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skin health

Feeding Your Skin – A Holistic approach to Skin Conditions with Geraldine Georgeou

skin health

Feeding Your Skin – A Holistic Approach to Skin Conditions

Today we welcome Geraldine Georgeou, an Accredited Practicing Dietitian and author of The Australian Healthy Skin Diet to Wellness by Designs. Geraldine chats about feeding your skin and how a holistic approach to skin conditions is essential for lasting results.

About Geraldine Georgeou:

Geraldine is the director of Designer Diets private clinics in Sydney, with more than 20 years of experience in Dietetics. As well as treating hormone and skin conditions with nutritional advice, she specialises in metabolic health, diabetes prevention and management, gastrointestinal health, inflammation and weight loss. Geraldine regularly appears in the national media and is co-author of The Gut Foundation Cookbook and Kickstart Diet, and a presenter and content development for Food Investigators on SBS. I also provided dietary advice and wrote the what2eat nutrition programme on behalf of Diabetes NSW and ACT.

Her dietetic practice prides itself on keeping up to date with the latest research and best practice guidelines for patient care. Geraldine is passionate about sharing scientific research with the broader public in a way that is accessible.

Connect with Geraldine

website: www.designerdiets.com.au 

Email: geraldine@designerdiets.com.au 

Instagram: @auhealthyskindiet 

 

Transcript

Introduction

Andrew: This is “Wellness by Designs” and I’m your host, Andrew Whitfield-Cook. Today we’re joined by Geraldine Georgeou, an Accredited Practicing Dietitian and today we’re gonna be talking about feeding your skin. Nourish from within. Welcome to “Wellness by Designs”. Geraldine, how are you?

Geraldine: Good. Thank you, Andrew. Thanks for having me on. Great to catch up again.

Andrew: Yeah, it’s our pleasure. And might I compliment you on that incredible picture on that wall behind you that is absolutely stunning?

Geraldine: Thank you. It’s actually a Margaret Hodge. I’m hoping it’s going up in value.

Andrew: A Margaret Hodge. Yeah, I think so. So, Geraldine, firstly, tell us a little bit about you. I said, accredited practising dietitian. But can you take us through a little bit of your history? How you got to be a dietitian? And what sort of open your mind a little bit to using nutrients?

Geraldine: Yeah, so my background’s been quite colourful. I’ve been a clinical dietitian, initially in the hospital system, I’ve been a dietitian for more than two decades. And so, I started off in gastro, and endocrine and really looking after people that were in their acute setting.

So, there was nothing about prevention at that point in my career in the early days. And then it got me thinking, “Well, if we know that nutrition can be therapeutic, then yes, we can look after people with, like, tube feeding and enteral feeding and dealing with disease processes, you know, post-surgical, it could be in ICU and high dependency. It made me start thinking I really need to get out into the…I suppose, if you think about it, into the battleground before hospital, and be able to help people in different disease processes.

So, as we went along, we developed…we first recorded reality check, which was interesting. No one wanted one, though. But we went then into designer diets. And so, designing an eating plan that’s right for you, for your presenting condition, and what condition we may be wanting to prevent.

And so, it really inspired me in looking at holistically how people’s health are, in particular, still maintaining that multidisciplinary approach, working with your GP, your specialist, your allied health professional, and really being able to provide a nutritional clinical service, like I said, for your health condition.

So, the areas that I’ve really sort of got more involved in over the years have been basically hormones, weight, bowels, skin and inflammation. And I’ve been very fortunate working with a lot of world leaders. So, from Professor Murrell in dermatology, Professor Bird in rheumatology, Professor Coetzee in endocrinology, Professor Bolin in gastroenterology, and even spending some time on the Gut Health Foundation, writing their gut foundation cookbook.

And even been lucky enough to do a bit of media work along the way with the wonderful Dr. John D’Arcy, and the Kick Start Diet. That was about 15 years. And working with “Food Investigators” TV show. And even with the Navy.

So, I’m pretty colorful as a dietitian in private practice entirely now, but I’m very fortunate. And I like working with “Designs for Health” and those therapeutic companies that are out there that can really provide that functional nutrient to support nutrition wellness. I’m very privileged.

Andrew: You said Navy. What did you do with the Navy?

Geraldine: I know, well, interestingly, you know, as you know, Navy people have to be really fit for sea. And I was very fortunate of being involved in working with the medical team at Equitable, which is in Sydney and working with…so if you can imagine you’ve got fit, you’ve got in, you’re going really well and you’re being deployed and then on your return, your health changes.

