, right? So we need a combination of soluble fiber and insoluble fiber, and typically it's like 70% soluble and about 30% insoluble. Now that can get confusing for people, right? But these days, fortunately, they have AI. They can go on chat or Claude and say, Hey, Claude or chat, give me an example of what I would eat each day. If I want to get 30 grams of fiber a day, 70% soluble and 30% insoluble, it'll give you all of these wonderful examples of nuts and seeds and berries and, you know, Bran and cassava and all these wonderful things, right? So the intake of fiber, and then the intake of polyphenols, and you want about a pound of of polyphenol, rich berries per day. It sounds like a lot, right?

Dr. Kay Durairaj 13:52
But a pound, a pound, yeah, is that like a square carton of blueberries, or more than basically,

Speaker 1 13:58
yeah, it's, it's basically

Dr. Kay Durairaj 13:59
that

Speaker 1 13:59
actually about half of that may even be enough, especially if you're getting a mix right. So let's say you get some blueberries, blackberries, strawberries, anything in the berry family contains the right type of polyphenols that really feed acromancy and really feed some of these keystone species. And just think about, you know, after each meal, maybe get a few 100 grams of a handful of berries, if you will, as your dessert. You know, everyone likes a little bit of a sweet treat. So instead of going for a cookie or a piece of cake or something, do a handful of berries. And that goes a really, really long way in feeding the keystone species and getting their numbers up. Now the spores. We also published a study in 2019 showing that when you take the spore based probiotic that I mentioned that just thrive, for example, it increases some of the keystone species because the spores can compete against dysfunctional organisms that the keystone species struggle with. Competing with, right? So the spores come in, they start knocking down some dysfunctional organisms. That gives more room for the keystone species to increase.

Dr. Kay Durairaj 15:09
Wow, I think that's so helpful to know. Like, I need to adopt that habit. I have not been doing that very here and there, but like a sprinkle, yeah, to be a ton of and you're gonna, for the audience listening, you get polyphenols from any rainbow colored fruits and vegetables. So the bright things, bright,

Speaker 1 15:30
absolutely, yeah. And the other advantage of that, right? So, so within the category of polyphenols, there are compounds called care carotenoids, and some of these Carotenoids are very powerful antioxidants. We had actually done some studies when I was running microbiome labs back in the day, showing that both dietary and supplemental carotenoids play a very important role in protecting the skin from UV, from blue light irradiation, and even from UV to a certain degree, but blue light irradiation for sure, which we're all exposed to consistently, right on a day to day basis. And so, so, yeah, there's additional side benefits. And then these polynoids

Dr. Kay Durairaj 16:12
are more they're more than just in carrots. You can also find them in other fruits that have high vitamin A content. So what would that be like?

Speaker 1 16:20
Yeah, so most of the berries will have a carotenoid content in it. They'll have things like astaxanthin, zeaxanthin, lutein, right? Lutein is also fond of them. You can also get it from things like green tea. So black tea, green tea, both of those have a good amount of carotenoids and polyphenols in them. So if you're making green smoothies, the colors of the rainbow, the fruits and vegetables, those all contain both polyphenols and carotenoids. And you know, when you look at like long term studies on diet and macronutrients that have a massive impact on overall health, right, nothing compares to the studies on fiber and polyphenols. For example, fiber, there was a study that was published in 2020 it was a meta analysis study of almost a million subjects. They showed that for every 10 grams of fiber you add to your daily diet, you can reduce your all cause mortality by 10% right? Which is massive, and that's all the way up to around 40 to 45 grams, which reduces it 40 45% after that, it's a little bit of a diminishing return, so you can't get to 100% unfortunately. But imagine being able to reduce your your risk of dying from all disease states by 40 to 45% that's massive, right? And that's just by getting 40 grams of fiber per day. Then you add polyphenols on top of it, and polyphenols work differently than fiber, so this is likely an additive effect for those that got more than you know, it was somewhere around 404 50 milligrams of polyphenol per day, which you can get from about a pound of the of the berries that we talked about, those individuals will were able to reduce their all cause mortality by 25 to 30% so just between those two things, right? If we're diligent about it, and we do it every day, and most of it is it was good and easy to eat, we can dramatically improve our health and reduce our risk for long term conditions.

