Wellness by Designs - Practitioner Podcast
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Your go-to podcast for evidence-based education and inspiration in integrative healthcare. Whether you're looking to deepen your expertise in nutrition, herbal and naturopathic medicine, or sharpen your clinical and business skills, this podcast is made for you.
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Wellness by Designs - Practitioner Podcast
A Deep Dive into Acne with Jacinta Barbagallo
Why isn’t your acne responding, no matter how “clean” your skincare routine is?
In this eye-opening episode, skin specialist nutritionist Jacinta Barbagallo shares why stubborn breakouts rarely start on the skin’s surface—and why real solutions lie far deeper. Together, we explore the three root causes of acne: retention keratosis, hypersebum secretion, and skin pH imbalance, and the surprising internal drivers behind them, from nutrient deficiencies and cortisol surges to gut dysfunction and metabolic imbalances.
Jacinta unpacks how to go beyond surface-level treatment with targeted clinical tools like strategic blood testing (e.g. SHBG, fasting glucose, insulin, hormone panels) and foundational nutritional strategies, including 30g of protein per meal, omega fatty acid balance, and key herbal medicines like burdock, Oregon grape, and peony licorice.
Most importantly, she reframes what progress really looks like. With hormones taking months to recalibrate and skin cells needing 6–8 weeks to renew, Jacinta shares what signs to look for along the way, like faster breakout recovery and reduced inflammation.
Whether you're navigating your own skin challenges or supporting clients through theirs, this episode offers a comprehensive and empowering roadmap to finally understanding what your skin is trying to tell you.
Discover the Clear Skin Blueprint
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health
This is Wellness by Designs, and I'm your host, amy Skilton, and joining us today is Jacinta Barbagallo. Jacinta is the founder and skin specialist nutritionist of Arenda Women's Health and, having worked with hundreds of clients one-to-one, as well as educating skin therapists across the world, jacinta has worked extensively with some of the most complex skin conditions, including acne, rosacea, perioral dermatitis, melasma, psoriasis and eczema, staph infections and so much more, previously working in the realm of functional pathology interpretation. The basis of Jacinta's clinical practice is helping her clients find the answers to the cause of their skin condition and provide realistic, long-term solutions to achieve and manage clear skin, and we're so honored to be chatting with Jacinta today about the naturopathic approach to treating acne from the inside out. So, jacinta, welcome to the podcast.
Speaker 2:Thank you so much, amy, for the introduction. I'm very excited to get into everything today, and I know that you love skin too. It's been a great conversation.
Speaker 1:I'm so excited to be speaking with you because skin is certainly a huge passion of mine as well, and for me personally, it was born out of having chronic acne as a much younger woman, which led me to studying to be an aesthetician as well. But I'd love to hear your story like how did you end up working in this space yourself?
Speaker 2:So, as you mentioned in my little bio, so I used to previously work for a company that was a supplement company and also functional testing. So I was really working in the space of education for quite a period of time and with that, involved me training a lot of different skin therapists around the benefits of essential fatty acids and how it can support their clients to be able to meet the topicals halfway and to really work on the internal drivers of a lot of most of the time acne. And it really helped me to find my niche of an area that I wanted to really delve into in clinic because I could just see that they could really only get to this the skin so far with the type of treatments that they did and their clients really required that internal support and they just weren't feeling supported by finding a long-term solution with being given prescriptions of the pill or doxycycline or arachatine and they really wanted to find a long-term approach and essentially from there it's a whole.
Speaker 1:The whole of arenda started because I was educating so many skin therapists about how they can support their clients but they did just need somewhere to go to have someone else to really delve into all the internals with them and I think that's one of the challenging things, because one of the blessings of a skin issue, if I can call it this, is it's an organ that we can actually topically apply things to, which means we can support our skin in additional ways that we perhaps can't do topically, to our liver, for example. But I do find, you know, in the general public, most people end up pursuing topical treatments over and over again, thinking the holy grail lies in a certain cream or a certain serum or a certain treatment, when you know chronic skin conditions are a sign of chronic dysfunction internally, and so the naturopathic approach is always to find those root causes and to address them. That being said, towards the end of our conversation today, I do intend to talk to you about topical support, because it is one of those unique aspects of health where we can use a combination approach and enhance each of those things as well. But looking into the internal causes, I know that taking a long-term approach is certainly what you're very passionate about, and when I say long-term approach, I also don't want people to hear it takes a long time to fix.
Speaker 1:Certainly, that can be true for certain patients, but what I mean by that is the approach that Jacinta crafts is one that sets people up for good skin for life, meaning it's not like a symptomatic fix or a quick cleanup with antibiotics or you know something that temporarily shifts the state of the skin, only for it to return to its default because the underlying drivers weren't actually addressed. And I think you know again, allopathically speaking, for convenience, you know things get pigeonholed and therefore, if it looks like this, you give this particular medication, but when it comes to this, you give this particular medication, but when it comes to, you know, functional and root cause medicine, you might have 10 acne clients and each one of them has a different prescription, lifestyle nutrition and, you know, supplement wise, and so I'd love to hear from you your reflections on why there isn't a blanket treatment for acne and why, you know, different patients can present so differently.
Speaker 2:Absolutely well, I think with that, it's probably good to delve into what we define as acne and the causes of acne, because it's really the causes of acne and once we truly understand that, we then know why there's no blanket treatment and why it's so different for every individual. So the way that we essentially define acne, it's an infection of the palosibaceous unit and it's driven by an excess proliferation of C acnes bacteria and essentially that's because there's a blockage in oxygen into the hair follicle which then creates the environment for the C acnes bacteria to proliferate. So essentially, when we're looking at our individual acne clients, we need to look at the three main causes of what allows the blockage of the oxygen flow into the hair follicle, and each individual can then be different with the causes of what could be driving that pathophysiology to start off with. So one of the main causes. So we'll break it down into the three causes of what blocks the oxygen flow into the hair follicle. One of them is retention, keratosis, and that's essentially where we get the thickening of the shard and corneum and that's that outer layer of the skin and that blocks the hair follicle, the oxygen into their oxygen flow into the hair follicle and that can be driven by, from an internal perspective, dehydration of the skin, which includes things like lacking essential fatty acids. So if the skin and the stratum corneum doesn't have enough essential fatty acids, then it'll cause basically like a buildup of these skin cells on the top of the surface that stops the oxygen flow to come in to the hair follicle. But then we also think of other naturopathic reasons that would cause retention, keratosis, like thyroid dysfunction, because an underactive thyroid would cause sluggish desquamation of the skin. So you get that dryness, the build-up of the stratum corneum, and again we then get this blockage of hair, of oxygen flow into the hair follicle as well. Um, for other people can also be a vitamin a deficiency as well, and that's where, even just in that one cause, you can see that it's so different person to person, because not everyone has a thyroid issue, but there might be some that have a thyroid issue and their symptom is they present with acne.
