Jacinta: So, as you mentioned in my little bio, so, I used to previously work for a company that was a supplement company, and also a functional testing. So, I was really working in the space of education for quite a period of time. And with that involved me training a lot of different skin therapists around the benefits of essential fatty acids, and how it can support their clients to be able to make the topicals halfway, and to really work on the internal drivers of a lot of, most of the time, acne.

And it really helped me to find my niche of an area that I wanted to really delve into in clinic, because I could just see that they could really only get to the skin so far with the type of treatments that they did. And their clients really require that internal support, and they just weren’t feeling supported by finding a long-term solution with being given prescriptions of the pill, or doxycycline or Roaccutane, and they really wanted to find a long-term approach. And essentially, from there, it’s, the whole of Orenda started because I was educating so many skin therapists about how they can support their clients. But they did just need somewhere to go, to have someone else to really delve into all the internals with them.

Amie: And I think that’s one of the challenging things, because one of the blessings of, you know, a skin issue, if I can call it this, is it’s an organ that we can actually topically apply things to, which means we can support our skin in additional ways that we perhaps can’t do topically to our liver, for example. But I do find, you know, in the general public, most people end up pursuing topical treatments over and over again, thinking the holy grail lies in a certain cream or a certain serum or a certain treatment, when, you know, chronic skin conditions are a sign of chronic dysfunction internally, and so, the naturopathic approach is always to find those root causes, and to address them.

That being said, towards the end of our conversation today, I do intend to talk to you about topical support, because it is one of those unique aspects of health, where we can use a combination approach, and enhance each of those things as well. But, looking into the internal causes, I know that taking a long-term approach is certainly what you’re very passionate about. And when I say long-term approach, I also don’t want people to hear it takes a long time to fix. Certainly, that can be true for certain patients. But what I mean by that is the approach that Jacinta crafts is one that sets people up for good skin for life. Meaning, it’s not, like, a symptomatic fix or a quick clean-up with antibiotics, or, you know, something that temporarily shifts the state of the skin, only for it to return to its default, because the underlying drivers weren’t actually addressed. And I think, you know, again, allopathically speaking, for convenience, you know, things get pigeonholed, and therefore if it looks like this, you give this particular medication but when it comes to, you know, functional and root-cause medicine, you might have 10 acne clients, and each one of them has a different prescription, lifestyle, nutrition, and, you know, supplement-wise. And so, I’d love to hear from you your reflections on why there isn’t a blanket treatment for acne, and why, you know, different patients can present so differently?

Jacinta: Absolutely. Well, I think with that, it’s probably good to delve into what we define as acne, and the causes of acne, because it’s really the causes of acne, and once we truly understand that, we then know why there’s no blanket treatment, and why it’s so different for every individual. So, the way that we essentially define acne, it’s an infection of the pilosebaceous unit, and it’s driven by excess proliferation of C. acnes bacteria. And essentially, that’s because there’s a blockage in oxygen into the hair follicle, which then creates the environment for the C. acnes bacteria to proliferate. So, essentially, when we’re looking at our individual acne clients, we need to look at the three main causes of what allows the blockage of the oxygen flow into the hair follicle, and each individual can then be different with the causes of what could be driving that pathophysiology, to start off with.

So, one of the main causes, so, we’ll break it down into the three causes of what blocks the oxygen flow into the hair follicle. One of them is retention keratosis, and that’s essentially where we get the thickening of the stratum corneum. And that’s that outer layer of the skin, and that blocks the hair follicle, the oxygen flow into the hair follicle. And that can be driven by, from an internal perspective, dehydration of the skin, which includes things like lacking essential fatty acids. So, if the skin and the stratum corneum doesn’t have enough essential fatty acids, then it’ll cause, basically, like, a buildup of these skin cells on the top of the surface, that stops the oxygen flow to come into the hair follicle. But then we also think of other naturopathic reasons that would cause retention keratosis, like thyroid dysfunction, because an underactive thyroid would cause sluggish desquamation of the skin. So, again, you get that dryness, the buildup of the stratum corneum, and again, we then get this blockage of oxygen flow into the hair follicle as well. For other people, can also be a vitamin A deficiency as well. And that’s where, even just in that one cause, you can see that it’s so different person to person, because not everyone has a thyroid issue, but there might be some that have a thyroid issue, and their symptom is they present with acne.

And then we have another cause. Our second cause is either hypersebum secretion, so, excess sebum production, or we have an increase in the sebum viscosity. Now, when we’re thinking of hypersebum secretion, this is that classic kind of picture, where everyone’s like, “acne is driven by excess androgens, because androgens are what cause excess sebum production,” or they control the sebum production in the sebaceous gland. But the sebaceous glands also react to things like, well, testosterone, DHEA, cortisol as well, and also histamine. So, when we’re thinking about the reason that our clients might be presenting with hypersebum secretion, it may not be testosterone and DHEA. It could also be cortisol because they’re stressed. And just because they’re stressed doesn’t mean that they’ve got excess testosterone and excess DHEA. And then we think about the sebum viscosity. And this is one that we do see in a lot of acne clients, which is where the sebum viscosity is quite thick and it’s congested. And that’s because they’re lacking essential fatty acids. And we can see that there’s either that excess omega 6 in the diet, or that lacking of omega 3. So, even within that, again, the root cause of acne can be so different person to person, because you can have clients that have low androgens. Their testosterone is bottoming out. Their DHEA is so low. But then we see them present with acne, and it doesn’t necessarily mean that they’re getting this hypersebum secretion because their androgens are high. They could be very stressed, and it’s the cortisol that’s causing their sebum to be excessively produced.

And then, our final cause we have is the pH balance, And that’s where the skin pH in the acid mantle, which is the outer layer, that protects the, it’s essentially the skin barrier function. That pH is so tightly regulated, in order to protect the skin, and it has certain antimicrobial peptide properties, that are really important to try to prevent acne, and essentially, the pH balance, that can be drastically impacted by the type of topical products that clients are using. So, everything from their cleansers, their moisturizers, their serums, their SPF as well. But the pH balance of the skin can also be impacted by the gut microbiome. Just like we know that the gut microbiome pH can be impacted by the types of short chain fatty acids that are produced within the gut, it’s very similar with the skin, that the skin pH can then be influenced by both the gut microbiome and the skin microbiome. So, that’s essentially why, in a nutshell, that when we’re looking at different causes of acne, no true cases are ever the same, because you can even see, with the definition of acne, the complexity of all the potential drivers, and how no two clients have the same exact hormone history, the exact same blood sugar issues, the exact same diet, and you’ve gotta treat them based on the individual you’re seeing in front of you.

