Do you suffer from persistent skin conditions and wonder if underlying inflammation might be the culprit? You're not alone. Dr. Jill Carnahan and Jen Fugo explore the various hidden triggers that could be causing your skin woes, including the roles of h.pylori, candida, and other gut-related issues. They also discuss how Biologic inhibitor drugs and JAK inhibitors are being used to manage chronic skin problems.

Key Points

• How underlying inflammation drives chronic skin issues
• Challenges with the elimination diet approach (research demonstrating disordered eating patterns triggered by elimination diets used for skin issues)
• Biologic + JAK inhibitor drugs — what can we learn from how they work
• Gut triggers (like h.pylori, candida) for specific cytokines

Our Guest – Jennifer Fugo, MS, LDN, CNS

Jennifer Fugo, MS, LDN, CNS is a clinical nutritionist supporting adults who’ve been failed by conventional medicine to beat chronic skin such as eczema, psoriasis, rosacea, dandruff and hives in her virtual practice. She founded her own line of skincare and supplements available at www.QuellShop.com and is the host of the Healthy Skin Show podcast with over 1.1 MILLION downloads. Jennifer holds a Master’s degree in Human Nutrition from the University of Bridgeport and is a Licensed Dietitian-Nutritionist and Certified Nutrition Specialist.

Stop My Skin Rashes eGuide → https://www.skinterrupt.com/opt-in-stop-my-rashes/
SkinCare: https://www.quellshop.com/

Jen's Sites
URL: https://www.skinterrupt.com + https://www.jenniferfugo.com
Healthy Skin Show Podcast: https://skinterrupt.com/listen
Quell Shop: https://www.quellshop.com
Facebook: https://www.facebook.com/GlutenFreeSchool
Pinterest: http://www.pinterest.com/gfreeschool
Instagram: http://www.instagram.com/jenniferfugo
Twitter: https://twitter.com/jenniferfugo
Tiktok: https://www.tiktok.com/@jenniferfugo
Youtube: https://www.youtube.com/jenfugo
LinkedIn: https://www.linkedin.com/in/jenniferfugo/

Dr. Jill Carnahan, MD

Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy.

As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs. 

A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.

Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names. 

The Podcast

The Video

The Transcript

215: Resiliency Radio with Dr. Jill: Is Inflammation Causing Your Skin Condition? w/ Jennifer Fugo

Dr. Jill  00:01

Welcome to Resiliency Radio, your go-to podcast for the most cutting-edge insights in functional and integrative medicine. I'm your host, Dr. Jill, and in each episode, we dive into the heart of healing and personal transformation. Join us as we connect with renowned experts, thought leaders, and innovators who are at the forefront of medical research and practice, empowering you with knowledge and power to overcome any obstacles or any chronic illness. 

Dr. Jill  00:24

Today, I am absolutely delighted to introduce my friend, Jen Fugo. She is a clinical nutritionist who supports adults who failed conventional medicine to beat chronic skin conditions such as eczema, psoriasis, rosacea, dandruff, hives, and many other things we're going to talk about today in her virtual practice. She founded her own line of skincare and supplements available at www.QuellShop.com. She is the host of the Healthy Skin Show podcast, with over 1.1 million downloads. We were just talking about podcasting and all the tips and tricks in the background that we do. Jen holds her Master's degree in human nutrition from the University of Bridgeport and is a licensed dietitian, nutritionist, and certified nutrition specialist. 

Thank you for letting me get through that intro, Jen, and welcome to the show!

Jennifer Fugo  01:19

Thank you for having me. I'm so excited and honored to be here!

Dr. Jill  01:22

Yes. We've been friends and followed each other's pathways in the background for a long while. I always love to start with the background story. How did you get into this area? Do you have any personal stories or reasons that you got into skin? 

Jennifer Fugo  01:38

Unfortunately, yes, I do. The reason that I ended up specializing, I guess, in these chronic skin conditions is because when I was in the midst of my master's program, I developed something called dyshidrotic eczema on my hands. That is a very specific type of eczema, for those who might not realize, that impacts the palms and sometimes also the bottom of the feet. But I just had it on the palms of my hands. You get these weird, clear little blisters and the skin dries out. It flares up. The blisters eventually break, and it's oozy and awful and painful and so itchy. Then it dries up and the cycle starts again. 