Speaker 2:And then we have another cause. Our second cause is either hypersebum secretion, so excess sebum production, or we have an increase in the sebum viscosity. Now, when we're thinking of hypersebum secretion, this is that classic kind of picture where everyone's like acne is driven by excess androgens, because androgens are what cause excess sebum production or they control the sebum production in the sebaceous gland. But the sebaceous glands also react to things like testosterone, dhea, cortisol as well and also histamine. So when we're thinking about the reason that our clients might be presenting with hypersebum secretion, it may not be testosterone and DHEA, it could also be cortisol, because they're stressed, and just because they're stressed doesn't mean that they've got excess testosterone and excess DHEA.
Speaker 2:And then we think about the sebum viscosity, and this is one that we do see in a lot of acne clients, which is where the sebum viscosity it's quite thick and it's congested, and that's because they're lacking the essential fatty acids.
Speaker 2:And we can see that there's either that excess omega-6 in the diet or that lacking of omega-3.
Speaker 2:So even within that again, the root cause of acne can be so different person to person, because you can have clients that have low androgens, their testosterone is bottoming out, their DHEA is so low, but then we see them present with acne and it doesn't necessarily mean that they're getting this hypersebum secretion because their androgens are high.
Speaker 2:They could be very stressed and it's the cortisol that's causing their sebum to be excessively produced. And then our final cause we have is the pH balance and that's where the skin pH and the acid mantle, which is the outer layer that protects the essentially the skin barrier function. That ph is so tightly regulated in order to protect the skin and it has certain antimicrobial peptide properties that are really important to try to prevent acne. And, essentially, the ph balance that can be drastically impacted by the type of topical products the clients are using, so everything from their cleanses, their moisturizers, their serums, their, their spf as well. But the ph balance of the skin can also be impacted by the gut microbiome. Just like we know that the gut microbiome ph can be impacted by the types of short chain fatty acids that are produced within the gut, it's very similar with the skin that the skin ph can then be influenced by both the gut microbiome and the skin microbiome.
Speaker 2:So that's essentially why, in a nutshell, that when we're looking at different causes of acne, no two cases are ever the same, because you can even see with the definition of acne, the complexity of all the potential drivers and how no two clients have the same exact hormone history, the exact same blood sugar issues, the exact same diet and you've got to treat them based on the individual you're seeing in front of you and it just, you know, such a domino effect when we're looking at the cause of the cause.
Speaker 1:Also, you know, just thinking about retention, keratosis and vitamin A deficiency, obviously we've got to consider, you know, what's their retinol intake or vitamin A intake, because beta carotene conversion is pretty low. I personally, in clinic, have seen high amounts of SNPs for BCM01, meaning the conversion of beta carotene to vitamin A is even lower than 1.5%, which is on average what Gen Pop will have. But further to that, zinc deficiency is incredibly common and you need zinc for retinol binding protein to distribute vitamin A around the body and therefore, even if you're consuming sufficient vitamin A, zinc deficiency will have your skin remain vitamin A deficient and fail to desquamate properly. And you know there's just such a flow on effect, you know, with pH balance and antimicrobial peptides being produced at the skin. You know a vitamin d deficiency alone will do that, and we know that more than half australians are vitamin d deficient at any time of the year.
Speaker 1:So that's exactly right yeah, and it's so important, you know. And again, essential fatty acids. If anyone's listening to this who is maybe struggling with their skin and like, oh, but I take essential fatty acids, you know, are you digesting and absorbing them properly? Are they in the right ratio? Are you taking omega-3 in plant form? Because alpha-linolenic acid is not the same as EPA and DHA from fish oil, even though they remain in the same family? So, yeah, I certainly think that's just even just scratching the surface ultimately of what's behind someone's skin presentation, but I think really serves to explain why there's not a cookie cutter approach that practitioners can take, and that's also why if someone is struggling with acne and they try something that worked for someone, it might not necessarily work for them because it's not working on the drivers that they actually have. That's exactly right.
Speaker 2:I see that so often in clinic. We see such an influx of you know new clients that will say well, you know, I've been trying this supplement that's been advertised for acne and it's you know, it's not working. Or, like I've heard, vitex is really great for acne and it's flared my skin. Or you know, you hear so many different things. But then you'll hear the next person say Vitex worked incredibly well for my skin.
Speaker 2:And that's where you can't say this is the only herb you can use for premenstrual breakouts and this is the only thing you could use for the lymphatics or anything like that, because everyone is going to respond so differently based on their own individual cause, and that's where I think it's so important as a practitioner. We really have to understand their timeline of the client's skin, the things that they have done, they haven't done, what it responds best to what it you know what it doesn't respond to at all, and also couple that with things like you know you're testing to see your hormones, so you're not guessing, because I think that's a really important thing. You can't guess a person's hormonal status unless you actually see what's going on with the bloods yes, yes, oh my gosh.
Speaker 1:So this is such a good segue into my next question for you because when we're looking at those root causes like so much of what we've already mentioned can be tested either directly or indirectly. Certainly there is a time and a place for hormone testing, assuming you're testing for the right thing at the right time of the cycle to be able to actually interpret those levels properly. But I also know from my own clinical experience and also our chat is that there's a lot you can also glean from basic pathology blood testing as well. So I'd love if you would take me through some of the general bloods you might run and what you're looking for when you do that.
Speaker 2:Yeah, exactly.
Speaker 2:So essentially, when it comes to looking at the bloods, the main thing that we want to try to do is rule in or out potential pathology like PCOS, for example, because we know a lot of individuals that have PCOS. They also have acne and a lot of clients that will come to us they're coming with a suspicion that they think they have PCOS because of how they're presenting. So when we're doing the bloods, we're really trying to find a specific hormonal profile that either rules in or rules out of diagnosis for PCOS or we're trying to find a particular imbalance with the connection between the brain and the ovaries that can signal the areas that we need to optimize with their diet and their lifestyle and determine what types of herbal interventions that you need to use as well, what types of herbal interventions that you need to use as well. But basically, we're always running a hormonal profile pretty much on every single one of our clients that come with acne, because we want to rule in or out. That it's, you know, their hormones that are impacting it.