So, you do get then asked to look after your health and meet your health need to be deployable. So, I’ve been very fortunate looking after Navy personnel and their health as well as providing nutrition talks, and presentations and even nutrition challenge programs. And even been…I thought I’ll share it. One time, I was on HMAS Newcastle. But were you? Love a man in uniform.

Andrew: Hopefully you weren’t straddling a gun.

Geraldine: Not totally, but I was going up and down ladders in a skirt. That was interesting. Didn’t think that through but anyhow…but we had a lot of time and I still see, like, you know, Commodores. Like, can you believe? Like, yeah. A real privilege to serve Australia really, looking after their Navy personnel.

Andrew: Well, thank you for doing that because I’ve gotta say any person or persons who dedicates their time to serving this country gets my stamp of respect immediately. So, thank you very much for helping them. Good on you.

Geraldine: Yeah, thank you Andrew.

Andrew: So, look, you’ve worked with The Gastroenterological Society. And you’ve done a lot of work with gut hormones. One of the naturopathic sort of idioms is all diseases start in the gut which I disagree with. But certainly, the gut plays a major role in presentation and mitigation of certain ones.

So, is this what we’re talking about when we’re talking about feeding your skin, nourish from within?

Geraldine: Yeah, absolutely. I think that we’re learning a lot more about gut health day-by-day. And I think we don’t realize that if you’re…as you know, the gut has more cells, and more…the microbiome and the DNA in our gut is even more than our whole entire body.

So, if you can imagine if that gets disrupted, and I’m speaking to already the people that will agree with this, that if our gut is not in the right eubiosis, so dysbiosis, we need to actually support gut nutrition.

Now, we can obviously support with pre and probiotics, but we also need to nourish from within to be able to promote the actual commensal bacteria that we already have to be able to help get it into the right ratios to reduce inflammation. For example, one of the skin conditions as we’ve been going along working…I provide dietetic service to the University of New South Wales Registrars, going into dermatology, and they’re learning along the way.

So, say for example, you have rosacea. Can you believe we might think hormones, we might think they’re alcoholics, and they’re drinking too much, and they’re menopausal women, and they’ve got their adult acne? But what if they’ve got underlying Helicobacter pylori, that’s disrupted their gut microbiome? And that’s what we target first and take away the incursion that shouldn’t be there to be able to actually help skin.

So that gut access, an inflammatory process, and disease process that can happen from within will definitely show on your skin and to be able to target your gut health will be a primary area, particularly for rosacea for one. I mean, I can talk to Andrew somewhat…forever, Andrew, so I’m just warning you that, like, even for example, eczema, eczema, and hives, and urticaria, that’s another area where we might turn leaky gut and we might talk about zonulin response. But we’re actually talking about…and histamine response, which is another area that we look at.

And understanding then if we’ve got a systemic change that’s occurring. And what if we need to identify if we’ve got underlying celiac disease? Or something that’s really sort of coming to the forefront is this new idea of non-celiac gluten sensitivity, which can come across in skin areas, rheumatology areas, many areas really. And you could be then experiencing sadly, terrible eczema and dermatitis just not knowing that you’re not reacting to the actual gluten. You’re actually reacting to the amylase trypsin inhibitor which is another protein found in wheat, that can be then creating a systemic effect and then showing on your skin such as dermatitis and eczema, for example.

Andrew: Right, okay, so look, I guess, first off, do you now give lectures to dieticians?

Geraldine: I think I need to.

Andrew: I think you need to.

Geraldine: Yeah, I do actually. Yeah, I do actually. I…

Andrew: Because you are so way ahead of the ball.

Geraldine: Yeah, I think what happens is that you’ve gotta keep abreast with the latest research. And I think just understanding that there is more to just a balanced eating plan. I’m all about balance, though. So don’t get me wrong. I actually was involved with Diabetes Australia, New South Wales branch writing the “What to Eat Program” for diabetes, New South Wales ICT.

And just the concept of the role of glycemic load and balancing, but as you know, if you’ve been a practitioner, patients do wanna know what to eat. And I think we’re quick to give a prescription of some kind if it’s not from a medication point of view, but a supplement point of view. But we really do need to show what to eat.

