How can L-histidine, melatonin & activated charcoal help you? – The Eczema Podcast (S4E03)

Abby ([00:03]):

I’m so excited to have you here today. I have a great podcast for you today. It’s a continuation of last week’s podcast… or sorry, the last episode. And if you heard the podcast, you know that we had such a great guest, he’s an amazing dermatologist who was just so rare to find in case he missed the episode. He shared about why eczema dermatologists like him who specialize in adult eczema can actually take a 70% pay cut and get paid three to four times less than their other dermatologist’s counterparts. And you’ll learn why. And he also shared a lot of great information about why he doesn’t practice like a regular dermatologist. Anyway, in today’s episode, it’s all about other things that he includes in his practice, like different types of supplements that he’ll recommend.

Abby ([01:03]):

And I just loved that. So, I hope you love today’s episode. Today’s episode is brought to you by conquerors, conquer skin care, conquer skin here has shipped over 20 countries. It’s all natural, which is super important because we only want to put clean thing and clean ingredients on our skin with no harsh ingredients and no, no harsh preservatives as well. So, if you use the code podcast 10, you can get 10% off at just head to eczema conquerors and go to the shop section or either just visit shop.eczemaconquerors.com and you’ll get 10% off with the code podcast 10 I hope you enjoy today’s podcast.

Abby ([02:00]):

In a way I feel like you’ve mastered like the psychology behind the patient and the doctor like the relationship because you know, like I was mentioning how you know, most doctors don’t really take the time to listen or spend a lot of time with their patients, but you do. So, what’s an average time you spend with your patient? And then also, how long are we times for… to see you?

Dr. Matthew Zirwas ([02:24]):

Yeah. So, believe it or not, since dupixent came out, wait times to get in to see me have gone way down. And it’s because so many patients that I used to have to see like every six weeks, now I can just see once a year because they’re doing so much better. But the, the normal sort of new patient, we scheduled 20 minutes in appointment. Sometimes it’s easy and it only takes 10. You know, sometimes it’s hard and it takes 45 minutes, but however long it takes, it’s overload it takes. Now, that’s one of the frustrations I’m seeing me as that it’s not rare that a patient will sit in my waiting room for an hour and a half because if I had two or three difficult patients that I had to spend a lot of time with, it’s going to take, you know, I’m going to be way behind the rest of the day cause I can’t, if I booked an hour per patient, then it would take two years to get in to see me. So, but we scheduled 20 minutes for new patients’ appointments, my follow-up appointments we generally schedule 15 minutes. But again, I do have some normal patients who have skin cancer or acne or that kind of stuff that I can do in five minutes. So, if I need to spend more than 15 minutes with my eczema patients, I often end up doing them.

Abby ([03:40]):

So, do you also I know you mentioned that you also do believe in probiotics, you believe in a diet as well? So, I know well actually do most doctors and dermatologists believe in that or even prescribe that these days?

Dr. Matthew Zirwas ([04:00]):

I would describe it as most dermatologists, know that there’s something there, but we don’t know enough yet to have like a, you’ve got eczema, here’s the probiotic for you to take. So, it’s like a kind of a discussion of like, yeah, I did probate. They definitely help. But I’m not sure which one you should take. I would recommend this one because it’s cheap. But there might be other beds, you know, so it’s again, a longer conversation. I’m also a believer in a lot of what is termed complimentary or integrative medicine. Because then it makes sense, right? That now the part of why I believe in those things is because of how we now understand eczema, right? So, eczema is now a really simple thing to explain to patients like it is, it’s a one-minute explanation that makes it, it doesn’t, well really makes it click.