Speaker 2:We generally always do day two or day three testing where we would be doing things like FSH, lh, estrogen, your prolactin testosterone, dhea, shbg, and then we're also looking in some cases that post ovulation estrogen and progesterone ratio, and I generally do that in some of my clients that may also be presenting with a little bit more PMS or maybe they've got a bit of an endo or adenomyosis kind of history as well as acne. So you can see what's going on post ovulation and the main things that we're trying to look out for in that day two or day three testing is first the ratio of the FSH and the ALH, because that can give us an indication if there is some kind of other blood sugar dysregulation that's associated with PCOS and if there's that imbalance there, if there's something that's there that's connected to the androgen profile as well. We then also like to take into consideration things like the SHBG, because the SHBG is a really great indicator if there is excess estrogen but is actually so important when we're trying to potentially rule out cases or rule in where the client actually may be under eating and maybe it's actually insufficient nutrient intake or dietary intake in general that's impacting their skin. So even in the hormonal profiles we can see if a client isn't eating enough food and if that's impacting their skin, because you can see a classic low estrogen, low testosterone, high SHBG kind of profile or low LH, low FSH and that kind of profile. You know you're treating that client so differently to say a classic PCOS kind of case, so differently to say a classic PCOS kind of case and that client is so.
Speaker 2:The treatment plan is really supposed to be focused on really rebuilding their system and supporting their adrenal, supporting their reproductive system, giving them enough food in their diet, making sure they're eating enough, they're not skipping meals, they're not running off caffeine, and then also making sure they're coupling that with rest and they're not running off caffeine, and then also making sure they're coupling that with rest and they're not over training. And that's the. That's the beauty of the hormone test, because it can be so easy for clients to think okay, well, I've got breakouts in my skin and my cycle is irregular, I must have pcos or I need to train more and I need to eat um very low carbohydrate. But if that's not the right profile for that type of client, they're actually really negatively impacting their hormones in that regard. So we look for similar patterns, like basically trying to create a story with your hormones. That's what we're trying to do so we can see how does this match the type of diet or lifestyle you're currently living and what do we need to then change to support that profile?
Speaker 2:The other things that we generally look at as well is, of course, beyond the hormones, we're always looking at nutritional status, like your iron, your b12, your folate, your vitamin d, because, especially when we're thinking about iron, that's so important for building collagen, which we need for skin repair. So, for those clients that have sluggish skin cell turnover and that's the same as investigating their zinc as well and just like we all know as naturopaths, when you find specific things in the bloods, it can lead you down other areas that you may not have thought of before, like if you can see severe iron and B12 issues. You're thinking is there maybe something going on in terms of absorption in the gut? Is there a digestive pathology that has been completely overlooked, that maybe they have undiagnosed celiac disease, which I can tell you. I've seen so many times in clients that they've got an undiagnosed celiac disease and that's the cause of their acne and their hormones are actually fine.
Speaker 1:You can just see it in their nutritional profile and their digestive symptoms as well and if someone's looking at their bloods, um, while they're listening to this, what are they looking for? Like as far as like fsh lh ratio, and like where do you like to see shbg sitting to kind of say that's not an issue, like, what is your framework there?
Speaker 2:yeah, it's really dependent because I often like to look at them all in relation to each other. But essentially the thing is, with FSH and LH, I generally rather than saying like I specifically want to see it in this exact ratio, because sometimes it's really difficult to get it that exact I generally just don't like to see the lh sit higher than the fsh. So as long as it's sitting below the fsh, um, even if you can see it's kind of sitting one-to-one with fsh, that's not ideal um, and we generally like to see the fsh sit below the 7 to 8 mark on that day 2 or day 3. And with your estrogen it's really on day 2 or day 3, ideally we like to see it between like 120 to 160. But that can also really vary.
Speaker 2:Like I've seen some clients that have had an estrogen that sits at 110 and it's not a massive issue. You've just got to take it into consideration with their testosterone levels and their SHBG as well. But in saying that, with testosterone that's a massive one, because I can tell you now the amount of clients that I've seen with testosterone that sits above the reference range. It's probably like less than five clients in total that I've seen that actually have testosterone that sits above the conventional reference range, and generally I see testosterone that sits at 1.0 to be problematic for clients that have acne, and there can be such a difference between, you know, a 0.7 to a 1.0. You can actually have clients that have testosterone at 0.7 this they're you know that it's not androgen dominant, for example but then it sits at 1.0 and we can see that's a problem for them. And that's because we're taking into consideration some of those other markers like the DHEA and the estrogen levels as well.
Speaker 1:Yes, of course, and SHBG in terms of when you would think, oh, this person's under eating or overexercising or just running themselves ragged. Where do you start to get concerned on what?
Speaker 2:you see, generally, if we see it above, like that 90 to 100 mark, we're seeing that as a bit of a flag for our clients.
Speaker 1:Okay, Red flag. Yeah, so from what you're saying there is so much that can be gleaned from just standard blood tests. I'm curious to know, like when we zoom out and think about all of the ways in which we can assess someone's hormonal balance. I'm a big fan personally of basal temperature tracking. I can see so much based on when the thermal shift happens, the length of the cycle, all of those kinds of things. In the past I've done a bit of salivary hormonal profile testing.
Speaker 1:I also have clients that come to me with urinary not necessarily estrogen metabolites for like elimination, but maybe a bit more of a broader profile. But all of these things add up either in the time it takes to track them, whether it's, you know, basal temperature tracking or ordering specialized functional pathology, and you know just in our brief conversation about what you can pick up from just a day three, hormonal panel progesterone excluded. You can tell an awful lot on basic blood testing if you know what you're looking for and you're testing it at the right time. And how often would you then go on to you know functional, fancy functional testing or secondary testing? Or maybe a better question is to ask how many clients can you just simply proceed with, based on just normal standard blood pathology alone. Yep.