Jennifer Fugo  02:27

I was already gluten-free, dairy-free, and egg-free for six years at that point. I had, and I still do, a non-toxic, organic lifestyle. I was doing all the right things except I had taken on this huge endeavor of going back for a master's program full-time while working full-time. I have never had so much suffering in my life. I'm not comparing it to other people—because I know, Dr. Jill, you've gone through a lot of health situations yourself—but you don't realize a lot of times how much you use a part of your body until you can't. You can't wash your hair. You can't wash your hands because water burns so badly. You can't go to the gym because the weights tear your skin. 

Jennifer Fugo  03:19

My skin became thinner and thinner as I went through these cycles. The dermatologist was like, “Just put some steroid cream on and then cover it with Vaseline.” I was like—I mean, it's my hands—”How do I get through my day? I have cats. I have things I need to do.” It became very challenging for me to function. I'd wake up in the middle of the night with blood on the sheets because I found that I was scratching myself in the middle of the night while asleep. It just was really awful. 

Jennifer Fugo  03:56

My husband was like: “Maybe you should start thinking about this from a different perspective. What if you were your client? What are some of the things that you might look at?” It took time. Honestly, people are like, “What did you do to make it go away?” I wouldn't even want you to do that because I know so much more now. I'm not even sure why what I did worked.

Jennifer Fugo  04:19

That created a lot of empathy for me to realize that we have various conditions, like thyroid conditions, where we suffer a lot of times in silence and in private. People can't necessarily see that you have this condition that impacts so many different body functions. When it is on your skin, especially areas that are forward-facing—like the palms of your hands, where somebody can dive out of shaking your hand because they see that you look almost like you're infected with something or it's on your face or somewhere visible—it does a tremendous amount of damage to your sense of confidence. Everyone thinks either you don't know how to clean yourself, you're not using the right soap, or you have some sort of infection that you're neglecting. They don't understand the level of pain and suffering that you go through trying to manage this highly uncontrollable skin situation because you don't know what type of skin you're going to wake up to on any given day. 

Jennifer Fugo  05:24

That was what ultimately sparked my curiosity. As I dove deeper into it, I realized the way that we approach skin from a more integrative perspective was limited because everyone lumped it in with autoimmune disease. That was where all the research, all the interviews—I have over 350 episodes of the Healthy Skin Show; you're on the Healthy Skin Show too—talking about various things that we don't necessarily think could be connected to chronic skin issues that are complicated, I think, and separated from other conditions like, say, celiac disease or Hashimoto's and other autoimmune conditions. We talk all about eczema, psoriasis, and rosacea. I also had hidradenitis suppurativa, also known as HS. 

Jennifer Fugo  06:20

[With] a lot of these conditions, people suffer in silence. There's a lot of shame. I've made it my mission to help people figure out what some of these root causes are so that they can begin using—if they would like to—a combination of conventional and integrative options to hopefully speed the process along because I don't think we're here to just suffer through life. I think that we are here to live life, being there as a mom, a parent, a caregiver, a daughter, a son, a friend, a coworker. We have all these other roles in life that are so important. I want to empower people to be able to bring things to their dermatologists, to ask better questions, to get better results, and to utilize the best tools that work for them to ultimately help the skin symptoms hopefully calm down and even potentially resolve entirely. 

Dr. Jill  07:16

Jen, I love that. And I am sorry you had to suffer, but clearly, it's given you a passion for this topic. And it's interesting; one of the reasons I am so happy to have you on this show and personally so proud of the work you're doing is because I was like you. I had this severe dyshidrotic eczema as a child. I would scratch and bleed. When you talk about your story, that could have been me. I totally understand. And the hands—like you said, you can't do anything. I remember wearing cotton gloves to bed with the Vaseline and the steroid because that's the only way you couldn't scratch yourself to death. In the middle of the night, you'd pull them off because you wouldn't know. The itch is so bad sometimes. I just remembered that, so I can relate to every point. 

Dr. Jill  07:54

And then, after the mold and the issues there, I had horrible, horrible periorbital dermatitis that looked like I was so diseased. That's a billboard, and here I am supposed to be a doctor. The eczema was before I was a physician. Some of the eye stuff was after. I was like, “How in the world can people trust me if I look like I can't take care of myself?”—because they don't know the whole story. So thank you for being a leader in this field. 