Dr. Matthew Zirwas ([05:06]):

Right? So, what is eczema? Two things. One, you have an immune system that overreacts to things in the environment. Things in the environment doesn’t mean necessarily chemicals and pollen. Your environment also includes the bacteria living on your skin. Your environment includes the temperature and humidity of the air that you’re in. Your environment includes water hitting your skin, right? So, we there’s now evidence, recent studies have shown that water just plain water makes your skin less effective as a barrier. So even if you get a shower without any soap at all, it still makes her skin worse as a barrier, right? So, our… the whole modern world is basically set up to be bad for your skin, right? We evolved to live naked outside, right? And to never get a bath. That’s what humans evolved for. And that is the exact opposite of what we do.

Dr. Matthew Zirwas ([06:03]):

Now. That’s a part, one of eczema is an immune system that overreacts to the environment and every person is unique for you. It might be 50 things in the environment for the next patient. There might be two, but your immune systems are reacting to stuff in the environment. Now, if your skin works the way it’s supposed to work, you still won’t get eczema. Even if you’ve got an immune system that overreacts because the stuff in the environment can’t get into your skin, right? So, if you just have an overreactive immune system, you get allergies, you might get asthma, you don’t get eczema. Second part of eczema, you have skin that doesn’t work as well as it should. So, this your skin lets water out and it lets things from the environment in and the things from the environment. Everything from air pollution and residual lager detergent in your clothes to your own sweat, to the natural bacteria on your skin.

Dr. Matthew Zirwas ([06:52]):

Like the environment in general, your skin is letting in. Now if all you have is skin that doesn’t work that well, you’ve got dry skin sensitive skin, but you don’t have eczema. I have eczema. You have to be the lucky winner who gets both an immune system that overreacts to things and the skin that lets things get in so your immune system can see them. Now what’s really interesting about this is that we now know that the, the atopic march is completely driven by your skin, right? So, the reason why people get they start with… kids start with eczema, then they get food allergies is because the way you get a food allergy is by getting food on your skin. And so as a baby, you’re getting food all over your skin. You develop food allergies. The way that you treat food allergies is by exposing the, your, your intestines to the food.

Dr. Matthew Zirwas ([07:47]):

Right? So, from an evolutionary perspective, what our immune system thinks is if it’s getting on my skin and getting into my skin, it must be biting me. So, it’s a parasite. And so, I need to react against it. If I’m seeing it not in the skin but in the intestines to get into my intestines, they probably, it was intentionally put into my mouth. So, it’s good at something I want to have consumed. So, anything that goes in that your immune system is seeing in your intestines, it is desensitizing your immune system, your immune system’s learning. It’s okay. So, babies get food allergies because they have eczema because the food that they’re getting on their face when they’re trying to eat is getting into their immune system. Their immune system is saying, Oh, things that come in through the skin are bad.

Dr. Matthew Zirwas ([08:36]):

You can react to it. Then as they get older and they stopped getting it all over their face and get it into their mouth. Now that ratio of how much exposure there is on the skin compared to how much exposure there is in the intestines changes as the food is exposed more via your intestinal route. You get desensitized to it and your food allergies go away. Right. So, the like all of this stuff about my food allergies are causing my eczema bologna. Your eczema is causing your food allergies. Right, and it’s now that we understand did the problem with eczema is an overreactive immune system and skin that doesn’t work very well. It totally changes how we think about those food allergies. Now. It also changes, and again, this goes back to how I relate to patients. Another thing that I tell them, almost universally moms of kids with eczema, if you really ask them, they have been, it has been implied to them by every single doctor they have ever seen that it is their fault.

Dr. Matthew Zirwas ([09:37]):

Their child has eczema because they are a bad mother. Now, has anybody said that to them? Nobody has said those words, right? But what people have said is, well, how many times a day do you give them a bath? How many times a week do you give a bath? What temperature is the water? What kind of soap are you using? What kind of clothes do you have them wearing? What kind of laundry detergent are you using? What did they heat for every single meal for the last three years? And what exactly happened? 10 minutes after they ate? What about an hour after they, what about the next day? You’re not keeping a diary of exactly what happens with every single food your child has ever eaten. Oh, you’re not having them eat organic will. Oh, my goodness. Right? So, what that is all saying is if you’re a good enough mother, your child would not have eczema because it’s really their environment.