Speaker 2:I could tell you now I haven't run any other form of hormone testing for a very, very long time when you really understand bloods and you know how to interpret them, you understand the role of FSH and LH and how that impacts the reproductive system and the connections between prolactin and androgens and thyroid function and all that that comes into it, you can get so much from your bloods. I've never done well, I haven't done for a very long time actually like any form of urine hormone testing, and the reason is is because I generally find like one I can get enough through bloods, um, but two I don't particularly find that it gives me any additional information that I wouldn't be able to be able to detect from a blood panel. The. If you're trying to look at things like your estrogen detoxification capacity, that post ovulation estrogen and progesterone ratio via blood I tend to find can be enough. And if you have an extreme estrogen dominant case, you see it in the SHBG. The SHBG is often well above the range in clients that you can see that that's actually a problem for them. So I generally don't find it adds any extra value.
Speaker 2:And I absolutely agree with what you were saying about the cost, because, especially when you've got clients that are coming to you. They've had acne. On average, I think most people spend about $6,000 a year on acne treatments if they have acne, and we've got to consider that those same clients that are seeing us they're already either seeing a dermatologist or a dermal clinician or a skin therapist and they're spending $400 to $500 every five to six weeks on a facial or a new range of like a change in their skincare prescription. So if we can also meet the client halfway, especially with economic crisis at the moment, with, you know, clients not being able to maybe afford as much as they used to, we're really going to be cautious with where we're thinking that we need to prioritize the testing, and I'm I absolutely think that we can. You can just do it with bloods. Even the whole, our whole team at arenda, every single practitioner that we have in the team when we onboard them.
Speaker 1:We all go through hormone training together, like I'll go through that hormone assessment and how to do it with them, and no one is doing urine testing for hormones so, jacinta, you mentioned PCOS a couple of times and we're going to talk about diet in just a minute but In terms of people assuming PCOS means that they need to go on a low-carb diet or they necessarily have blood sugar or insulin problems, I think it's important to point out there are different kinds of PCOS. Not all of them are related to insulin and blood sugar metabolism issues, but by the same token, you could have someone with acne who doesn't have PCOS but who does also have some sort of metabolic dysfunction there. Where it comes to insulin sensitivity and blood sugar balance, do you have any further insights on what we're looking for when looking at blood sugar, insulin and determining that, if that's an issue, yeah, absolutely so.
Speaker 2:One standard test that I always do for every client is a fasting glucose test and generally a fasting insulin as well, the reason being because we want to be able to see if there is hyperinsulin secretion and whether that might be associated with the cause of, let's say, if there is an androgen dominant acne. We want to see is that stemming from too much like excessive insulin secretion? And generally what we're looking for. Ideally, we want the insulin to be less than nine if it's fasted and if we're looking at a fasting blood glucose, I find it gives me so much information. Ideally, we want a fasting blood glucose around 4.6 to 5.0. Generally, anything from 5.0 plus is a flag that there's something going on in terms of blood sugar regulation, and anything less than 4.6, I'm questioning if they're actually eating enough food. And that's where I'm also making sure that when I'm looking at a client's test results, you've got to be so specific Look at the time that they got the test, because they could have got that test in the afternoon and they fasted all the way until 2 o'clock and then that's an inaccurate result.
Speaker 2:But also questioning well, what time was the meal the night before and what kind of meal did you eat the night before? Because if it was a night that they've had more sugar, then that could be an inaccurate reading just based off the consumption of what they've eaten. Or if they didn't eat enough the night before, is their fasting glucose just low because of that? But that's where I find the insulin doesn't generally lie.
Speaker 2:Oh, that much um, but the fasting glucose can give us plenty of information and in some clients that have pcos or that, I can see that they've just got metabolic dysfunction. I generally get them to track their blood sugar response and I often get them to do, like the blood sugar, the finger prick test, where they can, you know, do a fasting test in the morning, eat their breakfast, track their blood sugar two hours later and continuously do that throughout the day, especially with those clients that I can see have a major blood sugar dysregulation issue, because I want to actually see what is their body doing when they eat oats, rather than just because the internet says you can't eat oats if you've got blood sugar issues.
Speaker 2:I want to see how your body actually handles oats when it's coupled with the protein and a fat, or I want to see how your body handles potatoes with dinner, but potatoes with dinner, then you go for a walk and let's see how your body handles that, and I find that's such an incredible clinical tool because I'm not just giving my clients blanket treatments in terms of diet and lifestyle advice. You're actually being able to tailor the advice according to the way that they live their life already and then, and the factors that we can see are impacting their blood sugar, based on actual data.
Speaker 1:Yes, I think that's so important because you know bioindividuality. We preach it, but sometimes I think clinically you can fall back on protocols without thinking about how to apply that. I've got a couple of questions for you on that. In terms of monitoring blood sugar, you sort of mentioned the finger prick. Do you have a reason you prefer that over a CGM, or is it more just price accessibility thing?
Speaker 2:Yeah, so I'm actually starting to move more over to doing the CGMs. I've personally actually recently just did it over the summer and I actually chose the Christmas period of time to do it, which was kind of fun because obviously lots of different periods, and the only reason I hadn't up until that point was because I just thought it would be a barrier for me to confidently explain to my clients this is how we can use it, this is how we can interpret the data. If I hadn't had the experience myself doing it.
Speaker 2:So now that I have, then I can easily guide my clients through it, whereas I know with the thing I know the ins and outs of the finger prick test. So it was more just being able to know that if a client had a question I wasn't stuck with how to respond to it. I knew exactly how they could you know navigate?
Speaker 2:But yeah, when I did the CGM recently, I actually I have the finger prick test at my parents' house and I did the finger prick test at my parents house and I did the finger prick test at the exact same time that obviously I had the CGM, so I could see the accuracy and it was probably a 0.1 or 0.2 difference. So it's very close in terms of like the accuracy of the CGM. So I would absolutely still use the CGM with clients.
Speaker 1:Yeah.
Speaker 2:It's just that I haven't done it just yet.
Speaker 1:Yeah, yeah, great. I mean, that makes perfect sense. You want to have that lived experience. So if you can troubleshoot with them, you know, having actually done it yourself, and I think it's nice to hear that, given you've done it for so often already, we're using another method that they dovetail really nicely in terms of data. Um, one last question on on the blood sugar thing before we move on to diet. But you mentioned obviously low blood sugar, potentially indicating under eating. What about low insulin? What's your read on that?