Amie: And it just, you know, it’s such a domino effect, when we’re looking at the cause of the cause, also. You know, just thinking about retention keratosis and vitamin A deficiency, obviously, we’ve gotta consider, you know, what’s their retinol intake, or vitamin A intake, because beta carotene conversion’s pretty low. I personally, in clinic, have seen, you know, high amounts of SNPs for BCMO1, meaning the conversion of beta carotene to vitamin A is even lower than 1.5%, which is on average what gen pop will have. But further to that, zinc deficiency is incredibly common, and you need zinc for retinal binding protein, to distribute vitamin A around the body, and therefore even if you’re consuming sufficient vitamin A, zinc deficiency will have your skin remain vitamin A deficient, and fail to desquamate properly, and, you know, there’s just such a flow-on effect, you know, with pH balance and antimicrobial peptides being produced at the skin. You know, a vitamin D deficiency alone will do that, and we know that more than half of Australians are vitamin D deficient at any time of the year. So…

Jacinta: Mm-hmm. That’s exactly right.

Amie: …yeah, I think… Yeah, and it’s so important, you know, and again, essential fatty acids, if anyone’s listening to this who is maybe struggling with their skin, and like, “Oh, but I take essential fatty acids,” you know, are you digesting and absorbing them properly? Are they in the right ratio? Are you taking omega 3 in plant form, because alpha linoleic acid is not the same as EPA and DHA from fish oil, or, even though they remain in the same family. So, yeah, I certainly think, you know, that’s just even just scratching the surface, ultimately, of what’s behind someone’s skin presentation, but I think really serves to explain why there’s not a cookie-cutter approach that practitioners can take. And that’s also why, if someone is struggling with acne and they try something that worked for someone, it might not necessarily work for them, because it’s not working on the drivers that they actually have.

Jacinta: Yeah. That’s exactly right. I see that so often in clinic. We see such an influx of, you know, new clients that will say, well, you know, “I’ve been trying this supplement that’s been advertised for acne, and it’s not working,” or, like, “I’ve heard Vitex is really great for acne, and it’s flared my skin,” or, you know, you hear so many different things, but then you’ll hear the next person say “Vitex worked incredibly well for my skin.” And that’s where you can’t say this is the only herb you can use for premenstrual breakouts, and this is the only thing you could use for the lymphatics, or anything like, that because everyone is gonna respond so differently, based on their own individual cause. And that’s where I think it’s so important as a practitioner. We really have to understand their timeline of the client’s skin, the things that they have done, they haven’t done, what it responds best to, what it doesn’t respond to at all. And also couple that with things like, you know, you’re testing to see your hormones, so you’re not guessing, because I think that’s a really important thing. You can’t guess a person’s hormonal status unless you actually see what’s going on with the bloods.

Amie: Yes. Yes. Oh, my gosh. This is such a good segue into my next question for you, because when we’re looking at those root causes, like, so much of what we’ve already mentioned can be tested, either directly or indirectly. Certainly, there is a time and a place for hormone testing, assuming you’re testing for the right thing at the right time of the cycle, to be able to actually interpret those levels properly. But I also know from my own clinical experience, and also our chat, is that there’s a lot you can also glean from basic pathology blood testing as well. So I’d love if you would take me through some of the general bloods you might run, and what you’re looking for when you do that.

Jacinta: Mm-hmm. Yep. [inaudible 00:14:58] Exactly. So, essentially, when it comes to looking at the bloods, the main thing that we wanna try to do is rule in or out potential pathology like PCOS, for example, because we know a lot of individuals that have PCOS, they also have acne. And a lot of clients that will come to us, they’re coming with a suspicion that they think they have PCOS, because of how they’re presenting. So, when we’re doing the bloods, we’re really trying to find a specific hormonal profile that either rules in or rules out of diagnosis for PCOS, or we’re trying to find a particular imbalance with the connection between the brain and the ovaries that can signal the areas that we need to optimize with their diet and their lifestyle, and determine what types of herbal interventions that you need to use as well. But basically, we’re always running a hormonal profile pretty much on every single one of our clients that come with acne, because we wanna rule in or out that it’s, you know, their hormones that are impacting it. We generally always do day two or day three testing, where we would be doing things like FSH, LH, estrogen, your prolactin, testosterone, DHEA, SHBG. And then we’re also looking, in some cases, that post-ovulation estrogen and progesterone ratio. And I genuinely do that in some of my clients that may also be presenting with a little bit more PMS, or maybe they’ve got a bit of an endo or adenomyosis kind of history, as well as acne, so you can see what’s going on post-ovulation.

And the main things that we’re trying to look out for in that day two or day three testing is, first, the ratio of the FSH and their LH, because that can give us an indication if there is some kind of other blood sugar dysregulation that’s associated with PCOS, and if there’s that imbalance there, if there’s something there that’s connected to the androgen profile as well. We then also like to take into consideration things like the SHBG, because the SHBG is a really great indicator if there is excess estrogen, but is actually so important when we’re trying to potentially rule out cases, or rule in, where the client actually may be undereating, and maybe it’s actually insufficient nutrient intake, or dietary intake in general, that’s impacting their skin. So, even in their hormonal profiles, we can see if a client isn’t eating enough food, and if that’s impacting their skin, because you can see a classic low-estrogen, low-testosterone, high-SHBG kind of profile, or low LH, low FSH. And that kind of profile, you know you’re treating that client so differently to, say, a classic PCOS kind of case. And that client is so…it’s, the treatment plan’s really supposed to be focused on really rebuilding their system and supporting their adrenals, supporting their reproductive system, giving them enough food in their diet, making sure they’re eating enough, they’re not skipping meals, they’re not running off caffeine. And then, also making sure they’re coupling that with rest, and they’re not overtraining. And that’s the beauty of the hormone test, because it can be so easy for clients to think, “Okay, well, I’ve got breakouts in my skin and my cycle’s irregular. I must have PCOS,” or “I need to train more, and I need to eat very low carbohydrate.” But if that’s not the right profile for that type of client, they’re actually really negatively impacting their hormones in that regard. So, we look for similar patterns, like, basically, trying to create a story with your hormones. That’s what we’re trying to do, so we can see how does this match the type of diet or lifestyle you’re currently living, and what do we need to then change to support that profile.