And I think in the realm of dietetics, we need to do more of that. And we need to give people a roadmap. And then we need to understand if you think of it this way, you’ve got medical, nutrition, it’s a triangle, by way, lifestyle, and your head. We need to understand how it’s all working together. And what bit do we need to focus on? And when do we need to call in calvary?

So, an example even this morning, I’ve got a patient who’s had a pretty significant surgery for whipples. And what’s happened now there’s been a body organ change, and their glucose response is very erratic. Now, do we just keep changing the food? Or do we need to intervene medically and nutritionally as well? I mean, that’s an extreme case, but working with the endocrinologist showing what have we done, what can we put as a platform.

So, it’s like providing a platform of nutrition to allow then any further medical nutritional intervention to also work because you gotta create an even playing field. So, you’ll even find in the Australian healthy skin diet, that we might go into a bit more, but the idea of that was about understanding your skin, understand your anatomy, understand, then what nutrients play a role, what conditions you have, the involvement of your multidisciplinary team, and then providing a menu plan program that you can start with to give you a good start whilst working in with your team. And knowing that you’re doing the right thing, because even with designer diets, we design implants right for you, so we can’t get it wrong.

So, people that say, “I heard I’m gonna do a cleanse, I heard I’m gonna do 800 calories. I heard intermittent fasting.” All these things won’t work if they don’t know you. So really getting into the dynamics of that person’s health situation, and what road they’re walked along. A lot of people describe me as working like a mechanic.

So, I check the car, and I hope you drive that car. And I try not to bash up the driver. Let’s face it, people might speed and not drive the car very well. But we also know that if you’ve got a lemon, we still have to tinker the car. So, we’ve gotta work it through. I won’t name any car dealerships that I bought a lemon from, by the way, but at the end of the day…and if you’ve got so many kilometers on the clock, we know every decade there are changes that will occur out of your control.

And really understanding then well, what, when, you know. We all wanna look good, feel good, feel good, look good. So how we can get that as well as wellness along the way is the key.

Andrew: Yeah, good stuff. Just to mention a couple of names that you mentioned before. You mentioned Paul Bird, rheumatologist?

Geraldine: Yes.

Andrew: Yeah. So now he’s in a group of specialists that were frustrated with what was offered medically. And so therefore, explored nutritional avenues, which is very often poo-pooed by many orthodox specialists.

Geraldine: That’s right.

Andrew: And he is a very forward-thinking man, and I so enjoyed podcasting with him some years ago. So, I guess to ask you that sort of same question. Coming from a dietetic background, are you bound by using nutrients in food alone? Or can you choose to use judiciously, responsibly chosen accessory nutrients where appropriate?

Geraldine: 100%. So, we, as we say, you know, food first, true. However, we already know and we all recommend…like, for example, if you’re vitamin D deficient, and there’s diseases that are driven by vitamin D deficiency, Crohn’s, multiple sclerosis, depression…

Andrew: Lupus, yeah.

Geraldine: Brain health, mood health, bone health, we’re not going to say, “Just try and get it out of the food.” We have to supplement. We may even need an injection. So, let’s look at iron, iron infusions. I’m all for an iron infusion. I’m all about getting you there better, quicker if we can, while we fix the background issue.

And I think, you know, when we’re in ICU, in a hospital and say, “You’ve been in a starvation situation, and we’re refeeding you.” There’s a condition called refeeding syndrome that will occur.

Andrew: Refeeding syndrome yeah.

Geraldine: Yeah, refeeding syndrome and this can actually kill you if we don’t monitor your potassium, your phosphate, and your magnesium, carefully. And we do have to then give you even through IV drips or oral supplementation, we need to top up these nutrients. It could be quite precarious for some patients, and they can even develop, like, a tetany situation if their levels and their electrolytes fluctuate too much.

So yes, we do need to look at therapeutic nutrients for patients. You know, I was involved in the nutritional benefits of arginine and wound healing, for example, and there’s so much research that supports arginine at a therapeutic dose for poor wound healing, including diabetic leg ulcers.

And also, if you’ve got someone bed-bound, and they’ve got wound healing problems from, you know, being in that situation, or even a burns victim, you know, you’ll find in my book actually…yeah, sorry, you go. Yep.

Andrew: No, well, no, please continue, because this is really interesting.

Geraldine: Yeah, so another area I might work in… if you look at the book that I wrote, I wrote some buzz nutrients, and I’ve shared some information about…well, you know, we are going in this area. I think the danger that people have is that they may just run with the supplement rather than actually looking at the whole picture.