Speaker 2:yeah, I don't really see it as the same as well. I often see if clients have a low insulin reading, it's that there's no demand to have to increase insulin because there's low intake of the carbohydrates as well. So I kind of couple the both the same, the same.
Speaker 2:Yeah, and you can also see in some other markers as well, if the clients are under eating as well, like in some cases, if you can, the clients are under eating as well, like in some cases. If you can see that there's low blood sugar, low insulin, but a high cholesterol profile, you're questioning, well, what's going on here? Because we know that we can see high cholesterol even in individuals that have anorexia. So we have, and if you have that plus an elevated shbg, you've got a whole story there telling you that the client may not be eating enough food yeah, yeah, brilliant.
Speaker 1:Well, speaking of food, I know um, again coming back to bioindividuality that there might be some nuances for people as far as macronutrient. You know ratios, micronutrient profiles, but can you walk us through what you find to be time and again applicable in acne patients, maybe more across the board than otherwise?
Speaker 2:Yeah, absolutely. I generally try to educate my clients on diet in three kind of categories. So one is making sure that we're actually correcting, like nutritional deficiencies in the diet, so making sure that they're actually eating enough antioxidants and such to be able to support their skin, whilst also correcting deficiencies we can see in the bloods. And the reason that I go through that is, of course, because the skin is the last place to get our nutrients and if we're nutrient deficient, our skin cells every single day they're developing new DNA and they're growing and they're the skin cells we're going to see on the surface in six weeks time. So if there's insufficiencies in things like your b vitamins, vitamin a, your zinc, even calcium, that's all going to significantly impact the health and the function of that skin. So I'm often working with clients to try to increase diversity in the diet and to make sure that they've got enough fuel nutritionally to be able to support the function of the skin cell. The second aspect is, of course, optimizing blood sugar regulation and I find that that's just crucial, even if it isn't an insulin resistance, pcos kind of case, because let's say, for example, it's a client that's got a very stress driven acne.
Speaker 2:We all know naturopathically that a healthy, stable blood sugar helps to support the nervous system, to feel calm and feel safe, and you're supporting your adrenals in that way as well and, with that, optimizing the blood sugar.
Speaker 2:That's where I have a very big emphasis on clients making sure they're having at least 30 grams of protein with every meal, particularly making sure breakfast is a priority as well. I know that there's a lot of individuals that will educate on making sure every meal and every snack is protein rich, which I understand because it's so important because we need protein to synthesize new skin cells and so on. But I think if we can really aim for getting three protein rich meals in a day at least 30 grams each then that's that's a really great goal to aim towards and, of course, try and optimize, if it is a blood sugar issue, to focus on those low glycemic carbohydrates as well and generally, with that I'm often advising if they're going to be eating sweets, have a sweet after a meal to try to optimize that blood sugar response. If you're going to be having a larger carbohydrate meal and you've got blood sugar issues, to go for a stroll or something afterwards to help with the metabolism of the glucose um yeah from a blood sugar perspective.
Speaker 2:That's generally the factors of what we're looking at, and then, finally, there's the whole inflammatory aspect of it. So trying to balance the omega-3 to the omega-6, which is where, of course, we're looking at increasing essential fatty acids omega-3, so like your sardines and mackerel, herring, anchovies and so on and then also looking at reducing omega-6, which is going to be from canola oil, sunflower oil. I know a lot, of a lot of individuals then start to become, have a have a fear around food and they're like well, that means I can't eat nuts and I can't eat this, I can't eat that.
Speaker 1:But it's all just about the balance and the quality and the source that you're getting from as well yeah, I think that's important because it can feel a bit overwhelming looking at it all, which is why you put together the Clear Skin Blueprint Masterclass, which I just want to quickly mention. It's something that Jacinda created for clients. It's a 90-minute masterclass, I think it was, and really just summarizes all of those key principles and provides that information to clients outside of the one-to-one setting. And you can actually access that straight off Jacinta's website, which we have in the show notes. And although it is for clients, if you are a practitioner who is looking to learn more in the space, jacinta welcomes you signing up for that too, to learn a bit more. But the other I guess important thing to share here is there is going to be practitioner training later in the year from Jacinta on acne specifically. So if you do want to sign up to be notified about that, the link in our show notes to sign up to her newsletter will give you access to that.
Speaker 1:And the only other thing I just want to share from my own clinical experience is circadian eating as well, which is like just a whole other layer of blood sugar balance. But our insulin sensitivity is also dictated to by light and dark environments and eating one particular meal under blue light and the same meal outside in sunlight has quite different and profound effects on blood sugar as well, and that's probably really like a phase two thing. Like getting those core elements right is always the place to start. But I think, because so many of us work indoors and we spend we spend 95 of our time indoors, you know, I'm noticing that some of that uncoupling of blood sugar and insulin sensitivity is partly a result of non-native emf and and blue light exposure too. So if anyone's listening to this and they're like tick, tick, tick, tick, tick, I've done everything you've just mentioned, then I would be starting to go a bit deeper and looking at your circadian biology, timing of eating you know that kind of thing as well.
Speaker 1:But once you get those core basics right, that's when we can look at how do we support those really important like dietary elements with you know this the judicious use of supplements and my gosh, we're so lucky to have so much to choose from Um and I know at Arenda health you've got your own compounding dispensary, which means you're in the you know, a wonderful position to actually customize formulas for clients um on site, which I just think is so brilliant, and I'd love it if you would take me through maybe some of your favorite ingredients and like where you see those applied and a few that I would love to hear you riff on. Are you know, myo-inositol PHGG, where you might use broccoli sprout, or glycine or calcium duclucarate? What are?
Speaker 2:your. What are your favorite?
Speaker 2:favorite children, absolutely yeah so we I guess a lot of the clients of what we see if they're presenting with more of like a hormone, a hormonal kind of acne. A classic formula of what we would put together would be kind of similar ingredients, like you said and also told. We would use broccoli sprouts, we'd use calcium to glucurate, we'd also add in some zinc, we'd also add in some dim, and that's essentially because we're trying to work on all those specific areas of optimizing insulin receptor sensitivity with the insulin. That was sorry, with the inositol. That really helps to get that glucose into the cell.
Speaker 2:And then we're working on things like supporting those phase two detoxification pathways and sulfation, specifically when we're looking at things like the broccoli sprout extract and that is really helpful when we're looking at things like an estrogen dominance or even a testosterone excess issue.