Dr. Matthew Zirwas ([10:17]):

You’re not being careful enough with how you’re bathing them. Do you have carpet in their bedroom? Oh my God. You have carpet in their bedroom, dust whites. You’re getting them a humidifier in their bedroom. No, the air’s too dry. You’re hurting them. Yes, you do have a humidifier with that’s causing more deaths. My turban, right? So, moms come in with this incredible guilt that the eczema is their fault and the research has shown that eczema, significant eczema has a more dramatic psychological effect on parents than any other medical problem except cancer. So, if your child is diagnosed with diabetes rheumatoid arthritis anything, eczema is worse. It affects parents worse than anything else. And it’s because what is implied to them as if you are good enough about managing your child’s environment and diet, they wouldn’t have eczema, totally yes. The problem is not in a wrong environment.

Dr. Matthew Zirwas ([11:14]):

The problem is you’ve got an immune system that will react to whatever’s in your environment. And if you take the stuff that they’re reacting to away, there are mood system, we’ll find other stuff to react to. Like you cannot manage eczema with environment. But then what I’ve slowly learned over time was that the same applies to adults. Like every time I hear somebody talk about, well, if you can get the patients to use the right voice dresser and use the right soap professorate right and be in the right environment and do everything right, then they’re, you know, I find that their eczema does much better. It’s what I would have say is like, okay, great for the one patient in a million who has the time and money to do exactly what you said, maybe that’ll help my experiences. It doesn’t, right that if you add, but as an adult patient, if you do everything perfect, use the right moisturizer, the right soap, the right bathing frequency, the right clothing, the right bleeds, pass the right diet.

Dr. Matthew Zirwas ([12:07]):

If you did everything perfectly, you might get a little better, right? But it’s not going to be like my eczema went from horrible to now I’m cure just doesn’t, I’ve never seen that happen. Not, not once in 20 years. So, it becomes much more about, you have to eliminate the big stuff, right? So, you know, I don’t want somebody using dial bar and getting three hot showers a day and never putting moisturizer on. Obviously, that would make anybody have dry, irritated skin. Right? So, but once you’ve done the very basics you know, for me that’s used of bar as your, so you Sarah V as your own, as the only moisturizer that you put on. I’m pretty much done. That’s it. Okay. Rest of your environmental stuff. See how it seems to affect your skin, but it’s not what’s going to be, makes a big difference.

Dr. Matthew Zirwas ([12:59]):

Now the, the things that I think can make a difference. It’s been, again, really fascinating for the last probably five years. We’re starting to find out so much more interesting stuff. Right? So, the microbiome, both intestinally and cutaneous no question. Probiotics help a ton, but probiotics now, I think that they have to be started very early in life to have the main effect. I don’t know, I haven’t seen them make a huge difference in adults, but I, I do think they make a difference. Melatonin, multiple trials now showing that melatonin helps with eczema, doesn’t it? It helps with people sleep. But it also seems to have a direct effect on the eczema Virgin coconut oil. Right? So and now w what people need to understand about coconut oil, it has to be Virgin, unrefined, cold pressed coconut oil, because the key ingredient in coconut oil are the medium chain triglycerides, which have an anti-Steph and they help reducing bacteria on your skin and they help as an anti-inflammatory.

Dr. Matthew Zirwas ([14:04]):

As soon as you refine or heat coconut oil the medium chain triglycerides go away. Right. So those are sort of three relatively obvious, I don’t want to say obvious, three things that have really good literature in evidence behind them that if somebody said to me, I think that’s baloney. Melatonin raw, we should be telling people to use hydroxyzine. Here’s the study, right? Here’s the randomized double-blind placebo-controlled study that shows melatonin helps. Oh, and by the way, here’s the study that shows that taking hydroxyzine or doxepin basically doubles your chance of having Alzheimer’s whenever you’re old. Right? So, trying to get away, like I get it. If I as a patient, I don’t want to take drugs. Do I think drugs are the biggest thing that has helped mankind? Yes. But if I can get away from taking them, I don’t want to take them either.