The other things that we generally look at as well is of course, beyond the hormones, we’re always looking at nutritional status, like your iron, your B12, your folate, your vitamin D, because especially when we’re thinking about iron, that’s so important for building collagen, which we need for skin repair. So, for those clients that have skin cell turnover, and that’s the same as investigating their zinc as well. And just like we all know as naturopaths, when you find specific things in the bloods, it can lead you down other areas that you may not have thought of before. Like, if you can see severe iron and B12 issues, you’re thinking, is there maybe something going on in terms of absorption in the gut? Is there a digestive pathology that has been completely overlooked, that maybe they have undiagnosed celiac disease, which I can tell you I’ve seen so many times in clients, that they’ve got an undiagnosed celiac disease, and that’s the cause of their acne. And their hormones are actually fine. You can just see it in their nutritional profile and their digestive symptoms as well.

Amie: Mm-hmm. And if someone’s looking at their bloods while they’re listening to this, going, “Hm,” what are they looking for, as far as, FSH/LH ratio, and where do you like to see SHBG sitting, to kind of say that’s not an issue. Like, what is your framework there?

Jacinta: Yep. It’s really dependent, because I often like to look at them all in relation to each other. But essentially, the thing is, with FSH and LH, I generally, rather than saying, like, I specifically want to see it in this exact ratio, because sometimes it’s really difficult to get it that exact, I generally just don’t like to see the LH sit higher than the FSH. So, as long as it’s sitting below the FSH, even if you can see it’s kind of sitting one-to-one with FSH, that’s not ideal. And we generally like to see the FSH sit below the 7 to 8 mark on that day two or day three. And with your estrogen, it’s really…on day two or day three, ideally, we’d like to see it between, like, 120 to 160, but that can also really vary. Like, I’ve seen some clients that have had an estrogen that sits at 110, and it’s not a massive issue. You’ve just gotta take it into consideration with their testosterone levels and their SHBG as well. But in saying that, with testosterone, that’s a massive one because, I could tell you now, the amount of clients that I’ve seen with testosterone that sits above the reference range, it’s probably, like, less than five clients in total that I’ve seen that actually have testosterone that sits above the conventional reference range. And generally, I see testosterone that sits at 1.0 to be problematic for clients that have acne. And there can be such a difference between, you know, 0.7 to a 1.0. You can actually have clients that have testosterone at 0.7, this, their, you know… Yeah. It’s not androgen-dominant, for example, but then it sits at 1.0, and we can see that’s a problem for them. And that’s because we’re taking into consideration some of those other markers, like the DHEA and the estrogen levels as well.

Amie: Yes. Of course. And SHBG, in terms of when you would think, “Oh, this person’s undereating, or over-exercising, or just running themselves ragged,” where do you start to get concerned on what you see?

Jacinta: Yeah. Generally, if we see it above, like, that 90 to 100 mark, we’re seeing that as a bit of a flag for our clients.

Amie: Okay. Red flag. Yeah.

Jacinta: Yeah.

Amie: So, from what you’re saying, there is so much that can be gleaned from just standard blood tests. I’m curious to know, like, when we zoom out and think about all of the ways in which we can assess someone’s hormonal balance, I’m a big fan personally of basal temperature tracking. I can see so much, based on when the thermal shift happens, the length of the cycle, all of those kinds of things. In the past, I’ve done a bit of salivary hormonal profile testing. I also have clients that come to me with urinary, not necessarily estrogen metabolites for, like, elimination, but maybe a bit more of a broader profile. But all of these things add up, either in the time it takes to track them, whether it’s, you know, basal temperature tracking, or ordering specialized functional pathology, and, you know, just in our brief conversation about what you can pick up from just a day three hormonal panel, progesterone excluded, you can tell an awful lot on basic blood testing if you know what you’re looking for and you’re testing it at the right time. And how often would you then go on to, you know, functional, fancy functional testing, or secondary testing, or maybe a better question is to ask how many clients can you just simply proceed with based on just normal standard blood pathology alone?

Jacinta: Yep. I could tell you now I haven’t run any other formal hormone testing for a very, very long time. When you really understand bloods, and you know how to interpret them, you understand the role of FSH and LH, and how that impacts the reproductive system and the connections between prolactin and androgens and thyroid function, and all that that comes into it. You can get so much from your bloods. I’ve never done… Well, I haven’t done for a very long time, actually, like, any form of urine hormone testing. And the reason is is because I generally find, like, one, I can get enough through bloods. But two, I don’t particularly find that it gives me any additional information that I wouldn’t be able to be able to detect from a blood panel. If you’re trying to look at things like your estrogen detoxification capacity, that post-ovulation estrogen and progesterone ratio, via blood, I tend to find, can be enough. And if you have an extreme estrogen-dominant case, you see it in the SHBG. The SHBG’s often well above the range, in clients that you can see that that’s actually a problem for them.

So, I generally don’t find it adds any extra value, and I absolutely agree with what you were saying about the cost, because especially when you’ve got clients that are coming to you that have had acne, on average, I think most people spend about $6,000 a year on acne treatments, if they have acne. And we’ve gotta consider that those same clients that are seeing us, they’re already either seeing a dermatologist or a dermal clinician or a skin therapist, and they’re spending $400 to $500 every five to six weeks on a facial, or a new range or, like, a change in their skincare prescription. So, if we can also meet the client halfway, especially with economic crisis at the moment, with, you know, clients not being able to maybe afford as much as they used to, we’re really gonna be cautious with where we’re thinking that we need to prioritize the testing. And I absolutely think that you can just do it with bloods. Even, our whole team at Orenda, every single practitioner that we have in the team when we onboard them, we all go through hormone training together. Like, I’ll go through, like, hormone assessment, and how to do it with them. And no one is doing urine testing for hormones.