Dr. Kay Durairaj 18:24
Wow. Does that apply to like powdered and soluble fiber, fiber gummies, or any kind of fiber, fiber as fiber. Or I do. I really, of course, you want to sit and eat a giant bowl of salad, but you don't always have to. Yeah, so can I get fiber gummies, and I'm going to be just as good.

Speaker 1 18:42
Most things in gummies will not necessarily absorb the same way, but fiber is going to be a little bit different. So if it was like an active ingredient, say creatine and gummies, I would always favor the capsule or the powder over the gummy because it's hard to get the creatine out of the gummy fibers a little bit different, because we don't digest the fiber anyway. So it doesn't matter if we break it down in our small bowel and absorb it. What we really care about is that it makes its way into the large bowel. So when it comes to fiber gummies, if that's the way, that's the easiest way to stay compliant with it, absolutely do it. Now, the ideal scenario is you want a diversity of fiber, right? So you want some nuts, some seeds, some some root vegetables and tubers, so some potatoes and cassava and things like that. Then you want some leafy greens and fiber from that source. And you want some fiber from from fruits. And then some supplementation, some simple psyllium husk, for example, or Ph GG is one of the most well tolerated fiber, even for people that tend to be very sensitive to it. It's called partially hydrogenated guar gum. Phgg people can look for and then resistant starch. Resistant starch is also very well tolerated and easily adds to the five. Per intake. So what I've done, for example, with my goal of reaching 40 to 50 grams of fiber per day, I supplement with each meal about five to 10 grams, right? So what does that mean? It means prior to the meal, prior to eating food, I take about five to 10 grams of soluble fiber. Now, the soluble fiber does a couple of the interesting things, because soluble fiber is soluble in water. It forms a gel structure. So when you consume it, it goes into your stomach and it and it binds water, and it forms a gel and as a result, it expands your stomach. And when it expands your stomach, it does the same thing that GLP one agonists do. It triggers a satiety response, and it triggers a fullness and it slows down gastric emptying, right? So that means that, number one, your your glucose response is going to be blunted from whatever meal you're eating. Number two, you're going to eat less automatically. You'll eat about 20% 25% less, because you feel full much faster. And so you're going to have all these metabolic benefits of weight loss and insulin better, insulin control and so on, on top of getting the fiber right so and then if that meal itself contains some fiber, say, another five grams or 10 grams from some vegetables or fruits or roots and tubers and nuts and seeds and so on. Then you've got about a 15 grams of fiber in that meal, about eight to 10 grams of it before the meal. That actually gives you metabolic benefit as well, right? So that becomes a really cool strategy to do it

Dr. Kay Durairaj 21:37
that's so good to know that I should definitely adopt that I have a very important question for you, what does Diet Coke do to my microbiome? That's my one vice. And I'm like, I'm sure it may not be positive. I don't know if I want to know the answer, but I kind of want to know the answer.

Speaker 1 21:55
Well, you know what's what's so interesting about it, right? The the automatic knee jerk response is that it's not good for the microbiome. When you dig into the studies, though, okay, so I have not found any real credible information that it's really bad for the microbiome, even the if the sweetener that they use, because I think in Diet Coke, they use sucralose right now, sucralose is not great. Of all the sweeteners that are out there, I prefer, for example, sugar alcohol. So I prefer that they're using erythritol then, or inulin or xylitol, kind of sugars versus sucralose. But nonetheless, it's not like it's not as bad for your microbiome as you think, right? And so I would always play this balance game. For me, it's an 8020 rule, if your microbiome was fairly resilient, then if you get a certain amount of joy and functionality from that Diet Coke, then by all means, have that Diet Coke. And all the other decisions are good decisions in your day, right? And so I really hesitate to tell people to clean up everything right, because I think we have to also live, and we have to have a little bit of joy and a little bit of fun in this life. And so if a piece of cake makes you feel better, if a cookie is good, if you know, if a Diet Coke gives you some psychological response and also makes you feel more energetic, by all means, do it, but then make the other 80% of decisions, the right decisions, and the microbiome will remain resilient, right? And so everyone that asked me, like, what are my health goals? And it comes from my microbiome. I always say my goal is resilience, because I don't want to have to be healthy by making 100% the right choices. I want to live by the 8020 rule. I want to make 20% bad decisions and still be fine, right? Because there's a lot of living that happens in that 20% and so it's only practical, right? I mean, we all see the biohackers online that seemingly live these perfect lives, and every decision is meticulous for their body and all of that. But that's not feasible. That's not humans. That's not how we function, right? Yeah. And so it's unattainable. And so to be the response to that is be more resilient so you can make poorer decisions,

Dr. Kay Durairaj 24:16
yeah, in terms of alcohol too. Then, has that got the similar kind of impact.