Dr. Matthew Zirwas ([14:57]):

Right. So, I’m not, I’m not like anti pharmaceuticals. I’m very pro pharmaceuticals, but I get, if I could not take them, I wouldn’t take to either. You know, other things that I, I’ve had some success with I use a fair amount of activated charcoal. So again, activated charcoal, lots of evidence that it’s going to bind intestinal toxins that are being produced by the bacteria in your intestines and help reduce those being absorbed into the skin. I think there’s maybe some evidence, not a lot. I think there’s maybe some benefit to going to a mostly vegetarian diet. I don’t think that people need to be vegetarian, but the less meat they eat and the more plants they eat, I think the better that they will do. Other things I’m less excited about. So now one example might be fish oil.

Dr. Matthew Zirwas ([15:56]):

We know there is good evidence that taking fish oil can help improve your skin barrier. The problem is that you would have to take basically a whole bottle of fish oil pills every two days in order to get enough fish oil to meet the amount that has been shown to be helpful in the studies. Okay. the, you know, I do think there’s some role for acupuncture. There’s good studies showing the acupuncture when done well has a very good anti-itch effect. I think there’s good evidence that for stress reduction techniques, but that goes for everything. Not just eczema. I don’t care what’s wrong with you. If you can reduce your stress, you’re going to be better. The another one that, that doesn’t seem like a natural approach but is I mentioned Sarah V a few minutes ago. Now I’m going to give everybody a big caveat right here.

Dr. Matthew Zirwas ([16:51]):

I have been working with the Sarah V company for 10-15 years now because 10-15 years ago I went to them and said, I think this is the best product in existence. I want to tell everyone in the world that it’s a fantastic product and occasionally they pay me to tell people. Right? Most of the time I’m telling people that it’s what everybody should be using without being paid to tell them that. No. Why is Sarah unique? Sarah is unique because it’s the only product out there that has Sarah, my one and let me also tell you I have no stake in like how much therapy gets sold. It’s not like, oh my God, if I say people should do Sarah V and they buy more like nothing. Okay. I don’t, I don’t care if you buy Sarah V. What’s unique about Sarah V in series minds one and Sarah minds three in it, it is the only product that is widely available comes in a large container and it’s cheap.

Dr. Matthew Zirwas ([17:41]):

That has Sarah one and three. The studies are pretty good, that combining Sarah might one and three together is dramatically more effective than having either Sarah minds one or Sarah minds three in a product. And so, and what does Sarah minds actually do? Sarah minds are the limiting step in how much natural protective oil your skin can produce. So now it varies in, you know everybody. There are many, many, many different genetic reasons why somebody’s skin doesn’t work as well as it should. Sarah minds are one of them, but so they are the rate limiting step for most people in terms of how much natural protective oil their skin can produce. So traditional moisturizers, how do they work? They are [inaudible], they’re taking artificial oil, right? So, petroleum jelly or mineral oil. Historically now we’ve gotten more natural with coconut oil, jojoba oil, Shea butter, those kinds of things.

Dr. Matthew Zirwas ([18:41]):

But they’re taking oil that is artificial to your body, putting it on your skin surface to try and supplement your skin’s natural oil. If you could stand in your bathroom naked all day, that would be extremely effective. Most of my patients want to put clothes on. And what to leave their bathroom right, and as soon as you do that, that artificial oil starts getting wiped off your skin and there’s no longer helping you. Okay, so traditional moisturizers better than nothing but not that good. Sarah, my ads get absorbed into your skin and then your skin cells tape the Sarah minds in, use the Sara minds to make more of the natural protective oil in the deep layers of your skin. That’s what makes Sarah V unique. Now, to see if you’re going to have a benefit from it, you have to use Sarah V for at least two weeks because it takes a while for your skin to do this whole process.