Amie: So, Jacinta, you’ve mentioned PCOS a couple of times, and we’re gonna talk about diet in just a minute, but in terms of people assuming PCOS means that they need to go on a low-carb diet, or they necessarily have blood sugar or insulin problems, I think it’s important to point out there are different kinds of PCOS. Not all of them are related to insulin and blood sugar metabolism issues, but by the same token, you could have someone with acne who doesn’t have PCOS, but who does also have some sort of metabolic dysfunction there, where it comes to insulin sensitivity and blood sugar balance. Do you have any further insights on what we’re looking for when looking at blood sugar insulin, and determining if that’s an issue?

Jacinta: Yeah. Absolutely. So, one standard test that I always do for every client is a fasting glucose test, and generally, a fasting insulin as well. The reason being because we wanna be able to see if there is hyperinsulin secretion, and whether that might be associated with the cause of, let’s say, if there is an androgen-dominant acne, we wanna see is that stemming from too much, like, excessive insulin secretion. And generally what we’re looking for, ideally, we want the insulin to be less than 9, if it’s fasted. And if we’re looking at a fasting blood glucose, I find it gives me so much information. Ideally, we wanna fasting blood glucose around 4.6 to 5.0. Generally, anything from 5.0 plus is a flag that there’s something going on in terms of blood sugar regulation. And anything less than 4.6, I’m questioning if they’re actually eating enough food. And that’s where I’m also making sure that when I’m looking at a client’s test results, you gotta be so specific. Look at the time that they got the test, because they could have got that test in the afternoon, and they fasted all the way until two o’clock, and then that’s an inaccurate result. But also questioning, well, what time was the meal the night before, and what kind of meal did you eat the night before? Because if it was a night that they’ve had more sugar, then that could be an inaccurate reading, just based off the consumption of what they’ve eaten. Or if they didn’t eat enough the night before, is their fasting glucose just low because of that? That’s where I find the insulin doesn’t generally lie all that much.

But the fasting glucose can give us plenty of information. And in some clients that have PCOS, or that I can see that they’ve just got metabolic dysfunction, I generally get them to track their blood sugar response. I often get them to do, like, the blood sugar, the finger prick test, where they can, you know, do a fasting test in the morning, eat their breakfast, track their blood sugar two hours later, and continuously do that throughout the day, especially with those clients that I can see have a major blood sugar dysregulation issue, because I wanna actually see what is their body doing when they eat oats. Rather than just because the internet says you can’t eat oats if you’ve got blood sugar issues, I wanna see how your body actually handles oats when it’s coupled with a protein and a fat. Or I wanna see how your body handles potatoes with dinner, but potatoes with dinner, then you go for a walk, and let’s see how your body handles that. And I find that’s such an incredible clinical tool, because I’m not just giving my clients blanket treatments in terms of diet and lifestyle advice. You’re actually being able to tailor the advice according to the way that they live their life already, and then, and the factors that we can see it impacting their blood sugar, based on actual data.

Amie: Yes. I think that’s so important, because, you know, bio-individuality, we preach it, but sometimes, I think, clinically, you can fall back on protocols without thinking about how to apply that. I’ve got a couple of questions for you on that. In terms of monitoring blood sugar, you sort of mentioned the finger prick. Do you have a reason you prefer that over a CGM, or is it more just price, accessibility thing?

Jacinta: Yeah. So, I’m actually starting to move more over to doing the CGMs.

Amie: Okay.

Jacinta: I’ve personally, actually recently just did it over the summer, and I actually chose the Christmas period of time to do it, which was kind of fun, because obviously, lots of different foods. And the only reason I hadn’t up until that point was because I just thought it would be a barrier for me to confidently explain to my clients, “This is how we can use it.” This is how we can interpret the data if I hadn’t had the experience myself doing it. So, now that I have, then I can easily guide my clients through it. Whereas, I know with the…I know the ins and outs of the finger prick test, so it was more just…

Amie: Yes.

Jacinta: …being able to know that if a client had a question, I wasn’t stuck with how to respond to it. I knew exactly how they could…

Amie: Yeah.

Jacinta: …you know, navigate, but..

Amie: Yeah.

Jacinta: …when I did the CGM, recently, I actually, I have this in the finger prick test at my parents’ house, and I did the finger prick test at the exact same time that I’ve obviously had the CGM, so I could see the accuracy. And it was probably a 0.1 or 0.2 difference. So, it’s very close, in terms of, like, the accuracy of the CGM. So, I would absolutely still use the CGM with clients.

Amie: Yeah. Yeah, great.

Jacinta: It’s just that I haven’t done it just yet.

Amie: Yeah, yeah. Great. I mean, that makes perfect sense. You want to be, have that lived experience. So, if you can troubleshoot with them, you know, having actually done it yourself, and I think it’s nice to hear that given you’ve done it for so often already, using another method, that they dovetail really nicely in terms of data. One last question on the blood sugar thing, before we move on to diet, but you mentioned, obviously, low blood sugar potentially indicating undereating. What about low insulin? What’s your read on that?

Jacinta: Yeah. I generally see it as the same, as well. I often see, if clients have a low insulin reading, it’s that there’s no demand to have to increase insulin, because there’s low intake of the carbohydrates as well. So I kind of, I couple the both the same.

Amie: The same.

Jacinta: But I guess… Yeah. Yeah. And you can also see, in some other markers as well, if the clients are undereating as well. Like, in some cases, if you can see that there’s low blood sugar, low insulin, but a high cholesterol profile, you’re questioning, well, what’s going on here? Because we know that we can see high cholesterol even in in individuals that have anorexia.

Amie: Yes.

Jacinta: So, we have… And if you had that plus an elevated SHBG, you’ve got a whole story there, telling you that the client may not be eating enough food.

Amie: Yeah. Yeah. Brilliant. Well, speaking of food, I know, again, coming back to bio-individuality, that there might be some nuances for people as far as macronutrient, you know, ratios, micronutrient profiles, but can you walk us through what you find to be time and again applicable in acne patients, maybe more across the board than otherwise?

Jacinta: Yeah. Absolutely. I generally try to educate my clients on diet in three kind of categories. So, one is making sure that we’re actually correcting, like, nutritional deficiencies in the diet. So, making sure that they’re actually eating enough antioxidants and such to be able to support their skin, whilst also correcting deficiencies we can see in the bloods. And the reason that I go through that is, of course, because the skin is the last place to get our nutrients, and if we’re nutrient-deficient, our skin cells, every single day, they’re developing new DNA, and they’re growing, and they’re the skin cells we’re gonna see on the surface in six weeks’ time. So, if there’s insufficiencies in things like your B vitamins, vitamin A, your zinc, even calcium, that’s all gonna significantly impact the health and the function of that skin. So I’m often working with clients to try to increase diversity in the diet, and to make sure that they’ve got enough fuel nutritionally to be able to support the function of the skin cell.