Speaker 1 24:22
It's exactly the same, yeah, for me. So alcohol is it can be toxigenic to the microbiome, but again, in in bursts and spurts, if you're drinking every night, that's a different thing, versus social gatherings. And you know, if I'm going out to meet friends and it's a birthday, I'm going to have a couple of drinks, you know, and I'm not going to sweat it, because I know that my microbiome is going to be fine, given that I'm working hard 80% of the time to build that resilience. And that's really human nature, right? So we think about humans having evolved as omnivores, we were forced for long. Periods of time to eat, non ideal things, right? And our system tends to adapt to these changes. And our system is resilient. You know, we if we're making majority good decisions, our system will be fine.

Dr. Kay Durairaj 25:15
I think that's so true. You mentioned a little bit about the skin barrier, the pH and how we change and dry as we age. What kind of changes do we see the microbiome with menopause patients, both on skin and gut?

Speaker 1 25:29
Yeah. So huge, huge. In fact, it's, it's one of the big drivers of all the change in disease risk for women as they hit menopause, right? So we know that that women catch up to men with with cardiovascular disease risk, with diabetes, with obesity risk, and all that once they had late perimenopause menopause. We also know, and this is, this is really profound. I've been doing a lot of work in the joint health space in osteoarthritis and understanding the role of the microbiome in osteoarthritis. Because one of the things I found is that between the ages of 45 and 55 women report newfound musculoskeletal pain 10 times more frequently than men do, right? And so women are much more susceptible to new onset of pain in that critical period of perimenopause to menopause. And so of course, then you have to look at, well, what's the connection? You know, it's it's not true before that, and it's not true in the 60s. In your 60s, men and women are about the same, but in that critical period, women seem to accelerate. So one of the things we know that occurs with with estrogen levels dropping is that when estrogen levels start to drop in perimenopause, the diversity of the microbiome starts to go down quite dramatically, and then inflammation in the lining of the gut increases. The gut lining has estrogen receptors, and binding of estrogen receptors in the gut actually facilitates an anti inflammatory response the microbiome. There's also microbes that feed off of estrogen, which is one of the ways in which we clear it through the body, right? And so as estrogen levels drop, you get two things that are happening. You get lowering of diversity in the gut microbiome, and you get an increase in inflammation. Both of those lead to a condition called endotoxemia, which is the clinical impact of leaky gut, which means that now you've got these toxins, in particular, one called LPs, that leaks through more often and ends up in circulation. It goes through the liver, first, it creates a lot of toxic effect on the liver, and then it escapes the liver and goes throughout the circulation. Now that elevation in LPS in circulation and in the liver is directly associated with an increase in cardiovascular risk, with osteoporosis, with obesity, with anxiety and depression, and also with skin conditions. Right LPS increases inflammation in the sebaceous glands and other immunological structures within the skin. It thins out the skin and it and it reduces the diversity in your skin microbiome. Now you know the diversity in your neck and face. You don't want very high you want a predominance of cutie bacterium and Staph epidermidis. But on the body, you want high diversity on your skin microbiome, the diversity of the body comes down dramatically as estrogen levels decrease as well. So for women who are going into menopause, it becomes extremely important for them to focus on the diversity in their gut microbiome, right? And the diversity on their skin microbiome and modulating the skin microbes, because inevitably, those two things will go down as a result of estrogen going down and inflammation goes way up.

Dr. Kay Durairaj 28:56
So it's so interesting. I think women need to know this, because, you know, things sort of slowly and visibly change, but there is that one layer barrier between the GI tract and the body. It's such a such a strange concept. What can we do to actually improve that barrier thickness so this LPS is not diffusing through, you know?