Dr. Jill  08:16

Where do we start with this? As we know, there are membranes, permeability, and gut. Give us an overview. Skin stuff is often connected to similar things. Maybe [you can cover] skin and [give an] overview and then we go deeper into specifics. 

Jennifer Fugo  08:29

Yes. I would say that I think what complicates skin is that there's usually a combination of root causes going on. It's not usually just one thing. A lot of times you go to the dermatologist, and they give you medications. You may or may not want to go that route. I respect that. Everybody's choice is their own. Usually, the first thing is getting rid of any kind of toxic chemicals—your cleaning products, your laundry detergent, and your body care products. You try and swap those all out. A lot of times people won't find that to be sufficient, so then they're possibly rehoming their pets or tearing out carpeting from their home. They're trying to do everything in the external environment to address this because that's what they think will ultimately get things to stop. 

Jennifer Fugo  09:20

And then maybe we go down the route of food allergies. If it is a food allergy, usually it's fairly straightforward for an allergist to figure out what that may be, especially. When I say food allergy, I'm in like an actual IgE food allergy. But then there's this whole host of other issues. 

Jennifer Fugo  09:44

When I started my practice… I think this is helpful for people to know why I care so much, especially about liver detoxification. I don't mean liver detox or liver cleanse in the trendy sense. It's a beautiful, transformative process that our liver does to help support us on so many levels. But when I graduated from my master's program, I used to do a lot of organic acid testing. I was working with gut clients—people who had diarrhea, constipation, belching, bloating, all that stuff. One thing that I noticed, oftentimes, was that benzoic acid or benzoates were elevated. We could attribute that to dietary benzoates, but the reality was most of my clients weren't eating processed foods where you would find those. And then sometimes equally, hippuric acid, or hippurate, was also elevated.

Jennifer Fugo  10:38

I started to dive into this hard because I found it to be an odd pattern that tended to get overlooked in the whole process. I started to realize that with gut clients and cases, there was this significant problem happening with phase 2 liver detox. As I started to get more and more chronic skin issue clients, as I shared my story and we started the podcast and whatnot, I began to see that it was of even greater importance to those individuals because the liver detoxification capacity in phase 2 is highly nutrient-driven. It's not like you can castor oil pack your way out of it. I find that you can't even take sufficient herbs to increase the level of nutrients required to run phase 2 pathways sufficiently if they're highly depleted already. A lot of times they are because people have had these issues for a really long time, and they have other confounding factors. They have chronic gut microbiome imbalances that also chip away and overwhelm that system because the benzoates can be produced within the GI tract and then have to go to the liver in order to be processed. 

Jennifer Fugo  12:03

As the supplies get lower and lower for this system to run, your body is becoming increasingly reactive. People will find that they'll begin to react to salicylates, which are a type of chemical found in various plants and such. It's something that shouldn't be a problem, but especially, for example, as the amino acid glycine becomes depleted, we become increasingly sensitive to salicylates. This is something that you'll see in eczema, for example. With psoriasis, you'll start to see a significant increase in fatty deposits within the liver that things get gummed up. They don't run as well. That's why it's, unfortunately, a comorbidity within psoriasis that we start to see increases in liver fibrosis and other liver issues—non-alcoholic fatty liver disease, which I know is being turned into metabolic [dysfunction]-associated [steatotic] liver disease, I believe. 

Dr. Jill  13:04

A new name we have to learn. The same thing.

Jennifer Fugo  13:08

Exactly. 

What really hasn't been focused on in a lot of these conditions is that beautiful interplay between what's going on in the gut, what's happening to the liver as a result, and the need for nutrients that may or may not be coming in at a sufficient level to at least help the body have a better fighting chance at dealing with the problem. If you just dive into a lot of these gut protocols—say you do stool tests, and you find out you have a bunch of bacteria and unfriendly fungus and all this stuff hanging out in different spots throughout the GI tract—as you start to deal with it, it's not uncommon for individuals who have skin issues to start to see a flare-up. It's because their liver can't bear the brunt of what's happened. I think that's part of it. The other part is sometimes we're just trying to push things too fast for what our body's capacity to heal is at that particular time. I think there's this beautiful dance in honoring these truly important pathways that help us ultimately manage how reactive the skin becomes. 