Dr. Matthew Zirwas ([19:36]):

My experience is that for about half of patients, Sarah V is significantly, noticeably better than any other moisturizer they’ve ever used. 40% of patients, it’s the same. It’s no better than the SITA fill or the Avino or the userin or the whatever, and for about 10% of people, other moisturizers work better, right, and all of that. I think if we really have the science to get down to it, it comes down to genetically different people have different reasons why their skin doesn’t work as well as it should. But so, the other thing that’s really great about Sarah V though, or that their products do not have any of the common allergens in them. So, there are no, no servi products have fragrance. No. Sarah B products have propylene glycol know Sarah V products have a ISO thigh Zola notes. Nope. Every product has formaldehyde, blah, blah, blah.

Dr. Matthew Zirwas ([20:26]):

You go down the list. So, I can recommend them knowing that I’m not going to cause allergic contact dermatitis on top of their atopic dermatitis who I knew I was forgetting something. My gosh, my favorite natural thing that nobody knows about. This was an absolutely mind blowing whenever it came out two years ago. So, in your skin, you have a substance called filaggrin. Okay. if you, if you ever have like a geneticist or somebody on talking about eczema, they will tell you that filaggrin is the most common genetic deficiency underlying eczema. Your skin doesn’t make enough flagger. Okay. What’s filaggrin do? It’s called filaggrin cause it’s filament aggregating protein. It helps, I’m sure you’ve heard the term bricks and mortars. What your skin is the flagger and helps make the bricks. Okay. Don’t care. That is has nothing to do with eczema.

Dr. Matthew Zirwas ([21:21]):

What the way the filaggrin has to do with eczema is that after it helps make the bricks, it gets broken down into natural amino acids, right? So, every protein is you can remember those little things as a kid, the little pop things, or it’d be like little balls that you popping them together. That’s what every protein is like. Individual amino acids all stuck together in a line. Well, after the filaggrin causes the bricks to form, it then breaks out into its amino acids. And those amino acids make what is called natural moisturizing factor. This is what holds the water in your skin. So, we know that a deficiency and flag [inaudible] [inaudible] is the most common genetic thing that leads to skin that doesn’t work very well. What did filaggrin used to be called? It used to be called histidine rich protein, somebody two years ago did a study really well done where they gave people studying by mouth and they showed that if you take his study in by mouth, the amount of filaggrin that your skin produces goes up and the amount of natural moisturizing factor goes up.

Dr. Matthew Zirwas ([22:28]):

An eczema gets about 30% better on average. Turns out you can buy. So, it’s other two different types of histidine and there’s L histidine and R histidine. It’s got to be L histidine. You can buy L histidine on Amazon and it’s cheap. And so, I’ve started recommending to patients by L-histidine. It’s a totally right, it’s a chemical, they make it a lab, but it’s an amino acid, so it’s totally natural. Buy it, start taking it as a supplement. The thing you’ve got to tell people though is the normal recommended dose of his study is 500 milligrams a day. To get the effect of it helping your skin, you need 4,000 milligrams a day. So, you need eight times the normal dose that it recommends on the package. So, if you buy the L histidine pills, you have to take eight pills a day and it’s ridiculously expensive.

Dr. Matthew Zirwas ([23:18]):

However, they sell it as a powder and in the powder it’s cheap, but it tastes terrible. So, it’s like this problem where if you can stand taking it because it tastes so bad, my experience is about a third, probably about a third of people with eczema. It really makes a big difference. And how does it do that? It does that by stimulating your body to make more filaggrin and thereby to make more natural moisturizing factor. It also probably reduces at the pH of your skin. Oh, that’s another one of my favorite natural things. So, it probably reduces the pH of your skin because it’s an amino acid and your skin is supposed to be slightly acidic. If your skin is not acidic, it doesn’t function correctly. And it’s been shown that people with eczema, their skin is not acidic enough. And so, the history and probably helps stimulate the national acidity of your skin.