Speaker 1 29:17
Yeah, yeah. So the things that actually stops LPS from leaking through the spore probiotics, for example, that we talked about earlier, we've published at least two studies on it in in a gastroenterology journal, showing that if you take even just a spore probiotic by itself, there's about a 60, 70% reduction in that leaking in of LPs, so that, in itself can be very useful. There's, there's a product called immunoglobulin G IgG

Dr. Kay Durairaj 29:47
that is a supplement, sort of like the colostrum type treatment.

Speaker 1 29:50
It is. It's like colostrum has some immunoglobulin G. In this case, it'll be a concentrated form of it. So if people just search IgG or bovine. Serum IgG, the those you'll find, you know, a dozen products on the market that have that, those that IgG binds LPS in the gut, that toxin in the gut and reduces inflammation and lining of the gut. Another one, and this can be a dual action for women, is a is an ingredient called lactoferrin, right? Because the other thing women suffer from is anemia, right? And lactoferrin is responsible for increasing iron absorption. So just taking iron supplementation and eating steaks is not going to do much for your ferritin levels. It's not going to do much for your iron levels. What you really need is lactoferrin, which then facilitates the absorption ion. But a lactoferrin also modulates inflammation in the lining of the gut, and it binds to LPs, so look for lactoferrin as another ingredient. So if you add spore probiotics, IgG and or lactoferrin, if you could do both, do both, it's fantastic. And then get your fiber in, get your polyphenols in, like we talked about. And then the last thing is, manage your stress, right? Stress has one of the biggest impacts on your skin, on your gut microbiome, and your skin microbiome, right? Because there is this skin neuro immune access, right? And we all are familiar with this to a certain degree, because we know, for example, when people who are prone to dermatitis, or people who are prone to acne when they're really stressed, they get flares, right? Their acne flares, their dermatitis can flare. You get all this

Dr. Kay Durairaj 31:40
breakouts, everything

Speaker 1 31:41
exactly, course or breakouts, all this inflammation right on the surface. That is part of this of the skin's neuro immune access, because the skin is acting as a signaling beacon, if you will, for the impact of stress inside the body, and then also often it leads to more fidgeting, more scratching, more itchiness. And that itch scratch cycle is also a skin neuro immune cycle, you know, and so all of that just facilitates more damage to the barrier, more inflammation. So managing stress is one of the most powerful things you can do both for your gut microbiome and your skin microbiome, right? And then the question becomes, well, how do you manage stress? Right? There's, there's so many things that people talk about doing, you know, mindfulness work and all that. My, my, my response to people is, number one, do whatever you think can work for you. It doesn't matter if it's drawing, sketching, you know, deep, diaphragmatic breathing, sauna, whatever it may going for a walk, but some of the things you can do to facilitate those actions is utilizing a psychobiotic. Right? A psychobiotic is a probiotic bacteria that works on the gut brain axis that dramatically reduces the fight or flight response, which is what we're in when we're in a stress state, right? An example of a psychobiotic on the market is a product called Zen biome, z, e, n, b, i, o, M, E. It has a strain in it called bifida, bacterium longum 1714, that has about nine published studies, randomized control trials, on managing anxiety and stress response. And it can be a real big help, along with the other things you may do, like, you know, meditation, breathing, work, walking, you know, weightlifting, which is very powerful against stress, because when you lift weights and you you increase resistance on your muscles. Your muscles release a set of compounds called myokines. Some of these myokines are actually very strong endorphins and actually modulate stress response. Some of them actually help the lining of the gut. So weightlifting can actually be very beneficial for your stress response, for your gut and thereby for your skin as well.