Jennifer Fugo  14:23

We also find—and I don't know if you've seen this, more [of what] I call histamine overload-type cases (chronic hives, or urticaria, dermatographia)—that when you nutritionally support the liver, and that's before you start trying to deal with the gut and whatnot, that also can reduce reactivity. In some instances, it's helped some of our clients reduce the need for multiple doses of antihistamines per day. I'm not saying you get to stop entirely, but they tend to go: “The doctor said I could take this antihistamine up to three times a day, but I only need it twice. And I noticed I'm less reactive to things,” which I really like to hear. So I feel like it helps people get going in the right direction. 

Dr. Jill  15:12

What a great overview. What I love, Jen, is that you're going to the liver. What we know is that when the gut has some permeability—which I think that with every skin condition, there's some degree of permeability, whether it's excess microbes or yeast, or even histamine can all create that—what happens is the dumping of the contents of our gut into the bloodstream, which goes directly to the liver. Like you said, it frames so well our filter organ. And what we know is that the root of even diabetes, heart disease, mood disorders, and, of course, skin disorders is this endotoxemia, which means toxic load from within. 

Dr. Jill  15:46

So I really love that you frame it instead of being like, “What creams and potions can we put on you?” You and I know that doesn't work. That's the outside-in approach. But at the core, I think what you're describing is that we're getting toxic. Endotoxic means from inside out. And that endotoxemia has a limit of what the liver can process each day. One thing I've often said is we mobilize the toxins out of our blood, liver, and kidneys; all the organs are detoxing. But if we can't excrete them, we get stuck and then that liver gets overloaded. And it sounds like that's exactly what you found to be the root of most of the skin things that you advise clients on. 

Jennifer Fugo  16:18

Yes. And you want to look in different places because some individuals do have—like I was saying—a combination of things. It's usually some sort of phase 2 liver detox overload. And granted, there could be nuances here where somebody has a genetic SNP or something like that going on. But we'll just say, generally speaking, [that with] phase 2 liver detox overload, there's usually some type of gut dysfunction. Perhaps we're not breaking food down or absorbing it appropriately. 

Jennifer Fugo  16:48

There could be issues with, as you were saying, eliminating things. Being constipated can absolutely increase skin reactivity. It can make you more itchy. It can make you feel worse and [cause] your skin to flare up much more easily. We also then want to dive into things like thyroid imbalances, if that's present. Especially with psoriasis, and I would say with urticaria, there are some interesting overlaps with thyroid imbalances and thyroid issues like Hashimoto's. 

Jennifer Fugo  17:20

We also want to look at what's going on in the gut microbiome. Do we have any foods that we are reactive to? We can talk more about the diet thing, but I do think that we have focused a bit too much on assigning blame to every single food that's become deemed inflammatory by, I would say, the functional/integrative space. So I think we want to be cautious. I think the primary focus needs to be allergies because, obviously, IgE allergies should be removed. If you truly have something that you're allergic to, you should not be eating it. You might also need to avoid it in products that you put on your skin. But there are environmental factors as well. You talk a ton about mold. Mold can certainly be a factor. So can pollen allergies, and so can chemicals in your environment. 

Jennifer Fugo  18:29

We have various chemicals that are in the air, like diisocyanates, that we know tend to be increased in areas where we see higher rates of eczema. There was a great paper that was published a year ago—I believe it was in January of 2023—with a group that Dr. Ian Myles was associated with that talked about this chemical that we're inundated with, unfortunately. They connected these interesting dots between the incidence of eczema and the higher rates of this chemical existing in that environment. There are so many other factors. 

Jennifer Fugo  19:12

I think where I get a little nervous is our reliance on blaming it all on food and saying the only way is to diet your way out of these conditions. Unfortunately, I'm the person who sees the folks who have taken almost everything out and they've done multiple elimination diets overlapped. At that point, they are so nutritionally depleted that they hate food; they hate the act of eating. That breaks my heart. It really, truly does.

Jennifer Fugo  19:40

As someone who has an Italian background—and I love food—I think food gives us joy, it gives us nourishment, and it's connection. When you start to hate that, maybe we need to start asking: “What's going on? What are we doing with these tools that are elimination diets and how can we potentially be smarter about them?” 