Speaker 2:And plus the DIM that's in there as well. That DIM is extremely supportive for supporting that detoxification pathway's in there as well and that DIM is extremely supportive for supporting that detoxification pathway via the liver as well. Then the PHGG is amazing as one to add in, because we know PHGG works incredibly well for supporting blood sugar regulation when you're having it with a meal because of the fibre and the slowing of the gastric emptying as well, whilst also helping with supporting bowel motion regulation and gut microbiome balance as well. So it ticks quite a few boxes when you're thinking of a client that might have constipation and detoxification elimination issues whilst also having blood sugar problems. That, alongside of those other nutritionals that we just mentioned, can work incredibly well. And then, of course, most of our clients get a zinc in their compound formula because we know how important it is for supporting the aromatase enzymes, for supporting the antimicrobial properties that it has within the skin and the skin repair, as well, beautiful, such a lovely place to start.
Speaker 1:And of course, nutrition always comes first, over and above herbal medicine, because you can't. Your enzymes literally need minerals to function. But once you've covered those bases, of course herbal medicines can be incredibly powerful to up regulate or down regulate enzyme activity where we see it's required. What are some of your favourites in your herbal dispensary?
Speaker 2:Yeah. So I'd say the most popular ones that we have would be burdock, peony licorice, oregon grape and gosicola. They're probably the ones that are used the most in our clinical practice, reason being, I guess, that peony licorice is that classic combo for when we're seeing like an androgen-dominant type of acne, alongside salt palmetto that will be added in there as well, of course. But again, the herbs are really specific based on what the hormonal profile is actually showing us as well. And then the Oregon grape.
Speaker 2:We love that because it helps to act as an anti-inflammatory for the skin when we can see there is more of those painful cystic type of breakouts. But because Oregon grape also works as an antibacterial, it's also working on the fact that acne is an excess proliferation of C acnes bacteria. Although we don't love to treat acne as, oh, it's an infection, just kill the bacteria and it's gone, because that's very reductionist in its approach, we do recognize that the immune system needs a bit of a helping hand to try to support those deeper cystic breakouts. And that's where the combination of something like oregon grape and burdock work really well together, because you've got burdock in there to support the lymphatics and to support the immune system whilst the oregon grape works its magic as the anti-inflammatory as well, and then having the rest of the herbal formula being made up by the specific hormonal issue that's present.
Speaker 1:Well, yes, of course, as you mentioned earlier, like sometimes, it's easy to assume it's hormonal or, in particular, it's androgen-driven, when in actual fact it's not. It's just you can look that way on the surface, but when you actually look at what's underneath, you realise that's not the case, in which case, if it's not hormonally driven, you're not going to be including herbs herbs for hormones, I'm sure, um, but I'd love to hear a bit more about where you see gotu kola playing into this yep.
Speaker 2:So we love gotu kola when we're thinking about specifically tissue repair. So when we can see clients are maybe even going through that, stepping into that route of doing more skin needling so their skin they're actually trying to work on the scarring aspect. And for those that may not be aware, skin needling it's essentially a process, a method that's used by dermal clinicians and skin therapists to try to induce inflammation in the skin, to provoke an anti-inflammatory and immune response, to get the skin to heal and to support repair and helps with collagen synthesis and so on. And we find that gotu kola can really help with supporting that aspect of it. So to support the rate of acne repair.
Speaker 1:Yes, that makes perfect sense. So from a prescription point of view it sounds like I'm generalizing greatly here, but clients will almost always get zinc, maybe inositol, something for liver detox, maybe PHGG for elimination and microbiome support and then a custom herbal blend which is going to address those drivers. So if it's hormonal we'll see hormonal regulating herbs. But we've got so many other tools in the toolkit and of course I think probably every client will get essential fatty acids to try and correct that.
Speaker 2:Without a doubt, yeah, yeah, yeah, absolutely, because you know you could be working on trying to reduce the hypersebum secretion with, you know, hormone regulation or working on the stress response or whatever that might be. But if the sebum viscosity isn't addressed, then the oil that's still going to be produced. It could be produced within a normal rate, but it's still thick and it's still going to cause congestion in the skin. And I think that's where it's even important for us to recognize that a blackhead is essentially a pimple in the skin. And I think that's where it's even important for us to recognize that a blackhead is essentially a pimple in the making. It just hasn't become severe enough to actually cause a breakout. And that's where, if we're still seeing that clients are saying there's a lot of congestion in my skin, then we can see that that really requires the essential fatty acids to step in.
Speaker 1:Yes, yeah, I think a lot of people are shocked to learn that oily skin is usually dehydrated and the oil can sometimes be a bit of a compensatory mechanism in some ways to try and prevent that water loss. But actually allowing the right essential fatty acids to provide a healthy hydro lipid film will then help regulate the sebum and it's kind of hilarious really that it's oils that's regulating oil. But yeah, that's right, yeah, it is what it is. Um, I'm gonna ask you about lifestyle in a moment, because, of course, taking a holistic approach, that's always really important. But you did just mention that go to COLA as one of those ones that you think, oh, let's support tissue healing If they're, say, doing skin needling, or maybe they're having sclerosing agents utilized in, maybe deep pockmarks or you know more heavy sort of scarring situations.
Speaker 1:And one of the things that I really love about your practice and your approach is how intimately you work with dermal therapists, and I wanted to just touch on this for a moment because there's a couple of key elements that I want to just pop in this conversation before we end it to.
Speaker 1:You know, I guess bring this into an awareness for practitioners who are working in the skin space about just how powerful it can be to work collaboratively and what that looks like and why you would want to do that. Because it is that, again, as I said at the start of our chat, the blessing of the skin disorders is that you can apply things topically and you can do things topically that are really powerful also. So will you talk me through, like how you began collaborating with skin therapists and dermal clinicians and, number one, what you look for in terms of the way they approach skin, because of course, there are different avenues you can go down and that break down the skin barrier versus preserve and protect it. And also, for a clinician who's working in this space, like how they should expect that to look and ways in which you'd recommend they approach dermal therapists.