Dr. Kay Durairaj 34:04
That's so interesting. Could you repeat the name of that? Bifidobacterium Bifido? You tell me,

Speaker 1 34:10
Bifido longum? Yeah, the brand name. The brand name is called Zen biome, z, e, n, b, i, o, M, E, and it's B longum. So it's Bifidobacterium longum, 1714, 1714, is a strain ID. It was actually developed at University College Cork in Ireland. Fascinatingly, they were looking at, you know, Irish women who were really who slept really well, who were jolly, who nothing bothered them. And they were comparing them to people with high stress and anxiety, they were looking at the gut microbiomes, and what they found was that the women who had very controlled moods and slept really well had very high levels of this Bifidobacterium longum, 1714, in there. So they isolated the strain, and then they looked at what was going on. And then I had the pleasure of working on. Strain early on, and here's what we figured out what's happening here, and this is so fascinating. So when you consume this strain, it goes into your gut. It doesn't live in your gut. It goes in and at this terminal end of your small intestine, it sits there. And your own immune cells, called dendritic cells, reach across the lining of your gut, they grab these microbes and pull them into circulation, right, which in itself is a crazy thing that your immune cells are pulling in bacteria from your gut into your circulation. But they do this, and then what they do is they digest the bacteria, and the bacteria have a very unique carbohydrate on the outer surface, they release those carbohydrates into circulation. Those carbohydrates actually have a way of binding receptors like glucocorticoid receptors, and facilitating the downward regulation of cortisol response and stress response, right?

Dr. Kay Durairaj 35:57
It's,

Speaker 1 35:58
it's such an elegant thing, and nature's already created this magical thing for us. We just have to know enough to utilize it.

Dr. Kay Durairaj 36:05
I love that. That's incredible. And then, when they've looked at microbiomes of the centenarians that live to be more than 100 they've also identified some key findings. Do you know? Can you talk about what that is?

Speaker 1 36:18
Yeah, there's a few things. So number one is their diversity of the microbiome tends to be very high, and as you age, you lose diversity in the gut microbiome. We talked about how for women, part of that is facilitated because of the reduction in estrogen. For men, it just continuously happens from your late teens onwards. The diversity keeps going down. And so what they find is centenarians tend to have very high levels of diversity in their microbiome, which is absolutely correlated with longevity. They also found that they have certain key species. So keystone species in general are really high in them, but in a lot of these centenarians, they have very high levels of a type of lactobacilli called Lactobacillus rooteri. Now rooteri is really interesting, right? Because it's assumed that rooteri plays a very significant role in the release of oxytocin.

Dr. Kay Durairaj 37:09
And

Speaker 1 37:09
oxytocin, right? Is our love and bonding hormone. It works antagonistically against the stress hormone. It also gives us a sense of community and bonding, and that's one of the key features of centenarians, is that community structure, right? They have purpose. And community are the two things that are that are basic among all centenarians, no matter where they are, whether they're in Okinawa, Japan, or they're in Costa Rica, or they're in the part of Italy and Sardinia, all of them are the same. Their diets a little bit different, their habits are different. But there's two things that are always true, is that they all have a strong sense of community and a strong sense of purpose. And when you lose that community, and you lose that purpose, then you start you rapidly start to decline, starting with your mitochondria, your cells, your organs and so on. And that bacteria, ruderite, facilitates community and purpose.

Dr. Kay Durairaj 38:08
So interesting. So when I retire from working and having community and busyness and purpose, is my microbiome going to change? Maybe

Speaker 1 38:17
it might, unless you, unless you find your new community right in that case. So, so, for example, in, you know, in Sardinia, Italy, or even in Okinawa, Japan, it is very, very common for all the retired older people get together every day. And in fact, they dress up, they ride their bikes, they meet at a cafe, they sit and talk, you know,

Dr. Kay Durairaj 38:39
like, what the heck? There's no Starbucks hangout seniors. Starbucks for seniors. We need

Dr. Kay Durairaj 38:45
that, right? We need that, right? We need put them in a

Dr. Kay Durairaj 38:48
nursing home, in isolation with no sunlight, talking to strangers. Yeah, it's weird,

Speaker 1 38:53
yeah. And what, what are they seeing in nursing home, right? So you imagine if you're someone in your late

Dr. Kay Durairaj 38:59
bacteria,

Speaker 1 39:00
right? Yes, exactly. You're someone in your late 60s, and you're you're put in a nursing home. You're seeing, you're in there with people in their 80s and 90s who may not be very healthy and not, may not be at a very good stage in life, and that's what you have to look forward to, right? You're seeing your future self when you're looking at those individuals that doesn't give you a lot of hope, it doesn't give you a lot of sense of purpose. And then you start to, you know, start to lose your own self, knowing that now you're in this 20 year sentence to end up like that. And so what people need is to start to maintain activity, maintain a sense of purpose. You know, gather together, do some service together. You know, start a company. You know, it doesn't matter if you're 70, start a small company that does something tiny, right? It doesn't matter