Jennifer Fugo  20:02

But there are so many other factors. And, obviously, with skin issues, there is a skin microbiome, so it's not just what happens internally. If you have an infection on the skin or an imbalance of what's happening on the skin—that could look bacterial or fungal; you can even have parasitic overgrowth such as Demodex mites, which are commensal but can overgrow in certain cases—there is no amount of doing gut protocols that are going to necessarily fix that. We have to be aware of so many different facets with skin issues. I think this has been a huge educational journey since I started working specifically with these clients since 2017 because of how many different things we need to be aware of. 

Dr. Jill  20:45

Wow, what a great overview! Some of the summary points I want to mention are, first of all, I love that you're coming back to toxic load because, at the core of that overload of the liver, we know it does present in the skin. And I love that you start there versus like, “Let's apply a cream.” You and I agree on that. 

Dr. Jill  21:00

I love how you're talking about elimination diets; I could not agree more. In my first years of practice, we were taught, “Let's try these things.” Sometimes it works temporarily. But it's not a cause; it's more of a symptom of a permeable gut. I always say: “You have Swiss cheese for guts, so if you eat corn, soy, or even gluten, those antigens will pass through.” The bloodstream first is like: What the heck is this? It starts to create a reaction. We start to measure those. The more food IgG sensitivities you have—it's just a symptom of a deeper problem, which is gut permeability, maybe dysbiosis, maybe toxic exposure, maybe mold. So I could not agree more. 

Dr. Jill  21:40

While I do find there's a time and place for those elimination diets—even my own history with skin issues, Crohn's disease, celiac, and all those things, I had severe permeability, for years I was on very restrictive diets—what I've realized is that you have to go to the core and maybe temporarily limit. But my goal for patients and myself is to continue to add back these nutrients because of the nutrition. So thanks for saying that because a lot of people are still in the old mindset of, “Oh, just eliminate all these things,” and people come in and they're eating four foods. You've seen that just like I have. That's not nutritionally adequate. It just doesn't work long-term. 

Dr. Jill  22:14

Or even, say, FODMAP. Say you have SIBO and you go on a low FODMAP, which is well-studied and evidence-based. But guess what? You're starving the microbiome. So the long-term elimination of the foods that feed the microbiome is not a good idea. Now short-term, yes; long-term, no. 

Jennifer Fugo  22:29

I also would add to that. I was associated with a study that was done a couple of years ago. I worked with a research team out of UC Davis. We surveyed over 600 people who have chronic skin conditions, and we asked them about the use of elimination diets to help their skin and what happened to them when they used these diets specifically with their relationship with food. I think that is equally troubling. 

Jennifer Fugo  23:05

I'll just give you a couple of stats here. We even asked people in the age group bracket: “Did an elimination diet trigger a negative association with food?” If you're in the 18- to 24-year-old bracket, which [is] very highly impressionable—I remember that age; if you told me to cut all these foods, I was in the “Eat fat-free,” that was that bracket for me—over 80% of these individuals now have a negative association with food from using an elimination diet to try to address their skin issues. That is deeply troubling. 

Jennifer Fugo  23:45

We have this tool that is important, but it's how we use the tool that is also important. What we don't want to happen is that we say: “If you do this, you can save your skin—you can fix it all—but you've got to blow up your relationship with food.” I don't think that that's a fair trade-off because the disordered eating patterns last with you for a really long time. In fact, by the time you even get to the 55- to 64-year-old bracket, it's still close to 50% of people who now have a negative association with food. 

Jennifer Fugo  24:24

We also looked at people who shared with us whether they had a history of eating disorders—anorexia, bulimia, binge eating—or no eating disorder history at all. Especially those who had a history of eating disorders did find that this was triggering. However, even having no history of an eating disorder, there were still about 50% of people developing this negative association. Again, it's not to say that they're bad to use. It's not to say that there isn't a time and place, because there certainly is. I think as clinicians, as practitioners, if we're going to talk about the whole body, the whole self, we have to factor in how this is going to impact someone. 

Jennifer Fugo  25:17

I've had clients where they may have seen a doctor. The doctor said, “Do low histamine.” Low histamine didn't work, so they said: “Okay, let's take out all these foods.” “Okay, now let's take out these.” The diet gets smaller and smaller and smaller with no regard for how that person mentally and emotionally is handling this. 

