THE OWNERS MANUAL · ĵ Summary of Omega-3 Fatty Acid Benefits 101 ĵ Different Types of Omega-3s 101 ĵ The Role of Omega-6s 102 ĵ Omega 9 and the Other Omegas 103 ĵ What Happened

SEBORRHEICDERMATITIS

THEOWNERS MANUAL

1ST EDITION

SkinDrone

An extensive look at the latest research on seborrheic dermatitis and suggestions for long term treatment.

Michael Anders

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Copyright © by Michael Anders

All rights reserved. www.skindrone.com

No part of this eBook may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the author.

The information provided within this eBook is for general informational purposes only. While we try to keep the information up-to-date and correct, there are no representations or warranties, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the information, products, services, or related graphics contained in this eBook for any purpose. Any use of this information is at your own risk.

The methods describe within this eBook are the author’s personal thoughts. They are not intended to be a definitive set of instructions for this project. You may discover there are other methods and materials to accomplish the same end result.

This eBook contains information that is intended to help the readers be better informed consumers of health care. It is presented as general advice on health care. Always consult your doctor for your individual needs.

Before beginning any new exercise program it is recommended that you seek medical advice from your personal physician.

This book is not intended to be a substitute for the medical advice of a licensed physician. The reader should consult with their doctor in any matters relating to his/her health.

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Table of ContentsIntroduction 11

ĵ Why This Book Was Written 12 ĵ Some Issues Encountered In My Journey 12 ĵ The Turning Point 13 ĵ Who This Book Is For 14 ĵ Sources of Information 14 ĵ A Little About Me 14 ĵ Disclaimer 15

Seborrheic Dermatitis 17

ĵ How to Tell If You Have Seborrheic Dermatitis 18 ĵ Most Commonly Affected Areas 18

ĵ Why Does It Occur In These Areas 19 ĵ What the Doctor Will Likely Tell You 19 ĵ What Holistic Practitioners Will Tell You 21

ĵ The Issue with Holistic Health Practitioners and Naturopaths 22

ĵ How the Natural Health Industry Works/Thrives 23 ĵ Gluten and Candida 24 ĵ The Best Way to Approach Holistic Treatments 26

ĵ Summary of Medical Literature 28 ĵ Classification and Underlying Cause 28

ĵ Hormones 28 ĵ Fungal Infection by Malassezia 29 ĵ Exaggerated Response to Malassezia 30 ĵ Abnormally High Rate of Cell Division 32

ĵ Underlying Immune System Issues 32 ĵ Summary of the Medical View 33 ĵ Who Funds the Majority of Popular Research Studies 34 ĵ Related Conditions You Should Be Aware Of 36

ĵ Atopic Dermatitis 36 ĵ Rosacea 36 ĵ Psoriasis 37

ĵ The Most Common Medical Treatments 39 ĵ Antifungals 39 ĵ Corticosteroids 43 ĵ Potential Treatments on the Horizon 43

ĵ Most Popular Holistic Treatments 46 ĵ Raw Honey 46 ĵ Apple Cider Vinegar 48 ĵ Dietary Modification 49 ĵ Sea Salt (Dead Sea Salt) 51

ĵ Skin Barrier Restoration Products 52 ĵ Why No Pictures of Affected Skin Are Included 53

Understanding Skin 55

ĵ DNA Sequencing 56 ĵ The Structure of the Skin 57

ĵ The Epidermis 57 ĵ The Acid Mantle 59 ĵ The Ridges 59

ĵ The Important Role Our Skin Plays 60 ĵ Skin Microbiome 61

ĵ Moist 61

ĵ Sebaceous 61 ĵ Dry 62 ĵ Additional Microbiome Representatives 62 ĵ Changes with Age 63 ĵ The Relation to Immunity 63 ĵ Dysbiosis in the Microbiome 66

ĵ Proposed General Strategy for Correcting Skin Issues 69 ĵ Determination of Underlying Health Issues 69 ĵ Overall Immune System Enhancement 69 ĵ Topical Regulation of Microbial Communities 70

Digestion 71

ĵ Basics of the Digestive Process 72 ĵ The Mouth 72 ĵ The Esophagus 73 ĵ The Stomach 73 ĵ Small Intestine 74 ĵ Large Intestine 75 ĵ Other Crucial Components 76

ĵ The Importance of Proper Digestion and Absorption 78 ĵ Protein 78 ĵ Fats & Lipids 82

ĵ The Intestinal Microbiota 84 ĵ Dysbiosis and Immunological Dysregulation 85

ĵ Understanding Gut Permeability and Leaky Gut Phenomenon 86

ĵ Improving Digestion 90 ĵ Learn to Relax 90 ĵ Learn to Listen To Your Own Body 91 ĵ Improving Nutrient Absorption 93 ĵ Ways to Quickly Cut Down Inflammation 94 ĵ Improvement of Digestion Requires an Ongoing Ap-

proach 95

Omega Fatty Acids 97

ĵ The Historic Ratio 98 ĵ Why Omega-3s Are So Important 99

ĵ Eicosanoids and the Impact of Omega-3 Fatty Acids 99 ĵ Some Specific Highlights from Studies 100 ĵ Summary of Omega-3 Fatty Acid Benefits 101 ĵ Different Types of Omega-3s 101

ĵ The Role of Omega-6s 102 ĵ Omega 9 and the Other Omegas 103 ĵ What Happened in The Western World 104 ĵ Strategies for Adjusting the Ratio 105

ĵ List of Most Common Sources of Omega-6s 105 ĵ Best Sources of Omega-3s 105 ĵ A Few Final Words on How to Improve Our Ratio 106

The Skindrone Approach 109

ĵ The Proposed Cause of Seborrheic Dermatitis 111 ĵ The Connection to Lipids and Fatty Acids 111 ĵ The Connection to the Immune System 114 ĵ The Connection to the Environment 117 ĵ Proposition for Improving Sebum Composition and

Skin Barrier Function 124 ĵ Goals Towards Being Seborrheic Dermatitis Free 127

ĵ Improve Immune Function 128 ĵ Reduce Sebum Production 129 ĵ Shift Omega Ratio 129 ĵ Improve Lipid Metabolism 130 ĵ Stabilize Sebum Composition 131 ĵ Learn To Cope With Stress 132 ĵ Reduce Environmental Irritants 134 ĵ Stop Over-Relying On the Internet for Information 134 ĵ Eat What Your Genes Are Designed To Eat 136 ĵ Reduce Topical Microbial Activity 138

ĵ Actionable Steps to Take Based On Discussed Goals 140 ĵ The Author’s Approach to Obtaining Clear Skin 141 ĵ Things to Expect in Future Editions 145

Bibliography 147

SkinDrone

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CHAPTER

1 IntroductionWhy this book was written

Things Covered In This Chapter:

o Why This Book Was Written 3 o Some Issues Encountered In My Journey 3 o The Turning Point 4 o Who This Book Is For 5 o Sources of Information 5 o A Little About Me 5 o Disclaimer 6

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Why This Book Was Written

In my early twenties I started to have strange issues with the skin on my face. And it seems to have all started from a small spot on the right of my nose. However, within several months this single small spot spread to a significant part of my face and ears.

Countless doctor and dermatologist visits later I came to learn that I had what is called seborrheic dermatitis. They informed me that it is a chronic lifelong condition and there is not much that can be done about it.

Some doctors prescribed anti-fungals, while others anti-biotic steroid creams. For me this was unsatisfactory. First of all, these creams did not produce long-lasting results and secondly they did not fit well into my natural life style.

Plus, even when using the creams, the skin was inflamed, flaking, and looked relatively unhealthy. This was no way to go into my twenties.

At that point, I knew I had to take matters into my own hands. So it began, a quest to find the solution to my seborrheic dermatitis problems.

This book will look at my experience and provide you with all the information I have obtained to date. It is my hope that the knowledge contained within this book can help you overcome your skin condition and live life to your fullest potential.

Some Issues Encountered In My Journey

During my research endeavors, a significant amount of time was spent searching for a natural cure. My mind was set on finding the magical pill or dietary adjustment that will return my skin to normal. I wanted to

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show those doctors (and dermatologists) who wouldn’t listen that I was smarter and that nature was smarter.

This approach was one of the most stressful and unsuccessful experiences in my life. The internet is full of horrible information, scams, unproven claims and snake-oil salesmen. Putting critical thinking to the side, I continued along this path. I was like a drug addict searching for his fix.

The biggest issue seems to be that when you have a skin condition on your face, you become extremely eager to fix it. This eagerness can easily be taken advantage off. Particularly online, where anyone can be anyone.

After trying hundreds of different approaches and spending thousands of dollars on supplements, creams, and soaps my seborrheic dermatitis remained. Well actually, it didn’t just remain. It seemed to have gotten worse at that point.

The Turning Point

At this point I was broken. Feeling betrayed by both the medical community and the internet that I had come to trust, I went inwards. It was definitely one of the lowest point in my life.

However, this was a critical turning point. It really was a point of no return. I made myself a promise to stop searching through Google and this was the most beneficial point of my recovery.

Being free from new information it seemed the information I had obtained to that point had a chance to settle in and organize itself in my brain. Things started to become much clearer, and seborrheic dermatitis finally started to make sense.

At the writing of this book I’ve been sharing my experience through

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a website and have helped hundreds of people in their fight against seborrheic dermatitis. This book aims to be a simple and easy-to-read guide for anyone faced with seborrheic dermatitis in their life.

Who This Book Is For

This book is aimed mainly at adults who have encountered issues with seborrheic dermatitis. Some of these principles and ideas may apply to children as well, but everything discussed is based on my own experience with adult seborrheic dermatitis.

Sources of Information

The only real resource of information I had during my search was the internet and access to academic journals through my university. Dermatologist and doctor visits were often quite void of information.

The majority of this book will focus on academic literature and scholarly research papers, due to lack of positive results from information found through forums and blogs.

A Little About Me

I’m not a doctor or any sort of health care practitioner. I’m simply a person who has suffered with seborrheic dermatitis for several years and has decided to provide my knowledge to others who may be going down the same path.

I am actually a fourth year finance student and this is how I was able to obtain much of the medical literature described in this book.

My overall health has been good throughout and I’ve never really experienced skin problems prior to SD. Even going through puberty, I was able to avoid teenage acne. So, when seborrheic dermatitis entered

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my life I was truly blown away by the psychological depression that came along with it.

My experience with seborrheic dermatitis lasted roughly 3 years. The main affected areas were my face, scalp and ears. Luckily I did not have issues with any other parts of my body.

Disclaimer

Since I am not a medical professional none of the information in this book should be used as medical advice. You should always consult with your doctor before attempting any medical treatments, diets, or supplements.

This book is simply me sharing my own understanding of seborrheic dermatitis. Any recommendations made are simply speculative and are based on my own personal experiences and research. I do, however, hope that the quality of this work will rise above the various blogs and forums online that did little/next to nothing to help me.

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CHAPTER

2Seborrheic DermatitisAn overview of the skin condition and potential treatments

Things Covered In This Chapter:

o How to Tell If You Have Seborrheic Dermatitis 8 o Most Commonly Affected Areas 8 o What the Doctor Will Likely Tell You 9 o What Holistic Practitioners Will Tell You 11 o Summary of Medical Literature 18 o Classification and Underlying Cause 18 o Summary of the Medical View 23 o Related Conditions You Should Be Aware Of 26 o Common Treatment Approaches 29 o Skin Barrier Restoration Products 42

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How is seborrheic dermatitis defined and how does it differ from similar conditions? This chapter will also go over how it relates to

eczema and rosacea.

How to Tell If You Have Seborrheic Dermatitis

So how do you know you have seborrheic dermatitis and not something else? Well, the easiest way to tell is if you have a combination of the following symptoms:

• Dryness

• Patches of greasy skin covered with skin flakes

• Patches of white or yellow scales

• Redness and irritation

• Itching, burning and crawling sensation of the skin

On the scalp, it is most commonly referred to simply as dandruff. On the face, however, it almost always goes by the name of seborrheic dermatitis. Essentially, they are the same thing.

When the seborrheic dermatitis occurs elsewhere than the scalp, it also looks visually similar to eczema. These two conditions are quite similar in nature, and the biggest difference appears to be the greasiness and scaling that accompanies seborrheic dermatitis. Eczema typically has dryer crusting and less flaking.

Most Commonly Affected Areas

The most common areas for seborrheic dermatitis are the scalp, nasal folds, ears and other hair-bearing areas of the face.

For the most part, people believe that this is due to these areas having the most sebaceous activity (sweat and oil production).

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Treating seborrheic dermatitis on the scalp (dandruff) is the most straight-forward and widely available dandruff shampoos can quickly produce good results. However, treating seborrheic dermatitis on the face can often pose a variety of difficulties due to the sensitive nature of the facial skin.

Why Does It Occur In These Areas

The most common explanation is that seborrheic dermatitis occurs in these areas because of the heightened sebaceous activity mentioned above. However, I believe it is not as straightforward as that.

Specifically, there is one study that used thermal imagery to examine other possible factors affecting the location of seborrheic dermatitis. This study concluded that seborrheic dermatitis most commonly affected the warmer areas of the facial skin (source).

This heightened facial temperature is likely responsible for attracting a greater amount of the bacteria present on the skin surface. As more bacteria accumulate in these warmer patches of skin, the seborrheic dermatitis can become triggered.

Prior to seeing the thermal images of the face, I had a hard time understanding why my seborrheic dermatitis often took the butterfly pattern. However, after seeing the images (source), everything made much more sense. Additionally, you can specifically see that the nasal folds and the inside of the eye sockets appear to be the warmest, and these are areas where people seem to have most difficulty.

What the Doctor Will Likely Tell You

Typically, most doctors will tell you that it is a lifelong condition influenced by genetics. They will also tell you that the best way to treat it is proper management.

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When they refer to managing the seborrheic dermatitis, they typically imply one of three things: an anti-fungal solution, an antibiotic solution (if they are less familiar with seborrheic dermatitis), or a corticosteroid. These are all typically prescribed for a period of two weeks. But if the seborrheic dermatitis returns, then treatment is usually recommended on a long term basis.

Additionally, from my personal experience and from communication with others on the website, it appears that most medical professionals provide patients with very little information on seborrheic dermatitis. Plus, it seems that the recommended solution that the doctor will usually recommend depends on their own knowledge of the condition. The more up-to-date doctors seem to prescribe anti-fungals, while the less up-to-date simply go with a broad-spectrum antibiotic and corticosteroid cream.

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What Holistic Practitioners Will Tell You

The actual meaning of the word holistic health is defined as the “treatment of the whole person, and not just the issue”. In-line with this definition, the holistic practitioners don’t really focus on any specific answer to seborrheic dermatitis. Instead, they take a shotgun approach and list all the possible methods in which they know you can improve your health.

Most of the items on their list can typically overlap with practically every other health condition they treat. The most common items they focus on include:

• Avoid chlorine and fluoride in your water

• Buying local foods

• Reducing sodium intake

• Switching to natural products

• Eating whole, raw organic foods

• Cut sugar and simple carbohydrates

• Cut gluten all together (recent trend)

• Drink lots of water

• Get tested for “food intolerances”

• Avoid inflammatory foods

• Fix your Omega fat ratio

• Supplement with probiotics and enzymes

So, there you have it, the very core of all holistic advice. Additional items are further added to this list depending on the specific condition the patient describes. A great example of this open ended holistic “cure” for seborrheic dermatitis can be found at TrustNature.com.

For seborrheic dermatitis, the things that are mentioned most often are Apple Cider Vinegar, Coconut Oil, Sea Salt and Tea Tree Oil. However,

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you don’t really need to be a professional to find out about these. The internet is full of success stories on each, and they are even discussed in detail on my website.

Overall, though, the most common holistic understanding of seborrheic dermatitis seems to be that you have inflammation and immune issues inside your body, and in order to control these issues you must bring your body back to pristine health. The way to do this is with a myriad of healthy supplements you should buy and a large makeover of your diet according to current beliefs on what you should be eating.

Generally, genetics are never mentioned in the holistic approach. Hereditary and cultural differences are also rarely considered. The basic belief is that everyone should have equally good health if they follow all the known recommendations; I believe this is a crucial shortcoming of the holistic approach.

The Issue with Holistic Health Practitioners and Naturopaths

The biggest issue with naturopaths, natural nutrition specialists, and many other holistic health care services is their unregulated nature. Most of these practitioners operate small practices based on information they simply learned on-line or through word of mouth.

For example, the International Organization of Nutritional Consultants (IONC), with around 1,000 members, is operated out of a PO Box address in Ontario, Canada. If you’re interested in taking a look, here is the address: 115 George St. in Oakville, Ontario.

To start your own practice, you can simply take a few courses, learn a bit about opening a business and find a few clients. That’s it. No degree or work experience required. And this is exactly what creates the problem. Due to low barrier to entry, many uneducated and unethical individuals have an opportunity to earn a living.

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Now, I’m not trying to say that natural health care practitioners are all evil. I’m simply stating that the industry is mainly unregulated, and the knowledge and ethical standards of each practitioner can vary greatly.

As a result even though natural health care practitioners can have fairly good general health advice, it can become problematic when actual health conditions require treatment like seborrheic dermatitis, as the practitioners simply do not have enough technical knowledge and experience.

Without research, anyone is able to claim anything really. The nutritional market and industry is full of unethical business practices, and a majority of the supplements are unregulated. This brings up many issues in one’s journey in trying to sort the truth from the sales material.

How the Natural Health Industry Works/Thrives

Not too long ago (about a century and a half ) “snake oil” salesmen went around the United States selling vast amounts of fake medical cures and potions. Fast forward to modern day and you will see many of the same characteristic in the natural health and wellness market.

In the United States and Canada, the nutritional supplements and holistic medicine market is currently unregulated. To get a product onto the market requires no actual testing, no safety control, no ethical standards and just a bit of good marketing. Anyone can practically sell anything.

This, in turn, creates a flooded market, and the vast amount of different products creates big issues for external quality control regulation. When supplements are actually examined by external parties, many quality issues can emerge (source).

Interesting interactive infographic.

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With the introduction of the internet, things have only gotten easier for unethical companies. Now they have direct access to millions of consumers and can practically get away with saying anything. This creates the perfect environment for advertising based on false information, fake testimonials and a myriad of other tricks that can be used against the common consumer.

The value of the USA supplements industry alone is currently estimated at upwards of $21 billion per year. In addition to this, there is a vast amount of holistic health care services, which for the most part involve uninsured out-of-pocket payments. However, the pharmaceutical industry still dwarfs this number with an estimated value of $300 billion per year. Regardless of size, both industries rely on profiting from people’s health.

Gluten and Candida

In recent years there has been two fairly large movements in the holistic and natural health care markets. One of these is a fight against gluten and the other is a widespread belief that Candida is responsible for practically all health conditions.

Gluten is Bad

The gluten free trend really picked up speed in 2007. Since then, the market for gluten free products has grown rapidly, and now it is estimated that a whopping 22% of North American adults are trying to avoid gluten. This creates an industry that is valued at a whopping $8.8 billion for consumers trying to replace their product choices (source).

That is quite a large industry that really came out of nothing (source). So, how is it that prior to 2007, and really for the past 10,000 years, the human race has been relying on wheat to feed the majority of the world’s population? Can gluten have really been causing health issues for almost 25% of the world population all this time?

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The most popular health issues that have been attributed to gluten cover a wide range of topics. This includes brain fog, skin rashes, headaches, joint pain, gas, systemic inflammation, depression, and IBS. Even though most of these can actually be related to gluten, others are so broad in scope that it becomes essentially impossible to actually come to a conclusion.

Seborrheic dermatitis can also often be found under this large umbrella of gluten intolerance symptoms. Typically, people make bold claims that gluten is the cause of your seborrheic dermatitis and the accompanying sadness/depression. However, even simple logic may suggest your depression and sadness can simply be a result of having a visible skin condition which negatively affects your social interactions. Or perhaps life’s infinite amount of unique circumstances has been causing you depression and stress, which alone is enough to trigger inflammation within the body. Realistically though, a case can be made for just about anything you can think of.

One large aspect of going gluten free that is not often considered is pastries. Typically when you go gluten free you also get rid of a significant amount of high-fat and high sugar products. As a result, this shift in dietary choices alone can lead to clear improvements in health for a large amount of people. In turn, this helps drive awareness to the trend, and more people rush to test it out.

Candida Does It All

Another trending item is Candida. Candida is species of yeast and is actually one of the most common fungal infections worldwide. It is actually a real threat, and the widespread use of antibiotics has in fact promoted its growth in the last century.