The second aspect is, of course, optimizing blood sugar regulation. And I find that that’s just crucial, even if it isn’t an insulin resistance PCOS kind of case. Because, let’s say, for example, it’s a client that’s got a very stress-driven-acne. We all know naturopathically that a healthy, stable blood sugar helps to support the nervous system to feel calm and [inaudible 00:34:36] safe. And you’re supporting your adrenals in that way as well. And with that optimizing the blood sugar, that’s where I have a very big emphasis on clients making sure they’re having at least 30 grams of protein with every meal, particularly making sure breakfast is a priority as well. I know that there’s a lot of individuals that we’ll educate on making sure every meal and every snack is protein-rich, which I understand, because it’s so important, because we need protein to synthesize new skin cells and so on. But I think if we can really aim for getting three protein-rich meals in a day, at least 30 grams each, then that’s a really great goal to aim towards. And of course, try and optimize, if it is a blood sugar issue, to focus on those low-glycemic carbohydrates as well. And generally, with that, often advising, if they’re gonna be eating sweets, have a sweet after a meal, to try to optimize that blood sugar response. If you’re gonna be having a larger carbohydrate meal, and you’ve got blood sugar issues, to go for a stroll or something afterwards, to help with the metabolism of the glucose.

Amie: Hm. Yes.

Jacinta: So, from a blood sugar perspective, that’s generally the factors of what we’re looking at. And then finally, there’s the whole inflammatory aspect of it. So, trying to rebalance the omega 3 to the omega 6, which is where, of course, we’re looking at increasing essential fatty acids, omega 3. So, like, your sardines and mackerel, herring, anchovies, and so on. And then, also looking at reducing omega 6, which is gonna be from canola oil, sunflower oil. I know a lot of a lot of individuals then start to become, have a fear around food, and they’re like, “Well, that means I can’t eat nuts and I can’t eat this. I can’t eat that,” but it’s all just about the balance and the quality and the source that you’re getting from as well.

Amie: Yeah. I think that’s important, because it can feel a bit overwhelming, looking at it all, which is why you put together the Clear Skin Blueprint master class, which I just wanna quickly mention. It’s something that Jacinta created for clients. It’s a 90-minute master class, I think it was.

Jacinta: Mm-hmm.

Amie: And, really, just summarizes all of those key principles, and provides that information to clients outside of the one-to-one setting, and you can actually access that straight off Jacinta’s website, which we have in the show notes. And although it is for clients, if you are a practitioner who is looking to learn more in the space, Jacinta welcomes you signing up for that too, to learn a bit more. But the other, I guess, important thing to share here is there is going to be practitioner training later in the year, from Jacinta, on acne specifically, so if you do want to sign up to be notified about that, the link in our show notes to sign up to her newsletter will give you access to that.

And the only other thing I just wanna share from my own clinical experience is circadian eating as well, which is, like, just a whole other layer of blood sugar balance, but our insulin sensitivity is also dictated to by light and dark environments, and eating one particular meal under blue light and the same meal outside, in sunlight, has quite different and profound effects on blood sugar as well, and that’s probably really, like, a phase two thing, like, getting those core elements right is always the place to start, but I think, because so many of us work indoors, and we spend 95% of our time indoors, you know, I’m noticing that some of that uncoupling of blood sugar and insulin sensitivity is partly a result of non-native EMF, and blue light exposure too. So, if anyone’s listening to this and they’re, like, “Tick, tick, tick, tick, tick. I’ve done everything you’ve just mentioned,” then I would be starting to go a bit deeper, and looking at your circadian biology, timing of eating, you know, that kind of thing, as well. But once you get those core basics right, that’s when we can look at how do we support those really important, like, dietary elements with, you know, the judicious use of supplements. And, my gosh, we’re so lucky to have so much to choose from. And I know, at Orenda Health, you’ve got your own compounding dispensary, which means you’re in a wonderful position to actually customize formulas for clients, on-site, which I just think is so brilliant. And I’d love it if you would take me through maybe some of your favorite ingredients, and, like, where you see those applied, and a few that I would love to hear you riff on are, you know, Myo-inositol, PHGG, where you might use broccoli sprout or glycine or calcium D-glucarate. What are your favorite children, Jacinta?

Jacinta: Absolutely. Yeah. So, I guess a lot of the clients of what we see, if they’re presenting with more of, like, a hormonal kind of acne, a classic formula of what we would put together would be kind of similar ingredients like you said. Inositol. We would use broccoli sprouts. We’d use calcium D-glucarate. We’d also add in some zinc. We’d also add in some DIM. And that’s essentially because we’re trying to work on all those specific areas of optimizing insulin receptor sensitivity with the insulin that…oh, sorry, with the inositol, that really helps to get that glucose into the cell. And then we’re working on things like supporting those phase two detoxification pathways, and sulfation specifically, when we’re looking at things like the broccoli sprout extract. And that is really helpful when we’re looking at things like an estrogen dominance or even a testosterone excess issue. And plus the DIM, that’s in there as well. And that DIM is extremely supportive for supporting that detoxification pathway, via the liver, as well.

Then, the PHGG’s amazing as one to add in, because we know PHGG works incredibly well for supporting blood sugar regulation when you’re having it with a meal, because of the fiber, and the slowing of the gastric emptying as well, whilst also helping with supporting bowel motion regulation and gut microbiome balance as well. So, it ticks quite a few boxes, when you’re thinking of a client that might have constipation, detoxification, elimination issues, whilst also having blood sugar problems, that, alongside of those other nutritionals that we just mentioned, can work incredibly well. And then, of course, most of our clients get zinc in their compound formula, because we know how important it is for supporting the aromatase enzymes, for supporting the antimicrobial properties that it has within the skin, and the skin repair as well.