Dr. Matthew Zirwas ([24:08]):

But that comes back to one of my other favorite natural things. Apple cider vinegar. Right now, Apple cider vinegar is something I could tell people like. So, over the last 20 years I’ve been experimenting in my garage and I have developed a new pharmaceutical that is a cure for everything known to man. All you have to do is take one pill and you’ll live to be 150 and they’d be like, okay. Or I could say, I want you to take Apple cider vinegar and the big Apple cider vinegar. That’s great. That’s what my grandma said I should use. Right. People love Apple cider vinegar. The right way to use Apple cider vinegar. I will often have people add a tablespoon of Apple cider vinegar, a two a one-pound jar of moisturizer. So that takes the pH, which is a marker of how acidic something is.

Dr. Matthew Zirwas ([24:55]):

It takes the pH of the moisturizer from about seven. Most of them are about seven down to being about five. So, it helps support the natural acidity of your skin by adding that little bit of Apple cider vinegar to the moisturizer. So that’s another natural approach that I frequently use. And if I’m, if I’m giving people a one-pound jar of topical steroids, how often I’ll have them add the tablespoon of Apple cider vinegar to the, to the jar of triamcinolone cream. Again, to help support the natural acidity of the skin. How want I get that from the histidine to the Apple cider vinegar. So, you can kind of see where, right. These visits can get long. And as you can see, I get excited about this stuff. I think that’s another thing that helps is that like when I’m talking to the patient, like you’re take L histidine and that stimulates your skin to make more natural ways. Obviously, that’s having your doctor sound excited about something that’s natural and totally safe. Most patients really like that. So, the, yeah, you can see I get excited about this stuff. Sorry. Sorry.

Abby ([26:06]):

That’s awesome. You are the first dermatologist I know that recommends activated charcoal and L histidine and I just think it’s so cool. So, okay. I have a couple of questions for L histidine. What brand do you recommend and how many, how, what percentage of your patients you see get better on L-histidine?

Dr. Matthew Zirwas ([26:25]):

So, I was recommending a brand called bulk supplements, which they sold a hundred-gram bag of it for about $17. I think they started selling so much of it that they actually, they stopped making the hundred-gram bag and only make now like a I think 250 grams bag is their smallest and it’s about 30 bucks. But any, sorry. I think another couple of other companies have now started making L-histidine and powder. So, it’s one tablespoon a day. Well X, I can never remember. It’s either a tablespoon or a teaspoon. So, on the back of the bag it recommends an eighth of an, I think it’s an ease of, I can’t remember if the teaspoon or tablespoon, I’m sorry. I think a tablespoon. Think it recommends an eighth of a tablespoon. You’ve gotta take eight times the normal dose because you need 4,000 milligrams, not 500 milligrams.

Dr. Matthew Zirwas ([27:18]):

It tastes unbelievably bitter. So, one of the first people that I asked that I told to start taking it came back and was like, do you know what this tastes like? No, wait here, taste it. So, I’ve learned it tastes horribly bitter. Apple juice is what people have told me. It helps the most. It still tastes pretty bad. Even an Apple juice though, my, my guess is a third of people come back and say, that really made a big difference. And two thirds don’t know. Right. So, if it made a difference in the other two thirds, it wasn’t a huge difference. But I’d say about a third of people come back and say, wow, that really made a big difference.

Abby ([27:59]):

And how long does it usually take to notice a difference?

Dr. Matthew Zirwas ([28:03]):

Two weeks to a month. If I tell people, if you take it for a month and you haven’t noticed a big difference, forget it.

Abby ([28:09]):

All right, sounds good. Maybe I’ll try that as well. Okay. Sorry.

Dr. Matthew Zirwas ([28:15]):

It has been, it has benefits for people without eczema too. So, it just hydrates your skin better. I tell a lot of people just have dry skin to take it. And same thing, I think about a third of people read it. It sounds good. It’s like, okay, you’re taking, you need to moisturize your whole body rather than try and put moisturizer all over. You can almost think of it as a moisturizer that you take by mouth.

