The Brain-Skin Connection with Dr. David Perlmutter

Trevor:  Hi there. I’m Dr. Trevor Cates. Welcome to The Spa Dr. Podcast. Today we’re discussing the skin-brain connection. This may seem like an odd connection to discuss, but as you’ll see during the interview there is a common bond between the skin and brain that impacts the health of the entire body.

My guest today is Dr. David Perlmutter, a board-certified neurologist and fellow of the American College of Nutrition, who specializes in preventative medicine and neurology. He is recognized internationally as a leader in the field of nutritional influences in neurological disorders. Dr. Perlmutter has contributed extensively to medical literature with publications appearing in journals like the Journal of Neurosurgery, Journal of Applied Nutrition, and Archives of Neurology. He is the author of the international bestsellers Grain Brain, a Grain Brain Cookbook, Brain Maker, and his recent book, Grain Brain Whole Life Plan. You may have seen Dr. Perlmutter on TV shows like the Dr. Oz Show, Today Show, 20/20, Larry King Live, Fox and Friends, CNN, and Oprah.

On today’s podcast, we discuss what has been the missing link in much of the treatments for neurological conditions, and how it also impacts the health of your skin. Please enjoy this interview with Dr. Perlmutter. Dr. Perlmutter, it’s so great to have you on my podcast.

David:                      Well, Dr. Cates, I am delighted to be here as well.

Trevor:  Great. I know we have lots to talk about, but first, you have a book called Grain Brain. I know for some people, they may not be familiar with your book or what that means. I’d love for you to explain to people why you wrote the book, what is really the meaning behind that title?

David:    Grain Brain is a book I wrote back in 2013. That was I guess four books ago. It is a book that is still very, very relevant today, especially I think in terms of where our discussion is going to go. While it deals with the brain, I think it really comes from the perspective of taking a big step back and recognizing that what is good for the brain is good for the heart, it’s good for the skin, it’s good for the joints. The major players in terms of mechanisms that are involved in degeneration are evident throughout the body. There aren’t some things that are bad for the brain while they’re good for the heart, or a heart-smart diet that’s bad for the skin or bad for the joints. It doesn’t work that way. What’s good for the body is good for the entire body.

It is, for purposes of our discussion, a very holistic kind of approach that recognizes the body as a whole. Clearly, the most important mechanism that we deal with, which is somewhat of a surprise to a lot of people, in terms of brain degeneration, is the mechanism of inflammation. For so many of your viewers who have watched your podcast, I’m sure they’ve heard about inflammation left, right and center as it relates to the skin, maybe the joints. It’s the same process of inflammation that leads to Alzheimer’s, Parkinson’s, MS. The autistic brain is a brain that is inflamed. Even ADHD to some degree is an inflamed brain.

All of the lifestyle factors that come to bear in terms of working through this mechanism, reducing inflammation, are just as important as it relates to the brain as would relate to skin or joints or any other body part. We know that inflammation is the cornerstone mechanism of diabetes, of coronary artery disease and even cancer, as well as, as I mentioned, Alzheimer’s and certainly various skin disorders.

Grain Brain was written to really explore what it is that we are doing in terms of our lifestyle choices that amp up inflammation and therefore set the stage for all of the bad brain issues that you don’t want to get. It really focuses on the damaging effects of a high-carbohydrate, high-sugar diet, as well as the damaging effects of a protein called gluten, which is found in wheat, barley and rye and their derivatives. These are all issues that when looked through using the lens of inflammation, are really very, very important well beyond the brain.

The title Grain Brain focuses on the brain, and obviously grain because by and large grain-based foods are high in gluten and high in sugar and carbohydrates, and it rhymed so we went with it. Now that book is in 29 languages, and I’m sure that the title doesn’t rhyme in the rest of the languages that we see.

Trevor:  Absolutely. With grain in particular, let’s talk more about why grains, and why you chose that. Obviously it rhymes, but let’s delve more into grains and why they are an issue for people in the brain.

David:    Sure. As contradictory as this may sound, I am not voting against all grain. I think that whole grain in its very natural state, provided it is gluten-free, is not necessarily something that needs to be categorically avoided. A serving of wild rice, some non-GMO corn, these are valid grains. They are by definition grains, the seeds of grass, and I think that when you simply take into account their carb content and weigh that against the rest of the carbs in your diet over the course of a day, there’s a place for those in the diet. They’re good sources of fiber, there’s some good B vitamins, riboflavin, etc.