And we know a supplement alone may not work as effectively, or you may not be taking it at the right time, or there could be a drug nutrient interaction. So, this is where you need to have very good advice on what, when, and if it’s not through a dietitian, you know…and those that are listening, you know, a pharmacist can definitely help too to know what nutrients should not be put with, you know, different nutrients.

Like, we used to worry about Warfarin and vitamin K, for example. They that I don’t tend to use Warfarin as much anymore. So, I think, you know, I think it’s really important that…I think we need to look at nutrition more therapeutically. I do. And I think that we need…and we’re learning as I said, and… like, for example, working with Professor Bird, what a breath of fresh air.

He actually got me to do a presentation to a whole group of colleagues about the truth about gluten sensitivity, and even using a food change to help a disease process, not just supplementation.

So, I think, you know, understanding that we can be much more in the fighting space of disease process, rather than just saying, you know, “Eat better, lose weight,” which is what they think dietitians do. You know, I know I had a patient yesterday, that was quite interesting. We we’re fixing her metabolic health for her skin, and underlying insulin resistance. And I know Dr. Coetzee’s got a big area of interest in this and I wish we had more Dr. Oscar Coetzees here in Australia, because I think where he works, we need more clinics like that.

And interestingly…like, I know BMI is pretty outdated, you know, it’s not including bone mass, muscle mass, and frame. But it’s still a guide, like, it is still a guide in our literature that we need to have some cutoff point of underweight and overweight. And I don’t get this very often. But because I was managing these patient’s insulin resistance, she was losing weight and midriff weight to help her skin. But that wasn’t the goal. But that was the byproduct of what we were doing.

And her progress has been slow and steady. But she couldn’t cope with the change because she kept saying, “I haven’t been this weight since I was in my late 20s.” I go, “But what your body will be will be as long as we’re nourished, and we’re well, and you’re not underweight.”

And so, it was really interesting just to see how, if you’ve got it all right, your body will reset to be where it should be if we provide the right nutrients, the right menu, plan, the right medical treatment, the right lifestyle, the right exercise. Better sleep is another area.

Andrew: Sleep once again. Geraldine, I love how your mind thinks though, that you’re not just going, you know, “You’ve got rosacea. So, we’ll attack the rosacea.” You’re thinking, “Why have you got the rosacea?”

Geraldine: Yes, exactly.

Andrew: You know, as you said, you know, you could very quickly blame the, you know, the usual suspects, you know, the alcohol, that sort of thing. But looking at things like Helicobacter pylori, I think there’s also a new Helicobacter raising its head from pets. So, it’s a different species. Dogs, I think.

Geraldine: Wow.

Andrew: Yeah. So, but, you know, looking at that…

Geraldine: I won’t kiss that pug anymore. That’s not gonna happen.

Andrew: Yeah. But I love your detective mind and how you’re really approaching the care of your patients from looking about what’s happening with that person, rather than what they taught you in a textbook. It’s a different mindset, it’s great.

Geraldine: That’s right.

Andrew: So, can we talk a little bit further about your book because…like, I’ve got it. This…for everybody out there, this, it’s not a coffee table book, this is a learning book. Like, this is, you know…like, you can get it anywhere between $35 and $45. Go to booko.com and choose whoever. You can get it from your local bookstore.

But I love how you’ve set this out. Because it’s…in fact, you know, I’m not gonna say it, I’m going to ask you. What was your reasoning behind the way you set this out? Because there’s a couple of telltale things in there that are really important.

Geraldine: Okay, so I suppose firstly, I was approached to write a book. We knew there was a book in there. Initially, I was gonna do one about bowel health, funny enough, and sell the book in a paper bag, but they didn’t like it.

And what we realized is that everyone does care about…like, if something’s showing in your skin, you don’t want that to happen anymore. And you don’t wanna have pimples, and you don’t wanna have all these things. And realizing I’d worked in skin health for some time but really, I was working in metabolic health that evolved in skin health.

So, for example, if you had any patient with psoriasis, do you know all patients with psoriasis are insulin resistant. So, all the UV light therapies, all the elimination of different vegetables, and fruits, and nightshades, and all that, none of that will be sustainable or long-term outcome without treating the metabolic disease process.

So fixing psoriasis saves lives, because you’re actually fixing heart health, preventing diabetes. And also, if you’re overweight, by managing the underlying, you’ll reset your best weight for you and will end up arresting the metabolic disarray that’s going on.