Dr. Jill  25:35

Oh, yes. I had low FODMAP, low oxalates, and low salicylates. You name it. There are four foods left. And then they're like, “What do I do?” It's traumatic. And like you said, I think what I've seen is that there often is a short time or place when the cytokines are overwhelming—and maybe we can go to that point—where it does help to decrease the load. But doing it with the right mindset and also just talking through with them like, “Maybe this is temporary.” I often do have gluten out of patients' diets, because that's a whole other ball game. But I agree with you 100% because it is more of a symptom, not a cause of the underlying issue. So thanks for going there. 

Dr. Jill  26:17

Let's shift just briefly. Biological and JAK inhibitor drugs are commonly used in some of these severe conditions. Those aren't always the end-all-be-all because they suppress the immune system. But what can we learn from how drugs are used for these chronic inflammatory conditions that you particularly see in your practice? 

Jennifer Fugo  26:34

I know that many of us are very skeptical of big pharma and medications. There are pros and cons to every single thing. But I find the fact that we have the research now that's been done to at least get the FDA clearances for these medications really fascinating because we didn't know a lot of the information that was going on under the surface, specifically with certain cytokines. I want to first say that I don't think we should think of cytokines or these inflammatory messengers as inherently bad because, to be fair, your body uses them to try to communicate between systems. It's essentially trying to help in some regards to recruit help into certain areas and do different things. Yes, too much of a certain cytokine could be problematic, and blocking certain cytokines has consequences that can be problematic. But I do think that—this is the nuanced conversation—that cytokines themselves, which are produced in our bodies, knowing which ones can be elevated, I personally think has changed how I approach skin issues. 

Jennifer Fugo  27:53

I'll give you an example. I personally think after looking at the amount of cytokines that are produced in, say, eczema, psoriasis, or rosacea and the incidence of certain gut organisms that show up either high or lurking under the surface, something like H. pylori, which oftentimes I found most… I presented at a naturopathic conference about this, and they were like: “No, if you don't have any symptoms of H. pylori, I would never deal with it if it's high on a stool test. I would never do it because it's fine. It's not doing anything.” I said: “But when we specifically look at the cytokines that H. pylori increases, and we know that in these particular conditions, these cytokines are elevated, why do we have to necessarily go off of symptoms in order to justify potentially working in that area?” 

Jennifer Fugo  28:54

I'm sure you've seen the same: I have had clients who have massive amounts of overgrowth of H. pylori and tons of parasites, and they have no gut symptoms. I don't understand that because I had a lot of gut problems growing up, so that doesn't quite make sense to me on the practical level. Yet, when we addressed what showed up clinically based off of blood labs, stool testing, and their case history, they got better. So I don't know. 

Jennifer Fugo  29:32

Listen, I'm not a doctor. I'm not saying that I'm smarter than anyone else, but it does not make sense to me that we simply say the test is 100% right; we go by that. My dad was a surgeon. He told me that sometimes testing is not always the end-all-be-all. We can't always go off of that to determine what's going on. And somebody who really looks, like [Dr. House]—not the attitude of Dr. House, but that show Dr. House—where Dr. House would dig into the case and try to figure out what was going on, [even when it] didn't always make sense and wasn't always clear, can be a powerful way to help someone uncover and deal with underlying inflammatory triggers that are driving the levels high. Does dealing with H. pylori make somebody's rashes go away all the time? No. I have had some clients where it makes a huge improvement. In others, they've got so much else going on, it's like a piece of the puzzle. 

Jennifer Fugo  30:41

For example, with psoriasis, we tend to see elevations of IL-17 or interleukin 17; interleukin 23 as well. If you start to look at the literature and [consider] “What do these IL-17 blockers, for example, do?” they block the IL-17, which is actually there to help control fungal overgrowth. If this is news to you, for anyone listening, there tends to be a lot of fungal problems. It's not the whole thing, but there's a lot of fungal problems underlying psoriasis. 

Dr. Jill  31:17

I think that's the elephant in the room, let's just say it again, because if I look back at my history—Crohn's, celiac, and eczema—maybe 60% to 80% of it was fungal issues. I want to say that specifically because many doctors, even functional doctors, are not looking at that. They look at SIBO and they're ignoring SIFO. 