Speaker 2:Yeah, absolutely so. Essentially the way that it started was similar to like how I mentioned before. I was working in the education space with a lot of skin therapists and then I started my practice and essentially from there they were like we need our clients, someone to go to to do all the internals, and that's where that kind of rapport building really began, and a lot of my Instagram is actually tailored around education, just in general on the skin. But it also then sparked the interest of a lot of dermal clinicians and skin therapists because they could see that there was a gap, that there's like right, we're doing everything we can, there's something going on, and I guess it's because there are such a. You know, there's a large demographic of skin therapists and dermal clinicians that think from a holistic perspective and understand that the skin is a living organ. It doesn't need to be stripped and peeled and killed and so on, and that treatment needs to be focused on identifying the internal drivers. So a lot of our practice we have a really strong standpoint and it's something that I continuously always speak about with Arenda is that we do not touch the topicals, and I think that's really important where you're identifying your scope of practice and understanding where you need to collaborate with your client, with your um, with another skin therapist for your client. And I guess it's just like with anything. If we thought, you know, our clients needed to see a physio, we weren't, we wouldn't all of a sudden youtube how to, like you, you know, relocate this in a person's body. Like you know, you would actually refer them to a physio, and it's the exact same when it comes to the skin. The unfortunate thing is, of course, with the nutrition and the naturopathy degree. We do cover skin, but we do not learn it in the lengths of a dermal clinician or a skin therapist. That is their specific focus and I think we don't know enough like we don't know near enough to be able to understand how to identify what type of cleanser they might need, the type of moisturizer they might need, the serum that they need. And we know a lot about internals, but we shouldn't have to take on the responsibility of the externals as well.
Speaker 2:So this is where, with our clients, I'm always having honest conversations with my clients. If they ever have any questions to say, what do you think I should do with my topicals, I just straight out say it's not my area. I know people that can help you and I know that they're going to work incredibly well for you. But I would be doing you a disservice if I tried to tell you what type of skincare to do. And I think that's really important because, from that perspective, like there's some people that can think, oh, you know, from a business perspective you could be taking them on and doing topicals. But I don't care about that aspect because my care is making sure that the client has the right practitioners on their team and, especially when they've been suffering with the skin condition for so long, they want someone that they know can get to the root cause from a topical perspective very quickly.
Speaker 2:So with that, the main things that we're looking for are skin therapists and dermal clinicians that focus on maintaining and restoring the skin barrier function, and what I mean by that is you'll see a lot of clients that will be focusing on doing, you know, microdermabrasion and peels and dermaplaning and excess exfoliation. I've had some clients that exfoliate four times a week and it's like their skin is constantly trying to repair and rebuild, but every two days they're going, they're stripping and stripping and stripping. I guess if we were to think about it from a similarity of the gut. Our gut microbiome, you know, tries to maintain a healthy, happy environment. And then when we put alcohol or anything like that into the gut, that impacts the gut microbiome, which we know is counterintuitive to supporting a good, healthy gut microbiome. And it's the same with the skin. Skin conditions start because there's a skin microbiome imbalance and that there's something wrong with the skin barrier function. So anything topically that's touching the skin can impact that homeostasis of a good, healthy skin microbiota.
Speaker 1:So the treatments of what we try to focus are on skin therapists that have a very holistic approach in their way that they're treating and possibly also making sure that the skin therapist is on board of knowing that the internals have a role, but it's also not an overnight thing as well yes, I have a really important question to ask you around expectation management, which I'm going to just save for just a moment because I want to just lastly touch on lifestyle for a moment, and that is, you know, obviously a holistic approach does require us to assess where people might be living in a way, or have developed habits that are counterproductive to, you know, skin health, either directly or indirectly, and so I'd love to hear about what you see come up time and again for acne patients as well, and what kind of lifestyle recommendations you often find yourself giving in that case.
Speaker 2:Yeah, I think we can see people that sit on completely different ends of the scale. Sometimes we can see the individuals that they get up, they go to work, they come home, they go to bed and there's nothing in between in terms of exercise or sunlight and the sleep quality is not great and they're not feeling happy with their kind of environment in that way and their schedule of how they're running. And then, on the opposite end of the scale, you see the people that are waking up at 3 am to fit in the gym, their steps, their breakfast, their morning routine that's supposed to counteract all their stress, and then work and come home and then just the excess. You know the type of case that you can see of a client where they're excessively running, that go, go, go type of energy. Running that go, go, go type of energy.
Speaker 2:And our ideal goal of our lifestyle change is, you know, for that individual that's presenting with that go, go, go is how can we change your schedule to help you to actually slow things down so your skin actually has time to repair, so your hormones can balance a little bit better and so we can actually get the body to feel a bit safe? And then, in the other end of the scale, when we have a client that might just get up, go to work no sunlight, no exercise, maybe not eating home-cooked meals how can we shift their lifestyle to kind of be that midway in between?
Speaker 2:and they can incorporate more exercise to support their lymphatics, because the poison with anything is in the dose right Like exercise is great, but you do too much and it's a problem. You don't do enough and that's a problem you know, there's.
Speaker 2:It's the same with being able to, you know, be too social, you're too social.
Speaker 2:That's, you know, can be a problem for some, and then not having enough social life is a problem as well. So I think, when it comes to to lifestyle, it's about finding out where your client sits on that scale and then being able to find a healthy dose of the lifestyle things that are really important for them. And, of course, sleep is an essential one, um, making sure that they're getting really good quality sleep. So, whatever lifestyle that is that they live, that they're having enough time to wind down, get good quality sleep, wake up not feeling excessively stressed or that they're anxious as soon as they wake up, because their sleep quality is obviously so important for getting their hormones balanced and that's where a lot of repair happens. Like, melatonin is one of the body's most natural antioxidants. It's so powerful and if you're not sleeping enough, then that can have such an impact on the skin as well. So our lifestyle factors is definitely trying to find that healthy balance with good, good exercise routine, good sleep and, of course, good, good methods of stress reduction and management as well.
Speaker 1:Yes, it's such a so lovely to capture all of those different elements that come into a holistic strategy, and you mentioned, you know, giving yourself enough time to allow your hormones to rebalance, and I think this is probably a lovely place to wrap up our conversation, and that is we live in a day and an age of instant gratification, and sometimes, certainly pharmaceutically or allopathically, we can produce a swift result, albeit, you know, maybe temporary if the underlying causes haven't been addressed.