However, it seems that the holistic and natural health market has really capitalized on it’s existence. It has been touted as the cause of a wide variety of symptoms including everything from feeling tired to arthritis.

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In fact the list is so large that basically any ailment you might have, you can simply blame on Candida.

Taking advantage of this trend, many support sources and self-treatment discussion boards have popped up across the web. Even though these discussion boards can sometimes contain valuable information, it can be easy to get carried away with uneducated speculation. In turn, this speculation can create a myriad of distraught thoughts, discussions, ideas, and can in-itself lead to self-propelled phobias (source).

It seems that the most reasonable thing to do if you believe you have a Candida infection is to simply undergo medical testing. The accuracy of modern medical testing is fairly good and definitely beats the dominating “self-test” published across the web.

The Candida Self-Test Debunked

The most popular method self-test for Candida is a simple spit test that is exceptionally popular online. This method has absolutely no validity and was actually created as a marketing tool by a creative company (Global Health Trax Inc) in the 90s. Unsurprisingly, the company’s main product is ThreeLac, a simple probiotic product for regulating digestive microflora and fighting Candida.

The Best Way to Approach Holistic Treatments

In the end, it seems that the holistic approach can at least be partially beneficial to SD sufferers. The biggest takeaways are in areas of proper nutrition, hydration, and exercise recommendations. However, this knowledge is becoming fairly widespread and many cultures deeply integrate them into tradition anyways.

If you are planning to take the holistic approach to treatment, please be aware of the potential “snake oil” salesmen out there. And since a skin

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condition can be so visible, the urgency to fix it can open us up to easy manipulation. I’ve fallen in this trap myself, and the power of urgen-cy and confusion surrounding SD can really make it hard to resist the potential appeal of a quick fix. So, prior to heading down this path you should at the very least make yourself familiar with the basics of critical thinking.

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Summary of Medical Literature

Seborrheic dermatitis affects 1% to 3% of the healthy adult popula-tion. While males seem to be more prone than females, age related

factors appear to have greater significance. Most commonly, seborrhe-ic dermatitis is observed in infants within the first 3 months of life, in adolescents and another spike in patients over 50 years old. Regardless of age, seborrheic dermatitis has finally been gaining recognition as a condition which has a substantial negative effect on an individual’s quality of life.

This section will summarize the most up-to-date medical research regarding what seborrheic dermatitis is and many of the factors that may be responsible for its occurrence. However, it can be difficult to ensure every single piece of medical ligature has been reviewed, especially as new research is published, so this section will likely get frequent updates in the future.

Classification and Underlying Cause

Despite the frequency of seborrheic dermatitis, there is still much controversy in the medical community regarding both its classification and pathogenesis. Some classify it as a cutaneous disease, others as a fungal disease, while others simply classify it as an inflammatory disease. However, the controversy and confusion regarding the cause of the disease is even more riddled. Some areas which have been implicated and theorized include:

Hormones

Even though there are no studies which have been able to make a direct connection between hormones and seborrheic dermatitis, there does seem to be a connection between sebaceous gland activity and presence of the disease. For example, except for infantile seborrheic

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dermatitis, it is rare before puberty and most commonly occurs during the stages of life when the sebaceous glands are most active. This includes, adolescence (10-19 years) and young adulthood (18-35). And these changes in sebaceous gland activity are typically the result of hormonal changes in the body. In addition to this, since the disease is more common in men than in women, some researchers hypothesize that the influence of androgens on the pilosebaceous unit may play a significant role in the progression of seborrheic dermatitis. However, this approach does not appear to fully explain why the hormonally triggered sebaceous gland activity results in the progression specifically of seborrheic dermatitis.

Fungal Infection by Malassezia

This theory was first established by Louis-Charles Malassezia in 1864 and implies that specific lipophilic (feeds on lipids) yeasts are responsible for the progression of seborrheic dermatitis and various other skin conditions. These yeasts are categorized as Malassezia and are actually found on the normal skin of 75-98% of the healthy adult population. However, since seborrheic dermatitis most commonly occurs on lipid rich areas of the skin (face, scalp, and trunk), it responds especially well to antifungal treatment. Recolonization by malassezia leads to disease recurrence, and scientists have indicated Malassezia as the main culprit behind seborrheic dermatitis.

Regardless of these facts, scientist have struggled to observe the specific method in which Malassezia causes seborrheic dermatitis. When examined under the microscope, no observation of the yeast morphing into its pathogenic (spore forming) phase has been observed (which is the case with other disease in which malassezia has been directly implicated as the cause (piteriasis versicolor)). No clear differences has been observed between the amount of malassezia residing on the skin of healthy subjects and those suffering with seborrheic dermatitis. However, lesion specific yeast density has been observed, indicating some sort of relationship does exist, but it becomes difficult to

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understand if the yeast density is the result of seborrheic dermatitis or seborrheic dermatitis is the result of yeast density.

When scientists tried to identify differences between the presence of specific malassezia strains, lots of overlapping evidence surfaced. Some studies have shown that various strains seem to dominate seborrheic dermatitis affected individuals, while other studies demonstrated contradictory evidence. However, an increased number of Malassezia furfur was noted in seborrheic dermatitis individuals. This, along with the simple fact that when individuals successfully treated with nystatin relapsed after being introduced to a nystatin resistant strain, appears to demonstrate that a definite connection exists and that specific strains may be responsible for the progression of seborrheic dermatitis.

Exaggerated Response to Malassezia

Research in this area is one of the most contradictory. While some researchers demonstrate that seborrheic dermatitis is not due an altered immune response to the malassezia (source), others attempt to demonstrate that it is.

Research Showing No Altered Immune Response

Research which demonstrated that there is no difference in immune response, did so by introducing the Malassezia (malassezia furfur specifically) to the skin of individuals with and without seborrheic dermatitis. And the specific research paper discussed was sponsored by Unilever (the makers of Head and Shoulders). After the introduction, the skin was closely monitored and the response was analyzed. In the end, researchers could not find any significant differences in the antibody response between healthy individuals and those affected with seborrheic dermatitis. However, they did note that individuals with seborrheic dermatitis demonstrated characteristics of the adaptive immune system being triggered in seborrheic dermatitis sufferers versus the innate immune system in healthy controls.

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Research Showing A Significant Connection

The contradicting research mainly examines the connection between the various associated factors of malassezia and the resulting immune response. These factors include the oleic acid (source) that malassezia leaves behind and a wide variety of other compounds specific to malassezia strains specifically isolated from seborrheic dermatitis affected skin (source). Unfortunately, these studies are far too complicated to summarize here, but overall, they demonstrate that there are marked differences in the immune response of seborrheic dermatitis affected individuals.

A major part of this exaggerated immune response seems to stem from a disrupted skin barrier. High concentrations of Malassezia furfur, even in its non-pathogenic form, have been shown to reduce the protective barrier of the skin and affect the skin’s innate control of inflammation (source). While at the same time, the Malassezia produces the potential irritants discussed above. Thus, researchers hypothesize that the level of an individual’s susceptibility to the combination of barrier disruption and irritation determines the specific outcome. Less susceptible people experiencing no symptoms, while the more susceptible undergo significant changes in skin barrier function, inflammation, and specifically experience what is considered seborrheic dermatitis.

In addition to this, when DNA analysis was performed on the lesion skin of 15 sufferers, researchers observed significant differences compared to healthy skin. Most significant of these differences was a marked increase in inflammatory gene expression and suppressed lipid metabolism gene expression (in lesion skin). More specifically, the gene-encoding differences related to lipid biosynthesis (creation of fatty acids) was reduced by nearly 50%.

When all of this is viewed together, it becomes apparent that there are clearly significant differences between healthy and seborrheic dermatitis affected individuals. However, the differences are not as clear

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cut as one would hope; instead it’s an interrelation of a large variety of factors that scientists are still trying to grasp.

Abnormally High Rate of Cell Division

This theory suggests that seborrheic dermatitis and the accompanying yeast activity is only a secondary feature of seborrheic dermatitis which occurs due to an increased rate of cell turnover rate and skin inflammation (source, source). Specifically, it was suggested that the increased yeast colonization is a result of excess of dead skin (scales) which directly provides additional surface area and nutrients needed for survival. The evidence used for this argument was that even the malassezia was suppressed with anti-fungal treatment, and no effect on dandruff resolution was observed in the subjects studied.

One of the biggest issues with this theory is that most of these findings/discussions were published more than 30 years ago. Since this time, both research methods and antifungal solutions have significantly advanced. There does not appear to be any recent research which has further supported this theory.

Underlying Immune System Issues

The theory of underlying immune system issues is quite difficult to fully grasp, due to its broad reach and the complicated relationship of immune system function to seborrheic dermatitis. The origins of this theory stem from the fact that seborrheic dermatitis is significantly more common in immunosuppressed individuals than in the common population. In fact, the difference is quite staggering, with 34% (source) to 83% (source) of immunosuppressed individuals being affected by seborrheic dermatitis compared to with only an estimated 3% of the general population.

For the most part, this has been attributed to weakened cellular immunity, which is one of the main defences against viral and

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fungal infections. But, this connection also indicates that, once again seborrheic dermatitis does have a significant fungal and/or viral component and the state of the immune system plays a large role in its progression and development. But, seborrheic dermatitis is not the only disease that has been correlated with immunosuppressed individuals, and various other diseases are also frequent. This list includes oral candidiasis, hairy leukoplakia, pruritic papular eruption and herpes simplex. The progression of which has been shown to have a direct relationship to the T-helper cell counts of the specific individual.

In the end though, it is still unclear how seborrheic dermatitis progresses in an individual with an overall competent immune system. Does the malassezia yeast degrade the cellular immunity of the skin allowing it to colonize and disrupt barrier function or is the malassezia secondary to immune system malfunction? This is a question that has yet to be answered, but overall, it appears that an intimate relationship exists and it is yet to be fully understood.

Summary of the Medical View

The most common explanation for seborrheic dermatitis seems to be related to the skin’s reaction to malassezia yeasts. In general, this is the current theory which is taught in medical textbooks and is at the foundation of the approach that dermatologists take when prescribing treatments.

Seborrheic dermatitis affects 1% to 3% of healthy adults (with proper immune function). Overall, it appears to be more common in men than in women (source). This has been attributed to the role of hormones and resulting spikes in sebum production.

In general, however, the medical community concludes that the actual cause of seborrheic dermatitis remains unclear. Yet, it seems that family history is often mentioned.

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Who Funds the Majority of Popular Research Studies

Many of the research studies appear to be funded by companies that produce antifungal treatments (particularly those studies which compare the effectiveness of various antifungal preparations for treatment).

The issue here is that these companies have specifically chosen to dedicate their time and efforts on proving various antifungal preparations instead of focusing on solving the initial cause. As the focus becomes too narrow, it becomes hard to make any conclusions. It’s like comparing tire patch kits without looking at why the tire may be flat in the first place.

More specifically, much of the research on the malassezia yeast has focused on ways to minimize its population. However, there are studies which clearly show that individuals with healthy skin can have similar amounts of malassezia yeast on their skin as those experiencing issues (source). But, there does appear to be differences in distribution of these yeast on the skin (source). So perhaps it would be more beneficial for research to focus on the biological differences in the skin’s composition instead of just the yeast.

Hard to Come to Conclusions Due to Large Amounts of Inconclusive Studies

The biggest issue I have faced when looking at medical research is the sheer amount of inconclusive research. This is especially true when attempting to pin-point the underlying cause of seborrheic dermatitis.

There are studies out there which try to link it to a vast amount of different things. For example Vitamin E (source), essential fatty acids, vitamins A, E and D, vitamins B1, B2, B6, niacin and biotin, vitamin

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C selenium, zinc, iron (source), immunodeficiency syndrome (source), malassezia yeast, candida and many others.

Many of these studies simply end with the conclusion that further research is needed. Even when it comes to the malassezia yeast (which is the most documented reason behind SD), many studies indicate that healthy subjects can also show similar levels of this yeast on their skin (source).

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Related Conditions You Should Be Aware OfThere are several conditions that appear to often bundle together with seborrheic dermatitis. This includes atopic dermatitis, rosacea, and psoriasis. Some of these conditions have overlapping symptoms and this can make self-treatment fairly confusing.

Atopic Dermatitis

Atopic dermatitis is a fairly broad issue. Typically, the term may be used to cover all general inflammation of the skin. The literal definition of atopic dermatitis is “skin inflammation”.

Typically, atopic dermatitis occurs from contact with allergens or irritants, and this is specifically called contact dermatitis. In the majority of individuals, it is rarely an ongoing condition and usually goes away after a short period of time. Ongoing cases tend to be due to continued contact with the allergen or irritant causing it or various other factors (genetics, nutritional deficiencies, etc.). But going into too much depth on atopic dermatitis is outside the scope of this book due to the extremely broad nature of the term.

Rosacea

A condition often seen in conjunction with seborrheic dermatitis is rosacea. This skin condition is characterized by:

• Facial redness (typically same butterfly areas as SD)

• Swollen red bumps on the skin (similar to acne)

• Eye issues (dryness, irritation)

• Flashes of heat (tingling and heat sensations of the skin)

• Red nose

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Similar to seborrheic dermatitis, rosacea also has a tendency to spread and progress. Most medical professionals will aim at achieving initial clearance followed by continuous management if issues persist.

The condition seems to be genetic and family history has been indicated in a large variety of cases. However, statistically the condition seems to affect women more than men.

Psoriasis

This skin condition is extremely similar to seborrheic dermatitis. At its core, it involves hyper production of skin cells and their accumulation on the top layer in the form of dead skin. Many of the same symptoms as SD are presents:

• Red patches of skin and inflammation

• Silvery scales

• Dry and cracked skin

• Itching, burning, and tingling sensations

However, it can also include a myriad of other issues (swollen joints, nail problems and many more). Overall, psoriasis appears to be significantly more aggressive than seborrheic dermatitis.

This skin condition does not currently have a cure and typically on-going treatment is used for management. Many of the same treatments as SD are used.

Latest Research from Related Atopic Conditions Could Be Helpful

Recent advances in genome sequencing and microbiology have been shedding new light on eczema and atopic dermatitis. The most interesting of this research has been in the area of filaggrin and a

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genetic mutation which occurs in some individuals (source). This mutation has been shown to increase the chance of a variety of skin and allergic disease (source).

Perhaps, seborrheic dermatitis is closely related to this gene mutation as well, and there simply has not been any research specifically on its relation yet.

The future of DNA sequencing is likely to hold many answers to seborrheic dermatitis. And hopefully, much of this research will be published in the near future.

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Common Treatment Approaches

Similar to the complexity and amount of proposed causes of sebor-rheic dermatitis, the amount of proposed treatment approaches

is just as varied. First, several common medical treatments are briefly discussed, along with potential treatment approaches which are quick-ly coming to light. And secondly holistic and more natural treatment approaches are also discussed and evaluated. Hopefully, by providing the reader with enough information of each approach, one will be able to make a more informed decision when it comes to treatment of their own issues.

The Most Common Medical Treatments

This section will examine the most common medical treatments used by medical health care professionals and specifically dermatologists for the treatment of seborrheic dermatitis.

Antifungals

The main focus of all anti-fungal products is to inhibit fungi on the skin’s surface. Many of these target a fairly broad spectrum of fungus and yeast.

Most common prescriptions come from the azole family. However, other popular options are selenium sulfide, zinc pyrithione, and nystatin.

This is the most common treatment as defined in recent medical and dermatological text-books. However, recent advances in the understanding of skin biology question their effectiveness (source).

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Ketoconazole

The azole class of antifungals have gained a substantial amount of popularity since 1990 when these agents underwent significant progress in development. The azole, as a class, target a specific enzyme of fungal organisms causing damage to the cell membrane and results in cell death. Ketoconazole specifically appears to be one of the most effective of the azoles at destroying the malassezia yeast and as a result, relieving seborrheic dermatitis (source).

Based on research papers examined, Ketoconazole is safe if used according to the 2-3 times per week recommendations (source). However, please note that the strength of the solution will play a big role in its safety. All the research papers examined used a maximum concentration of 2% (which is the max you will find anywhere for sale anyway).

Even though ketoconazole has been described as the most effective azole, there appears to be slight variation, and some individuals may experience better results with other azole agents. These include: bifonazole, miconazole, clotrimazole, flutrimazole, sertaconazole (listed in descending order of effectiveness).

Clotrimazole

Clotrimazole is another popular and well documented antifungal agent from the azole family. Some studies have demonstrated its superiority when compared with Ketoconazole (source), while others have shown contradictory results (source).

However, Clotrimazole has made it on the list of World Health Organization List of Essential Medicines (source) and has been around for longer than Ketoconazole (source).

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Pyrithione Zinc

Much of the research on Pyrithione Zinc has been conducted by Proctor and Gamble, the parent company behind Head and Shoulders. When compared to Ketoconazole, it has been shown to be less effective (source), but it must be noted that a 2% concentration of Ketoconazole was compared to only a 1% concentration of Pyrithione Zinc.

In addition to its antifungal component, zinc pyrithione may improve scalp healing by normalizing the outer-layer of skin tissue and normalizing sebum production. These characteristics may in fact be of equal or perhaps even greater importance than the antifungal activity alone.

Even though many creams are currently available on the market that contain pyrithione zinc and are typically targeted specifically at the control of seborrheic dermatitis. It appears dermatologists and medical professionals do not often prescribe or recommend it, due to a preference for the azole group of medications. This preference seems to stem from the clinically documented higher efficiency of these medications for treatment of pervasive seborrheic dermatitis. However, this has not stopped Head and Shoulders from aggressively dominating the retail market of dandruff products.

Selenium Sulfide

Clinical studies equate it to being as effective as ketoconazole (source). It may potentially be even more effective than pyrithione zinc and coal tar (source).

Even though selenium sulfide works well for controlling seborrheic dermatitis, there are significant safety concerns of prolonged use (source).

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Nystatin

This specific antifungal does not have much documented research in relation to seborrheic dermatitis. Thus, it is not often prescribed by medical professionals.

However, a reader of the website indicated that a dermatologist in his home country of Denmark prescribed this for treatment. His results were superior to anything else he has attempted, and several readers have confirmed similar results.

Nystatin is a fairly popular anti-fungal agent in medicine and is included in the World Health Organization list of essential medicines (source). Based on the examined research, it appears to be safer than other commonly prescribed antifungal agents because of its minimal absorption through mucocutaneous (where mucosa transitions to skin) membranes (source).

One thing to note though, is that there appear to be nystatin resistant strains of malassezia (source). So this could explain why it is not one of the most commonly prescribed treatments for seborrheic dermatitis.

Tar

Tar has a long history in medicine for its use in the treatment of various skin conditions (source). Most popular is its use in the treatment of psoriasis (source), but its effectiveness for treatment of seborrheic dermatitis is also well documented. The most popular and widely available of the tars is coal tar, but other tars from more natural origins exist as well and have been used throughout history. This include tars such as pine tar and sulfonated shale oil.

Tar based products work mainly by slowing skin cell reproduction, normalizing the skin’s inflammatory response mechanism, normalizing sebum production and killing off bacteria/fungi. The overall method in

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which the tars control seborrheic dermatitis seems to be very similar to that of zinc pyrithione.

Overall, tar products have proven to be safe for topical usage. Many of the producers of tar containing products (such as Neutrogena) conduct a fair amount of testing to ensure both quality and safety of their preparations. The natural alternatives don’t have quite the same amount of research and testing behind them, but these have withstood the test of time. The most researched of the natural tar preparations appears to be sulfonated shale oil and research suggests less side effects when compared to coal tar (source).

Corticosteroids

These appear to be more often prescribed by non-dermatologists for the treatment of seborrheic dermatitis (source). This is likely due to a poor understanding of cutaneous fungal disease.

When compared to antifungal solutions, the effectiveness of hydrocortisone cream appears to be only marginally better (source). However, potential issues exist with prolonged use of hydrocortisone, mainly development of atrophy or telangiectasia (dilation of the capillaries) (source). However, some studies suggest that their relative danger is rather small and has been blown out of proportion (source). Regardless of this, seborrheic dermatitis is believed to be a long term condition, and thus, corticosteroids are likely not the best option.

Overall though, corticosteroids are effective for quickly getting rid of seborrheic dermatitis symptoms. However, issues tend to quickly return after application is stopped (based on communications with readers).

Potential Treatments on the Horizon

This section will examine several treatment methods which may present more robust and complete solutions to seborrheic dermatitis issues. The

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only issue is that these treatment solutions are still not widely available and do not currently have a substantial amount of evidence/research in regards to their effectiveness for the treatment of seborrheic dermatitis.