What I object to is obviously the gluten-based grains, the wheat, barley and rye, but beyond that, the way grain-based products have insinuated themselves into our diet so aggressively in the form of highly processed cereals, using grain as additives to make other foods, and just how these are powerful sources beyond the gluten story of carbohydrate and even raising blood sugar fairly dramatically, which is devastating for the brain. Not only devastating for the brain, but more importantly, devastating for the gut bacteria, the microbiome, and as such will have an effect throughout the body.

We are now at a place where we’re really bringing together a lot of seemingly very disparate areas of research, and these areas are coming together, coalescing into a sense that diet affects every part of the body – who knew? Hippocrates knew – and that these mechanisms that are involved in degeneration of the joints, of the heart, are the same mechanisms that lead to fragility and breakdown of the skin and breakdown of the brain as well.

What you’re finding is that a lot of so-called specialists are really finding a lot of common ground, like you and I today in our discussion. Who would think that we would talk about similarities between our approaches in dealing with the skin and the brain? They are about as far apart as can be, much less the gut and the brain. I think that really wonderful peer-reviewed, well-respected research is clearly validating that this type of discussion is really on firm ground.

Trevor:  We know that there is more research coming out about the gut-brain-skin connection, and the connection between the three, a lot of this goes back to the gut. It’s really interesting to see this research coming together, right?

David:    It’s true. I think about that years ago when we would see a skin disorder that would have along with it another disorder in part of the body. Let me give you an example. Psoriatic arthritis. Well, we had to mention psoriatic because there’s a psoriasis component, and we had to mention the arthritis. Even though we’re still calling it psoriatic arthritis, we’re still compartmentalizing it to the joints and the skin. Who would think there could be a relationship? Well, these are manifestations of inflammation of a disrupted immune system throughout the body. People with psoriatic arthritis have increased risk of cognitive issues as well. People with ulcerative colitis and Crohn’s disease, which are classically called inflammatory bowel disorders, have a much higher incidence of depression and cognitive issues in comparison to those who don’t.

We’re really starting to recognize that it doesn’t matter where you jump on the carousel. Once inflammation has had its beginning, it’s going to manifest throughout the body. We see a lot of skin manifestations, for example, related to bowel issues. There are a group of neurological conditions that are called the phakomatoses that we all had to study, like von Hippel-Lindau syndrome and all these things that make people think you’re really smart, where there would be skin manifestations of a neurological issue. Now we’re really recognizing that inflammation as a fundamental mechanism when it manifests as dementia will also manifest in other parts of the body, not uncommonly in the skin and certainly in the gut.

For the huge push to compartmentalize and break the body down into its aggregate parts over the years, we’re now seeing – which is really very welcome, again – this much broader perspective in recognizing that skin events affect the joints affect the brain, the gut affects everything, and it’s really time to take a step back and stop feeling so good about the fact that we can compartmentalize things into very, very small areas.

Trevor:                    That’s so true. I see a lot of chronic skin conditions in my practice, and very rarely are people just have skin issues. There’s usually a number of other health issues, like you’re saying. It’s great that there’s more awareness being brought to this, and we’re talking about the root causes behind what’s going on and the inflammation and the microbiome.

David:                      That’s right. When we focus on the root causes and get away from focusing on the symptoms, then we’re actually treating the fire and not just paying attention to the smoke.

In the book that came two books after Grain Brain, called Brain Maker, we really focus on the gut and the role of gut bacteria in modulating the immune system and inflammation. I present a case of a woman named [Nikki 00:11:29] – and I use her name because she’s allowed me to do so. Interestingly, she had lots of skin disorders, all kinds of bowel disorders, depression, cognitive decline, and her problem was gut-related. When we treated her gut, the other things fell into line because we paid attention to the first step, not the end of the process, and treated the fire and not the smoke. Ultimately, smoke goes away when you put the fire out.

Trevor:  Right. People obviously now are hearing we want to get to the root cause, so let’s talk about what you do to help address the inflammation and microbiome imbalance.

David:    The first and most important issue is diet. Here I am a neurologist, and at this stage in my career, what am I paying attention to? Diet and the gut. They don’t teach you that in neurology school, and still don’t. They didn’t 35 years ago. That said, diet is paramount. Really, the focus of all of my work, the number one focus, is of course diet. We recognize that we as Americans are critically deficient in terms of our consumption of fiber, and specifically a type of fiber called prebiotic fiber, which is the type of fiber that nurtures the gut bacteria.