Abby ([28:34]):

So maybe it has anti-aging benefits too.

Dr. Matthew Zirwas ([28:37]):

Maybe it grows hair, right? That, Oh my God, if it grows hair.

Abby ([28:43]):

All right. Okay. So, I wrote down so my other question, okay. What do you think about, I’ve heard, you know, people have said that because coconut oil does is antimicrobial, it does kill the bacteria, but they say that it lowers the it really changes the acidity of your skin too much where because it kills too much bacteria. It’s actually not that great for your pH and your skin. What are your thoughts about that?

Dr. Matthew Zirwas ([29:06]):

I have never heard anybody say that before. Let me think about that for a minute.I will tell you, I have not had coconut oil be as stunningly effective as I would like. So, it’s something I probably more go to coconut oil when I’m dealing with a patient who I can tell is, is more natural, is more important to them. So, in mine I’d say my normal patient, I recommend Sarah the first, but if they’ve had a problem with Sarah V or you know, moisturizers in general or if they’re just very natural, then I go to the coconut oil. But I have not seen the Coke. I can’t say that I’ve seen it be like terrible eczema, totally use coconut oil. Oh my God. Now they’re better. So, I’m not like a stronger studies that support it. It’s natural and it’s cheap, but I haven’t seen it work like that great.

Abby ([30:11]):

Another question I had was melatonin, I want to learn more about how it can help the skin and not just with sleep, but how you mentioned that it has benefits for the skin as well.

Dr. Matthew Zirwas ([30:23]):

So main answer I have to that is I have no idea how or why there had been two randomized double-blind placebo-controlled studies, right? So, the Holy grail of medicine, randomized, double blind placebo-controlled study must work if it’s lots of things work, even if they don’t, even if a randomized double-blind placebo-controlled study didn’t show, they were. But if a randomized double-blind placebo-controlled studies showed that it did work, it does do something. And so, there are two of them looking at melatonin in kids with eczema. And really where that came really helpful for me was it came out right around the same time that the first studies came out showing that there might be an association with taking anti-histamines on a long-term basis. So, Benadryl, diphenhydramine, hydroxyzine, doxepin that those may be associated with an increased risk of dementia later in life.

Dr. Matthew Zirwas ([31:23]):

So there suddenly became a reason to try it. And I want to tell you, I never really use those drugs much because right. Here’s what you always heard. Dermatologists say anti-histamines don’t help with eczema. I just give people the hydroxyzine because it helps them sleep, right? The correct answer to that is that you’re a moron, right? Because there’s a reason if you go to your primary care doctor and say, I’m having trouble sleeping, they do not give you hydroxyzine because it has way more side effects than normal medications to help people sleep. So, right. I can never remember the generic name of an Ambien many fewer side effects than hydroxyzine. So, if I’m going to give you something to help you sleep, I can choose between hydroxyzine tons of side effects, pretty dangerous drug or Ambien. Many fewer side effects, much safer. I’m going to give you Ambien and not hydroxyzine right.

Dr. Matthew Zirwas ([32:16]):

Or Atarax is the other name for hydroxyzine. But so, when the studies though came out that showed that any of these drugs, Ambien, hydroxyzine, any of them may increase the risk of getting dementia when you’re old. It became much more important to me. I need to find something else to recommend for people who the eczema is cause of sleep problems. And it was right around the same time that the melatonin studies came out. Now why it, it seems to help with the eczema. I do not know. I can’t, I’m all, I’m somebody who’s always looking for a story, right? I want, I want some reason to be able to tell the patients, here’s what’s happening, right? The medium chain triglycerides in the coconut oil and the acidity of the histamine, the acidity of the, you know, I want a store. I don’t have a story with melatonin. It’s one of those things where studies have shown it works. I don’t know why. [inaudible]

Abby ([33:06]):

That’s so interesting. My mind is so intrigued as well.