Antimicrobial Lipids

Lipids make up an integral part of the skin barrier, particularly for oil rich areas such as the scalp and face. The lipids on these areas play a vital role in maintaining moisture and providing a layer of defence for our most exposed areas of our skin. Some of these lipids possess (source) broad antimicrobial and antifungal abilities and disturbances of these fatty acids have been observed in atopic dermatitis (source). Even though their relation to the yeast that is believed to cause seborrheic dermatitis (malassezia) remains unclear (source), their effect on the overall microbial community of our skin’s surface may present an environment more favorable to these yeast.

Some researches have identified a specific fatty acid (cis-6-hexadecenoic acid) which only appears to be present on human skin and hair, but generally not much elsewhere in nature (source). These researches noted that there was less of this unique fatty acid present on the skin of individuals affected by atopic dermatitis. A novel production process for the fatty acid was suggested through use of bacterial cultures, and its ability against malassezia was demonstrated. The biggest draw to this approach is that it makes use of the exact fatty acid that is supposed to be present on the skin in the first place, as opposed to reliance on various antifungal solutions discussed previously.

Additionally, there are studies that have demonstrated the potent anti-malassezia capabilities of organic fatty acids found elsewhere in nature. The most prominent of these appears to be caprylic acid (source). This fatty acid is most abundant in coconut and palm kernel oils, but also makes up a significant portion of the breast milk of various mammals (goats, humans, and cows). As a result, due to its potent ability to suppress various malassezia species and its natural origin, caprylic acid

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may hold value in the treatment of seborrheic dermatitis if properly utilized in a skin care formulation.

Antimicrobial Peptides

Another component of the skin’s natural defense mechanism are various antimicrobial peptides. The most famous and well documented for these are cathelicidin, dermcidin and b-defensins. Lack of these peptides has been attributed to the progression of various skin diseases (source). These peptides are produced from amino acids which must be obtained through diet, and their expression appears to depend on various environment factors. For example, one study showed that simply watching a humorous video increased the production of dermcidin-derived peptides (source).

Though the internal production of these antimicrobial peptides may be hard to predict and control, researches have been attempting to mimic their functions using peptides produced in the lab with promising results (source). However, there do not appear to be any products currently on the market which utilize antimicrobial peptides for the treatment of seborrheic dermatitis.

In the meantime, it may make sense if we attempt to improve our natural levels of these antimicrobial peptides. This topic is discussed in more detail in the in SkinDrone Approach section of this book.

Internal Antifungals

As discussed earlier, medical treatment of seborrheic dermatitis typically involves either topical anti-fungal or corticosteroids. When these treatment approaches do not produce significant improvement, some medical professionals/researches have attempted treatment through the use of oral antifungal therapies. The most studied oral antifungals have been itraconazole, ketoconazole, fluconazole and terbinafine. Results for these oral therapies have been mixed, with

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improvement rate varying from 58.6% to 93.0% (source). The most significant improvement was seen in a study that used itraconazole therapy for a period of 12 months where a complete cure rate of 68% was reported. However, even with such prolonged antifungal treatment, some patients failed to show significant improvement (source). On the other end of this spectrum, ketoconazole actually seemed to show the least effectiveness out of the examined oral therapies, and patients who underwent this treatment showed the most relapses.

The biggest difficulty with this approach is the questionable and frankly unknown long-term effects that such a treatment may have on the immune system as a whole. Initial safety data and the general lack of side-effects reported by individuals seems to indicate that therapy may in fact be safe (source). However, many aspects remain unclear due to the complexity of our bodies.

Most Popular Holistic Treatments

Next, we take a brief look at some of the most popular natural/holistic treatments for seborrheic dermatitis. Even though the effectiveness of these is not well documented in medical literature (except for few small scale studies), they still have a significant amount of user testimonials on their effectiveness available across the internet.

Raw Honey

What makes raw honey different from regular honey is that it does not undergo filtration or pasteurization. As a result, it contains many of the natural waxes and impurities (much of which are hypothesized to be antibacterial).

The most common approach seems to originate from a study done in 2001 (source). In this study, a mixture of 90% raw honey and 10% warm water was used. The treatment involved rubbing this mixture onto seborrheic dermatitis affected skin for 2-3 minutes and leaving

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it on for 3 hours before being washing off. This treatment was then repeated every second day for a period of 4 weeks. The individuals who experienced improvement were further included into a second portion of the study. In the second portion, half of the improved individuals received on-going once-a-week treatments lasting six months, while the other received no such treatments.

The results of this studied were quite substantial. During the first part of the study, itching and scaling was documented as being relieved in a period of just 1 week, skin lesions healed and disappeared within 2 weeks, and hair loss improved as seborrheic dermatitis improved. Luckily, the second part of the study also provided some insights on the long term effectiveness of this treatment. In this follow up phase 15 of the 15 individuals who underwent follow up treatment experienced no relapse of the condition. While in 12 of 15 patients who did not undergo the prolonged (once weekly) treatment, the seborrheic dermatitis lesions reappeared within a period of 2-4 months after treatment was stopped. It is these results, coupled with the all-natural appeal of raw honey, have made this treatment quite popular across the internet. However, likely due to the inconvenience factor of this treatment approach, it has failed to gain the popularity that it might have otherwise deserved.

In the skincare industry, honey is classified as an emollient (prevents moisture loss), humectant (attracts moisture) and moisturizing (provides moisture) product (source). Regular use has been shown to aid the retention of skin youthfulness and aid in the prevention of wrinkle formation (source). Both of these benefits are attributed to honey’s moisturization abilities. But, when it comes to seborrheic dermatitis, the main beneficial properties have been attributed more to the antibacterial and anti-fungal properties (source). These properties appear to differ between different honey varieties (source). Since raw honey is not by any means a standardized product, the variation of its effectiveness appears to be common.

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Apple Cider Vinegar

Another popular natural treatment method for seborrheic dermatitis is vinegar and more specifically apple cider vinegar. This method does not have much medical literature behind it at all; however, it has gained immense popularity throughout the internet and positive testimonials are abundant. Most proponents of apple cider vinegar emphasize its powerful antifungal abilities and attribute this to the malic acid content, while research to back this up is lacking.

A more reasonable hypothesis on the method in which apple cider vinegar works against seborrheic dermatitis is through its lipid peroxidation inhibitory properties (protects lipids from oxidation) (source). These properties could in theory contribute to the proper breakdown of fatty acids secreted from the sebaceous glands and prevent them from being utilized as a food source for the malassezia yeast. However, this is just a hypothesis, and there does not appear to be any research that examines this connection.

Overall, the lack of research behind apple cider vinegar and its use for the treatment of apple cider vinegar leave a lot of questions to be addressed. Specifically, its effectiveness for the general population, its effect on skin barrier function and whether or not the pH of apple cider vinegar makes it a suitable treatment approach for oil rich areas of the skin.

The biggest red flags are raised when you examine the book that was used to first introduce apple cider vinegar as a cure-all remedy to the natural market. The title of the book was “Apple Cider Vinegar: Miracle Health System”. This book provides an extensive list of things apple cider vinegar is said to treat, yet, it provides practically zero hard facts or research to back any of its claims. And worst of all the book was published by Paul C. Bragg and his wife Patricia Bragg who profit directly from the sales of apple cider vinegar. To make matters worse, they both include the Ph.D. titles beside their names right on the cover

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of this book, but a 1940 Federal Census shows that at the age of 45 Paul C. Bragg has only finished one year of high school, while Patricia’s records indicate she never finished her degree at the University of California-Berkeley.

In the end though, the strong user support for apple cider vinegar remains mysterious and attractive. In experience though, the majority of people only achieve satisfactory results and not total clearance of seborrheic dermatitis. Even with its regular use, seborrheic dermatitis continues to have a significant negative impact on their daily lives.

Dietary Modification

This is one of the most broad and complex treatment approaches discussed in this book. The link between various atopic dermatitis conditions and diet has long been established; however, the results of this treatment approach are extremely hard to predict. This is likely due to the unique environmental conditions of each individual, combined with their own dietary preferences and genetic makeup.

Dietary Elimination

The majority of studies and online discussion tend to focus on isolating specific foods which may be creating issues within the body. Once these foods have been isolated, they are removed from the diet, and this can provide long-term relief for the specific individual. The biggest issue with this approach is that attempting to isolate specific foods as the cause of everyone’s seborrheic dermatitis is virtually impossible due to the variation from one individual to the next. Even medical review literature suggests that common exclusion diets are not very effective method for resolving unselected atopic conditions (source). If considering this method, the strongest potential seems to lie in a customized approach, which involves a discovery phase where an individual attempts to find potential trigger foods.

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The discovery phase of this treatment approach can involve long periods of time, increases risks of nutrient deficiencies, may induce social stress, and can make one very self-conscious, and even then the possibility of false positive results due to incorrectly observed patterns still exist. These issues appear to be the reason why it is not a very popular treatment approach amongst the medical community.

Dietary Supplementation

On the other end of the dietary modification approach is attempting to find specific deficiencies in one’s diet that may be preventing the immune system from optical operation. This approach doesn’t seem to have as much popularity and an overall preference for supplements appears to be prominent amongst individuals.

If focusing on supplements, the main issues arise from uneducated supplementation based solely on online discussion or product reviews. At the core of this issue is the poor regulation of the supplements market which has allowed marketers to persuade consumers into believing various unproven claims and statements. As a result, when considering supplements, it may be a good idea to invest in the advice of a medical professional. This may not only save money, but also prevent you from making rash decisions which may have negative impacts on your health.

If we abandon supplements and focus on whole foods, a more robust state of health and immune function can be achieved and sustained. This approach may not only help resolve seborrheic dermatitis, but can significantly improve an individual’s overall quality of life. Several strategies and examples of this approach are provided in the SkinDrone Approach chapter. However, if resources permit, it may be beneficial for an individual to seek the help of a local dietitian who can help develop a customized approach targeted at specific dietary goals and needs.

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Sea Salt (Dead Sea Salt)

Sea salt has been in used since the ancient times for the treatment of various skin conditions, yet the results for its use in the treatment of seborrheic dermatitis are mixed. Many individuals across the internet report different success rates, and many appear to relapse after the initial treatment phase, even if treatment is maintained. Nevertheless, it does present a potential treatment approach and one that is very low cost, easy to maintain and all natural.

When scientists analyzed the effect that magnesium rich sea salt (Dead Sea salt) had on barrier function of atopic skin (skin inflammation due to various skin diseases), the results were impressive. In one study, 30 individuals with atopic dry skin of the forearms underwent a daily treatment in a 5% magnesium salt water soak for a period of 6 weeks (source). Overall, these individuals showed significant reduction in inflammation, improvement in barrier function and decreased transdermal water loss, but these results occurred gradually and throughout the whole 6 week period. This showed that it takes time for the salt water solution to have impact on overall results.

One thing to note is that each time the skin was washed, temporary loss of skin moisture and impairment of barrier function occurred. This was attributed to the removal of skin lipids and water binding compounds. As discussed earlier, most medical researchers have indicated that lipids strongly relate to the pathogenesis of seborrheic dermatitis. Then perhaps, it may be this exact component of this treatment approach that is beneficial for seborrheic dermatitis. For instance, as the lipids and water binding compounds are removed, the skin is temporarily freed from irritation and can start to rebuild. However, here an issue presents itself. What if the malassezia communities of the skin adapt to this environment and take advantage of the distributed skin barrier? In this case, even though the treatment may show initial benefit, the end-outcome becomes questionable. Add the fact that most of the studies done on the benefits of salt water only demonstrated the benefits for

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non-lipid rich skin surfaces, at which the malassezia do not make up a major constituent of the skin community, and you are left with no clear answer. Nonetheless, online communities seem to push this method forward as it has many favourable aspects. But, from my experience, very few individuals actually report long term results from this approach when it comes to seborrheic dermatitis.

Skin Barrier Restoration Products

The skin barrier is essential for keeping pathogens and irritants from disrupting our skin’s integrity. Theoretically, with a strong enough barrier, pathogens should not present any issues as they will be kept from activating further components of the skin’s immune system. Plus, a good barrier will ensure that the underlying skin remain moisturized as the barrier minimizes water loss (source). As a result, using skin barrier repair and restoration products may be a reasonable and effective approach to treating seborrheic dermatitis.

Even though majority of skin barrier restoration products have been targeted and marketed specifically towards atopic dermatitis and eczema, my experience has shown that their effectiveness for seborrheic dermatitis may be more significant than a strictly anti-fungal approach. However, due to the malassezia component of seborrheic dermatitis, some of the ingredients found in these products may be restricting their overall effectiveness. These ingredients include various oils and emollient agents, and it happens because the malassezia may be able to use them as a food source (source). So even though the skin barrier may be improving with their usage, the malassezia communities may also be growing. If this delicate balance shifts too far in favour of the malassezia, any beneficial aspects of the products effect on the skin barrier may not be enough in protecting against the well-nourished malassezia yeasts. In the end though, due to the complexity of many of these formulations (preservatives used, oils used, and other ingredients) and the specific malassezia yeast involved in an individual’s seborrheic dermatitis issues, it becomes quite difficult to predict the end-outcome for a specific case.

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A good approach may simply be to test a variation of skin restoration products and see what works best specifically for your skin.

When it comes to the scalp, the selection of skin barrier restoration shampoos is quite limited due to differences in marketing approach most companies use in this area. The scalp itself is not as visible as other areas of skin, and as a result, most shampoo producers tend to focus their efforts on the visible part of the scalp (the hair). And since healthy hair is often the result of a healthy scalp, individuals aiming to restore the skin barrier of the scalp may consider testing various shampoos targeted at improving and/or regulating hair growth and quality.

Why No Pictures of Affected Skin Are Included

After suffering with seborrheic dermatitis, pictures seem to elicit negative thoughts and emotions. For this reason, I have decided not to include any pictures of seborrheic dermatitis affected skin in the first edition.

If you would like to see some pictures you can either search Google or send me a request to add pictures into future editions.

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CHAPTER

3Understanding SkinThe essentials of how our skin operates and its complex eco-system

Things Covered In This Chapter:

o DNA Sequencing 45 o The Structure of the Skin 46 o The Important Role Our Skin Plays 49 o Skin Microbiome 50 o Proposed General Strategy for Correcting

Skin Issues 58

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Our skin is our body’s largest organ and is the home of a diverse and complex ecosystem. The diversity of this ecosystem varies from

individual to individual and has been shown to have a direct impact on our overall immunity. Many skin conditions occur as a direct result of changes and/or pathogenesis of the diverse bacterial communities of the skin.

The biggest challenge comes from the fact that the healthy skin is required to fight off and respond to potential dangers without the use of inflammation and cellular recruitment. Failure to either control or tolerate the present bacteria and/or pathogens will result in skin issues.

Recent research in this area over the last decade has finally allowed us to have a glimpse into the life of our skin. The research has shed light onto the complex connection between overall host immune function and the state of the microbial communities on the skin. This relationship is bi-directional (state of the skin impacts the immune system and vice versa) and extremely complex. This has made it difficult for the medical community to fully understand it. However, it is essential to look at the overall story when trying to understand skin issues.

This chapter will cover the different aspects of our skin. This includes: areas where potential skin issues can arise, how we may be able to make a difference, and the connection between our skin and our overall health.

DNA Sequencing

Previously, scientists and medical professionals relied on swabs to analyze the microbes on the skin’s surface. Today, advances in DNA technology have finally allowed for a deeper inspection of the skin’s surface and the microbial communities therein.

In 2007, the National Institute of Health initiated the Human Microbiome Project. The aim of this project was to identify the microbes

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present at the various organs of our bodies. This is the work that really began to reveal the astonishingly complex diversity of the microbial communities present in different areas of our own bodies and the variations between individuals. Not only were differences present between different organs (oral, nasal, gastrointestinal), but the skin alone was found to harbor drastically different microbial communities depending on location (palm, face, hair). An easy way to visualize these differences is to simply think of the differences between the locations (palms - dry, armpits - sweaty, face - oily). For example, the scalp is covered with thick hair, palms have some of the thickest skin, and the face has one of the highest number of sebaceous (oil) glands.

The Structure of the Skin

The skin is actually composed of various layers, and each layer plays a crucial function in the overall function of the skin as a whole. Issues in each of the skin’s layers can produce a domino effect and can contribute to breakdown in the overall health of the skin.

The Epidermis

A good way to think of the surface of the skin (epidermis), is to imagine a layer of bricks and mortar: the bricks being special skin cells called keratinocytes and the mortar being a protein by the name of collagen. These keratinocytes initially form deep within the skin, make their way to the top, and then die and shed off.

The rate of this epidermal turnover in healthy individuals typically takes about 48 days (40-56 days). Since this process is ongoing, it becomes essential for the body to produce healthy collagen and keratinocytes. However, in certain skin conditions such as seborrheic dermatitis, psoriasis and various others, this process occurs at a drastically increased rate. This increased rate creates challenges for healthy cell production and more chances for immature cells to make it to the front lines. Since the skin is one of the body’s largest organs, this process can

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create an imbalance throughout the whole system.

To get a good understanding of how much is really going on, consider the fact that the skin of an adult occupies an area of about 1.5-2 square meters and can actually make up about 16% of total body weight. Additionally, each square centimeter of skin is home to about 6 million cells, 100 sweat glands, 15 sebum glands, 400 cm of nerve fibers alone, and much more. This isn’t even considering the vast communities of microorganisms that call our skin their home.

The Sweat Glands

The epidermis is home to two types of sweat glands. One of these sweat glands is called the eccrine, while the other is called the apocrine.

Eccrine sweat glands are distributed practically across the entire skin surface and play a major role in thermoregulation through the secretion of sweat comprised mainly of water, salt and electrolytes. In order to protect this sweat, the acidity of the sweat has to be just right, and crucial antimicrobial peptides (such as cathelicidin and b-defensins) must be present. Several studies have demonstrated that a variety of skin conditions may be a direct result from the absence or reduction in the number of antimicrobial peptides or other issues in the composition of the sweat.

On the other hand, the apocrine sweat glands have a more limited presence. These sweat glands are mainly found inside the armpit, around the genitals, and the anus. Even though they exist from birth, they only become active during puberty and thereafter. These glands secrete a more oily liquid of mainly proteins, lipids, and steroids into the hair canal. It’s the consumption of this liquid by bacteria that produces the smell that we all associate with sweat.

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The Sebaceous Glands

The sebaceous glands are directly connected to our hair follicles. Together, they form what is called the pilosebaceous unit (basically the gland and the hair follicle). These glands secrete a lipid-rich substance called sebum. Sebum plays a crucial role in lubricating the hair and skin.

The composition of sebum mainly consists of triglycerides, wax esters, squalene, cholesterol, antimicrobial peptides and antimicrobial histones. The oily nature of sebum makes it a target of a fairly large number of oil dependent bacteria, such as propionibacterium acnes and malassezia yeasts. To defend against this, the skin relies on the breakdown of triglycerides to antimicrobial free fatty acids and an adequate supply of antimicrobial peptides and histones.

Failure of the sebum to defend against opportunist bacteria and yeast has long been considered the cause of a variety of skin issues. Since the sebum is secreted alongside hair follicles, it becomes an excellent site for bacteria to penetrate below the acid mantle.

The Acid Mantle

Above the epidermis, we have what is called the acid mantle. This is the very thin layer of “stuff” that sits on the epidermis. Typically, it is comprised of lipids, amino acids, sebum, sweat, hormones, lactic acid and various micro-organisms. This layer is crucial and serves as a fundamental top layer of protection, ensuring that pathogenic bacteria don’t have a chance to proliferate and cause havoc. If this layer is successful at doing it’s job, the epidermis has much less work to do and no inflammation is less likely to occur.

The Ridges

Some areas of our skin also contain very well defined ridges. The most abundant sites of these ridges are our fingers and palms. These

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ridges not only provide better fraction but may also provide anti-microbial functions, as their structures make the areas less inhabitable for bacteria. One of the best examples of this use can be seen in sharks; recently a material has been manufactured to mimic these characteristics for commercial application (see sharklet).

The Important Role Our Skin Plays

As discussed in the immune chapter, the skin forms the first line of defense for our bodies. Its main role is to protect us from our environment and to keep the outside world out. To do this, the skin uses both the innate and the adaptive immune mechanisms. However, what makes it unique is that it is constantly exposed to the outside world; this creates a complex problem when it comes to implementing a solid defense strategy.

The main functions the skin must perform include:

• Mechanical and chemical damage resistance

• Bacterial damage

• Ultraviolet radiation

• Thermal control

• Waterproofing

• Excretion of waste

• Production of Vitamin D

The biggest difficulty is that the skin must not only scale attacks against foreign invaders, it must do so under unique and ever-changing conditions (humidity, temperature, exposure, etc). At the same time, it is required to try (for the most part) and accomplish these things without the use of inflammation (which can undermine its normal structure and development).