Speaker 1:And so one of the challenges with taking a root cause approach is that it most often doesn't result in overnight results, and it can be. I think skin stuff, more than anything, is incredibly distressing maybe nausea and pain as well but the degree of suffering, because it's visible to everybody else, can make clients really anxious to see big changes really quickly, and I think it's important you know we don't conclude this conversation without talking about what kind of timeline should we expect, and also understanding that it's not binary that you're going to go to sleep with bad skin one day and wake up with good skin the next, there's a.
Speaker 1:There's a spectrum of healing and perhaps other green flags or signposts along the way that indicate you are actually on the right track and you just need to keep going and stay the course. So how do you couch that to clients, like, what do you say to them? Obviously, everyone's individual. I'm sure you can see from how severe something is. You'll have a rough timeline in mind, but just generally speaking, how do you manage that? What do you say and what do you really put on the table for clients to consider as they start their skin journey?
Speaker 2:yeah. So first I love to take a matter of fact kind of approach with my clients and I'm very factual with things and I'm very factual with things and I think that's important so they can feel like they have a plan that they can follow and they know exactly the timeline of potential things. And first, it's important to let our clients know the fact that a normal skin cell turnover is about four weeks in a condition or as you get older, that can extend in its time, which means our body right now is making the skin cells that are going to show on the surface in possibly about six to eight weeks time. So if you're trying to work on correcting your skin, everything we're doing right now is going to be impacting the quality of the skin barrier, the quality of the sebum production, your hormonal status in the skin or, even longer actually, if you're, hormones, in six to eight weeks' time. So anything that you're doing right now you're not going to see in seven days' time, you're going to see it in six to eight weeks' time. Even the pimple you see now that started its way six weeks ago and that's where it's important.
Speaker 2:Even when clients are going through flares, it can be maybe immediately. They drank a lot of alcohol last night and their skin's dehydrated and it's more inflamed. But those pimples would have probably started their way six weeks ago anyway. And first I lay that out to my clients. I'm like right, these are the facts of skin cell turnover. So let's wait at least six to eight weeks' time. That also means during that period of time I don't want you to change your skincare and go rogue and try different things. Because how do we know if you've had a flare is because of something internally or because you've tried to change skincare in between? And again that brings me back down to expectations of clients knowing you need to see a skin therapist that's guiding you through everything, because they probably won't change your skincare all that drastically in a six week period of time as well.
Speaker 2:So, first I'm discussing with them the skin cell turnover. The next thing that I'm getting them to understand is that hormones take a minimum of three months to see change, just like with any of our clients. When we're thinking about painful periods or regular periods or PMS or anything like that, we're usually giving them a timeline of about three months. And that's the same as when we're working with our clients with a hormonal skin condition and with them it's important to recognize. I might see you for your first appointment in Feb, but you might not get your bloods done until April and then we're finding out your hormonal issue then and then you can count three months from that particular point of time to work on your hormones.
Speaker 2:but the thing, that I also reiterate to clients is when you're seeing a before and after photo on TikTok or Instagram, you're not seeing week one compared to week four. You're seeing week one compared to like six months later, and that's not an overnight thing. So generally, when we're looking at improvements in the skin, we're seeing well is, this month maybe there's less severity in terms of the breakouts, maybe there was the same amount of breakouts, but this month they weren't cystic, they weren't painful, they were maybe a little bit more surface and they were easier to control. Maybe this month when the breakouts came up, they came up and they turned over very quickly and they didn't linger for weeks and weeks. Maybe this time when the breakouts came up, they were still severe, but there was less of them. So we're kind of looking for changes in the patterns of the breakouts rather than saying is it completely clear, did you get a breakout? Or if you've got a breakout, that means it's not working.
Speaker 2:No, it's still working it just means that we're looking for slow, like the other, signs of progression as well and for some clients. It can also be that I'm getting them to take a photo one month of their skin before their period if that's their most problematic period of time and the next month or maybe the following month, they're comparing that photo to the same period of time because if you're comparing your like post-period ovulation skin to your pre-period skin.
Speaker 1:It's going to be a very different type of pattern if your breakouts are premenstrual as well so I think having a formal measurement for your client is also really important, whilst also setting the expectation that we're looking for signs the skin is healing, rather than is there a complete resolution overnight yes, I think that's a wonderful way of actually monitoring things and, in particular, making sure before and afters are consistent with the cycle day that they were taken on too, and maybe that means two bookmarks a month you know a pre-ovulatory and a you know a mid-luteal or whenever their most problematic time is and counting the amount of you know comedones, pustules, and taking those sort of before and after pictures. The same position, same time of day, the same kind of lighting.
Speaker 2:Same lighting yeah.
Speaker 1:Yeah, so that they can be monitored. And I think, yeah, I think that's really lovely to be able to say, you know, it's either less inflamed or there's less breakouts or they're moving on quicker as green flags, um, that you're heading in the right direction and understanding that although skin, you know, six week every six weeks, is kind of refreshing itself, the hormonal drivers might be lagging behind a few months too. So it'll be, you know, it'll be incremental improvements, as opposed to you wake up one day looking, you know, with your dream skin, although wouldn't that be nice yeah, I know it would be a dream.
Speaker 2:Um, it would be, you know, I think that's where it is important to have those photos and also, in saying that, making sure you're then not becoming obsessive with that. I know that I've had, you know, some clients where their skin, it's their whole life, like it's what they think about all day, every day, and what am I going to do to fix this? And I've had some clients that, on their own accord, will decide to take a photo every single day, which I advise against, because then you're putting this energy every day that it's like there's something wrong. There's something wrong, there's something wrong or you're picking apart your skin. So, of course, take the photos, but don't take them every day and, you know, maybe spacing them out, like you said, in the same conditions and certain days of the month.
Speaker 1:Oh my gosh, jacinta, you're just such a wealth of knowledge and really your expertise and experience in this area just really shines through, and I just thank you so much for your time today.
Speaker 2:It's been such a joy chatting with you. Thank you. Yeah, thank you. I know we could talk for ages all about skin, but I appreciate you having me on today yeah, thank you.
Speaker 1:Well, for those of you enjoyed um, jacinta's naturopathic approach to acne, the links and resources we mentioned are in the show notes of this episode. And yeah, thanks again, jacinta, for your expertise and thank you for joining us today. Remember you can find all the show notes and other podcasts on the Australian Designs for Health website. I'm Amy Skilton and this is Wellness by Designs.