Amie: Beautiful. Such a lovely place to start. And of course, nutrition always comes first, over and above herbal medicine, because you can’t…your enzymes literally need minerals to function. But once you’ve covered those bases, of course, herbal medicines can be incredibly powerful to upregulate or downregulate enzyme activity, where we see it’s required. What are your, some of your favorites in your herbal dispensary?

Jacinta: Yeah. So, I’d say the most popular ones that we have would be burdock, peony, licorice, Oregon grape, they’re probably…and gotu kola. They’re probably the ones that are used the most in our clinical practice. Reason being, I guess, that peony licorice is that classic combo for when we’re seeing, like, an androgen-dominant type of acne, alongside saw palmetto. That will be added in there as well.

Amie: Of course.

Jacinta: But again, the herbs are really specific, based on what the hormonal profile is actually showing us as well. And then, the Oregon grape, we love that because it helps to act as an anti-inflammatory for the skin, when we can see there is more of those painful cystic type of breakouts. But because Oregon grape also works as a antibacterial, it’s also working on the fact that acne is an excess proliferation of C. acnes bacteria. Although we don’t love to treat acne as, “Oh, it’s an infection. Just kills the bacteria, and it’s gone,” because that’s very reductionist in its approach. We do recognize that the immune system needs a bit of a helping hand, to try to support those deeper cystic breakouts. And that’s where the combination of something like Oregon grape and burdock work really well together, because you’ve got burdock in there to support the lymphatics, and to support the immune system, whilst the Oregon grape works its magic as the anti-inflammatory as well. And then, having the rest of the herbal formula being made up by the specific hormonal issue that’s present.

Amie: Well, yes, of course. As you mentioned earlier, like, sometimes it’s easy to assume it’s hormonal, or, in particular, it’s androgen-driven, when in actual fact, it’s not. It’s just, it can look that way on the surface, but when you actually look at what’s underneath, you realize that’s not the case. In which case, if it’s not hormonally-driven, you’re not going to be including herbs for hormones, I’m sure. But I’d love to hear a bit more about where you see gotu kola playing into this.

Jacinta: Yep. So, we love gotu kola when we’re thinking about specifically tissue repair. So, when we can see clients are maybe, even going through that, stepping into that route of doing more skin needling. So, their skin, they’re actually trying to work on the scarring aspect. And for those that may not be aware, skin needling, it’s essentially a process, a method that’s used by dermal clinicians and skin therapists to try to induce inflammation in the skin, to provoke an anti-inflammatory and immune response, to get the skin to heal, and to support repair, and helps with collagen synthesis and so on. And we find that gotu kola can really help with supporting that aspect of it, so, to support the rate of acne repair.

Amie: Mm. Yes. That makes perfect sense. So, from a prescription point of view, it sounds like, and I’m generalizing greatly here, but clients will almost always get zinc, maybe inositol, something for liver, liver detox, maybe PHGG for elimination and microbiome support, and then a custom herbal blend, which is going to address those drivers. So, if it’s hormonal, we’ll see hormonal regulating herbs, but we’ve got so many other tools in the toolkit. And of course, I think probably every client will get essential fatty acids to try and correct that.

Jacinta: Oh, without a doubt. Yeah. Yeah.

Amie: Yeah. Yeah. Omega 3.

Jacinta: Absolutely. Because, you know, you could be working on trying to reduce the hypersebum secretion with, you know, hormone regulation, or working on the stress response, or whatever that might be. But if the sebum viscosity isn’t addressed, then the oil that’s, they’re still gonna be produced. It could be produced within a normal rate, but it’s still thick, and it’s still gonna cause congestion in the skin. And I think that’s where it’s even important for us to recognize that, you know, a blackhead is essentially a pimple in the making. It just hasn’t become severe enough to actually cause a breakout. And that’s where, when, if we’re still seeing that clients are saying there’s a lot of congestion in my skin, then they can see that that really requires the essential fatty acids to step in.

Amie: Yes. Yeah. I think a lot of people are shocked to learn that oily skin is usually dehydrated, and the oil can sometimes be a bit of a compensatory mechanism, in some ways, to try and prevent that water loss, but actually allowing the right essential fatty acids to provide a healthy hydrolipidic film, will then help regulate the sebum, and it’s kind of hilarious, really, that it’s oils that’s regulating oil, but…

Jacinta: Yeah. That’s right. Yep.

Amie: Yeah. It is what it is. I’m gonna ask you about lifestyle in a moment, because, of course, taking a holistic approach, that’s always really important. But you did just mention that gotu kola is one of those ones that you think, “Oh, let’s support tissue healing,” if they’re, say, doing skin needling, or maybe they’re having sclerosing agents utilized, and maybe deep pockmarks, or, you know, more heavy sort of scarring situations. And one of the things that I really love about your practice and your approach is how intimately you work with dermal therapists, and I wanted to just touch on this for a moment, because there’s a couple of key elements that I want to just pop in this conversation before we end it, to, you know, I guess bring this into an awareness for practitioners who are working in the skin space about just how powerful it can be to work collaboratively, and what that looks like, and why you would want to do that, because it is that, again, I said at the start of our chat, the blessing of the skin disorders is that you can apply things topically, and you can do things topically that are really powerful also. So, will you talk me through, like, how you began collaborating with skin therapists and dermal clinicians, and number one, what you look for, in terms of the way they approach skin, because of course, there are different avenues you can go down, that break down the skin barrier, versus preserve and protect it, and also, for a clinician who’s working in this space, like, how they should expect that to look, and ways in which you’d recommend they approach dermal therapists?

Jacinta: Yeah, absolutely. So, essentially the way that it started was similar to like how I mentioned before. I was working in the education space with a lot of skin therapists, and then I started my practice. And essentially, from there, they were like, “We need, our clients, someone to go to to do all the internals.” And that’s where that kind of rapport-building really began. And a lot of my Instagram is actually tailored around education, just in general on the skin, but it also then sparked the interest of a lot of dermal clinicians and skin therapists, because they could see that there was a gap, that there’s, like, “Right. We’re doing everything we can. There’s something going on. And I guess it’s because they are such a, you know, there’s a large demographic of skin therapists and dermal clinicians that think from a holistic perspective, and understand that the skin is a living organ. It doesn’t need to be stripped and peeled and killed and so on, and that treatment needs to be focused on identifying the internal drivers.