Again, we’re having discussion about the brain and the skin, and I’m talking about the gut bacteria. What kind of sense that make? Well, it makes a lot of sense because, again, it’s the health and diversity of the species of bacteria that live within us that regulate our immune systems and regulate our set point of inflammation throughout the body involving the skin, involving the joints and the brain, etc. Diet is key. A diet that is devoid of fiber, that is low in dietary fat, that has higher levels of sugar and simple carbohydrates, doesn’t nurture the gut bacteria. They can’t do their job in terms of balancing the immune system, and that sets the stage for this whole host of degenerative conditions: diabetes, cancer, Alzheimer’s, coronary artery disease. We’re seeing wonderful research that now links those types of diets to those conditions, and the connection is through the effects of these diets on the gut and the microbiome itself, the bacteria and the other microbes and their DNA and their metabolic products.

Interestingly, last week a study was published demonstrating a significant risk for both stroke as well as Alzheimer’s disease in people who consume artificially sweetened beverages, soda. For those of us who have been following the literature, this was totally expected. Why? Literature published three years ago demonstrated that the changes brought on by artificial sweeteners to the gut sets the stage for diabetes, weight gain and inflammation. Those are powerful hallmarks in terms of risk for dementia and risk for stroke.

This was an article that, amongst many of us, didn’t raise very many eyebrows but certainly caught the attention of the mainstream press when the headline said diet this and diet that are going to give you Alzheimer’s disease. Well, they may put it in headlines, of course, to grab attention, but it’s not necessarily because of the direct effects of the aspartame or saccharine on the brain, but rather more likely the indirect effects because of what those artificial sweeteners do to the gut bacteria that then sets the stage for inflammation, which, as mentioned, is the mechanism that we’re trying to avoid.

Trevor:  Gut is so essential for so many aspects of our health, and providing the right nutrients for it. You’ve mentioned prebiotics, you’ve talked about not getting too much sugar, not getting artificial sweetener, and you also mentioned fats. Could you talk more about fats and how they play a role in the gut health?

David:    Sure. We live in a time when everything has been labeled low-fat, no fat, because fat was demonized and castigated as being the cause of everything from having heart disease to having children who are born naked. It was a crazy world we lived in, the low-fat, no-fat world, when we’ve been eating fat and seeking out fat for more than two million years because of its caloric content and its important role in human health and physiology as a critical player in membrane formation, for example. Cellular communication, neuronal communication. We are desperate for fat, and the removal of fat from the human diet, as was advocated over the past 30 years, opened the door for higher levels of consumption of sugar and carbohydrates. It’s sort of a retrospective that we’re doing now, hopefully that we’ve turned this around. That led to incredible explosion of diabetes. As soon as the low-fat idea hit the mainstream, diabetes rates soared.

Why am I interested in diabetes? If you become a type-2 diabetic, you basically quadruple your risk for Alzheimer’s, which is a disease that has no treatment. That’s why diabetes is important. It also increases risk for cancer and heart disease as well. This move by the sugar industry to influence medical literature, especially in journals like the New England Journal of Medicine in the late 1960s, really I think is responsible for the ultimate deaths of tens of millions of people, more than World War I and World War II combined.

Fortunately, some sanity has been brought back to this equation and people finally recognizing that there really is no science that indicates that healthy fat is a bad thing. It’s actually, by definition, a good thing. By eating olive oil and coconut oil and nuts and seeds and grass-fed beef and wild fish, you’re nurturing your body with a very critical, fundamental macronutrient, which is fat. The reality is we require fat in our diets. The human requirement for carbohydrates is none. Zero grams per day. We require fat and protein and micronutrients.

It’s been a bit of a 180, but it’s actually a 360. We’ve come around full-circle to where humans have always eaten, the ideas of eating good fat and protein with less carbs and less sugar. It’s I think going to pave the way for some fairly dramatic improvements in what were otherwise really very worrisome rates of degenerative conditions and obesity that we’ve seen globally now since the entire planet adopted a lower fat, higher carb diet, with the exception of some areas that eat a traditional diet who continue to eat fat in the form of dairy products and meat, etc.

Trevor:  This shift in the diet, it really did impact the gut microbiome too, this shift that people did in trying to eat low-fat. What kind of damage do you think that that did specifically to the gut, and what can we do to reverse that damage now that we did that damage?