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Skin Microbiome

Much of the latest research focuses on attempting to understand the skin “microbiome”. By this, the researchers are referring to the analysis of the distinct bacterial communities that live on the skin. However, since the skin at various sites of the body significantly varies in its microbial communities, one must be very careful when discussing the overall skin microbiome. The simple truth is, the skin is home to a number of different ecosystems and environments. So when discussing the skin microbiome, it is essential to look at each one separately.

While trying to understand the microbiome, researchers have been able to make several key generalizations. Specifically, they have divided the skin microbiome into three main categories: moist, sebaceous, and dry. Analyses of these three more specific categories has allowed them to make some quantifiable observations.

Moist

Moist areas are places like the belly button, armpits, groin, sole of foot, inner elbow, and back of knee. These areas do not produce much of the oil sebum and mostly rely on the production of aqueous sweat for their protection and regulation. The most common bacteria that are active on these skin sites include microbes from the species of Staphylococcus (Firmicutes) and Corynebacterium (Actinobacteria).

Sebaceous

Sebaceous areas include places such as side of the nostril, behind the ear, the forehead and the back. These areas typically are home to the least diverse populations of microbes. However, these areas appear to be the most problematic for some of the most pervasive skin conditions affecting the adult population. On normal skin the Propionibacterium (Actinobacteria) species appears to be the most common and well

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established.

Dry

Dry areas include the forearm, hand, buttocks, and other areas with little perspiration or lubrication. These areas have been documented to contain the largest diversity of microbes. However, due to the vast variation and the relatively low numbers of each of the microbes in these areas, it is difficult to determine which are actually long-term residents and which are only temporary.

Additional Microbiome Representatives

The previous sections provided some insights into the specifics that researches have uncovered. So far, these sections have only discussed the findings in regards to bacteria, but the skin is also home to a large number of parasites, fungi and viruses.

For example, Malassezia (a fungi known to be involved in the pathogenesis of dandruff and seborrheic dermatitis) appears to be the most present fungi on both normal and problematic human skin. At the extreme, one study estimated that fungi from the Malassezia species accounts for up to 80% of all fungi present on the skin.

Additionally, parasites such as the Demodex mite (believed to be partially responsible for the pathogenesis of rosacea) reside in the pilosebaceous unit (hair follicles and sebaceous glands) of both normal and malfunctioning skin.

Viruses, which are also found on the skin surface, have not yet been adequately studied. The few studies that did try to analyze this diverse aspect of the microbiome have concluded that their diversity likely plays a crucial role in the immunity and functioning of the skin. Perhaps in the future this area may uncover some pivotal findings, which may drastically change the overall view of the whole microbiome.

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Changes with Age

Even though the skin is colonized with bacteria from birth, the initial microbiome has very low diversity across the body and is mainly determined by microbes present at the delivery site (mother’s vagina or through C-section). As we age, this microbiome develops and becomes more diverse.

The diversity and variation of its residents will depend on our environment and diets. By the time we become adults, this diversity is of staggering complexity and varies drastically among individuals. For example, one study determined that the average similarity in bacterial make-up of the palms of two individuals was only 13%. Surprisingly, even the similarity between our own two palms was determined to be on average only 17%. Individuals residing in the same home, however, have been shown to exhibit much more similarity between residents.

Thus, our lives truly do determine our microbiome, and several questions automatically come to mind. Like, how much does our workplace influence our biome, and do individuals living in sterile conditions improve or diminish their potential for healthy skin? Even though only a portion of our unique biome is provided directly by our mothers, it appears that genetics still play a significant role in determining our unique microbiome. This seems to be the result of the composition of our gland secretions and cellular makeup, which play a role determining the development of our microbial communities.

The Relation to Immunity

The relation of our immune function to the microbial community of our gut is well established. However, the relation of our skin’s microbiome is a much newer topic, and a significant amount of research has recently been carried out to try to determine the intricate relationship that exists. So, how much does the skin’s microbiome influence our immunity and health?

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So far, research has been able to suggest that the microbial communities of our skin play a significant role in several factors directly related to its immunity. Specific bacterial strains have been identified as a source of potent protection versus a myriad of pathogens. This relation is best demonstrated by mice raised in completely sterile conditions, which results in the inability for the skin of these mice to properly defend against various pathogens, opportunistic bacteria and viruses.

The method in which some microbes contribute to our immunity include:

Competition for Space and Nutrients

The presence of one bacteria will often result in a pronounced ability to defend against other competing pathogens. This occurs partially due to the simple fact that there is only a finite amount of space and nutrients available; thus, the more adapt bacteria will forcefully squeeze out the other.

Production of Antimicrobial Compounds

A significant number of bacteria have been shown to produce antimicrobial compounds. These antimicrobial compounds are capable of successfully inhibiting or destroying similar and competing bacteria. As a result, they may be able to directly enhance our skin’s immune function by assuming some of its work in the fight against various pathogens.

Inhibition of Biofilm Formation of Other Bacteria

Biofilms offer protection for bacteria and increase their tolerance to antimicrobial agents (source).As bacteria compete, some are able to effectively inhibit the production of others by interfering with the biofilm production process. For example, a bacteria by the name of S. epidermis (a relatively nonthreatening bacteria) has been demonstrated

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to inhibit the formation of S. aureus’s (a more problematic bacteria) biofilm (one of the main components responsible for the bacteria’s survivability).

Regulation of Cytokine Production and Potential to Decrease Inflammation

Specific bacteria have been shown to directly affect the regulation of inflammatory cytokines. For example, it has been demonstrated that the presence of S. epidermis at specific skin sites leads to local regulation of cytokine production and decreased levels of inflammation.

Influence on T Cells

There is evidence that suggests that the presence of some bacteria is essential to the proper functioning of the skin’s immunity. This has been demonstrated by germ-free mice who failed to produce an adequate immune response to Leishmania (parasite), even after recolonization of the gut by healthy microflora. Simple exposure of these mice to S. epidermidis alone was enough to regulate T cell levels and restore the immune deficiency.

Increased Production of Antimicrobial Peptides

Another observed phenomenon is that the presence of some relatively weak bacteria is able to stimulate antimicrobial peptide production by the skin. This increased production of antimicrobial peptides, in essence, prepares the skin to defend itself against pathogenic infection.

Priming of Anti-Microbial Compounds and Immune Function

Similar to the increased peptide production discussed above, some bacteria is capable of stimulating the overall immune functioning of the skin. This stimulated immunity (such as increased recruitment of mast cells) in-turn results in skin that is more prepared to defend itself against

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other, more dangerous bacteria.

Strengthening of the Epidermal Barrier

For example, the presence of one bacteria will often result in a pronounced ability to defend against other competing pathogens. This occurs partially due to the simple fact that there is only a finite amount of space and nutrients available; thus, the more adept bacteria will forcefully squeeze out the others. Additionally, many of the bacteria produce their own antibacterial compounds that directly inhibit and defend against competition.

Dysbiosis in the Microbiome

Based on the information discussed so far, it becomes rather easy to make the case that certain changes in the microbiome may create unfavorable conditions for the skin’s health. These unfavorable conditions may lead to problematic skin conditions and infection by pathogenic bacteria. This exact phenomenon has been called dysbiosis, which basically means an unfavorable change in the diversity of present skin microbes.

However, due to the complexity of the immune system of the skin and the significant contribution of overall host health, nutrition and immune system function, any direct relationship becomes quite difficult to establish.

Dysbiosis in Atopic Dermatitis

Many researches have tried to identify specific differences in microbiomes of individuals with healthy skin and those who suffer from atopic dermatitis issues. Even though these researchers were able to identify certain microbial differences (such as pronounced colonization and infection by S. aureus and/or diminished diversity of the overall bacterial community), several other factors were also identified.

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Some of these factors include: a diminished expression and/or function of antimicrobial peptides, mutations in the filaggrin protein (an essential component of epidermal barrier function), and mutations in the receptors and signaling molecules responsible for sensing microbes such as TLR2, CD14, and CARD4. With so many potential factors at play, it becomes very difficult to identify the specific cause of the issue at hand. However, it must be noted that in some cases, improvement of the overall diversity of the microbiome resulted in pronounced improvement of atopic dermatitis symptoms.

Dysbiosis in Seborrheic Dermatitis

The most commonly discussed fungi species in the pathogenesis of seborrheic dermatitis has been Malassezia. The majority of medical literature clearly indicates that this species of fungi is directly responsible for seborrheic dermatitis. Accordingly, many of the treatment options directly target inhibiting the Malassezia fungi. However, fungi from the Malassezia species is one of the most abundant fungi present on the skin of most adults, yet some individuals appear to be resistant to any issues that appear to arise from its presence.

More recent studies try to analyze the microbiome of affected individuals as whole, as opposed to focusing specifically on the Malassezia. These studies appear to indicate that lesion sites not only contain a threefold increase in the amount of Malassezia fungi present, but also significantly higher populations of many other non-Malassezia yeast and fungi. Additionally, lesions sites appeared to be predominated by certain Malassezia specimens, even though the relative percentage of Malassezia to total fungal colonization was roughly the same. Specifically, at lesion sites, the ratio of M. restricta M. globosa was higher when compared to non-lesion sites.

The higher colonization of the lesion sites was attributed to a greater quality of sebum present, and the Malassezia species require fatty acids for their growth. Another interesting aspect was that the Candida

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species (higher at lesion sites than non-lesion sites) are also capable of secrete lipases, which may then be another potential food source for the Malassezia. Overall though, lesion areas appear to be a hotbed for fungal activity and colonization.

The biggest area of insight may come from some research that was able to demonstrate that the fungal microbiome between patients with and without dandruff was quite similar, while the bacterial microbiome significantly different. Thus, based on the information discussed previously the hypothesis can be made that patients affected by seborrheic dermatitis simply have a dysbiosis of the bacterial community, which leads to a diminished ability for normal immune function (resulting in aggravation by Malassezia).

However, as with the case for atopic dermatitis, there are number of other additional factors and abnormalities which have been identified with individuals affected by seborrheic dermatitis. As a result it becomes difficult to single out a specific cause for the issue at hand.

Dysbiosis in Psoriasis

Psoriasis appears to represent a different issue than either atopic dermatitis or seborrheic dermatitis. This is because, with psoriasis, there does not appear to be any direct relation to infection. Instead, psoriasis appears to be caused by other auto-immune issues (such as arthritis, coronary vascular disease, etc.). Even though potential differences in the composition of the microbiome of individuals affected by psoriasis have been described, no specific micro-organisms were identified (neither fungal nor bacterial). Thus, the much larger and much more diversified nature of innate immune-related issues is suspected to be the more significant part of the issue.

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Proposed General Strategy for Correcting Skin Issues

Based on the information discussed in this chapter, it becomes evident that skin issues often have a significant amount of contributing factors, many of which vary from individual to individual. As a result, it becomes rather difficult to correct some of the most prevalent skin conditions today. However, it also becomes clear that there are certain factors which seem to underlie the vast majority of skin issues. Many of these factors directly relate to the composition and diversity of the skin’s microbiome, the composition of our skin’s secretions and underlying immune factors.

In essence, it may be beneficial to focus on all these aspects at the same time instead of wasting the time and resources necessary to find a specific single cause. This approach should result not only in the correction of the present skin issue, but in overall improvement of health, immune function and resistance to future issues.

Determination of Underlying Health Issues

The best approach to finding underlying medical conditions is through thorough medical examination by a professional. Full blood-work and organ analysis is recommended as a bare minimum. To best determine which tests are most suitable for you, the best thing to do is to speak to a medical professional. When speaking with the medical professional, avoid discussion of the skin issues and instead focus on providing all the necessary details regarding all other aspects of the state of your health (both physical and mental).

Overall Immune System Enhancement

Many chapters of this book are in direct relation to immune system enhancement (Omegas, Your Digestion, and SkinDrone Approach)

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Overall though, much of the focus should be on providing optimal nutrition, physical activity, stress relief and mental adjustment for the healing process.

Topical Regulation of Microbial Communities

The last, but definitely not least, component of correcting your skin issues is physical adjustments to the skin’s microbiome. However, due to the difficult and perseverance of many of the organisms residing throughout, changes may require a significant amount of time. However, this is not always the case and sometimes simply changing your current routine may lead to drastic changes. Nevertheless, the corresponding topical approach for each skin condition is unique and is discussed in detail in the corresponding chapters of this book.

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CHAPTER

4DigestionHow our bodies process and absorb the things we consume

Things Covered In This Chapter:

o Basics of the Digestive Process 60 o The Importance of Proper Digestion and

Absorption (Proteins and Fats) 66 o The Intestinal Microbiota 72 o Understanding Gut Permeability and Leaky

Gut Phenomenon 74 o Improving Digestion 78

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A significant part of our health and well being depends on the strength and condition of our digestive system. This is because

the digestive system is responsible for providing us with energy and nutrients that our bodies need to function. When the digestive system is running into issues, a wide variety of health issues can result. However, the process of damaging your digestive system typically doesn’t happen overnight and is usually the result of repeated damage and abuse.

This chapter will cover the digestive process. At first, we will start with the basics of the digestive process (what is suppose to happen when you eat and drink). Next, we dive a little deeper and take a look at one of the most common digestive issues around (gut permeability and leaky gut). Finally, we will examine certain tactics which may be of use for repairing and improving digestion for optimal health and immunity.

Basics of the Digestive Process

When we eat and drink, the contents travel through various organs in our body. During this travel, our body has to effectively break down the contents, neutralize pathogens and absorb the nutrients it needs. Failure in any section of this process can result in various health issues for the individual. To better understand potential areas where problems might occur, we must understand the different stages of the digestive process. So, let’s take a closer look at each of the major stages.

The Mouth

Our journey stats at the mouth. The first break down occurs when we chew, and when we chew, several things happen simultaneously. The epiglottis flap (located at the back of the throat) closes and prevents food from entering the breathing pathway, the teeth physically breakdown the food, and the tongue mixes an enzyme containing saliva that initiates the nutrition extraction process.

The most abundant enzyme in saliva is amylase. This important enzyme

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is responsible for the breakdown of starches. Thus, the breakdown of starches is among the first process to start and happens almost instantly.

The Esophagus

From the mouth, the food now passes into the esophagus. The esophagus is about a 10 inch passage that connects the mouth to the stomach. In this passage, mucous is secreted to coat the food and prepare it for the stomach. A very important component of this part of the process is a constriction of the upper and lower esophageal sphincters. This ensues that gastric juices from the stomach do not enter the passage. If these juices do enter the esophagus, we experience heartburn (gastric reflux or GERD).

Total time that food spends in the esophagus is fairly short. Typically it takes food content only 5-6 seconds to travel through the passage and make it’s way into the stomach.

The Stomach

As the food enters the stomach (basically a bag of muscle), gastric juice is added to the mix and the stomach begins to churn and contract. This thoroughly mixes the food with the gastric juice and creates a mixture referred to as chyme.

Gastric juice is mainly made up of water, hydrochloric acid, and an enzyme by the name of pepsin. Hydrochloric acid serves the role of preparing the protein for digestion, neutralization of pathogens, and activation of the enzymes.While, pepsin is responsible for the breakdown of protein into amino acids, which can be used by the body.

The environment in the stomach is extremely acidic and this plays an important role in killing any bacteria which may be present. The actual pH of the stomach ranges from 1.5-2.5. Without this acidity, foreign

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bacteria may get the upper hand and make it further into the body.

Also, it must be noted that at this stage, carbohydrate and protein digestion is well on it’s way, while only minimal digestion of fats has occurred.

The total time that food spends in the stomach is typically somewhere from 2 to 4 hours. However, this will depend on a variety of factors including the total amount of food consumed, fat content, and the current acidity of the stomach.

Small Intestine

From the stomach, the chyme now travels into the small intestine. Once the chyme arrives there, bicarbonate is used to neutralize its acidity.Additionally, more digestive enzymes are secreted and begin further breakdown of food and extraction of nutrients.

Even though it’s called the “small” intestine, this organ is actually quite large. To be specific, the small intestine of an adult is roughly 7 meters long. In addition to it’s sheer size, it consists of a unique structure which helps to further increase the amount of surface area that comes into contact with the chyme. This is achieved through the presence of bristle like extensions called villi which cover the small intestine; to further increase surface area, these villi are covered with even smaller bristles called micro-villi. This distinct structure allows for the maximum amount of surface area to come into contact with the chyme and allows for effective nutrient extraction.

The small intestine is actually so effective at its job, that the majority of nutrient absorption occurs here. For example, it absorbs 80-90% of fluids, and the majority of vitamins, minerals, carbohydrates, proteins and fats.

On average, the food (now chyme) spends about 5-6 hours in the small

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intestines. However, this number will vary depending on several factors (such as fat content, total amount, caloric availability, etc).

Large Intestine

The large intestine is basically the last step in the digestive process before emptying (defecation). Even though it is called the “large” intestine, it is actually smaller than the “small” intestine. The total length of the large intestine in an adult is on average only about 1.5 meters. However, it gets its name from its relatively large width.

Instead of depending solely on acids and enzymes for nutrient extraction and breakdown, the large intestine makes use of bacteria to do a large portion of the work. It is through this process that the rest of the available nutrients should effectively be extracted and absorbed. This includes any remaining fats, carbohydrates, vitamins, minerals (sodium, potassium and chloride), and water content.

In addition to the absorption, some vitamins and fats are actually produced by the bacteria residing here. This includes things such as vitamin K, certain B vitamins and substantial amounts of short-chain fatty acids.Unfortunately, the large intestine lacks the ability to absorb amino acids and B vitamins, so the host will only benefit if these are fermented by the bacteria to short chain fatty acids or if they can support beneficial microbial growth.

Since such a large portion of the work inside the large intestine depends on the bacteria living there, it is essential to keep these communities healthy and well diversified. That may not be a simple task, especially when you consider that the microbial density here is thought to be around 100 billion microbial cells per milliliter of content.

Towards the end of the large intestine is a section called the rectum. This is the final stage of the journey, and food is stored here until it can be safely expelled from the body.

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Other Crucial Components

The previous sections provided a general understanding of the path that food travels from the time of consumption to the time of defecation. However, there are several other components of the digestive system that play vital roles in this process. This includes the liver, the gallbladder, the pancreas and several crucial separators along the way.

The Liver

The liver is responsible for the production of bile; bile is crucial for adequate breakdown of fat. In addition to bile production, the liver is active in filtering and removing toxins which can result from the digestive process. As a result, the functioning of the liver directly influences the effectiveness of the overall digestive process. Without proper help from the liver, our systems would become overwhelmed with toxins and depleted of essential fatty acids required for healthy cells.

The Gallbladder

The gallbladder stores the bile created by the liver. It is responsible for releasing this bile into the small intestine. Thus, healthy gallbladder function is a required component of proper breakdown of fats.

Some professionals believe that too much fat in a person’s diet can contribute to the formation of gallstones that can cause severe abdominal pain and blockage of the bile duct.

The Pancreas

The pancreas is responsible for the production of the digestive enzymes required to process carbohydrates, fats and protein. Without these enzymes, we would not be able to properly assimilate the nutrients

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obtained from the food we consume. Accordingly, it becomes another essential component of the digestive process.

In addition to this vital function, the pancreas is also responsible for regulating blood sugar through the production of insulin. The most commonly known health issue as a result of irregular insulin production is diabetes.

Important Separators

If you have been keeping up, you should now know that different steps in the digestive process vary greatly in their microbial makeups, acidity levels, and bacterial tolerance levels. For these reasons, it is crucial that the contents of one organ are kept separate from the other until they are ready.

The first of these is the pyloric sphincter, and it separates the stomach from the small intestine. Failure of the pyloric sphincter to do its duties will result in a series of symptoms. This includes frequent vomiting, constant hunger, weight loss, and dehydration.

The next important separator is the ileocecal valve, and it is located between the small intestine and the large intestine. Issues in the functioning of this valve contribute to small intestine bacterial overgrowth. The symptoms of its dysfunction are fairly difficult to detect, but may include things such as: inability of finishing normal sized meal, feeling excessively full after meals, loss of appetite and bloating.

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The Importance of Proper Digestion and Absorption (Proteins and Fats)

Proteins and fats are vital for healthy development of cells and the body as a whole. The following sections dive deeper into understanding the roles that proteins and fats play and why it is crucial we are able to properly assimilate our required amounts.