So, a lot of our practice, we have a really strong standpoint, and it’s something that I continuously always speak about with Orenda, is that we do not touch the topicals. And I think that’s really important, where you’re identifying your scope of practice, and understanding where you need to collaborate with your client, with another skin therapist for your client. And I guess it’s just like with anything. If we thought, you know, our clients needed to see a physio, we wouldn’t all of a sudden YouTube how to, like, you know, relocate this in a person’s [inaudible 00:49:48] you know, you would actually refer them to a physio. And it’s the exact same when it comes to the skin. The unfortunate thing is, of course, with the nutrition and the naturopathy degree, we do cover skin, but we do not learn it in the lens of a dermal clinician or a skin therapist. That is their specific focus. And I think we don’t know enough. Like, we don’t know near enough to be able to understand how to identify what type of cleanser they might need, the type of moisturizer they might need, the serum that they need. And we know a lot about internals, but we shouldn’t have to take on the responsibility of the externals as well.

So, this is where, with our clients, I’m always having honest conversations with my clients, if they ever have any questions, to say, “What do you think I should do with my topicals?” I just straight out say, “It’s not my area. I know people that can help you, and I know that they’re gonna work incredibly well for you, but I would be doing you a disservice if I tried to tell you what type of skin care to do.” And I think that’s really important because, from that perspective, like, there’s some people that can think, “Oh, you know, from a business perspective, you could be taking them on and doing topicals,” but I don’t care about that aspect, because my care is making sure that the client has the right practitioners on their team. And especially when they’ve been suffering with the skin condition for so long, they want someone that they know can get to the root cause from a topical perspective very quickly.

So, with that, the main things that we’re looking for are skin therapists and dermal clinicians that focus on maintaining and restoring the skin barrier function. And what I mean by that is you’ll see a lot of clients that will be focusing on doing, you know, microdermabrasion and peels and dermaplaning and excess exfoliation. I’ve had some clients that exfoliate four times a week, and it’s like their skin is constantly trying to repair and rebuild, but every two days they’re going, they’re stripping and stripping and stripping. I guess if we were to think about it from a similarity of the gut, our gut microbiome, you know, tries to maintain a healthy, happy environment. And then when we put alcohol or anything like that into the gut, that impacts the gut microbiome, which we know is counterintuitive to supporting a good, healthy gut microbiome. And it’s the same with the skin. Skin conditions start because there’s a skin microbiome imbalance, and that there’s something wrong with the skin barrier function. So, anything topically that’s touching the skin can impact that homeostasis of a good, healthy skin microbiota. So, the treatments of what we try to focus are on skin therapists that have a very holistic approach in their way that they’re treating, and possibly also making sure that the skin therapist is on board of knowing that the internals have a role, but it’s also not an overnight thing as well.

Amie: Yes. I have a really important question to ask you around expectation management, which I’m gonna just save, for just a moment because I want to just lastly touch on lifestyle for a moment, and that is…you know, obviously a holistic approach does require us to assess where people might be living in a way, or have developed habits that are counterproductive to, you know, skin health, either directly or indirectly. And so I’d love to hear about what you see come up time and again for acne patients as well, and what kind of lifestyle recommendations you often find yourself giving in that case.

Jacinta: Yeah. Yep. I think we can see people that sit on completely different ends of the scale. Sometimes we can see the individuals that they get up, they go to work, they come home, they go to bed, and there’s nothing in between, in terms of exercise or sunlight, and the sleep quality’s not great, and they’re not feeling happy with their kind of environment in that way and their schedule of how they’re running. And then, on the opposite end of the scale, you see the people that are waking up at 3 a.m. to fit in the gym, their steps, their breakfast, their morning routine that’s supposed to counteract all their stress, and then work and come home, and then just, the excess, you know, the type of case that you can see, of a client where they’re excessively running that go, go, go type of energy. And our ideal goal with our lifestyle change is, you know, for that individual that’s presenting with that go, go, go, is how can we change your schedule to help you to actually slow things down, so your skin actually has time to repair, so your hormones can balance a little bit better, and so we can actually get the body to feel a bit safe. And then, in the other end of the scale, when we have the client that might just get up, go to work, no sunlight, no exercise, maybe not eating home-cooked meals, how can we shift their lifestyle to kind of be that midway in between? And they can, you know, incorporate more exercise to support their lymphatics, because the poison with anything is in the dose, right? Like, exercise is great, but you do too much and that’s a problem. You don’t do enough, and that’s a problem. You know, there’s, it’s the same with being able to, you know, be too social. You’re too social. That’s, you know, can be a problem for some, and then not having enough social life is a problem as well.

So, I think when it comes to lifestyle, it’s about finding out where your client sits on that scale, and then being able to find a healthy dose of the lifestyle things that are really important for them. And of course, sleep is an essential one. Making sure that they’re getting really good, quality sleep. So, whatever lifestyle that is that they live, that they’re having enough time to wind down, get good, quality sleep, wake up not feeling excessive stressed, or that they’re anxious as soon as they wake up, because that’s, their sleep quality’s obviously so important for getting their hormones balanced, and that’s where a lot of repair happens. Like, melatonin is one of the body’s most natural antioxidants. It’s so powerful. And if you’re not sleeping enough, then that can have such an impact on the skin as well. So, our lifestyle factors is definitely trying to find that healthy balance with good exercise routine, good sleep, and, of course, good methods of stress reduction and management as well.

Amie: Yes. Such a, so lovely to capture all of those different elements that come into a holistic strategy. And you mentioned, giving yourself enough time to allow your hormones to rebalance, and I think this is probably a lovely place to wrap up our conversation, and that is, we live in a day and an age of instant gratification, and sometimes, certainly, pharmaceutically or allopathically, we can produce a swift result, albeit maybe temporary, if the underlying causes haven’t been addressed. And so, one of the challenges with taking a root cause approach is that it most often doesn’t result in overnight results. And it can be, I think, skin stuff, more than anything, is incredibly distressing. Maybe nausea and pain as well, but the degree of suffering, because it’s visible to everybody else, can make clients really anxious to see big changes really quickly. And I think it’s important, you know, we don’t conclude this conversation without talking about what kind of timeline should we expect, and also understanding that it’s not binary that you’re gonna go to sleep with bad skin one day and wake up with good skin the next. There’s a spectrum of healing, and perhaps other green flags or signposts along the way, that indicate you are actually on the right track, and you just need to keep going and stay the course. So, how do you couch that to clients? Like, what do you say to them? Obviously, everyone’s individual. I’m sure you can see from how severe something is, you’ll have a rough timeline in in mind, but just generally speaking, how do you manage that? What do you say? And what do you really put on the table for clients to consider as they start their skin journey?