The other side is that, for example, psoriasis, and gluten can go hand-in-hand. So back to the book, I started realizing that if I worked, gut health, metabolic health, it all affects skin. So, wrapping my knowledge around skin was the obvious thing to me. And then I felt then if I took people on the journey of understanding, you know, about skin, or the conditions around skin, or the nutrients around skin, or the main sort of disease processes that people present to their doctor with, then helping you understand where they could come from and derive from, and then how nutrition plays in with that.

To me, it was just a perfect sort of handbook, and even a type of textbook that will be able to help people on the journey of helping themselves and even preventing conditions ahead. It’s like some people think I can read a crystal ball. Like, they might say, “Geraldine, I’ve got high cholesterol.” And I’ll go, “Have you got a skin tag?” And they’ll go, “Huh, how did you know I had that skin tag under my left armpit?” You know?

So, it sort of became apparent that if I can just show the journey of how gut health and metabolic health creates that flow through to skin, then we’ll talk about skin, but what you’re learning about is metabolic health and gut health.

Andrew: Gotcha. Just quickly, is the level of insulin resistance correlative…concordant with the severity of psoriasis? Or is there this genetic makeup, and there’s other interceding issues, of course, that may play an effect on the expression of psoriasis? Like, can you basically gauge how somebody’s insulin resistance is going by their lessening of psoriasis?

Geraldine: Yeah, it can actually because insulin is one thing that is creating an inflammation response. But at the same token, yes, there can be still underlying food sensitivities together with and there can be then even a gluten sensitivity together with. And a lot of research has shown that if you tackle all those three things…and then I feel that people’s psoriasis in general is inversely related to their midriff weight.

So, if their waist measurement is above what’s recommended…so if you think of “Life, be in it” and…do you remember “Life, be in it” ads?

Andrew: Norm.

Geraldine: And if you’ve got…yep, Norm. Think Norm and the big bulbous nose and at the RSL Club, you’ll find that…no, but you’ll find that your midriff weight will be indicative of how much psoriasis you might have.

Andrew: Wow.

Geraldine: So interestingly…I know. And for the menopausal woman, the same sort of thing, because at different stages in your life…that’s why you might notice that psoriasis can hit you at different times. Like, you don’t see it often in puberty, but you’ll see it more often in the 50 plus year old, 55 plus year old person. It’s all directly related to underlying metabolic disease in the family tree, time and age, procedure, inactivity, increasing midriff weight, poor lifestyle habits would exacerbate.

And when you go looking, then you might be…if you think of the cycle of diabetes, you’ll be insulin resistant, pre-diabetic, which is then impaired fasting glucose or impaired glucose tolerance. Then you might have the typical, “I’ve got a touch of sugar, type 2 diabetes.”

And again, people just get told to drop the carbs, or eat better, or go away and eat properly and exercise. Not knowing that the receptor cells that receive insulin are now misfiring. And they’re not recognizing and your pancreas is, like, revving out like a car, and then you develop the type 2 but insulin requiring.

So, it’s where do we wanna jump in? How much of it will be just a lifestyle change initially? So, we don’t have to directly be metabolic and therapeutic. But that’s then when the agents come in. Do we go medical? Or do we even look at what’s out there that can help.

So, for example, we had that great talk with Dr. Oscar not so long ago in berberine and the activity of berberine versus Metformin or both, like, to actually help to working together with lifestyle and nutrition.

So yeah, we definitely can see some amazing changes with just some tweak here, tweak there. And then working with your dermatologist, because I might get patients that are on immunological therapies and biological agents, because they’re…and they might be walking around with not just the psoriasis on their skin, but cirrhotic arthritis, for example, which is no good.

And we might have to treat inside out both ways to help two conditions that are coming systemically from one. You know, often patients coming to me…

Andrew: You go. Sorry. Often patients…

Geraldine: Yeah, they might come in and they’ve come with their skin. And the next thing you know, they’re walking out and finding out they’re in the diabetes cycle. But then when they understand what the driver can be, then together with…then they see the benefits and they see the health benefits. But they’re shocked that they walked out not just with psoriasis, which is what they think they’re just coming in for, which is interesting.

Andrew: Gotcha. Yeah. Like, I wanna move on, because there’s so much fun that we can talk about but…

Geraldine: I know.