Protein

Proteins are considered macronutrients and consist of one or more long chains of amino acids. For our body to use these amino acids, our digestive system first needs to break down the complex protein into single amino acids that can be utilized by the system. This section examines proteins and amino acids in greater detail and should provide the reader with a well rounded understanding of their functions and areas where potential absorption issues may arise.

Why We Need Protein

Our bodies require protein for a variety of essential functions. Without proteins, our bodies would break down and most function would be lost.

Even though some amino acids (most basic form of protein) can be produced in the body, 9 out of a total of 20 need to be obtained from diet. Therefore, these 9 are called the 9 essential amino acids. These 9 essential amino acids include:

• Histidine (important for cell replication and division)

• Isoleucine (promotes muscle recovery, forms hemoglobin, assists in regulation of blood sugar levels, and involved in blood-clot formation)

• Leucine (stimulates release of insulin, protects muscles, increase energy production, promotes tissue healing and skin repair)

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• Lysine (assists in prevention of herpes infections)

• Methionine (metabolic function, breakdown of fat, removal of heavy metals and primary source of sulfur)

• Phenylalanine (converted to tyrosine, which is used to create proteins, thyroid hormones and brain chemicals)

• Threonine (aids in formation of collagen and elastin)

• Tryptophan (used in production of niacin, essential for normal nerve and brain function and production of serotonin)

• Valine (required for muscle metabolism, maintenance of nitrogen balance, and repair/growth of tissue)

As you can see, these essential amino acids serve a variety of very different roles within our bodies. However, in addition to those, there are 11 other amino acids that a healthy body is able to produce on its own. We won’t be going over these 11; however, let’s briefly look at the main roles that amino acids play in our bodies:

• Growth and repair of tissues (muscles, organs, etc)

• Production of enzymes (all enzymes are actually proteins)

• Production of some hormones

• To carry oxygen through the bloodstream

• Production of antibodies (antibodies are proteins)

• Maintenance of blood pH

• Proteins are our neurotransmitters

• For use as a secondary source of energy (in the absence of carbohydrate and lipid supply)

In summary, proteins are crucial for regular functioning of our bodies. If something in our body or diet prevents us from obtaining our requirements, a myriad of health issues may arise. However, based on the complexity of some of these issues and variance among individuals, it is near impossible to make specific recommendations. The least you can do is understand the value of protein and acknowledge their significance for various functions.

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The Process of Protein Digestion and Absorption

In the last section, we touched upon the 9 essential amino acids that must be obtained from diet. Here, we will try to understand how they are absorbed by our bodies after consumption.

In the stomach, hydrochloric acid denatures proteins. This destroys foreign DNA and allows them to be assimilated by our unique bodies. Additionally, an enzyme called pepsin gets to work digesting the larger proteins into smaller polypeptides.

Once the food reaches the small intestines, a myriad of other enzymes join the effort. This includes trypsin and chymotrypsin, which continue the work of pepsin by aiding breakdown to polypeptides. The process in the small intestine takes things further, and enzymes are used to break down these polypeptides into even shorter peptides and individual amino acids. Once this fundamental breakdown occurs, the absorb the individual amino acids and pass these into the bloodstream for delivery to the liver.

Once the liver receives the amino acids, they are kept here for storage until they are required by the body. Thus, the liver acts as a storage organ for the majority of the individual amino acids.

The Relative Ease of Absorbing and Acquiring Enough Protein

The absorption of proteins is fairly straightforward and typically happens quite efficiently. However, the quality of the protein consumed will play a large role in determining the amount of usable amino acids obtained. The highest quality proteins have two qualities: they are easily digestible, and they have a good profile of essential amino acids. The best protein source of all the food out there is eggs; however, milk, meat and fish come quite close as well.

Basically, animal products are typically considered the best choice for

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obtaining the required proteins. This, however, doesn’t necessarily mean that individuals abstaining from the consumption of animal products can’t get their requirements. For these individuals, it is essential to combine complementary protein choices in order to get a good profile of the essential amino acids. There are tons of resources available on the internet for guidance in this area.

Additionally, even for those who eat animal products, some amino acids can be “limiting”. This basically means that the diet may not contain enough of them in proportion of total protein consumption. As a result, the lack of these amino acids becomes restricting on overall functioning. The most commonly discussed “limiting” amino acids are lysine, threonine, and methionine; the best way to ensure you get enough of them is by simply making sure you eat lots of leafy green vegetables or legumes.

One other thing to note is that proteins are typically spared from use as energy if dietary intake of nutrients is adequate. This allows amino acids to be stored away and only be used for the roles they are required for. However, if nutrient intake is inadequate, our body starts to use these stored amino acids for the simple purpose of energy production. This can deplete our reserves and potentially make us deficient in certain amino acids. As a result, we may see health issues arise, not from the fact that we are not obtaining enough amino acids, but simply due to the fact we are not obtaining enough nutrients to meet our energy requirements.

How Proteins Become Allergens

Most food allergies are the direct result of proteins that escape the digestion process but are still absorbed by the microvilli. These proteins still have their foreign DNA intact and as a result, cause a negative reaction in our bodies. The signs of an allergy typically occur anywhere within a few minutes and several hours. The most common foods to cause allergies are typically ones that are exceptionally high in protein

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and as a result, have a greater potential to escape digestion. This includes foods such as milk, eggs, peanuts, wheat, soy-beans, fish and shellfish.

Fats & Lipids

Fats also go by the name of lipids and have the highest caloric density of all the nutrients we consume. They are essential for healthy cells and are required for a wide range of normal bodily function. The two main groups of lipids are saturated fatty acids and polyunsaturated fatty acids.

Saturated fatty acids are the type of lipids that are solid at room temperature. They typically have a higher melting point and are more stable. The main source of saturated fats typically comes from animals and animal products. However, certain plant oils, such as coconut oil, are also rich in saturated fats.

Polyunsaturated fatty acids are liquid at room temperature and have lower melting points. These fatty acids come both from animal products and plants. Some of them are considered essential, because our bodies are unable to create them. Polyunsaturated fatty acids are discussed in further detail in the omegas chapter.

During the digestion process, fats are required to be broken down into single free fatty acids. Without this breakdown, the fats simply pass through our digestive system intact and end up in our feces. This section will examine the crucial importance of proper assimilation of lipids.

Why We Need Lipids

Lipids are a major source of energy for our bodies. This is because each gram of fat contains 9 calories as opposed to carbohydrates and proteins which only contain 4 calories per gram. As a result, they become an effective method of obtaining substantially more calories

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for the same amount of consumed food. However, meeting energy requirements is not the only thing we need fats for.

Firstly, fats act as the structural component of the cells in our bodies. This means that every single cell in our body depends on fat for meeting energy requirements and providing insulation. Secondly, fats are required for the absorption of fat soluble nutrients, such as certain vitamins (specifically A, D, E, and K) and sterols. And thirdly, fats are key components of many hormones and are required for the production of hormone-like fatty acid compounds called prostaglandins.

The Process of Lipid Digestion and Absorption

The digestion of fat starts at the mouth. Here an enzyme by the name of lipase is secreted and starts its work on breaking down large fat globules. As the food hits the stomach, the gastric juices further breakdown fat globules into even smaller components. The stomach is not very good at breaking down the majority of fats, but it does do a good job with medium chain fatty acids. And the more fat content present in the food, the more time it spends in the stomach.

Once the fat is passed from the stomach to the small intestine, the biggest part of the fat digestion process takes place. Here, the fat globules are broken down into tiny droplets by the bile salts. Because of fats strong surface tension, this breakdown is essential for better interaction with the lipase and eventual absorption of individual fatty acids by the microvilli. However, it must be noted that a stable supply of bile is essential for the breakdown of fat. Without this, the lipase doesn’t have much opportunity to do it’s job and thus the fat simply passes through our system.

The Potential for Malabsorption of Lipids

Due to the high surface tension (ability to hold together) of fat, the malabsorption of lipids can be quite common if the digestive system

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is failing to perform at full capacity. If more than 6-7% of the lipids you consume make it through the digestive system, this is considered abnormal and referred to as steatorrhea (basically means malabsorption of fat). Some possible causes of malabsorption include insufficiencies, shortened bowel, various diseases, or bile duct obstruction. However, the amount of total potential causes is much larger, and this can make the issues difficult to diagnose. The best approach to determining the source is to consult with a gastroenterologist, as they are the most qualified for this job.

In recent years, oils high in medium chain fatty acids (coconut oil, palm oil) have been gaining lots of popularity. Part of this can be attributed to the fact that medium chain fatty acids are extremely easy for our bodies to digest and absorb. This allows for quick energy extraction and may be of benefit individuals having issues with more difficult fats.

The Intestinal Microbiota

Our intestines are home to a diverse community of bacteria, fungi, yeast and even viruses. The complex interrelation among these communities, our immunity, and our bodily functions is highly sophisticated and research has shown that their effect on our health is unquestionable. Just to get a better understanding of the immense size of these communities, we must take a look at the amount of intestinal microbiota present in the various digestive organs of a typical adult:

(CFU = Colony forming units)

• Oesophagus - 10,000 to 1,000,000 CFU/ml

• Stomach - 10,000 CFU/ml

• Duodenum - 1,000 to 10,000 CFU/ml

• Jejunum - 1,000 to 100,000 CFU/ml

• Colon - 10,000,000,000 to 100,000,000,000 CFU/ml

• Ileum - 10,000,000 to 100,000,000 CFU/ml

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From these numbers, it becomes quite clear that the complexity of the intestinal tract may make it quite difficult to comprehend or draw any conclusion from. However, recent advances in DNA sequencing have finally allowed researchers to gain some insights into this complexity.

Dysbiosis and Immunological Dysregulation

One of the main areas in which the immune system comes into contact with microorganisms (both good and bad) is in the gastrointestinal tract. As a result, the microorganism populations through the gastrointestinal tract have a significant impact on the state of our immunity. Beneficial micro-organisms have been shown to complement our immunity and produce improvements in our states of health. However, pathogens and unfavorable microorganisms have the potential to severely disrupt immune function, alter our state of well-being and cause long term issues for our health.

Additionally, the cause of many non-infectious human disease such as autoimmunity, allergy and cancer all share one common characteristic; all of these diseases represent dysregulation of the immune system. Thus, it becomes essential to try and understand the actual impact that the microbial community of our intestines has on our immune systems.

The latest research in this area all point to the same conclusions. Diet, nutrition and genetics have an immense impact on the microorganisms that reside in our digestive tract, and this has a direct relationship to disease states and health.

For example, genetics determine our ability to effectively digest certain nutrients such as carbohydrates. If we unknowingly step outside of our body’s ability to digest these nutrients by enzymes, they are passed into the colon and fermented by the bacteria that reside there. Opportunistic bacteria may take advantage of this and can disrupt the balance of the whole community of the colon. This in turn creates a state of dysbiosis (microbial disbalance) and can contribute the dysregulation of our

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immune system. Eventually, if we are unable to rebalance the microbial community, we risk becoming deficient in certain nutrients and face immunity related health issues and a variety of connected disease states. Thus, it becomes essential we learn to listen to our own bodies and try to adapt the dietary choices of our close relatives (considering they demonstrate good health).

Understanding Gut Permeability and Leaky Gut Phenomenon

The gut requires nutrients to pass through the gut lining and into the blood to be used by the body. This is perfectly normal. However, if the amount of permeability becomes abnormal and large particles are allowed to pass through the lining of the gut, the inflammatory process of the gut is initiated and several issues arise.

Let’s first look at what happens under normal conditions. A stable gut barrier function ensures the following things occur:

• Vitamins are properly synthesized

• Short chain fatty acids are properly synthesized

• Pathogens are prevented from colonizing and leaking into the blood

• Immune system function remains stable and intestinal cells mature in a healthy manner

• Toxins and foreign substances from food are properly metabolized

However, if the gut barrier function is disrupted the following issues arise:

• Foreign materials and pathogens are more easily passed into the bloodstream

• Nutrient synthesis is disrupted to due excessive inflammation

• Immune system becomes unstable and cellular function is destabilized

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Thus, it becomes essential that gut barrier function remain normal. Without it, our digestive process becomes handicapped and health issues are likely to occur. However, the internet is full of wild assumptions in this area, and this makes it difficult for regular people to really understand what to look for if they believe they are experiencing the effects of a compromised gut barrier. Let’s first examine potential areas that may compromise barrier function( and then try to understand what to look for if we believe that gut permeability may really be the cause of our health issues.)

Some items that may impact gut permeability and barrier function:

• Dietary choices

– Low plant food intake

– Consumption of poor quality food

– Consumption of too much acidic liquids

– Eating while on the move• Not enough gastric acid

• Chronic stress

– Decreases gastric and pancreatic secretions

– Weaker muscle contractions

– Constriction of sphincters

– Increased cortisol levels can cause decrease immune function and rapid bodily consumption of nutrients

• Prolonged use of medication (specifically antibiotics)

• Environmental contaminants

• Frequent exposure to dietary antigens, bacteria, and toxins

• Overconsumption of alcohol

• Imbalance of gut flora (the gut’s microbial community)

• Disease and infection

The truth is, that at-least one of these can be applicable to just about anyone in the modern world. This makes it quite difficult to understand

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if you are really at risk of developing gut barrier issues. Additionally, studies appear to implicate that genetic factors also heavily impact whether or not someone is susceptible to developing gut barrier issues.

As a result, self-diagnosis becomes exceptionally difficult. Luckily there are medical tests that can help determine if you really are experiencing intestinal permeability issues. These tests typically rely on consumption of small, water soluble, non-toxic compounds which are not metabolized by the human body and not destroyed by the gut. Once consumed, the amount excreted is tested and this determines how much has escaped through the gut barrier. These tests have become quite advanced and can even detect specific regions of the gut where permeability may be an issue. Thus, if you really believe that you may have a compromised gut barrier, the best thing to do is to seek the help of a qualified medical professional.

There are studies that suggest that gut permeability may in part be responsible for, or at-least connected to, several health issues. This list includes:

• Autoimmune disease (abnormal functioning of the immune system against normally present substances)

• Diabetes (high correlation between type 1 diabetes and small interesting permeability)

• Crohn’s disease (abnormal permeability appears to be present prior to disease expression)

• Coeliac disease (some studies suggest that increased small intestinal permeability precedes gluten sensitivity)

• Dermatitis herpetiformis (high percentage of individuals of individuals with this disease have been shown to exhibit increased intestinal permeability)

• Atopic dermatitis (some studies showed no correlation while others found some correlation)

• Irritable bowel syndrome (intestinal permeability appears to be present, but most evidence suggests infection component involved)

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• Helicobacter pylori infection (most patients with helicobacter pylori infection have increased gut permeability)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856434/

This list is likely incomplete, and there are other associations with gut barrier dysfunction and disease states. The overall impact that it has on the overall immune system is likely to lead to a myriad of future health issues. Don’t spend your time second guessing; if you feel that you really have gut issues, perhaps it may be time to see a gastroenterologist.

Dysbiosis and Permeability

Gut permeability, however, doesn’t come about all by itself. There are various other gut issues which seem to complement it and at times might actually be the cause of the permeability issues. Some research suggests that impaired gut function is almost always the result of an acute infection.

One of these is gut dysbiosis. This occurs when the microbiota of the gut undergo alterations in the bacterial community that are unfavorable to digestion and absorption. These shifts in the community can lead to the build up of toxin producing bacteria, fungi, or yeast and increase gut toxicity. These then basically “eat away” the gut’s protective layer and permeability results. And the biggest items that impact the microbiota are diet and stress.

For example, it has been shown that a diet high in meat consumption promotes enzymes that in turn promote carcinogenesis and the formation of ammonia. While insoluble fiber appears to decrease carcinogenic enzymes concentrations, and carcinogenic enzymes can have detrimental effects on a healthy microbiota. Additionally, stress alone has been shown to affect the microbiota; however, the implications of this remain unclear. One thing to note is that gastric ulcers have been linked to high levels of stress; thus, it can be reasoned that the effect of stress is likely negative.

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Improving Digestion

This chapter will focus on methods for improving digestion. However, only general strategies are provided. Some individuals may have digestion issues due to issues outside the scope of this chapter. If these strategies fail to show any benefits, it is a good idea to visit your local gastroenterologist for a consultation and examination.

Learn to Relax

Simply taking time to relax while you eat your food has been to have a variety of benefits on the effectiveness of the digestive process. This includes:

• Increased gastric and pancreatic secretions

• Relaxation of sphincters

• Improved liver function

• Improved glycogen synthesis allowing better production of energy

• Improved gall bladder functioning

All of these benefits complement each other and act synergistically to improve the overall process. So, what are some ways to achieve a more relaxed state? Can it simply be all in the mind? Well, it appears that the answer is yes and no. Some researches believe that it all has to do with out individual characters, while others attribute it to lifestyle and dietary choices. And most likely, it’s a combination of a huge variety of factors. However, there are certain strategies which appear to provide a more relaxed state across the board. These strategies include the following items:

• Keeping busy with pleasurable hobbies

• Improving social activity and contact

• Practicing deep breathing and other relaxation techniques (meditation, yoga, etc.)

• Learning to mentally escape situations and to ignore stress

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Yet, this is only the tip of the iceberg. There may be things in your life that have a large bearing on your overall state. However, due to the unique nature of these, it becomes difficult to provide ideas that may of benefit. Perhaps remembering that every day that we are lucky to even be alive may shine some light even on the darkest of days.

Learn to Listen To Your Own Body

Our bodies are extremely well designed machines and have certain mechanisms in place to let us know if they aren’t happy. However, many of us never take the time to try and understand what our bodies are trying to tell us. Instead, we seek the help of others and try to get our problems resolved by third parties. This approach does have some merit for instances like critical illness and specific health issues, due to the fact that medical professionals have spent significant amounts of time diving deep into these issues. The problem occurs when we listen to the opinions and suggestions of people who have do not have adequate knowledge of the issue at hand or simply have other agendas. By learning to listen and depend on your own body, we may be able to regain awareness of issues from within.

Firstly, this involves ceasing (for the most part) reliance on the opinions of others when it comes to your own body. When we can end the influence of others, we are able to finally focus on ourselves.

Secondly, we must learn to listen, and one of the best methods is through simple meditation. Meditation doesn’t necessarily have to follow any rules or involve any special rituals. The main thing is to clear your mind, find a quiet place and simply step outside your regular thought process. This simple technique can help uncover some thoughts and ideas from your subconscious which may be quite valuable to your health.

The third thing you might want to try, is starting a food diary/log. And here again, you don’t need to overwhelm yourself with any specific

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rules or methods. Simply keep a diary of what you ate and any related thoughts or symptoms (gas, bowel movements, moods, skin integrity, stress levels) you experience. Keeping your diary in electronic format (smart-phone, tablet, PC) can help will later analysis of the data, however, sometimes simply writing it down on paper alone may be enough.

Specific Dietary Approaches

If you listened to your body and think that dietary choices may be affecting your health, but the diary didn’t help, there are more specific methods which may be beneficial. One of these is the elimination diet. This involves the removal of foods you believe may be causing issues for predefined periods (1-2 weeks at a time) and monitoring any changes you experience. The second one is the reverse- elimination diet. This one is a little more difficult. It involves cutting out the majority of foods, except those you feel the least likely to be causing issues. Then slowly adding things back at pre-defined periods and monitoring for any changes. The first approach works best if you already have some clues as to what dietary choices may be affecting your health; the other approach works best if you are clueless.

For reference, included below is a list of the most commonly reported food choices which cause issues for people:

• Nightshades (tomatoes, potatoes, eggplants, peppers)

• Wheat and Gluten (bread, cereal, pasta)

• Dairy and Lactose (cheese, milk, yogurt)

• Soy Products

• Eggs

Please note that the guidance of a dietitian is recommended for both approaches and for dietary advice in general. Your issues may be the result of deficiencies, and taking certain foods out may simply further advance the deficiency. This is important particularly for individuals with

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accompanying health concerns.

Improving Nutrient Absorption

This section will briefly go over some tactics to increase nutrient absorption. It is meant to simply provide ideas, and further information can usually be found online.

Increase Plant Consumption

Plants contain a variety of beneficial vitamins and minerals. Plus, they provide adequate amounts of fiber, polyphenols, and prebiotics that the bacteria residing in our gut need.

http://pubs.acs.org/doi/abs/10.1021/jf2053959

Reduce Consumption of Poor Dietary Choices

Processed food (junk food included) typically involves high amounts of poor quality vegetable oil or sugar in its production. Both of these tend to increase inflammation in the body and have been shown to have negative effects on digestion and overall health.

http://www.sciencedirect.com/science/article/pii/S0140673612620893

Increase Consumption of Cruciferous Vegetables

Cruciferous vegetables include broccoli, cabbage, turnip, brussels sprouts, cauliflower, and mustard greens. These vegetables have been shown to have significant impacts on health, cancer prevention and overall cellular stability (http://lpi.oregonstate.edu/mic/food-beverages/cruciferous-vegetables). Additionally, they have been shown to have a significant impact on the digestive system (http://jn.nutrition.org/content/139/9/1685.short).