Dr. Kay Durairaj 39:54
you just totally

Speaker 1 39:56
like volunteering, Yep, exactly. You know, mentoring. All of those kinds of things, right? That's what we're really missing in the Western world, right? We we isolate ourselves quite a bit as a result of technology and in our in our most active times of life, we are on the go a lot like both you and I are, and then we look forward to this downtime, but we forget that in that downtime is when we need community even more, right? Because, right now we inevitably have community because we have our staff that we care about, we have our families, we have the colleagues and all these people in a sense of purpose, then we think about just kind of kicking back by ourselves. But that's not really what facilitates health and purpose, right? So we need to find those communities as we get older.

Dr. Kay Durairaj 40:46
I definitely think so. I'm super interested in skin and the skin bacteria and how we nourish the skin microbiome. So you mentioned the pH 4.5 to 5.2 what? What can we do to improve skin microbiome? Are we over doing it on the cleansing and the amount of products that go on? I always worry, and I dislike the idea of a 10 step Korean routine, because I think for of preservatives and ingredients and compounds, and, you know, really ingredients that are not great that go on your skin must be insane.

Speaker 1 41:21
Yeah, absolutely. I mean, I think if we were to list a few daily habits that have a negative impact on the skin microbiome, you know, it would be number one cleansing too aggressively and too frequently, right? So we are cleansing our skin with antimicrobials and things that kill microbes, usually twice a day. That's very unusual, if you think, if you think about it, right? I mean, through most of the course of human evolution, we never did that, and so that can be really damaging the skin, also avoiding over exfoliation, right? So we've got this practice of just really exfoliating the skin way too much. I mean, soaps have exfoliants in them and all that. So now you've got a detergent and an exfoliant, which, again, can disrupt the top layer, the stratum corneum, which is actually a food source for the beneficial microbe on the skin, right? So we don't want to slough off that skin. You know, we all have this. Our skin has this natural delimation process, and part of that process is the microbes on the skin actually metabolizing the dead skin cells, the proteins and all that that are in there. So we want that there for the food, for the microbes, and then, of course, drying out of the skin, drying out of the skin has a huge impact on the microbiome of the skin, because so many of the microbes on the skin feed off of the oils that are produced in the skin, right? And so when our barrier becomes dysfunction, our ceramide layers become dysfunctional, and our skin dries out, that kills the microbes that are on the skin. We also want to be like you, like you mentioned, very strategic about the personal care products right there. You can very easily do too much of it, you know, if you're just looking at and I would challenge people to do this right, look at your skincare routine, and let's say you've got six products in that skincare routine that you're using twice a day or once a day. Just add up all the actives, all the ingredients that are in all of those products. Right? You may end up with somewhere around 7580 100 plus ingredients that you're putting on your skin once or twice a day. That can be quite a bit. That can be quite a lot. And the thing is, most of those things are not tested for its impact on the skin microbiome, right? The testing is around sensitivity to the skin.

Dr. Kay Durairaj 43:42
None of our skin products get a microbiome eval. They don't that. Karen, you need to start that. That's so cool. If it's like stamp of approval for protecting your good microbiome,

Speaker 1 43:54
totally. That's That's one of my goals, is to just develop a device, a standardized way of testing whether or not a product is going to impact the skin microbiome. Because really what we're looking at here when a product is tested is, does it create any sort of immediate or delayed hypersensitivity on the skin? And that's typically from a single or just as handful of exposures. We just don't know what the combination of all these things will do to the ecosystem, right? And then, and then, things that people may do at home that break the barrier too much, you know, I've talked about, for example, micro needling can be very beneficial, but the goal of micro needling is to, you know, do a control damage, and then you get the benefit from the rejuvenation and the repair, right? But if your skin barriers already damaged, and people use micro needles that are too long or they're doing it too frequently at home, for example, especially not under the care of a skin care professional, you can cause more damage. You can prolong the inflammatory response. You can translocate dysfunctional bacteria from the very surface. Fist deeper into the skin, right? You can actually cause repair, a signaling that is more scarring than rejuvenating, right? And so, so you want to be careful that if you're not really taking care of the barrier of your skin, you want to be careful on things that break and disrupt the barrier, on purpose, where you're counting on the rejuvenation aspect of it, improving the skin, right? So people need to be more self, more conscious about that, not overdo these things at home. Hope I can't hear you