Andrew: Just with regards to that insulin resistance sort of picture, do you…well, actually no because it is…like, it’s relevant for acne, it’s relevant for hirsutism. It’s relevant for psoriasis, as you’ve mentioned. And also, you know, whatever else goes along with it. Even aging, premature aging. But do you find that you use tests like, you know, the HOMA-IR that looks at insulin resistance? Or do you stick with things like, you know, not just blood sugar levels, but HbA1c. And you mentioned BMI wasn’t very sensitive, but things like that, low standard tests.

Geraldine: Yeah, I usually do the whole trifecta. So, I’ll do home index, I’ll do maybe…well, I find the home index may be skewed because some people, they’re fasting and some may not show. Often people are already trying to do things before they meet you. So, their carbohydrate load may not be there. So, it’s gonna be a false slow and/or they might be already drifting into type 2 diabetes.

And so, the insulin surprisingly doesn’t look too bad on fasting because they’re running out of it. Or you might find that you’ve gotta prep them for the three-day high-carb diet before the GTT with serial insulin levels throughout. And that will then help determine how they…so it’s like driving the car up the hill with people in the car to see how much their body responds to a set 75-gram glucose load.

And/or we can…HbA1c or glycated hemoglobin, depending on the company. Now the cutoff point for a diabetes is 6.5%. Now, some companies are now giving you a new diagnosis using thee HbA1c as glucose dysregulation, where the range might be between 5.5% to 6%. And you’ll be flagged then as a pre-diabetic with glucose dysregulation.

And they’ll actually write that on the pathology, but in the box next to it. So that’s why when you’re working with your doctor, if you’ve asked the GP to working with you to do these tests, you might find that they’ll then tell your patient, “You’re fine,” because it’s under 6%. But anything even more than 5.5%, they think it’s an undiagnosed dysregulation, patient on their way to diabetes.

So, those are some of the three tests I would do. But then also just for information. Like, we know CRP, then you might look at liver function and look for other clues like fatty liver, or other indicators of insulin resistance. For females, it could be a low sex hormone binding globulin and raised free androgen index in total testosterone, which is the polycystic ovary raised LH and lower FSH hormone.

Or you might even find you’ve got a hyperlipidemia patient and their triglycerides are elevated. And that also could be a clue where you may then target their metabolic and insulin resistance, underlying condition.

Andrew: Gotcha. Oh, gosh, this is so interesting. I’m learning so much. One last question before I move on. I just can’t help it. Do you ever measure C-peptide? Like, I was just wondering then about if you’re gonna do the HOMA-IR and you might get a false low, the only way to really check that would be is if you’ve checked free C-peptide, correct?

Geraldine: Correct. Or and CRP as well, like, another Inflammation ESR will be another one as well. Yeah. So yep, I would.

Andrew: Cool.

Geraldine: Yep. Yep.

Andrew: Great. Now let’s move on because, like, this book, we need to talk more about this book and how you’ve set it out. Because, like, I was going through the recipes and I’m going, “I like that one, I like that one, I like…” Like, the Moroccan salad, the chickpea, Moroccan chickpea salad. There was the Buddha bowl. There was the Reuben. I’m now hungry.

Geraldine: The Reuben on rye?

Andrew: I love Reuben.

Geraldine: I did put a swap in there, though. So, you’ll see I’ve got every recipe in there, you can swap to a gluten free option. So, they’re all gluten free modifiable.

Andrew: So, there’s not just gluten free, though. But there’s also vegan options in there as well, right?

Geraldine: There is, absolutely. So, with patients…

Andrew: Yeah, so talk us more about this.

Geraldine: Yeah, well, the actual book…this is how the recipes came about. So, if we’re looking at the best dietary…and you’ll see there’s a whole lot of nutrition panels in every single recipe. The ID and you’ll see the answer there is that every meal, we need to have evenly distributed carbohydrate for breakfast, lunch, and dinner. So, you’ll see what I’ve done is I’ve made sure I’ve kept you in a range. So, if we’re talking dietitian terms, one to two exchanges. One exchange is 15 grams of carb, 2 is 30.

So, with maybe a variance of plus or minus 10 grams, for example, but I was very mindful of glycemic load, so GL. And so, I made sure there was enough protein there to offset the carbs. So, if you look at the molecular, the protein and the carb are very similar numbers per serve, and the fat is around 10 to 15.