Jennifer Fugo  31:35

Exactly. I don't know where I learned this from, but we can't really test for SIFO, so you have to look at the case. You have to consider all the factors. I've also found that sometimes with eczema or rashes in certain areas, it doesn't mean you have excess candida, Malassezia, or some sort of fungal overgrowth on the skin. But for some reason, the inflammation will show up in certain areas, like the inner elbow, the armpits, behind the knees, and the feet—the areas where we tend to sweat more. Sometimes that can correlate with an underlying fungal issue. I find it fascinating. 

Jennifer Fugo  32:27

And I think we're on the same page about this because not everyone can go the distance to get fully healed entirely doing it the natural way. [With] these medications, like JAK inhibitors—which do carry, by the way, a black box warning—and biologic drugs, you should always look at the information that's provided to you online, talk with your doctor, talk with your pharmacist, ask a lot of questions, and go in with your eyes wide open. But sometimes we need help because the level of suffering is so great that you're not getting that time back. 

Jennifer Fugo  33:11

Life is so finite; it's so precious. To suffer for years when you could have been at your kid's soccer game but couldn't do it because your skin was so bad or be at your mother or father's 85th birthday party, you couldn't make it because of X, Y, Z—it was all flared up—I sometimes think: “How can we find a way to do the path that makes the most sense for the individual so that they get to have some semblance of a life that they're comfortable with while they do that underlying work?” 

Jennifer Fugo  33:47

And it is important for people to hear that you can do the underlying work while you're on those medications, and it is possible to wean off of them as well without flaring up as long as you dealt with those underlying factors. I want people to know that because a lot of times they think it's this either/or conversation. But if you have psoriasis and you start developing psoriatic arthritis, the doctors that I've interviewed who work with that condition and are more in the integrative space have said, as the damage is done to those joints, there is no recovering from that, unfortunately, at this point in time. Sometimes, for example, we'll want the use of a biological drug to bring those cytokines down, continue to do the underlying work, and then eventually be able to hopefully get off of the drug because we want to save the joints. So I just want people to know: You're not a failure. 

Dr. Jill  34:48

I could not agree more. I think this is very important because I deal with a lot of Chrohn's and colitis. It's a very similar field where biologicals help. I would say 50% or more of patients who come to me are so desperate that they need biological drugs because what I can do is going to take more time. They don't need to suffer. Or they already come in and are like, “Oh, is it too late?” The answer is no. It controls it, and for me, it buys time because the root cause medicine often takes 6 or 12 months or maybe even longer. And I totally agree. Each individual circumstance is appropriate to look at. 

Dr. Jill  35:20

I'll even test TNF-α and cytokines so that I know, “Is this an appropriate drug?” because I want to know, “Is that cytokine high?” I'm going to those levels and saying, “Do you have the cytokine that this drug blocks?” because it will work if that cytokine is elevated, and it's perfectly appropriate. So I love that perspective. 

Dr. Jill  35:38

In our last few minutes, do you want to give [some tips on]—there are many important things—the liver, the diets, what's really important, maybe what's not long-term important with elimination, the drugs when they're appropriate? What would be your top tips? If someone's out there saying, “I have struggled with eczema forever; where do I start, Jen?” what advice would you give them? 

Jennifer Fugo  36:00

The first thing that I would do is support your liver—specifically, that phase 2 detox—nutritionally. One of the easiest ways you can do that is by adding in supplemental glycine—the amino acid glycine—to your diet. I don't find that doing it just through collagen supplementation is sufficient enough. I don't know why I found it to be more effective when you take the amino acid. You're usually taking somewhere between 3 and 5 grams or 3,000 to 5,000 milligrams, twice a day. I would definitely consider that as a factor to start with, also potentially looking at how much vitamin B-6 you're taking because those pathways also need vitamin B-6. I can't tell you exactly how much to take because you can take too much. I think, generally speaking, people can stick somewhere around 10 to 20 milligrams a day. You can look at all your supplements. Sometimes it's in your multivitamin, and that can be a really easy baseline of supporting the liver. There are certainly more supports that you can do. And I talk about that in the Healthy Skin Show, but that's a good baseline. 