Dr. Kay Durairaj 45:35
such good information. I have so many patients who are buying home microneedling kits, and they think they're doing themselves a great service by two twice a week, three times a week, micro needling, and it's just really destroying the skin barrier, and also

Speaker 1 45:49
it is

Dr. Kay Durairaj 45:49
and sterile, introducing God knows what, bacteria there. So in the office, when we do micro needling, is there anything we should be aware of? Because we do create these beneficial channels. Would you recommend perfusing anything into them that's good for microbiome? Yeah, we normally do, which is like peak platelet growth factors and sometimes exosomes.

Speaker 1 46:12
Yeah, actually, there's, there's one compound that can be very beneficial for once you create channels, or you create any sort of damage to the skin in order to facilitate the best version of rejuvenone of repair, and that is beta glucans. So beta glucans have a tremendous amount of research on them in terms of facilitating the best and fastest form of repair on the skin with minimizing the inflammatory process, right? And so if you're doing any sort of injections, micro needling, any sort of Derma blasions peeling, I would absolutely look at a Beta Glucan cream,

Dr. Kay Durairaj 46:59
which kind?

Speaker 1 47:00
So there's a company called BWH labs. I just got a bunch of their Beta Glucan cream because I'm super excited to use it myself and do some further testing on it. And they've got some great studies. So BWH labs, they have a Beta Glucan cream that is an amazing reparative driver. And then I would follow that up. So for the first couple days after creating channels, I'd be very selective about what goes on the skin. I would use the Beta Glucan cream, and then after a couple of days, I would use the something like the SIB serum, so that you get the microbiome balance back in on the skin. And you'll see a significant difference in how well the skin repairs and rejuvenates. And in fact, it facilitates that most youthful form of repair, rather than the potential, you know, dysfunctional repair on the skin.

Dr. Kay Durairaj 47:53
That's so interesting. So I should probably build that into our regimen, and then for surgical wounds and things topical antibiotic cream applied like a Neosporin, Polysporin. Is that a generally, in general, we don't really need to do that if the wound is clean and sterile. But would you say don't do it anymore? For people who scrape their knee, don't do that?

Speaker 1 48:15
Yeah, I would. So what one of the discoveries around the skin, microbiome and repair of the skin. That is super interesting is that studies show that when there's any sort of break in the skin, like, let's say a laceration is scraped, it doesn't matter how deep the break is, as long as it's in the epidermal layer or lower, the first things that actually migrate to the edge of the broken skin are the microbes on your skin, and they migrate to that edge and start turning on the repair mechanisms right? So the the activation of keratinocytes, and all of those things that are going to play a role in repairing it's the presence of the microbes. So then, if we maintain a sterile surface on that wound, you're likely going to slow down the repair process. Now it's absolutely important to clean a wound when it's there. Well, you know, like when my kids, for example, cut themselves, or they scrape their knees, we wash it soap and water, right? And then from that point on, it's about keeping it hydrated. Because we want that hydration. We want. We don't want to maintain a sterile environment, because we want their skin microbes to actually start working and multiplying and migrating to the surface of the edge. So one of the best things is things like Vaseline, right? So once you've cleaned and sterilize it, put a thin layer of Vaseline on it, bandage, if you need to. It's an area that will get rubbed on, touched too much, or if it's like an open forearm or something just thin layer Vaseline, and then let the microbes do their thing.

Dr. Kay Durairaj 49:48
It's so interesting when we laser patients, then are we just ablating their entire superficial skin, and then our regimen of putting Vaseline on? Is that enough? I think now I need to add the. Beta glucan, if it's not too stingy, and definitely the sieve. And like, I'm just so curious about what microbiome steps should I take when I do laser? How about do a collagen stimulator? How about when we do neurotoxin? Does that screw with the microbiome?