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Reduce Constipation and Transit Time

Regular bowel movements can make a significant contribution to overall health. Constipation is typically a sign of either poor habits (poor food choices, unbalanced diet) or dis-balances in the bacterial populations of the digestive system. Things that can improve bowel movements include:

• Ensure adequate fiber and fluid intake

• Reduce caffeine intake

• Daily physical activity and exercise

• Keep food intake regular and consistent (frequency and meal size)

• Certain probiotics have been shown to alleviate constipation and improve bowel function (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799919/)

• Aloe vera juice has been shown to be beneficial for colon health (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313538/)

These are just some of the most common methods for improving bowel function and reducing constipation. Additionally, there are special exercises you can do to help alleviate constipation (http://www.med.umich.edu/1libr/MBCP/HealthyBowelHabits.pdf ). If you have serious issues with constipation, it is advisable you seek professional medical advice.

Ways to Quickly Cut Down Inflammation

An overstressed digestive system is particularly prone to inflammation and inflammation plays a large role in the health of the digestive system. With high levels of inflammation, digestive efficiency is compromised and issues may result. Below are a few of the most popular methods that can be used to help cut down inflammation and improve digestive function:

• Reduce consumption of spicy food

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• Cut out alcohol and caffeine

• Removal of histamine rich foods (http://ajcn.nutrition.org/content/85/5/1185.short)

• Eat foods high in pre and probiotics

– Food sources of pre-biotics:• Bananas• Garlic• Onions• Leek• Soybeans• Blueberries• Asparagus• Most fruit

– Food source of pro-biotics:• Cultured yogurt, kefir and dairy products• Tempeh• Miso• Sourdough bread• Sauerkraut• Kimchi

• Supplement with glutamine

• Supplement with quality omega 3 products or simply increase fish consumption

• Make sure you are getting enough minerals from food (improve vegetable consumption)

The items above are some of the more studied and well known approaches to reducing digestive inflammation. Information on any of these can easily be found online.

Improvement of Digestion Requires an Ongoing Approach

Many people think that a magical pill or cure is supposed to make their bodies bullet proof and free from illness no matter what they do to their own body. However, this is far from the truth, and the best way

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to approach health is through prevention. This means that you don’t necessarily need to wait until you are ill to start implementing tactics that have been shown to improve your health. This is particularly important for digestion. Here are some general strategies that you should consider going forward:

• Minimize consumption of processed foods and focus on simple whole food choices

• Increase consumption of plant proteins

• Cooking meals from scratch is the best way to ensure you know exactly what you are eating and how it was handled

• Learn to eat your vegetables (it’s okay to have favorites)

• Reduce intake of poor quality meat and animal products

• Learn which produce is in-season and eat accordingly

Once again, the strategies above are meant to serve as a reference. Anything that can improve your digestion and health on an ongoing basis will not only likely help you resolve your issues but will also contribute to improving both mental and physical health. If many of these changes seem new or drastic to you, the improvements you gain from them are likely to be just as drastic. Typically, people experience reduced stress, better mental clarity, improved physical performance, and general improvements in daily mood. Remember, it’s your health and it will likely determine the overall quality of your life.

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CHAPTER

5Omega Fatty AcidsThe connection between certain fats and inflammation

Things Covered In This Chapter:

o The Historic Ratio 86 o Why Omega-3s Are So Important 87 o The Role of Omega-6s 90 o Omega 9 and the Other Omegas 91 o What Happened in The Western World 92 o Strategies for Adjusting the Ratio 93

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Much of the fats we consume are in the form of omega fatty acids. The most commonly discussed of these are the Omega-6s and

Omega-3s. Both of these fatty acids are essential for human health and must be obtained through diet.

The number used to differentiate the omega fatty acids describes the location of the carbon-carbon double bond in the fatty acids carbon chain. Omega-3s have the double bond at the 3rd carbon atom from the end of the chain, and Omega-6s have the double bond located at the 6th bond (again counting from the end).

Most of the online discussion claims that omega-6s are strictly inflammatory fatty acids. However, this is not the case. Even though most of the omega 6 fatty acids are actually inflammatory, others, such as gamma-linoleic acid (GLA), are actually anti-inflammatory. However, only fairly specialty oils (such as primrose, borage, and hemp seed oils) contain significant amounts of GLA. But, even then, a properly functioning body can convert linoleic acid (LA - the most common omega-6) to GLA if required.

The Historic Ratio

Much of the scholarly literature suggests that humans evolved on a diet with a ratio of omega-6 to omega-3 of about 1. However, in the Western diet, it is currently estimated that this ratio sits much closer to 16:1. Meaning that for every 16 grams of Omega 6 people in the Western World consume, they are only consuming about a gram of essential Omega-3s.

Nutrition plays an extremely vital role in the development of the human body, and at the core of our nutritional requirements is our DNA. Scientists estimate that the rate of spontaneous DNA mutation (evolutionary changes) occurs at about 0.5% per 1 million years. However, the Agricultural Revolution occurred during a period of only the last 10,000 years. As a result, our genetic makeup has not

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yet had the time to adjust to the drastic changes in our nutrition and environment. The simple fact is that our current genes are extremely similar to that of our Paleolithic ancestors living 40,000 years ago. However, our diet is drastically different, and much of these differences are in the areas of essential fatty acids and antioxidant capacity of foods. (Importance of the Ratio of Omega–6/Omega–3 Essential Fatty Acids: Evolutionary Aspects)

Most research now points to the detrimental effect of such a significant dietary change. These effects include the promotion of pathogenesis of many health issues: items like cancer, cardiovascular disease (heart, arteries, etc.), inflammatory diseases and autoimmune diseases.

All this data when combined with the fact that Americans have the greatest proportion of cardiovascular disease in developed countries, really makes you wonder how strong the impact of this ratio could really be.

Why Omega-3s Are So Important

Experts believe that increased levels of omega-3s exert corrective effects. For example, one study demonstrated that, in the secondary prevention of cardiovascular disease, a ratio of 4:1 correlated with a 70% decrease in total mortality of study participants. Another study showed that a ratio of 2.5:1 reduced rectal cell proliferation in patients with colorectal cancer (progression slowed), yet a ratio of 4:1 did not produce any significant changes.

Eicosanoids and the Impact of Omega-3 Fatty Acids

Eicosanoids are signaling molecules used throughout our body, and they play an important role in physical activity, inflammation, immunity, and the central nervous systems. Even though they can be derived from both omega-3 and omega-6 fatty acids, the omega-6 tend to be pro-inflammatory. Thus, the fatty acids we make available to ours bodies can

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play a large role in determining the way in which many of our bodily functions occur.

Many of the most famous anti-inflammatory medications (non-steroidal anti-inflammatory drugs) act by down-regulation of the eicosanoid synthesis. The most famous of these drugs is aspirin.

Even though scientists are still not 100% sure if omega-3s can fully replace the role of anti-inflammatory drugs, they agree that omega-3s play a crucial role in regulating the eicosanoids. Thus, the potential to regulate the eicosanoid synthesis through improvement of the omega ratio holds much value.

Some Specific Highlights from Studies

The role of balancing the omega ratio has been shown to have the following clinically documented effects:

q A ratio of 4:1 correlated with a 70% decrease in total mortality of patients with cardiovascular disease

q A ratio of 2.5: 1 reduced rectal cell proliferation in patients with colorectal cancer (progression slowed), yet a ratio of 4:1 did not produce any significant changes

q A ratio of 3:1 suppressed inflammation in patients with rheumatoid arthritis

q A ratio of 5:1 had beneficial effect on patients with asthma, while a ratio of 10:1 had negative effects

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Summary of Omega-3 Fatty Acid Benefits

Specific cardio-protective effects of omega-3 fatty acids:

o Reduces triglycerides o Reduces blood pressure o Inhibits platelets o Reduces blood clotting o Improves plaque structure o Anti-arrhythmic (suppresses abnormal rhythms of the heart) o Improves endothelial (interior surface of blood vessels and lym-

phatic vessels) function o Cancer prevention o Improves insulin sensitivity o Enhances thermogenesis and lipid metabolism o Benefits vision and brain function o Decreases skin inflammation

Different Types of Omega-3s

Falling under the classification omega-3s are a large number of specific fatty acids, which we obtain from many different sources.

The most researched of these are DHA and EPA. These omega-3 fatty acids can be obtained through diet (mainly from seafood) or synthesized within the body from ALA (alpha-linoleic acid - another omega-3). However, the conversion of ALA to to DHA and EPA is not very efficient (conversion efficiency is below 5%). Additionally, the process used for conversion of ALA directly competes with the breakdown of omega-6 fatty acids. As a result, an abundance of omega-6 fatty acids further decreases the efficiency for humans to obtain needed EPA and DHA (from ALA) declines further. Luckily, DHA and EPA can be obtained directly through diet.

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Fish and marine products are the best source of DHA and EPA. However, there is significant variant among different fish species. For example, while Pacific Herring can have 1.06g of EPA and 0.75g of DHA per 3 ounce serving, Pacific Cod only has 0.09g of EPA and 0.15 of DHA for the same 3 ounce portion. As a result, some marine products are much better than others for obtaining these fatty acids.

ALA is widely available from plant sources. The most popular of these appears to be Flax Seeds, which contain roughly 50% of its oil composition in the form of ALA. As a result, a single tablespoon of ground flax seed contains about 1600 mg of ALA. At the 5% efficiency level mentioned above, this can be converted to about 80 mg of DHA and EPA, which is actually quite unimpressive. However, the pure oil is a little better as a single tablespoon contains 8.5g of ALA (425 mg ALA and EPA).

Some other sources of ALA include:

• Walnuts (1 ounce = 2.6 ALA)

• Canola Oil (1 tablespoon = 1.2 ALA)

• Mustard Oil (1 tablespoon = 0.8 ALA)

However, because these plant sources of omega-3 always contain some quantity of omega-6, the final amount of obtained DHA and EPA is unclear.

The Role of Omega-6s

Due to the vast amount of research documenting the benefits of omega-3 fatty acids, it becomes difficult to find the benefit of the omega-6s. However, they too have a vital role in our body, and we still need to meet our requirements through diet. The main role that omega-6 fatty acids seems to play in our bodies is in brain function, growth and overall development.

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Much of the research done to determine the result of deficiency inadvertently also restricted omega-3 consumption. Thus, it remains unclear what the actual requirement and outcomes of Omega-6 deficiencies are. However, due to today’s high consumption of vegetable oils, it is practically impossible to become deficient in omega-6 fatty acids.

Omega 9 and the Other Omegas

Unlike omega-3 and omega-6, omega-9s are not considered essential. This is because they can be produced within the body, and because they do not participate in the synthesis of eicosanoids. The most common omega-9 fatty acids are oleic acid (olive oil and macadamia oil) and erucic acid (rapeseed and mustard seed oil).

Olive oil is made up of about 85% oleic acid and has gained lots of popularity as part of a healthy diet. This in part to the high omega-9 levels, low omega-6 levels and a variety of beneficial polyphenols.

Other omega fatty acids include omega-5s (nutmeg), and omega-7s (sea buckthorn oil). These fatty acids are not considered essential, and there appears to be little literature as to their benefits. However, preliminary research suggest that sea buckthorn may be beneficial for atopic dermatitis.

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What Happened in The Western World

The Western diet underwent a significant shift during the 20th century. This change was even more drastic than the shift attributed to agriculture discussed above. Most of this has been due to the widespread use of vegetable oils in packaged foods and their addition to many of the condiments we use to flavor food.

To put things into perspective here are a few facts regarding this shift:

q The estimated per capita consumption of soybean oil alone increased more than 1000-fold from 1909 to 1999

q The consumption of margarine increased by 1038% from 1909 to 1999

q In the 13 years after its introduction in 1986, canola oil consumption increase 167-fold

q Soybean oil only accounted for 0.006% of our dietary caloric energy in 1909, while this level reached a staggering 7.38% by 1999

q The amount of linoleic acid (LA) our bodies have available for energy increased from 2.79% to 7.21% (2.6x), while alpha-linoleic acid (ALA) only increase from 0.39% to 0.72% (1.8x)

q The ratio of LA to ALA increased from 6.4:1 in 1909 to 10:1 in 1999

Considering all the positive research regarding the importance of a health ratio of omega-3 to omega-6s, this data raises several concerns. The first question that comes to mind, is, can we really sustain health on such diets? Second, who is responsible for these unhealthy changes, the consumers driving demand or the sellers who used quality marketing to drive the shift?

Fortunately, healthy dietary choices are on an upward trend, and consumers are finally realizing which products are worth buying. These trends are making it less profitable to produce unhealthy products, and thus, in an ideal world, the problem will correct itself. However, we

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shouldn’t forget the power of marketing and the potential for sellers to simply replace a known unhealthy ingredient will a lesser known alternative.

Strategies for Adjusting the Ratio

The first step to getting our omega ratios back on track is realizing the importance of a healthy ratio. The second step is to understand which products and dietary choices have the most impact on the ratio and how much we should consume.

List of Most Common Sources of Omega-6s

This list covers the products highest in total omega-6 fatty acid content. The figures are provided based on a 15g serving (about 1 tablespoon). However, many dressings and condiments depend on the use of many of these oils, and ingredients list should be examined.

• Safflower Oil (Linoleic) - 11.2g

• Grapeseed Oil - 10.4g

• Sunflower Oil (Linoleic) - 9.9g

• Poppy seed Oil - 9.4g

• Vegetable Oil (USDA Low Fat) - 8.7g

• Wheat Germ Oil - 8.2g

• Corn Oil (Canola) - 8g

• Walnut Oil - 7.9g Mayonnaise (soybean and safflower oil) - 7.8g

Best Sources of Omega-3s

This list is mainly focused on EPA and DHA, a list of the top sources of ALA can be found earlier in this chapter (Different Types of Omega-3s). The following figures are based on a 3oz (85g) serving:

• Pacific Herring, Cooked - 1.06g EPA 0.75g DHA

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• Chinook Salmon, Cooked - 0.86g EPA 0.62g DHA

• Atlantic Salmon, Cooked - 0.28g EPA 0.95g DHA

• Pacific Oysters, Cooked - 0.75g EPA 0.43g DHA

• Sockeye Salmon, Cooked - 0.45g EPA 0.60g DHA

• Rainbow Trout, Cooked - 0.40g EPA 0.44g DHA

• White Tuna, Canned - 0.20g EPA 0.54g DHA

A Few Final Words on How to Improve Our Ratio

Even though achieving a ratio of 1:1 is practically impossible and may not, in-fact, be that crucial for maintenance of health, moving closer to that ratio appears to be beneficial for correcting health issues (such as our skin). As the health condition resolves, it may be both financially and emotionally easier to ease our efforts to a more sustainable ratio. Which, most of the literature suggests to be in the area of 5:1 - 6:1.

The two biggest items towards a healthier ratio are:

1. The avoidance of packaged foods containing oils (chips, granola bars, ready meals, and most packaged food in general)

2. Removal of vegetable oils for the flavoring of our food (salads, marinades, dips)

Additional items to consider:

• Nuts and seeds contain high amounts of omega-6s

• Many candies use oil to stimulate a more pleasant mouth feel

• Much of the food at restaurants depends on cheap oils for preparation

Complete avoidance of items high in omega-6 fatty acids is typically not sustainable. The biggest changes should be made through focus on correcting consumption patterns rather than limiting them.

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CHAPTER

6The Skindrone ApproachA comprehensive approach to managing seborrheic dermatitis

Things Covered In This Chapter:

o The Connection to Lipids and Fatty Acids 99 o The Connection to the Immune System 102 o The Connection to the Environment 105 o Proposition for Improving Sebum Composition

and Skin Barrier Function 112 o Goals Towards Being Seborrheic Dermatitis Free 115 o Actionable Steps to Take Based On

Discussed Goals 128 o The Author’s Approach to Obtaining Clear Skin 129

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This chapter is a unique combination of all the previous chapters. It will try to provide the following:

1. A detailed hypothesis of why people experience seborrheic dermatitis.

2. A comprehensive approach to reversing the condition.3. General tips for dealing with everyday life while struggling with

skin issues.

One thing to be aware of is that this chapter is not fully based on medical literature. Instead, it is more liberal in nature and simply tries to provide an explanation of what I believe to be the cause of the majority of seborrheic dermatitis issues. Even though much of the ideas are inspired by my research, a significant part is based solely on my own experience with seborrheic dermatitis and the knowledge gained through interaction with hundreds of individuals affected by seborrheic dermatitis. For this reason I highly advise you to follow the rules of critical thinking, which include:

1. Ask questions and be willing to wonder2. Define your terms3. Examine the evidence4. Analyze assumptions and biases5. Avoid emotional reasoning6. Don’t oversimplify7. Consider the interpretations8. Tolerate uncertainty

For my part I will try to abide by these rules as much as possible throughout the writing of this chapter. Reference to research papers will be provided when applicable and assumptions will be explained as much as possible.

With all that being said, let’s dive right in.

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The Proposed Cause of Seborrheic Dermatitis

First let’s start by trying to understand why some people experience seborrheic dermatitis in the first place.

The Connection to Lipids and Fatty Acids (sebum and oils)

Since the condition is not contagious (source) and is typically restricted to certain areas of the skin (source), one could argue that there is something happening at that specific location of the skin. The first clue comes from the areas of skin which are most commonly affected and these are almost always sebum rich areas with a large amount of sebaceous glands. This include areas such as:

• Scalp

• Forehead

• Side of nostrils

• Cheeks

• Eyelids

• Behind the ears

• Front of the chest

• Area between shoulder blades

q Sebum rich areas do differ from individual to individual and some individuals experience seborrheic dermatitis on other areas of the skin, but these are the most common.

Since the unifying feature of skin affected by seborrheic dermatitis is the sebum, one can reason that the cause is directly linked to sebum. As discussed earlier in this book, the malassezia yeast is most commonly blamed for causing seborrheic dermatitis. Malassezia feed on lipids, and these lipids make up a large portion of the sebum our skin produces (source). And this feeding process is believed to be cause. However,

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since malassezia is present even on the skin of healthy individuals, its role remains unclear. As a result, instead of focusing strictly on the malassezia, it may make sense to focus on the composition of sebum instead.

q The composition of sebum mainly consists of triglycerides, wax esters, squalene, cholesterol, anti-microbial peptides and anti-microbial histones (source). The oily nature of sebum makes it a target for a fairly large number of oil-dependent bacteria and fungi, such as propionibacterium acnes and malassezia yeasts. To defend against this, the skin relies on the breakdown of triglycerides to anti-microbial free fatty acids and an adequate supply of anti-microbial peptides and histones.

The biggest obstacle for making any valuable conclusion in this area is that there appears to be very few studies which examine the sebum composition of seborrheic dermatitis affected individuals. Nevertheless, some studies do indicate that individuals who suffer from seborrheic dermatitis have decreased levels of vitamin E, glutathione, and specific polyunsaturated fatty acids (source). Additionally, some studies of seborrheic dermatitis in infants show an impaired function of the enzyme delta-6-desaturase (source), which is required for breakdown of certain essential fatty acids (source).

My proposition is simple. The skin is simply having issues producing the correct composition of sebum which is required for its protection. And more specifically the issue likely lies in the fatty acid composition of the sebum. This can occur due to several reasons:

� Issues in metabolism of consumed lipids � Insufficient vitamin E levels required for adequate protection of

fatty acids � Issues of fatty acid biosynthesis at the skin level

So not only does the first line of the skin’s defenses become compromised, the sebum secretions may be providing an excellent and unprotected food source for the malassezia. And this is where the heart of the issue may lie. The malassezia feeds on the skin’s first line

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of defenses, removing the protective layer and leaving behind fatty acids which are considered irritants (source). So, not only is your skin’s first line of defenses compromised, it is also turned into a unfavorable composition by the malassezia, which causes irritation. The skin then has to react by initiating the second line of defenses, which rely on inflammation and the activation of more complex immune processes (adaptive immune response). At the same time, the skin likely attempts to compensate for the broken sebum layer by producing more sebum and this may be creating a vicious cycle favorable for the malassezia.

Quantity and Quality of Sebum

Since sebum plays such an integral role in the progression of seborrheic dermatitis, it makes sense that changing either its quantity or quality may have a direct impact on the skin condition.