So, the formula is that. So, I’ve just shown you the color of my underpants. No, but I’ve just revealed it all. But the formula is what matters, as well as the functional nutrients. And so, you’ll see I’ve put, like, little things like one of my favorite recipes. I’m gonna grab my book that I carefully placed but anyway, I’m gonna ruin this set. There we go. It’s snoozing up there.

Andrew: I’m grabbing mine.

Geraldine: Here we go. All right. So, I’ll tell you my favorite.

Andrew: What page?

Geraldine: Which one do you think my favorite…well, which one do you think my favorite one is, Andrew? Just have a wild guess.

Andrew: How could I pick that? There’s so many. There’s pages and pages.

Geraldine: I don’t know. You might be spooky and pick it.

Andrew: Okay, so stuffed mushrooms. I was remembering Tammy and Marie Guest providing those beautiful morsels for my wife and I so thank you, Tammy and Marie.

Geraldine: Lovely, can you guess it?

Andrew: Are you a lamb lady?

Geraldine: Well, my husband’s Greek but not today.

Andrew: Right, your husband. I don’t know.

Geraldine: Well, I will tell you, my favorite is 157. Have a look at that page 157. So that’s the warm salmon…

Andrew: The warm salmon and potato salad with sauerkraut.

Geraldine: Potato salad with sauerkraut. And the reason why I like that one is because A, everyone demonizes the poor old potato. Now, but the potato is 80% water, okay. It’s from the ground. It’s rich in nutrients. I’ve left the skin on there. They’re little baby potatoes. And I like it because you can actually have these potatoes in the fridge pre-cooked.

So, you can always grab it, then grab some leftover cooked salmon, some green beans and cucumber and some onions. I’ve put the word scallions because this book was actually put in the U.K. as well. So, we’ve gotta be U.K.-able. And also, sauerkraut. And the idea is that I don’t know if you know…do you? What are your thoughts about potato, Andrew? Do you like potato?

Andrew: I love potato, but in moderation.

Geraldine: Yeah, potato’s a bit of a magical food. Because when it’s left cold, it actually…when your body then digests it cold, you actually make more butyrate than…

Andrew: Resistant starch.

Geraldine: Yeah, exactly, resistant starch. And that’s just a beautiful prebiotic to feed your gut. And then we added some sauerkraut to hold hands with the potato as it’s being digested. So, you get the best of both worlds. So, to me, that’s quite a functional recipe for gut health. And also, to help your tummy and help your skin.

And then you’ve got the Omega-3s as well. So, it’s, like, one of the most functional lunches you could have as a dietitian.

Andrew: But you’ve also gone through there and provided…there was a… what was it? There was the pumpkin…It was like a stack sandwich.

Geraldine: Yep.

Andrew: So, there was pumpkin and the leftover chicken roast.

Geraldine: Grabbing it. I’ve got sandwich station. Yeah, because so many people are funny with sandwiches. “Am I allowed to have bread?” Well, obviously, depending on which bread as well and we’ll work that out. But if you look at the lunch section, I put a sandwich station in nourishing bowls, because bowls are all on trend. And in the pumpkin section…you’re talking about this one, I think.

Andrew: Yep. Yep. That’s the one.

Geraldine: Yeah, and this is just a way to use your leftover rice dinner. And people sort of think, “GG, you’ve gone a bit far with the carb,” but it’s still within that balance of protein and carb. In the actual per-serve, the carbohydrates only worked out to be 37. And the protein was 40. And the fat was 11. So, from a ratio point of view and a glycemic load point of view, we’re laughing. It’s yummy. And it’s good for your skin.

Andrew: So, let’s talk….

Geraldine: And you get all that rich vitamin A.

Andrew: Well, yeah, that’s right. Let’s also talk though, about some accessory nutrients. Now can food alone, heal all of the skin conditions that you’ve covered in the book? Like atopic dermatitis, you’ve got…now I’m gonna get this right. Hidradenitis suppurativa.

Geraldine: I just make it up. Hidradenitis suppurativa. Hidradenitis suppurativa.

Andrew: Suppurativa.

Geraldine: Yeah, and that’s a horrible…have you heard of that before?

Andrew: No.

Geraldine: So, think of a pimple. It’s a pimple that’s from within. And sadly, people that suffer with this, it could happen in your armpits and your groin area or in creases, really. And it’s like a pimple that can actually have chambers and they burrow in so they can actually become these very underground type wounds.