Jennifer Fugo  37:13

The second thing that I would consider is educating yourself on what a skin infection looks like, because oftentimes, people will think that they're just in a flare. That goes for eczema. It even goes for psoriasis and some of these other conditions as well. We think the skin gets really angry and upset and it's really flared up, so we're trying to use various creams and ointments and all sorts of things when, in reality, there is an infection present. [It's about] educating yourself on what the symptoms are of an infection. If you believe that you have one, go to the doctor—yes, you have to go to the doctor—and ask for a skin culture with sensitivity testing. That way they can determine: Is there something overgrown? And then, what will kill it, essentially? 

Jennifer Fugo  38:03

There are times where we could say, “Oh, let's use colloidal silver or hypochlorous acid.” But if you have a full-blown infection or you have something like eczema herpeticum, which is this reemergence of the herpes virus that can cause you to go blind—it can creep into the eyes, so we want to jump on that right away—those infections are really, really important. 

Jennifer Fugo  38:26

Lastly, I would say [that it's about] looking at gut function. Look at how many times a day you're having a bowel movement. One to three times a day is probably the optimal, I would say, to shoot for. I know we get obsessed with having the perfect poop, but the reality is we've just got to start someplace. So figure out using different tools, whether it's digestive enzymes or some sort of probiotics or whatever, to try and help get that regularity back into the flow of things. 

Jennifer Fugo  38:54

The other thing I will say is that looking at your skincare considering what can be helpful, unfortunately, it's trial and error a lot of times. There's no one cream that's going to work for everyone. But I find that when you can find the right combination to help support your skin—whether it's with eczema where it's super itchy or you're dealing with psoriasis where you have these really scaly plaques—if you can find something or a combination of things to at least help you manage while you're in the process, that can really be helpful. Skin baths, specifically with sea salt and other minerals, can be really soothing. 

Jennifer Fugo  39:35

And I would just say that in general—the last point—nervous system work is really important because a lot of times we develop trauma from what happens to our skin. It's easy to feel a flare coming on, not know what to do, and start to panic because you're reliving the past flare-up that you had. The mind and nervous system go on overdrive, so it worsens every experience that you're having throughout your body. Whether that's talking with a therapist, doing gratitude work, breathwork, or whatever you can do to also help support the nervous system. And try to remind it as many times as you can a day—even putting post-it notes on the mirrors—that you are safe, your body loves you, and it's trying its darndest to support you. That's literally what it is trying to do. It's not working against you. That is a really important foundation for this entire journey that you can go on. There are so many things that I could dive into that are specific to different conditions, which I'm sure we could talk about, but I think these are a good foundation for everyone. 

Dr. Jill  40:45

Those are so practical and so applicable. I love it. I especially love the glycine. I found that to be such a key. It's a rate-limiting [inaudible] in glutathione production. It's core for glyphosate detox and so many other things. It's an essential amino acid. And like you said, I have people take grams of that, not just as a supplemental collagen. So thank you for sharing that. 

Dr. Jill  41:07

And I'm sorry you went through your own journey, but what a wealth of knowledge. Where can people find you? And I know you have a free resource for our listeners. Do you want to share a little bit about that? 

Jennifer Fugo  41:16

Yes. I can be found on the Healthy Skin Show podcast, as I shared. We have over 350 episodes. You're on the podcast as well. You can find the whole show on my YouTube channel. Or if you go to HealthySkinShow.com, you'll find every single episode. We have transcripts, links—everything that you could possibly need. 

Jennifer Fugo  41:38

We also have a guide that I think is really helpful because a lot of times people say: “Oh my gosh, you have 350 episodes. Where do I start? What are the first few episodes I need to listen to to understand how this process that you go through is different from the integrative approach?” We have a guide called the “Stop My Rashes” guide—I'm sure we can link that up in the show notes—that will give you the first few episodes that are crucial to building that foundational knowledge. We have links for the various diagnoses and such that you can dive into on that topic. So that's a really great place. And obviously, I'm here on YouTube as well. Those are the best places to find me. And as you had shared in the beginning, I have a supplement and skincare line that's specific for people who have chronic skin issues at QuellShop.com. 

Dr. Jill  42:37

Awesome. Jen, thank you for sharing. And like I said, it's so interesting—what you've been through drives your passion and purpose. And you've clearly done that. And that's what's so beautiful—when we transform those experiences to help others. You're out there doing that. So thank you. And skin—very personal to me. I so appreciate your work. And thanks for coming on today. 

Jennifer Fugo  42:57

Thank you for having me!