Blood Sugar Levels Effect on Sebum Production

Many studies demonstrate that blood sugar levels and high carbohydrate diets impact the amount of sebum production (source, source, source). Thus, reducing carbohydrate load can help regulate excess sebum production and may aid in resolving symptoms of seborrheic dermatitis by depriving the malassezia of a food source. However, this may not be a good long term strategy since carbohydrates are an excellent source of energy for bodies. For this reason I believe that improving sebum composition is a more viable approach.

Luckily, some researchers found that the specific types of carbohydrates consumed play a role in determining the fatty acid composition of the sebum (source). The issue is that this research was not pursued and no further studies were done to determine if any specific carbohydrates might be beneficial for relieving seborrheic dermatitis. Regardless, this is an interesting avenue for personal extermination, and perhaps simply changing the your main carbohydrate food source may prove beneficial

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for you. For example, going from rice to potatoes, or going from wheat to rice. We will leave this topic for now, but return to it towards the end of the chapter.

The Connection to the Immune System

In the immune system chapter we took a look at how the main components of our immune system work. This, however, was only a small introduction and covered some of the basics. In reality, the immune system is much more complex and new findings are always being discovered in regards to how it functions and what determines the strength of its ability to defend our bodies. Thus, it becomes rather difficult to summarize the whole system in the context of this book. What is most important, is understanding the connection of our immune systems to seborrheic dermatitis and potential ways we can improve its functioning.

Autoimmune Disease and Seborrheic Dermatitis

One thing is clear, the state of our immune system has a direct impact on the state of seborrheic dermatitis progression. This is best demonstrated through the simple fact that AIDS (auto-immune disease) patients have one of the highest occurrence rates of seborrheic dermatitis, estimated anywhere from 34% to 83% (source), compared to 3% in the general population.

In HIV-positive AIDS patients, the severity of the condition is closely related to the stage of HIV infection (source). The HIV virus attacks the immune system by destroying T helper cells which are part of the immune system’s strongest weapons. And as the immune system degrades, the seborrheic dermatitis spreads and becomes more aggressive. Even though this doesn’t mean that T helper cells are directly responsible for defending our skin against seborrheic dermatitis, it likely acts by indirectly draining the resources from other components of the immune system which tries to compensate for the

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reducing T cell count.

The Important Role of Omega 3s

The omega chapter examined the benefits of omega 3 fatty acids in great detail. Here, a case for their beneficial properties and how they relate to seborrheic dermatitis is presented.

Firstly, an improved ratio of omega 3s to omega 6s has been shown to significantly aid in normalizing inflammation (source). And once inflammation is under control, the following things are also likely to improve:

o The immune system’s ability to properly react to bacterial infection (source)

o The visual symptoms of seborrheic dermatitis (source) o Symptoms of depression and body’s ability to cope with stress

(source)

The last point may actually hold one of the biggest benefits. This is because improving depression has been shown to have a strong overall effect on stabilizing the immune system (source). The connection here is that chronic inflammation has been linked to symptoms of depression (source). And stress and depression have been linked to overall degradation of the immune system (source). Thus, a positive improvement in inflammation should inadvertently improve immune system functioning.

Secondly, if we obtain our omega 3s from diet and not supplements, the foods that contain omega 3s tend to also be high in vitamin E and selenium. And these nutrients have also been shown to have a strong impact on stabilizing and improving immune system function (source, source, source). For this reason, one could argue that whole foods appear to provide a better overall effect on immune functioning then supplements alone.

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Stress and Immunity

It now makes sense to briefly discuss the connection between stress and immune function in greater detail. Firstly, there are two main types of stress:

1. Acute stress - brief circumstances which create stress (exams, threatening situations, etc.)

2. Chronic stress - ongoing stress (marital problems, work related issues, financial stress, etc.)

The two types of stress are very different in nature and have equally different effects on health and immune function. Acute stress appears to actually improve immune function in the short term to aid in coping with the situation (source). However, chronic stress has been demonstrated to suppress overall immunity, thereby creating the optimal environment for illness and drastically impact the enjoyment one can obtain from life (source).

Overall chronic stress appears to have similar effects on immune system function as does HIV. Specifically, during times of chronic stress T cell activity was drastically reduced (source). And since seborrheic dermatitis is so common amongst AIDS patients, it could be argued that the similar negative effects on immune function caused by stress may also coincide with seborrheic dermatitis occurrence and severity.

q A study of 15,357 individuals clearly demonstrated that cumulative stress in childhood was a strong predictor for autoimmune diseases in adults.

When using the word “stress” it might make sense to first define exactly what it means. Most research and the medical community basically defines stress as “circumstances that most people find stressful”. The issue is that this meaning is quite broad in nature and clearly some individuals perceive a large amount of situations as stressful, while others are extremely good at ignoring the situation and moving past the “stressful” even without hesitation. This has long puzzled

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researchers, but overall it appears to be influenced by genetics (source), individual’s life experience (source), and maybe even perhaps nutrition (source). Regardless of what influences a given individual’s susceptibility to stress, finding strategies to cope or remove stress may hold significant value in improving immune system functionality and potentially reversing atopic skin conditions such as seborrheic dermatitis. Further discussion of stress is provided later in this section and several strategies are provided for eliminating chronic stress from our lives.

The Connection to the Environment

Our environments constantly challenge our immune systems and bodies. The challenges may come from stressful situations, foreign microbes (bacteria, viruses, yeast, etc.) or simply environmental conditions unfavorable to your health. Regardless of where the challenges come from, our bodies need to be able to adjust to the circumstances and ensure that proper functioning is maintained.

q A significant portion of this section does not have many medical references. Much of the logic is deducted from medical research surrounding the effects of chronic stress on immune function.

Similar to stress, such as acute environmental challenges, are likely to stimulate the immune system, while chronic challenges may drain substantial resources, causing breakdowns in the defense processes. This is particularly important in relation to infectious disease because of the way that microbes spread. Upon initial infection the microbe population is usually relatively small. However, if the threat is not properly handled at initial exposure (due to a weakened immune system), the microbes multiply. And as we discussed in the immune chapter, if not controlled, the microbial growth typically occurs in an exponential fashion (2,4,8,16,32). As a result, the environmental challenge may become too difficult for the already weakened immune system to handle as growth outpaces our immune system’s ability for defense. Additionally, as the microbial threat is allowed to establish

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itself, it may develop certain mutations further increasing it’s ability to defend against our immune systems.

This section will go over the most relevant environmental challenges in relation to seborrheic dermatitis.

Malassezia

The first environmental challenge we will discuss, is the one most associated with seborrheic dermatitis by the medical community, the malassezia fungi. The malassezia fungus resides on the skin surface of the majority of humans and many other animal. Typically, the fungus is commensal, meaning that it receives a benefit from residing on the skin, without causing any issues for host. But this is not always the case and the fungus has been linked to a variety of skin conditions (source).

Forcefully minimizing the amount of malassezia present on this skin appears to aid in restoration of normal skin functioning and clearance of the troubling skin condition (source). And to minimize the amount of malassezia, medical professionals often use the help of anti-fungals which can effectively combat the malassezia on contact. But even though this appears to be the best approach for relieving symptoms, it usually only provides temporary relief. This is because completely ridding malassezia from our environments is impossible, due to its widespread presence on other individuals and animals.

Regardless of how widespread the malassezia may be, if the anti-fungal is able to provide enough temporary relief to allow our immune system to regain control of the skins environment, relief may be long-term. The issue is that anti-fungal solutions drastically impact the overall environment of our skin and are typically combined with cleansing agents which may also remove our skins own natural sebum which it works hard to maintain. At this point, one could argue, that because both the malassezia and the sebum are removed concurrently, whichever is capable of re-establishing its presence first will gain the

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advantage. Additionally, if for some reason the immune system is failing to produce the correct sebum required for (inflammation free) defense against the malassezia, symptoms are likely to return.

q Using anti-fungals below their MIC (minimum inhibitory concentration) has been associated with development of more resistant strains of malassezia. For example, using ketoconazole below MIC was demonstrated to increase the MIC by 1600% (the amount of ketoconazole required for malassezia suppression would increase by 16 times) (source).

Based on this, the best strategy for long-term symptom relief is likely to be sustained not through complete elimination of malassezia, but rather thorugh improvement of our skin’s ability to cope with it’s presence.

q In the majority of skin conditions linked to malassezia colonization, it appears that its growth is allowed to go unchecked.

How Malassezia Appears to Cause Seborrheic Dermatitis

Malassezia feed off of the sebum released by the sebaceous glands. In their process of feeding, they consume specific saturated fatty acids, while leaving behind others (source). In essence, this feeding process modifies the fatty acid composition of our sebum. And this modified sebum is believed to cause the breakdown of skin barrier function leading to inflammation, irritation and flaking (source).

The amount of skin barrier breakdown caused by the modified sebum appears to vary from person to person (source). Even though researches are still unsure about what exactly determines individual susceptibility in the case of seborrheic dermatitis, some believe the cause is a defect in the permeability barrier of the skin, similar to that of atopic dermatitis (source). As a result, restoration of permeability barrier function may be a better approach to seborrheic dermatitis treatment then attempting to eradicate the malassezia.

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Diet and Nutrition

Another environmental factor, which appears to have a direct effect on seborrheic dermatitis progression, is the dietary choices we make. The medical research in this area is very sparse and there are no currently established connections between specific dietary choices and seborrheic dermatitis. However, in one study of 113 patients with atopic dermatitis, a significant percentage (40% of the re-evaluated patients who showed positive for food challenges) experienced clearance of skin issues briefly following removal of foods which were identified through oral food challenges to cause hypersensitivity.

Even though dietary choices may clearly be playing a significant role in seborrheic dermatitis progression, the stress that comes from attempts to self-diagnose based on anecdotal evidence found online may outweigh any results. (so true) This is because simply believing that certain foods may be causing your issues could create certain psychological fallacies and simply condition the body to react to these foods (mind over matter). Over time, the number of foods that you may attribute to your symptoms could increase and this could start creating social issues as your diet becomes drastically different from socially accepted norms. Eating out with friends may become difficult, social gatherings become stressful and depression is likely to take hold as you stress about things that you wish you could eat.

q The connection between depression and wrongfully self-diagnosed hypersensitivity to foods appears to be clear (source), but the question to which comes first is much harder to answer. Is it depression which causes an individual to look for something to blame their issues on, or is the misdiagnosed food allergies which cause depression to develop?

We will end this discussion for now, but a more concrete and strategic method for dealing with diet, food allergies and nutritional deficiencies is provided later in this section.

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Demodex Mites and Dust Mites

Our environments are full of a variety of different micro-organisms. And even though malassezia is believed to be one of the main culprits behind seborrheic dermatitis, it would be irrational to look at its existence in a vacuum. Instead it may be wise to try to look at some of the other micro-organism which also appear to impact epidermal barrier function. Two of these are the demodex mite and the dust mite.

The demodex mite is a tiny parasite which thrives in areas of lipid rich sebum (similar to malassezia). In healthy subjects, even when skin infestation and colonization occurs, symptoms rarely come about. Nevertheless, increased numbers of demodex mites have been correlated with symptoms of rosacea (source). This indicates that demodex mites may in fact be able to influence epidermal barrier function and bring about changes in skin immunity. As a result, potential infestation by these mites in tandem with infection by malassezia would compound any negative effects. This, however, is pure speculation and there are currently no studies which demonstrate any significant relationship of the demodex mite to seborrheic dermatitis.

q Incidence of demodex mite infestation is very high in individuals suffering with chronic blepharitis (source).

The house dust mite is another tiny mite which, as the name applies, predominantly feeds on house dust (mainly consisting of shed human skin). The mite enjoys stable environments and thrives in moisture rich homes. Even though the mite is typically harmless to human health, out of control dust mite infestation in the home has been linked to atopic dermatitis (source) and epidermal barrier damage has been documented (source, source). While house dust mites may not have been directly associated with seborrheic dermatitis, they could play a complementary role in degrading epidermal barrier function, allowing the malassezia to actually cause the symptoms of seborrheic dermatitis.

q In reality, demodex mites and house dust mites are only two of the

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millions of other potential micro-organisms in our environment that may cause epidermal barrier function issues. Trying to find the exact one responsible may prove to be an extremely challenging task.

The Internet, Seborrheic Dermatitis and Stress

The internet has become an integral part of modern day life and truly a large component of the environment we live it. Individuals all over the world depend on the internet for information search, entertainment/relaxation, and socialization. It’s true that the amount of convenience that the internet has created is truly unquestionable. However, as they say, with great power comes great responsibility.

First, if information which is actually beneficial (resolves the seborrheic dermatitis) isn’t found quickly, expectations for actually finding a solution are likely to decrease. The unfavorable outcome expectations are then likely to impact actual results. This can cause an individual to simply keep searching and trying different things hoping that the next one will be “the one”.

q Outcome expectations have been linked to actual outcome in cases of chronic illness (source, source). In essence, our results are likely dependent on our outcome expectations.

Second, there appear to be several issues with seeking information on the internet. And this is particularly true when one attempts to find seborrheic dermatitis treatment information online. Some issues include:

1. Uneducated and unproven ideas/methods can be presented as facts

2. Never ending supply of information can become difficult to comprehend

3. Actual medical research is hard to find and costs money to access4. Motives behind the presented information may simply be

commercial in nature5. Lots of contradictory information and advice

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The issues can then contribute to producing an information overload, which in-turn can lead to excessive levels of anxiety and stress (source).

So, by turning to the internet for a solution to your seborrheic dermatitis issues, you may actually create negative outcome expectations and introduce a source of chronic stress. This leads to degradation of the immune system and can drastically impact any potential results.

q The internet is an open place for exchange of ideas where anyone can basically write anything. The sort of openness that the internet offers in relation to the exchange of ideas can be both good and bad: Good because new ideas have the chance to be developed, discussed and spread; Bad because some of these ideas may be uneducated, misinformed, or purely deceptive in nature.

To minimize the negative effects of the internet (when seeking potential treatments) we must always be alert and question everything we read. By questioning the information we encounter we become more aware of what we actually retain. The following are some example questions you should always consider when you read something online:

p Why did the author share this information? p Does the information have any supporting research? p When was the information originally shared?

Asking questions like these allows us to filter out the majority of unreliable information and can relieve a large amount of stress and anxiety. Additionally, by reducing the amount of information we retain, we become more aware of our actions and take on greater responsibility for any potential results. This creates a sense of control and may also improve our outcome expectations.

q This book was created in an effort to accumulate and organize as much reliable information regarding seborrheic dermatitis as possible. Hopefully providing readers with the right mix of education and suggestions for approaches to long-term treatment.

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Proposition for Improving Sebum Composition and Skin Barrier Function

Finding studies which actually make concrete suggestions on how to improve sebum quality is fairly difficult. Much of this section is primarily a hypothesis, however, a great deal of research has gone into the ideas behind the proposed approach.

In essence, to improve sebum quality I believe that we must provide the following things:

o Adequate physical activity o Adequate nutrition o Improved state of well-being

Sorry for such broad recommendations, but sometimes people need to be reminded that the simple things are often the most effective. And these 3 have long been demonstrated to improve overall immunity and improve a wide range of bodily functions.

Physical Activity

The first suggestions is fairly straightforward. It doesn’t necessarily mean you need quality time at the gym or even to go on extensive runs. It simply implies that we should all constantly attempt to stay active throughout the day. When working on the computer, watching TV, long periods of driving, or anything else that requires you to remain seated, try to take short breaks whenever possible and move around. Staying seated for long periods of time is one of the worst things you can do to your health and your immunity (source).

! Busy with work? No problem, just go to the washroom, take the long route and maybe do some squats in the privacy of the washroom.

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Adequate Nutrition

Nutrition is an extensive subject with a large amount of information, which can at times be contradictory and incorrect. Particularly, the freedom of the internet has allowed uneducated individuals from offering health and nutrition advice. In fact, much of the information found online often offers no scientific basis or explanation. Instead it simply states whatever information being presented as true, which can pose a significant threat to the health of a large number of individuals, who treat this advice as the absolute truth. Why such a long ramble? Well, because this advice is simply a summary of my own findings and isn’t necessarily backed by strong scientific evidence in relation to improving sebum composition or lipid metabolism.

Nevertheless, I strongly believe the following nutritional items are essential to improving your sebum composition and the overall lipid metabolism in humans:

• Reducing consumption of Omega 6 fatty acids (primarily vegetable oils and vegetable oil containing products)

• Increasing consumption of Vitamin A containing vegetables (sweet potatoes, carrots, pumpkin, etc.)

• Increasing consumption of vitamin E containing foods (eggs, fish, lettuce, etc.)

• Eating foods relative to ancestral needs (discussed in greater detail further)

q Vitamin A is a relatively heat stable vitamin. Baking and grilling vitamin A containing vegetables will have a minimal effect on vitamin loss.

q Dietary cholesterol does not necessarily increase bad cholesterol levels as the majority of individuals believe. (source)

Improved State of Well-Being

Your state of well-being may be defined by the amount of positive

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thoughts, level of stress and general pleasure obtained from life(source for definition?). The biggest issue is that any skin disease, particularly on visible areas of the skin, can have a strong effect on the amount of pleasure you are able to obtain from life. At times, the skin condition can take over your thought process and drive individuals to become strongly introverted and greatly depressed. This in turn, further degrades the immune system and prevents the immune system from achieving a state powerful enough to reverse the skin condition.

As discussed previously, acute (short term) stress is very different from chronic (long-term) stress. Countless studies show that acute stress may actually improve immune function, while chronic stress is detrimental to immune function (source, source, source). This, I believe, occurs because of the constant resource drain resulting from an increased demand of the immune system to actually cope with the on-going stress being created by the mind and body. This can only be sustained for so long, and - once the demand surpasses supply - immune system degradation results.

There are strategies, I believe, which can be extremely beneficial for ending this vicious cycle. These include:

• Create a support network (friends, family, online communities, etc.)

• Use classical conditioning to re-train your reactions (will be discussed in further detail later in this section)

• Avoid over-reliance on the internet for medical and life advice (the internet is full of wrong and potentially harmful information, an overabundance of contradictory and confusing information can create large amounts of stress)

• Learn to understand the demands of your own body (will be discussed in further detail later in this section)

q The thing that had the biggest impact on the way I approach life is simply learning to “stay in the moment”. Simply take life as it comes and stop worrying about what might and might not happen in the future. Obviously don’t stop planning ahead, but focus the majority of your mental

efforts on taking full advantage of the present.

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Goals Towards Being Seborrheic Dermatitis Free

So far, the book has tried to provide as much relevant information as possible. This final section will try to actually present a number of specific takeaways from the discussed information for easier reference in the future. These takeaways will be referred to as “goals” and each of these will be discussed in brief detail here.

q Any steps taken towards the achievement of each goal is a step closer to regaining control of your skin.

For reference, these goals are:

o Improve immune system o Reduce sebum production o Shift omega ratio o Improve lipid metabolism o Stabilize sebum composition o Learn to cope with stress o Reduce environmental irritants o Stop relying on the internet for information o Eat what your genes are designed to eat o Prevent blood sugar spikes o Reduce topical microbial activity

q Following these recommendations will likely aid the majority of people dealing with seborrheic dermatitis issues. However, some individuals may have specific health conditions, which are preventing their immune system from regaining control. For this reason, if you are unable to obtain any results from following the rules discussed in this section, it is highly advisable to seek the help of a good medical professional and undergo full medical examination.

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Improve Immune Function

Improving immunity is an immensely far reaching rule. Many of the aspects of improving immunity have already been discussed. Without going into too much detail the following things appear to be some of the most critical to regaining control of the immune system and restoring its balance:

• Obtain adequate nutrition from diet

• Maintain adequate amounts of physical activity and exercise

• Reduce levels of chronic stress by learning to cope and/or avoid it

• Incorporate as much vegetables into your diet as possible

• Reduce consumption of red meat

• Increase consumption of quality seafood

These are general suggestions, but all-in-all you shouldn’t overthink things in this area. Just try to do as much good things for your body as possible, without worrying too much about them. If we worry and stress too much about our immune system, there is a chance we may be introducing a source of chronic stress into our lives.

In addition to the general recommendations above, I am strongly convinced that foods rich in the following micro-nutrients hold great potential for improving immune function:

• Vitamin A

• Vitamin E

• Omega 3s

• Selenium

• Zinc

Even though specific foods may provide an excellent source of these micro-nutrients, it may be wise to actually pick the foods you enjoy. By eating the foods you actually enjoy you build a dietary approach that will actually withstand the test of time. The aim is to shift your diet into

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one that is healthy, stress-free and sustainable. Not to force yourself to eat foods you don’t like.