And often people get them drained and they get misinterpreted as an abscess. They can form an abscess, but they are still part of that metabolic disease that drives that inflammatory skin, acne condition. And it can often be linked with women with polycystic ovary syndrome as well.

And so, talking about can food actually help heal this condition, I would say it can act as part of the healing process. Because if we’re then identifying we’ve got underlying insulin resistance, then trying to regulate insulin response with nutrition will only help create a platform for then what the doctors are doing and then if we do add on any other nutrients to help heal.

But with that, the food part with it, it is a slow road. So, like, we mentioned, Prof. Bird, Professor Murrell’s embraced nutrition and skin and finds it very difficult to have people get to the finish line, if we haven’t got the patient doing their job. Because every time they then start throwing one other medication to switch disease process off…so it’s like we’re at a volcano level with a lot of patients, and we’ve gotta get the volcano to calm down, and then we’ve gotta fix the background.

If we haven’t got this going, then when we’re trying to get them out of their heightened, acute part of their disease, this will always undo it. And there’s only so many treatments we can throw at it.

So, the third plan, yes, will have a significant role. And then lifestyle, and exercise, and midriff weight, metabolic disease. But yes, so I know that’s a bold statement. But definitely, it’s like diabetes prevention program. They found, you know, without doing the nutritional part, just putting a medicine to manage diabetes is only one part of the formula. That’s not the formula, though.

So, you really have to empower the patient. So yeah. So, we’re very relieved to actually have something out there that people can actually get to take on board while they’re in their treatment program.

Andrew: But I also…just talking a little bit further about that, the diabetes work. I like the approach of…like, I’m a nurse, I’m not against drugs at all, but certain drugs have certain common side effects, like for instance Metformin. There’s a lot of people that suffer from diarrhea. Wouldn’t it be great if you would use Metformin with berberine, a trophorestorative herb that has anti-cholesterolemic and anti-diabetic sort of actions, but also helps to sort of reduce diarrhea? Or at least might reduce your dose of the Metformin, which again, which would reduce diarrhea.

Geraldine: That’s right.

Andrew: So, this is the sort of thinking that I love.

Geraldine: Yeah, it can definitely…yeah, exactly. And you can titrate it, and also too, you don’t wanna be at maximum dose of medications, and then we’ve got nowhere else to go. So then, like you say, if you can add adjunct therapy together with to be able to have still the same efficacy without the side effects. Absolutely. 100%.

So, it’s like, for example, I’m astounded…actually, I sat through…so with Oscar’s last presentation. And I even got up to take a bit of a laughter because we we’re talking about, you know, how not only does it help glycemic response. But you know, it actually also helps rid of and help reduce the Helicobacter pylori, for example, as a therapeutic agent.

I mean, I have patients that acquired C. diff or Clostridium difficile in a hospital setting, and the role of Saccharomyces boulardii. Like, another doctor I do a lot of work with, I don’t know if you’ve heard of him, Dr. Vincent Ho, he’s part of the GI Motility Unit at the Western Sydney campus, and helping in reference to the best nutrition plan, eating plan as part of management of gastroparesis, which is…we’re seeing a lot more coming along.

And he’s a fan of Saccharomyces boulardii working in with management of small intestinal bacterial overgrowth, that’s aside…there’s a situation that arrives from dysmotility. And you can throw all the antibiotics, and erythromycin, and all those things to help to reset the accumulation of the wrong gut microbiome that’s creating more symptoms, and constipation for example.

Andrew: Yeah, we got rid of the cause.

Geraldine: And then we just manage that bit so that when we…because we’ve still also got maybe damage of the vagus nerve or other things that have happened. But you know, really being able to create that quality of life for that patient, you know, I find is really, really important.

And it’s like even with antibiotics and say, for example, acne. You’ll see in my book, I talk about different strains of probiotics that have been shown to reduce inflammation in acne. So being able to have that together with again, the food plan and if there is therapeutic treatment.

So, there’s a lot we can do. Support nutrition, you know, nutrition plans, working in with the patient. And it really empowers them because they feel helpless. You know, they’re sitting there and they’re looking at their doctor with such a horrible skin condition. And you’re wondering, “How long is it gonna take me till I start to get to see some health benefit and skin benefit?”

Because, you know, they can go on some pretty rough treatments, you know. And to be able to see them after and being…even weaning off some of the treatments they’ve had to be on to be able to not see any return of their acne after being on one of those antibiotics.