David:    It’s a very difficult question to answer, and here’s why: we have yet, to this day, despite really aggressive research around the globe – people like Rob Knight at UCSD and other people who are deeply involved in microbiome research – we don’t know what a normal microbiome is. The reason we don’t know that is because to some degree the microbiome relates to our genome, and as such, it will be relating to you in a different way than relating to me. First, what is the right microbiome for Dr. Cates versus Dr. Perlmutter? We don’t know that. What is the right microbiome for you in terms of your genetics, in terms of your history, in terms of your ongoing medical issues and medications, for example?

Beyond that, we don’t know if the adaptations made by the gut bacteria to this new diet have been necessarily detrimental. It might be that our microbiome has adapted to a higher carb, lower fat diet in such a way as to be preserving of our health and kinder to our physiology, though I doubt it. I think that what we see by and large in people on a higher sugar diet, which by and large means a lower fat diet hopefully, is that the changes that we see in the microbiome do in fact code for less favorable metabolic issues, outcomes, that diabetes may actually result from the changes in the gut bacteria that have taken place because of a person’s exposure to sugar.

We tend to be a little bit simplistic with the mechanism involved in producing type 2 diabetes, is you eat a lot of sugar, your blood sugar goes up, your insulin levels go up, ultimately your cells become less sensitive to insulin, you become insulin-resistant, and finally you become diabetic. It’s a fairly simplistic mechanism. It makes a lot of sense, but we now know that the metabolic changes that characterize diabetes may actually represent the manifestations of changes to the gut bacteria brought on not just by sugar but by artificial sweeteners as well. I think that those at-risk populations who tend to eat a lot of sugar also are being dialed in to this message that sugar is bad and are now tending to use more artificial sweeteners, which seemingly, paradoxically, is a dramatic risk factor for becoming a type-2 diabetic. Sugar-free, artificially-sweetened beverages are a powerful risk factor, more than doubling your risk for type 2 diabetes. Who knew?

It’s a huge study, European study, over 8000 women were involved in that study. Now it looks as if the reason that happens, it couldn’t have anything to do with insulin and sugar and all that, the signaling pathway. It likely, according to Israeli researchers, has to do with changes in the gut microbiome. They proved it, interestingly enough, by giving humans – volunteers, 20 volunteers – a lot of artificial sweeteners for several weeks, then they harvested their gut material and they infused it into the colons of laboratory animals. Lo and behold, the animals became diabetic and gained weight.

It’s another level of complexity in terms of gaining an understanding as to what causes things like diabetes, and now Alzheimer’s, but I think it also opens the door to all of us who are wanting to develop unique interventions, and whose hands have been tied over the years. Certainly for me as a neurologist, we have so little to offer people in terms of mainstream pharmacology. When it comes to Alzheimer’s, we have zero. We have nothing. When it comes to autism there’s nothing. Parkinson’s, we can give medicines to help symptoms a bit, but we don’t have medicines to alter the course of the disease.

Now that we understand this important role of the microbiome, the gut bacteria, it’s an exciting time because we are being offered a whole new playing field. We all grew up at a time when we were told we need a lot of sugar because the brain runs itself on glucose, and that’s why we need to eat candy bars before we take the SATs. The reality is, by far and away the most efficient fuel for the brain is powering the brain with fats that are called ketones. You can take ketones in your diet, but you can also increase your ketones by simply getting your carbohydrates and sugars really low and adding in some supplemental fats like coconut oil or MCT oil. That will tend to push you into what we call mild ketosis, where you’re beginning to have ketones in your bloodstream that your brain can use. It’ll allow your brain to produce energy, what we call ATP, much more efficiently with less production of damaging chemicals that are called free radicals. It’s really a state that we’re pushing for.

We’ve seen research studies, one way back in 2005 in the Journal of Neurology, that looked at a group of five individuals with moderate-stage Parkinson’s and put them on a very ketotic diet for several weeks, and demonstrated really fairly dramatic improvement in their performance. Actually not changing their medication, but having a pretty dramatic improvement in their ability to function just by allowing their brains to burn fat as a fuel as opposed to sugar.

Trevor:  That’s great. I think it’s really interesting seeing this connection with the brain, and that being the fuel. I certainly remember, yeah, you need to eat sugar to get your brain going, and how that just didn’t seem right.

David:    It was just an excuse to eat Mars bars, I thought, or frozen Milky Way bars.