Reduce Sebum Production

Many factors play into determining the level of sebum that our skin produces. The ones that appear to have the clearest impact include:

• Drastic changes in blood sugar levels (high glycemic load)

• Retinoids (Vitamin A) (source)

• Hormones (Androgens, Estrogens IGF and Growth Hormone) (source)

• Dairy consumption (due to effect on IGF production) (source)

To improve blood sugar control you simply need to be more consistent in food portions and intake frequency. Additionally, try not to binge on sugar or overeat as these can cause intense spikes in blood sugar. If you do overeat or binge a little here and there, don’t stress about it, it’s normal for us to break the rules once in awhile.

Increasing retinoids may be as simple as eating more Vitamin A containing foods. The best part is that the foods may not only help control sebum, but have also been documented to impact the functioning of hormones (source) and overall immune function (source).

The third (hormones) can be a little trickier to control and may simply be dependent on the state of your general well-being and other factors potentially outside of your control. One of the best things to keep hormones in-check is to simply try to balance your mental state and levels of stress you associate with everyday life.

Shift Omega Ratio

The Omega 3s have been discussed in great detail in this book. This is because they appear to have such a critical role in overall immune

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function, levels of inflammation in our bodies, levels of depression (source), and in the production of hormones related to carbohydrate and lipids metabolism (source). And to get the maximum benefit from Omega 3s, we also need to minimize our intake of Omega 6s as they can compete with each other for usage throughout the body.

q Eating seafood appears to be the most optimal way of obtaining good quality Omega 3s as it is also usually an excellent source of selenium, vitamin E, vitamin D, and protein. Plus incorporating seafood into your diet is likely to reduce the amount of red meat you consume. Fish oil supplements can only provide a portion of these benefits.

Improve Lipid Metabolism

The majority of research appears to indicate that a component of seborrheic dermatitis progression is related to the body’s ability to metabolize lipids. Thus, any attempts to improve the metabolism of lipids is likely to improve symptoms and potentially aid in reversing the condition. The following are some specific items which have been shown to directly improve lipid metabolism:

• Returning to traditional diet and lifestyle (source)

• Eating foods high in carotenoids, dietary fiber, and polyphenols (source, source)

• Reduce chronic stress and/or learn proper coping strategies (source)

• Improve dietary ratio of omega 3s to omega 6s (source)

• Obtain adequate amounts of physical activity (source)

Many of these points appear to be very similar to the goals discussed thus far. And any progress towards a single goal will likely also affect several other of the discussed goals.

q A significant amount of research studies are performed on rats/mice. These rodents demonstrate similar genetical and behavior characteristics to

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that of humans. Plus they’re inexpensive and have short reproduction cycles allowing for fairly large scale experiments to be carried out.

Stabilize Sebum Composition

Sebum secreted by the sebaceous glands plays an important role in the immunity and protection of our skin. It protects it from UV damage and moisture loss; delivers antioxidants where they are required; protects against friction; possesses anti-microbial activity; and can trigger or prevent inflammation (source, source). And as we discussed in the skin section of this book, its composition may directly impact the microbial community which resides on our skin and vice versa. In essence, without healthy sebum it becomes difficult to sustain healthy skin.

Finding actual research or medical advice dealing with specific tactics for improving sebum composition turned out to be rather difficult. Nevertheless, there are certain things which appear to have a direct impact on its composition, this includes:

• Dietary carbohydrate load (source, source)

• Hormones (source)

• Skin bioavailability of Vitamin E, carotenoids, polyphenols, vitamin C, zinc and selenium (dietary effectiveness will depend on absorption) (source)

• Levels of stress, anxiety and depression (source)

q The effect that each of these items is likely to depend on the relative initial state. For example, if you only have issues with vitamin E availability, but are good across all other points discussed, increasing its bioavailability will have the strongest impact on your skin health. Thus, it makes sense for each individual to try to analyze the areas in which the biggest improvements can be made.

In addition to these factors, the unique microbial communities which populate our skin also play a large role in determining the composition of our sebum. And this can makes things rather tricky, as any of our

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efforts to change the sebum composition from inside may be offset by the activity of the residing microbes. Topical solutions may be required in order to modify the composition of these communities, but providing specific recommendations in this area is rather difficult. This is because there are currently no guaranteed methods for topical modification of the microbiome in order to fully treat seborrheic dermatitis. And as discussed in the seborrheic dermatitis chapter, most of the medical solutions currently available are only partially effective. On the other hand, a combined approach (both internal and topical) is likely to yield the best results as the positive effects are compounded.

Learn To Cope With Stress

Stress has a huge impact on practically every aspect of our health. And as seen earlier it plays a large role specifically in many aspects of skin health. Regulating the amount of stress we experience in life and how we deal with any stress we encounter may hold tremendous value in reversing not only our skin issues, but also any other health issues we may be facing.

The biggest issue is that modern life makes it rather difficult to avoid stress altogether. The constant bombardment with media (movies, advertisements, music, etc.) which portrays life as a story that always has a happy ending, with beautiful actors and fascinating events throughout make everyday life seem boring and dull in comparison. This creates a gap between how we believe our lives should look like and what they actually do. Plus there are also life events which are unique to each and every one of us (divorce, loss of loved one, disability, etc.). For this reason, avoidance of stress is realistically impossible.

Instead, we should shift our focus on understanding that stress is only relative to our perception. For example, if we believe that the circumstances we live in are unfair and that we have somehow been cheated, then we create a situation in which we are unhappy with our current situation. This negative thought process may then affect many

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other attributes of our lives and push us towards depression. On the other hand, if we take life as it comes and simply accept our reality as something that we are blessed to even experience, we may prevent stress from surfacing in the first place.

Covering such a topic in the context of this book is rather difficult due to the sheer complexity of the topic. One thing that we can do is attempt to summarize some of the key points that are typically discussed in most self-help books which deal with stress. These points are:

• Learn to say no (be assertive)

• Eat a well-balanced diet (helps if you actually enjoy the food you eat)

• Avoid information overload

• Adequate physical activity

• Lower your expectations

• Learn to live in the moment

• Help others

q Helping others has a wide variety of physical and psychological benefits which can be of great benefit to you (source).

Think of this as just a starting point, though. Further reading will be very beneficial for improving your understanding of the subject. But in the end, overstressing stress is likely to simply fuel the fire. Perhaps, simply letting go of the topic is the best thing we can do.

q Think of stress as something that makes you stronger, not weaker. The worst thing we can do is give into stressful situations. Use the energy that stressful situations create in purposeful ways. This simple approach will provide a sense of empowerment and over time you will learn to feed off stress instead of being defeated by it. This only holds true for acute stress, though. If you experience chronic stress, you should look for a solution to the cause.

q Looking at your skin in the mirror while it isn’t looking too healthy is

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bound to create stress. Try not to avoid the mirror as much as realistically possible.

Reduce Environmental Irritants

When our epidermal barrier function is not performing as it’s supposed to, many harmless environmental elements may cause inflammation and irritation. As mentioned previously, this could include dust mites, demodex mites, and practically any other microbe or particle in the environment. At this point it becomes crucial to minimize the environmental irritants that come in contact with our skin, allowing the epidermal barrier function to recover.

To minimize the amount of things that might be affecting recovery the following things should be considered:

q Indoor air quality (particularly dust and moisture level) q Amount of times we touch our skin (try to minimize contact and

scratching) q The things we use on our skin (some products may be counter-

productive as they may be stripping away the barrier that our skin works so hard to create)

There are obviously many other factors which will influence the amount of stuff in each individual’s unique environment. The above are just some of the most obvious and widely applicable.

Stop Over-Relying On the Internet for Information

Think of the internet as a sort of Wild West of the age. This is because most the money people make online comes from advertising. This means that blogs, forums and other online information sources must constantly create content which attracts viewers. At first glance this seems like an innocent relationship, but upon further examination things are much different.

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Producing quality and well-researched content takes time, effort and a strong desire. The issue is that most content creators simply need to meet certain quotas. This causes the content creators to focus on a specific word count and not so much the quality. In turn, potentially misleading or incorrect information may be presented and discussed. If the effect was limited to just that single piece of content, this may not be that bad. The real problem is that once the content is online, other content creators may use it when creating their content without double-checking the presented information for accuracy. Now the original false/misleading piece of information gets recycled and spread.

The phenomenon described above is extremely common and happens every day. Even reputable newspapers have fallen victim to it. So how does a regular person protect themselves from false information? Well, to accomplish this we have two choices:

1. Completely stop relying on the information we find online2. Use rules of critical thinking discussed at the beginning of this

chapter to analyze all the information you encounter

Since the internet is such a convenient way to obtain information the first option is not very practical. The second option is clearly the only realistic method for approaching online information. This means that we simply need to be more aware of the stuff we read and always question the information presented to us. Look for facts, think about the writer’s intentions, and when seeking health related information make sure that there are at least some sort of studies or research papers used as references.

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q Some websites simply dump random links into the references section of their articles. Try to verify the references and see if they are actually relevant to the information being discussed.

Eat What Your Genes Are Designed To Eat

q This is less of a goal and more of a speculative approach to diet the I’ve personally found to be extremely effective for improving my health and helping me take control of my skin.

Evolution and genetics play a large role in determining various aspects of our bodies. This includes things such as your ideal body weight, your optimal cholesterol levels, your blood pressure, and practically everything else about each one of us that makes us unique. And as we discussed in the digestion section of this book, our guts are one of the most diverse components of our bodies. As a result of this uniqueness, I would like to present a new approach to diet. This approach moves away from the commonly prescribed methods of “eat this and not that” and moves towards one which may allow our bodies to function to their full capacity.

Firstly, you must consider what your ancestors likely consumed based on their geographic origins. What types of food did they eat, how did they prepare the foods, what proportions of macro-nutrients (fats, carbohydrates, and proteins) did they consume, how much did they eat and how often. Considering these questions instead of relying on what other people may think may help you uncover the type of dietary approach which is most suitable for your genes.

Secondly, we must consider how healthy our ancestors were. If they were unhealthy, it is very likely that they had likely migrated from the original place of origin and had made drastic modifications to their dietary intakes. In this case, we may be limited to the amount of benefit we may be able to obtain by following their diets and will need to look further up the family tree. If they were healthy, that means that their diets and lifestyle choices provided the perfect circumstances for

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their bodies to thrive and prosper. And it is the healthy models that we should try to mimic.

This idea of eating for your genes is not too far-fetched and recent research has actually shown huge potential for tailoring nutrition based on our genetic makeup to prevent disease and illness (source, source). Obviously, trying to achieve perfection through our own deduction may not be the most scientific approach, but it is likely more beneficial than relying on the opinions of unrelated individuals.

q Try to aim for food choices which your ancestors are likely to have eaten based on geographic origin. Our gut microbiomes are better optimized for the breakdown and absorption of specific foods (source)

Another related item to think about is the sheer amount of dietary information found online. For example, think of all the potential suggestions that can be found online:

• Avoid histamine containing foods

• Avoid salicylate containing foods

• Eat a high fat diet

• Eat a low fat diet

• We should avoid carbohydrates

• Our diet should consist mainly of carbohydrates

And this list can go on and on. Eventually, we no longer know what is right and what is wrong. And this can create a ton of internal anxiety as we constantly stress about what we eat. This is obviously a flawed approach to food. We shouldn’t be stressing about food, but instead we should enjoy and savor everything we consume.

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q The industrial age has brought about drastic changes when it comes to food which is available for consumption in the western world. A significant amount of food we now eat has been genetically engineered or formulated to stimulate our tastes buds causing us to crave more. These are not the types of foods that we should be enjoying, instead we should go back to whole foods and learn to love their unique and endless assortment of flavors.

Reduce Topical Microbial Activity

This last goal is one that is probably the most directly related to actually eliminating seborrheic dermatitis symptoms. As discussed throughout this book, the direct activity of the malassezia fungi on our skin’s surface is the most widely accepted source of seborrheic dermatitis symptoms. This means that even if we disregard all the other goals discussed so far and strictly focus on reducing malassezia activity we are likely to obtain quick and very noticeable results.

As we discussed in greater detail in the seborrheic dermatitis chapter, anti-fungal solutions are the most common approach in this area. These solutions are widely prescribed by dermatologists for the treatment of seborrheic dermatitis. The only issue is that most of these solutions appear to only provide results for relatively short periods of time. The good news is that there appear to be many new potentially viable alternatives on the horizon. This includes things such as anti-microbial peptides, anti-microbial fatty acids, and even the usage of topical probiotics, but these solutions are relatively new and are not yet widely accepted.

In addition, to actually reduce microbial activity with the usage of topical solutions, we must not forget that many of the goals discussed here also directly contribute to reducing malassezia activity. This includes:

• Reducing sebum production restricts the amount of oils that the malassezia have available for consumption

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• Improving sebum composition should directly influence it’s anti-microbial potential and aid in preventing excessive malassezia colonization

• Improving lipid metabolism should improve sebum composition

• Improving immune function will directly impact the skin’s ability to defend against malassezia

• Reduced levels of stress have been correlated with improved production of anti-microbial peptides on the skin surface

Thus, the compounded effect of both a topical and internal approach are likely to drastically improve results obtained. The topical will provide the initial relief we desire, but only the internal approach can secure long-term results and reduce our dependence on topical control.

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Actionable Steps to Take Based On Discussed Goals

Many of the goals discussed overlap and many of the steps towards a single goal are also steps towards achieving the others. To make implementation of these steps easier, here is an actionable list of things that we can do (compiling the lessons from the sections discussed above):

o Reduce levels of stress and learn to cope with stress o Improve the ratio of omega 3s to omega 6s that we consume o Be cautious when it comes to obtaining medical information on-

line o Eat a well-balanced healthy diet that you feel comfortable with o Ensure you get enough physical activity every single day o Improve indoor air quality, keep home free from dust and change

bed sheets regularly o Stop touching your skin o Eat lots of vegetables and fruits (find ones you love most) o Learn which carbohydrates your body loves most (based on per-

sonal opinion) o Eat nutritious foods and try to ditch processed foods

q The points discussed above are mainly a repetition and summary of previous sections.

This list can keep going on and on, but I think this would be counterproductive. The book has covered a ton of information, but since we are all unique each one of us must determine the items most applicable to them. Follow your intuition and simply go with what feels right. I truly believe that our mind and is much more powerful than we think. Simply allowing our mind to take in this information and letting our unconscious thought process take over may be the best thing we can do.

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The Author’s Approach to Obtaining Clear Skin

So far throughout the book I’ve tried to take a back seat and let the research drive the direction of the writing. This has allowed me to discover a great deal about my own skin issues and has allowed to fully recover from seborrheic dermatitis. This section is a summary of the approach I have taken to becoming seborrheic dermatitis free. Before reading ahead please be aware that this is my own unique experience and should be used only as a starting point.

After seeing countless dermatologists, the majority local clinics in my area, seeing a handful of naturopaths and alternative healthcare practitioners, and basically read all that I could find on the subject online nothing seemed to be providing a long-term solution. The seborrheic dermatitis that had affected original only the right side of my nose had spread to cover a significant portion of my face and everything I had tried was only effective for short periods of time. It seemed that once I found something that would control the thing, it would only return several weeks later with greater intensity. It felt like I was doomed, but I kept pushing on.

q At some point in my journey I decided to start documenting my experience online in the form of a blog. As this blog grew, my thirst for finding a cure grew as well.

Then one day by sheer luck I bumped into a pediatrician who noticed my skin condition and said that she had battled against the same thing. Her recommendation was clear and for some reason resonated extremely well with me. Basically she told me two things:

q Try a product by the name of Cetaphil Restoraderm q Stop reading online information, try to forget everything I’ve

learned and simply stop worrying about it

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At first I kind of brushed her recommendations off, but for some reason her words really stuck in my mind. Then one day I woke up and finally decided to give her advice a try. I ceased searching the internet and simply started washing and moisturizing my face with the Cetaphil Restoraderm products. As the days went on my skin got better and better. Days turned into weeks and the results continued. You can’t imagine the relief it brought. All that information I had picked up online about diet, candida, gluten and everything else went right out the window. I was eating normal food, I had normal skin and I felt like a normal person. Could it really be that such a simple approach can be more effective than everything I had attempted in this past? Honestly it felt like it was too good to be true and I couldn’t believe it.

q At about the same time as I strated using Restoraderm I had also decided to supplement with l-glutamine. I felt this amino acid, which is believed to improve intestinal permeability, gave me enough confidence to forget about dietary restrictions and just eat whatever I wanted to.

I shared the good news on my blog and many people reported similar results from following this approach. But one day a woman left a comment saying that she used a similar approach for a year, but then it stopped working and the skin issues returned. So even though my skin remained clear, I became concerned that my issues may one day also return. However, I wasn’t going to go back to searching the internet for a cure. Instead I decided to focus on compiling medical research on the subject and actually learn how the disease progresses at its most fundamental level. This led to me learning about various subject of health, immunity and the microbial world. The information that was accumulated out of this research has served as the foundation of this book.

In addition to the knowledge I had been accumulating, I had also been trying to understand why the Restoraderm was so effective. I studied the patents behind it, reviewed each individual ingredient and learned how to formulate my own solutions. And the timing of all of this couldn’t have been better. As I was trying to replicate the formula of the

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Restoraderm, my seborrheic dermatitis started to reappear. This was unfortunate, but gave me the opportunity to actually test my ideas and formulations.

What came out of this testing is an approach that has not only solved my skin issues, but has improved practically all other aspects of my health. Without going into too much detail, this is what I currently do:

o Almost never rely on Google for dietary and nutritional advice (particularly blogs, forums, and social networks)

o Only wash my face with water and the formulation I had created (Biom8)

o Avoid closely examining my face in the mirror o Take life as it comes and try not to overthink things (have created

my own strategy with the usage of classical condition) o Find strategies for dealing with stress and anxiety (implementing

classical conditioning to change your body’s reactions to situa-tions)

o Eat lots of vegetables, seafood, carbohydrates, eggs and various season produce. Some of my favorites:

• Cabbage, broccoli, cauliflower

• Carrots (try to eat at least one raw carrot a day)

• Sweet potatoes, yams, and regular potatoes

• Bread and various wheat products (reduce when consuming other carbohydrates)

• Fresh salmon, trout, calamari and various fish eggs (main source of protein)

• Organic chicken eggs (one of my main sources of protein)

• Apples (typically several apples a day)

• Celery

• Plus whatever vegetables which are in season

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o Drastically reduced my consumption of:

• Vegetable oils and packaged foods

• Red meats (small portions of organic quality meat are way better then large portions of the meat of unhealthy animals)

• Nuts and seeds (never really liked them much, but ate them because everyone said they are healthy)

• Majority of superfoods (was eating these not because I liked them, but because of how good they were supposed to be)

Overall the strategy was partially based on intuition and partially on the information I had accumulated. It’s easy to follow, requires little mental effort, has allowed me to enjoy life and drastically changed my outlook on health. The biggest things that I think have made the difference are specifically:

� Changing my omega ratio � Learning to love the food I eat � Removing stress and going back to living life � Using my own formulation which I feel comfortable with � Ditching toxic ideas and thoughts

There are likely many small things that I haven’t included in this list, but this is on purpose. The main idea I really want to communicate is that only you are able to take control of your own health. And in order to do so, it may be wise to stop relying on the advice of others and instead dig deep and learn as much as we can about ourselves.

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Things to Expect in Future Editions

The book you have just read is the first edition. Even though the topic has so far been covered in great detail, I still strongly believe that there is always room for improvement. The second edition is planned to include several new sections:

o Understanding Stress (a complete chapter on dealing with stress) o Complete Guide to Supplements for Seborrheic Dermatitis o The Role of Antioxidants in Immunity and Health o A Compilation of Success Stories from SkinDrone.com o Simple Recipes and Tips for Eating Healthy on a Budget

And various other improvements:

� Images and diagrams to simplify complex topics � Readers’ comments when relevant � General improvements based on community feedback

q All future editions of the book will be made available for free to anyone who has purchased the first edition of this book.

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A BibliographyResearch Papers Used

q The digital version of this book has direct links to sources used throughout the text. The bibliography section is here for reference only. This section will be organized and properly cited throughout the book prior to going to print.

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SEBORRHEIC DERMATITIS THE OWNERS MANUAL

This book is dedicated to all those who have had to face seborrheic dermatitis in their lifetimes.

It is my hope that the knowledge contained within this book can help you overcome your skin condition and live

life to your fullest potential.

Micheal Anders

SkinDrone