Speaker 1 50:17
So I think the the neurotoxin itself, probably not, but the act of injecting does have impact the skin microbiome to some degree, right? But, but these are pure, very, very fine points of injection. So I think that doesn't have a massive impact on the microbiome, but it can. So I would say that any of those processes where there is some sort of damage that occurs to the to the stratum corneum and epidermis of the skin, I would, I would absolutely look at a reparative cream like the Beta Glucan for the first day or so after the procedure, and then going to something like the sieve that can help restore the microbiome balance in that area. We actually get really, really phenomenal results with the sieve, for example, when people use it a day or two after they do a peel, or after they do micro needling and create channels. And then, of course, I would do the Beta Glucan cream right after the procedure. And then Vaseline for the laser is perfect, but I would add the beta blue can and put Vaseline on top of it.

Dr. Kay Durairaj 51:25
Wow. This is wonderful. I'm going to email you and we're going to get a whole list of all my shopping cart that I'm going

Dr. Kay Durairaj 51:30
to get

Dr. Kay Durairaj 51:30
for the office and for myself. And like, where do you are you in LA? Where are you based?

Speaker 1 51:35
I'm based in Chicago, actually, yeah, in the Midwest,

Dr. Kay Durairaj 51:38
yeah. Okay, that's so cool. Well, I have learned so much in this short hour. I really have like, one more page of questions, so we might have to do it again soon.

Speaker 1 51:48
We'll do it sooner this

Dr. Kay Durairaj 51:49
time.

Dr. Kay Durairaj 51:49
Yeah, part one, we're gonna do part two. Oh, that's part three, actually, because Part one was, if you guys scroll back, you can hear, a year ago, we did a great one that was much more acne focused, which we didn't even touch on today. But I think the building the microbiome, building the mucin layer back in the gut, getting happiness bacteria, these are such takeable concepts that people need to incorporate into their life. So I can't thank you enough. Karen, where can people find you on your Instagram and your other handles and give a plug to your skincare line too?

Speaker 1 52:20
Yeah, yeah, thank you. So on Instagram, my, my handle is Karen, biome Kay, I r a n, b, I O, M, E, so please reach out there if there's any questions. And I try to put as much good information out there on your microbiome as I can. My, I have a free membership for people from my circle community at biome, L, C, B, i, o, M, E, L, C, lots of resources there. I connect you with practitioners who are really well versed in the in the gut microbiome, if you have gut issues. And then I also have a couple courses there as well. And then check out the sieve the skin microbiome. It's the website is Civ care.com, so www, dot s, I, V, C, A, R, e.com, we've got great studies on dermatitis, anything inflammatory in the skin, any thinning of the skin, and we just actually completed a study on on age spots as well, seeing a significant reduction.

Dr. Kay Durairaj 53:17
Yeah, maybe you can send me that. And I'd love to, I think we should definitely get some for the office, but,

Speaker 1 53:23
yeah, absolutely, we predominantly sell it through professionals. So So yeah, it'll, it'll fit really well in your in your office, and especially for everything that you guys do, and how complete you think about skin and holistic health of skin. So it fits well.

Dr. Kay Durairaj 53:39
That's so incredible. Well, you guys, I had such a good time learning about microbiomes because I'm a nerd like that, but I also think it can change the course of how you age and your health patterns. So please do incorporate these tips into your life, and don't forget to find me on Instagram at Beauty by Doctor Kay D, R, K, a, y, Beauty by Dr Kay dot and our website is the same Beauty by Dr kay.com and that's where you'll find me doing amazing things with people's faces, much more microbiome incorporation into skin. And I have a brand new skin care line that's peptide base. It has mitochondrial boosters, NAD precursors and GHK cop or glutathione, and it has three peptides that I came up with that are specific for collagen and elastin stimulation. So I'm super excited. I'm going to send you some too.

Speaker 1 54:28
Oh, I would love that.

Dr. Kay Durairaj 54:29
Yeah, it's such a great line to increase activity of the skin cells, because they become senescent and they wear out. But that's all. That's it for now, guys, I hope you incorporate lots of good micro bacteria into your lives and stay beautiful.

Dr. Kay Durairaj 54:59
You. You.

Transcribed by https://otter.ai