Trevor:  We’ve talked a lot about diet. Let’s talk about exercise, and the best kinds of exercise for the brain.

David:    I would tell people that any exercise is going to be good. We are just beginning to understand how powerful exercise is for the brain. Everybody knows it makes you feel good, it gives you the endorphins, you get a little bit of a runner’s high, and we know it’s good for your heart and maybe helps your blood sugar. What research has really revealed, Dr. Kirk Erickson and researchers at both University of Pittsburgh and at UCLA have really done a lot of work to demonstrate that when we aerobically exercise, we actually turn on a gene pathway, turn on the DNA code to make a compound called BDNF, brain-derived neurotrophic factor, that actually allows the brain to work better. It actually tells the brain to grow new brain cells, a very protective chemical as it relates to the brain, and leads to actually increased size of the brain’s memory center which is called the hippocampus. Their research demonstrated not only those changes but actual improvement in cognitive function over a two-year period in comparing those who had simple stretching exercises versus those who were involved in doing something aerobic.

Just this past week a study came out, a meta-analysis looking at actual improvement in cognitive function, looked at various studies, in individuals over the age of 50 who regularly participate … In this study I think the magic number was 45 minutes of aerobics or resistive exercise. Exercise is a powerful influence on brain health, and it literally takes my breath away that no one’s talking about it. We live in a country where there are 5.4 million Alzheimer’s patients, with that number anticipated to triple by the year 2050.

We’re spending $230 billion each year in caring for Alzheimer’s patients with research by Dr. Melissa Schilling at NYU telling us that Alzheimer’s could be cut in half with people simply just changing their diets for example, and not becoming diabetic, with researchers like Dr. Kirk Erickson telling us that Alzheimer’s rates could be cut in half if people would just gain more exercise, indicating that 20% globally of the 43 million Alzheimer’s patients, 20% are related to a sedentary lifestyle. This is a big, big issue here that needs to be talked about. Yet the billions and billions of dollars in research are going into develop the next magic drug to get rid of amyloid plaque in the brain, which is actually there to protect the brain.

It’s a challenging time for people like myself to be out there with this message, but there are people who listen, like yourself, so that’s good.

Trevor:  Yes, and we know that exercise is great for so many different levels. It’s just another reason to exercise, is to help us with our cognitive function and our brain health.

David:    That’s right. A new study that came out several months ago has shown that those individuals who are more involved in exercise have higher levels of diversity of gut bacteria. Now, that might just be an observational issue. I don’t think it’s fair to extrapolate to say that therefore if you exercise you will increase your gut diversity, but I’m going to say it right now because I think it does happen. That study didn’t necessarily prove that, but heck, what’s the downside here?

Trevor:  Right, and it just seems like so many things come together when we start talking about this. We go back to this gut-brain-skin connection and all the different ways that living a healthy lifestyle – diet and exercise, stress management, all these things – can help us on many different levels.

David:                      It’s true. Again, it’s this fundamental importance of things that are going on in the gut in terms of regulating inflammation and the immune system. I often get a chuckle out of these commercials on television for people who have what’s called plaque psoriasis. There’s a girl that wants to go to the gym but she doesn’t go to the gym because she’s self-conscious about her psoriasis, and ends up taking a medication that blocks a particular chemical called TNF-alpha, and then she starts taking this blocker of TNF-alpha, a chemical, and they say 70% of people get better. Then you should not take this drug if you have underlying tuberculosis or you have a vowel in your name or some crazy thing. Risk of death, all this stuff.

You have to understand that this chemical, TNF-alpha, that is elevated in plaque psoriasis and Alzheimer’s and ulcerative colitis and various joint issues, is not just a marker of inflammation but it’s a player as well. It is involved in the inflammatory process, but it is ultimately being increased in these individuals with inflammatory disorders because of issues in the bowel related to permeability of the bowel lining, brought on by changes in the gut bacteria. The end game, the end story here is that, well, at the end of the line, TNF-alpha gets elevated and they’ve developed a drug to fix that, and they’ve ignored all of the other issues that came before, because the TNF-alpha is seen at the scene of the crime. It’s like you go to a fire and you see firemen are always there – well, you’ve got to blame the firemen for the fire. No. They are only there because this whole cascade happened, that somebody picked up the phone, called the fire department, they got in the truck, and all this stuff.