Jacinta: Yep. So, first, I love to take a matter-of-fact kind of approach with my clients, and I’m very factual with things. And I think that’s important so they can feel like they have a plan that they can follow when they know exactly the timeline of potential things. And first, it’s important to let our clients know the fact that a normal skin cell turnover is about four weeks. In a condition, or as you get older, that can extend in its time, which means our body right now is making the skin cells that are gonna show on the surface in possibly about six to eight weeks’ time. So, if you’re trying to work on correcting your skin, everything we’re doing right now is gonna be impacting the quality of the skin barrier, the quality of the sebum production, your hormonal status in the skin, or even longer, actually, in six to eight weeks’ time. So, anything that you’re doing right now, you’re not gonna see in seven days’ time. You’re gonna see it in six to eight weeks’ time. Even the pimple you see now, that started its way six weeks ago.

And that’s where it’s important, even when clients are going through flares, it can be, maybe immediately, they drank a lot of alcohol last night and their skin’s dehydrated and it’s more inflamed, but those pimples would have probably started their way six weeks ago anyway. And first I lay that out to my clients. I’m like, right, these are the facts of skin cell turnover, so let’s wait at least six to eight weeks’ time. That also means, during that period of time, I don’t want you to change your skin care, and go rogue and try different things, because how do we know if you’ve had a flare is because of something internally or because you’ve [inaudible 00:59:30] to change skin care in between? And again, that brings me back down to expectations of clients knowing you need to see a skin therapist that’s guiding you through everything because they probably won’t change your skin care all that drastically in a six-week period of time as well.

So, first, I’m discussing with them the skin cell turnover. The next thing that I’m getting them to understand is that hormones take a minimum of three months to see change. Just like with any of our clients when we’re thinking about painful periods, irregular periods, or PMS or anything like that, we’re usually giving them a timeline of about three months. And that’s the same as when we’re working with our clients with a hormonal skin condition. And with them, it’s important to recognize, I might see you for your first appointment in Feb, but you might not get your bloods done until April. And then we’re finding out your hormonal issue then, and then you can count three months from that particular point in time to work on your hormones.

But the thing that I also reiterate to clients is, when you’re seeing a before-and-after photo on TikTok or Instagram, you’re not seeing week one compared to week four. You’re seeing week one compared to, like, six months later, and that’s not an overnight thing. So, generally, when we’re looking at improvements in the skin, we’re seeing, well, is this month, maybe there’s less severity in terms of the breakouts? Maybe there was the same amount of breakouts, but this month, they weren’t cystic, they weren’t painful. They were maybe a little bit more surface, and they were easier to control. Maybe this month, when their breakouts came up, they came up and they turned over very quickly, and they didn’t linger for weeks and weeks. Maybe this time when the breakouts came up, they were still severe, but there was less of them. So, we’re kind of looking for changes in the patterns of the breakouts, rather than saying, “Is it completely clear? Did you get a breakout? Oh, if you got a breakout, that means it’s not working.” No, it’s still working. It just means that we’re looking for slow, like, the other signs of progression as well.

And for some clients, it can also be that I’m getting them to take a photo one month of their skin before their period, if that’s their most problematic period of time, and the next month, or maybe the following months, they’re comparing that photo to the same period of time. Because if you’re comparing your, like, post-period ovulation skin to your pre-period skin, it’s gonna be a very different type of pattern if your breakouts are premenstrual as well. So, I think having a form of measurement for your client is also really important, whilst also setting the expectation that we’re looking for signs that the skin is healing, rather than is there a complete resolution overnight.

Amie: Yes. Oh, I think that’s wonderful way of actually monitoring things, and in particular, making sure before-and-afters are consistent with the cycle day that they were taken on, too, and maybe that means two bookmarks a month, you know, a pre-ovulatory and a, you know, a mid-luteal, or whenever their most problematic time is, and counting the amount of, you know, comedones, pustules, and taking those sort of before-and-after pictures the same position, same time of day, the same kind of light angle.

Jacinta: Same lighting. So, Yeah.

Amie: Yeah. Yeah. So that they can be monitored. And I think, yeah, I think that’s really lovely to be able to say it’s either less inflamed, or there’s less breakouts, or they’re moving on quicker, as green flags, that you’re heading in the right direction, and understanding that although skin, every six weeks is kind of refreshing itself, the hormonal drivers might be lagging behind a few months too, so it’ll be incremental improvements, as opposed to you wake up one day looking, you know, with your dream skin. Although, wouldn’t that be nice?

Jacinta: Yeah, I know. It would be a dream.

Amie: It would be a dream.

Jacinta: But, you know, I think that’s where it is important to have those photos. And also, in saying that, making sure you’re then not becoming obsessive with that. I know that I’ve had…

Amie: Sure.

Jacinta: …you know, some clients where their skin, it’s their whole life. Like, it’s what they think about all day, every day, and “What am I gonna do to fix this?” And I’ve had some clients that, on their own accord, will decide to take a photo every single day, which I advise against, because then you’re putting this energy every day that it’s like, there’s something wrong, there’s something wrong, there’s something wrong, or you’re picking apart your skin. So, of course take the photos, but don’t take them every day, and maybe, you know, spacing them out, like you said, in the same conditions and certain days of the month.

Amie: Oh my gosh, Jacinta. You’re just such a wealth of knowledge, and really, your expertise and experience in this area just really shines through, and I just thank you so much for your time today.

Jacinta: My pleasure.

Amie: It’s been such a joy chatting with you.

Jacinta: Thank you. Yeah, thank you. I know. We could talk for ages all about skin, but I appreciate you having me on today.

Amie: Yeah, thank you. Well, for those of you who enjoyed Jacinta’s naturopathic approach to acne, the links and resources we mentioned are in the show notes of this episode, and, yeah, thanks again, Jacinta, for your expertise, and thank you for joining us today. Remember, you can find all the show notes and other podcasts on the Australian Designs for Health website. I’m Amie Skilton, and this is “Wellness by Designs.”