These medications, these TNF-alpha blockers, are not without risk. I think when people start to pay attention to the idea that the gut is involved in skin disorders and joint disorders and brain disorders, it’ll be a revelation. The problem with how medicine works in our modern society is there has to be a pill for that. Ultimately, maybe there will be a designer probiotic for each individual problem with the gut that then manifests as an inflammatory disorder. I think that’s coming. I think that drug companies are beginning to see that harvesting this information of the gut is, again, as I mentioned before, a new playing field.

Trevor:                    That’s great. I am excited to see that as well. What about supplements? How do you feel about people taking supplements to address gut issues?

David:    I think there’s a very important role for supplements today. In an ideal world where we were hunter-gatherers and we were eating things that we’d find on the ground, which were by and large either high in fat and protein or very, very high in fiber, we would live in a world that was very harmonious to our physiology. Well, we don’t anymore, based upon the food that is available to us, the environment that we are in which is very, very toxic both from a psychological perspective and certainly from a chemical perspective. I think we need a little help.

I think by and large people seem to be low in vitamin D. I think vitamin D is a huge player in terms of the gut, but also in terms of brain health, heart health, immune health, etc., certainly as it relates to even diabetes. I think there’s a very important role there. I think that supplementing with certain types of good fat like coconut oil is really a good idea. I think probiotics and prebiotics are a critical part of my supplementation recommendations and regimen, personally, especially prebiotic fiber. You and I touched on that earlier, and that may be a term that not all of your viewers are totally dialed into. That is a special type of fiber that nurtures the gut bacteria. There’s plenty of fiber that you can buy at the pharmacy that’s fiber by definition, but it’s not prebiotic fiber. The gut bacteria aren’t able to metabolize that.

We get prebiotic fiber from eating foods like Mexican yam, asparagus, garlic, onions, leeks, chicory root, dandelion greens – my favorite. In addition, there’s a terrific source of prebiotic fiber called acacia, the acacia tree, acacia senegal. It’s that big canopy tree that you see in Africa where the giraffe is underneath it and seeking shelter from the sun. That tree actually secretes a resin that is sustainably harvested and made into a powder, which turns out to be an amazing prebiotic fiber. Health food stores have it. You just go in, say, “I’d like a bag of prebiotic fiber from acacia,” and there it is. That’s a great thing to do for your gut bacteria before you even talk about taking a probiotic.

Even before probiotics are taken there are foods that are rich in probiotics, like kimchi, kombucha, cultured yogurt, sauerkraut, etc. Those are teeming with good bacteria by and large, but I still think taking a fairly broad-spectrum, very shelf-stable probiotic that is non-GMO is a good thing to do for your physiology.

Trevor:  Excellent. I’m so glad we were able to touch on that as well. Dr. Perlmutter, I want to thank you so much for coming on and doing this interview.

David:                      My pleasure.

Trevor:                    Tell people how they can find out more about you and your books, and all that information.

David:                      My Facebook site is David Perlmutter, MD, oddly enough, and my website is DrPerlmutter.com. I post every day. I do a lot of videos, a lot of reviewing of things that have just been written. That’s how people can track me down. Books are Grain Brain, Brain Maker, Grain Brain Whole Life Plan, Grain Brain Cookbook. I don’t know what my next book will be, but we’ll see.

Trevor:                    All right, excellent. Thank you for everything you’re doing to get more information about the different ways that we can address brain issues. Like you’ve said, it’s been so limited to what’s been available, and I really appreciate you addressing the root cause and helping people find a better way to do this.

David:                      Thank you, Dr. Cates. It’s been my pleasure.

Trevor:                    I hope you enjoyed this interview today with Dr. David Perlmutter. To learn more about Dr. Perlmutter and go to the links that he mentioned, you can go to TheSpaDr.com. Go to the podcast page with this interview, and you’ll find all the information and links there. While you’re there, I invite you to join The Spa Dr. community so you don’t miss any of our upcoming shows. Also, you can find there the skin quiz, or go to TheSkinQuiz.com. Get your own customized skin report. It’s free, it takes just a few minutes. You can find out which of the skin types you are that will help you with customized recommendations.

Also, join us on social media – on Facebook, Pinterest, Twitter, Instagram, YouTube – and join the conversation. Hop on over to iTunes and if you like this podcast, leave a review, subscribe to the podcast so you don’t miss any of our upcoming shows and other people know about how much you’ve enjoyed this.

Thanks for joining me today, and I’ll see you next time on The Spa Dr. Podcast.