Dr. Matthew Zirwas ([33:10]):

Agreed.

Abby ([33:12]):

Interesting. Okay. the other one I wanted to talk about was activated charcoal. So, I want to learn more about how you use it in your practice and the effects you’ve seen, how long it takes the work.

Dr. Matthew Zirwas ([33:25]):

Yup. So first, let me tell people a little bit about activated charcoal first, right? Just a tiny bit of education about it. So charcoal, right? Is, would that has been he did. Right? So, it’s a normal like black stuff that’s left after a fire activated charcoal is you take that and you put it in an oxygen, an environment that has no oxygen and you heat it up to about six or seven hundred degrees. That’s what activates it when it activates it. What it really does is create these massive number of little pores and channels in the charcoal. And then where activated charcoal is most commonly used medically is poisoning. So if, if your kid got into the medicine cabinet and took a whole bottle of one of your prescription drugs and you rushed him to the ER, the first thing they’re going to do is pump a bunch of activated charcoal into their stomach because activated charcoal will, all those little pores and crevices will absorb almost any large, not large, any small enough chemical or toxin.

Dr. Matthew Zirwas ([34:27]):

Right? And so when I first got interested in this, and I’ll also tell you most of the things that I’m interested in that I’m talking about are things I’d say half of them are things that a patient told me and like, Oh, I read this and started doing it. And then I’m always like, okay, I wonder it. And then I educate myself about it and see why activated charcoal is one of these things and the patient told me about, so, right? We know for certain that the reason that the bacteria in your intestines matter has nothing to do with the bacteria themselves. It has to do with the substances that the bacteria are releasing. So, they may be releasing beneficial substances both into your intestines and that get into your bloodstream. They may be release releasing harmful substances and toxins. The activated charcoal is whatever they’re releasing, it’s going to absorb it and prevent it from getting into your blood. If you had a really healthy intestinal microbiome, anything that the bacteria are producing and reducing the activated charcoal is going to bind to it and it’s going to stick to the activated charcoal. So, it’s not going to have its effect. So, if you’ve got a

Dr. Matthew Zirwas ([35:38]):

Bad microbiome, the aggravate Turk will be good for you. If you’ve got to do it microbiome, it could be bad for you because it’s going to be preventing the good stuff from getting it. So, kind of my working assumption is if you’ve got pretty good eczema, if anything, your microbiome is probably out of balance and not good for you. And so, the activity terminals are going to help. So, I have people start taking activated turquoise like I’m giving a month and see. Do you think it made a difference? Do you think you feel better? Do you think your skin is getting better? You know, your immune system is getting less activated and angry. The only real thing that you got to work that I have to work in about activated charcoal, if you take it before or with your prescription medications, it can bind to the prescription medication so they don’t get into your body. And so you got to be careful. You can’t just take it to your meds.

Abby ([36:34]):

You notice that people actually get better after taking it?

Dr. Matthew Zirwas ([36:37]):

Yes, but I’m not in any way convinced it is either it is the activated charcoal or it is a placebo effect. Right. So that’s the problem with everything with eczema is that if you believe it’s going to help and right if your dermatologist is like, Oh my God, activated charcoal target with fat and it’s so effective, you can’t take it with your prescription drugs because of the neutralize them because it’s so active and it’s going to change your life and be wonderful. You really are going to believe it’s going to make me feel better and then you might just feel better. [inaudible] I don’t know if it’s placebo or activated Turkle. I don’t really care.

Abby ([37:13]):

No studies yet. Right,

Dr. Matthew Zirwas ([37:15]):

Right. It’s like if you feel better, I’m happy.

Abby ([37:19]):

Awesome. Okay, one last thing. Super, super quick. I know you need to go soon. You mentioned that food allergy is caused by babies putting food on their face. So, tell me more about that. Like, how does it actually activate the allergy symptom? And is it every baby that puts, you know, food on their face or…

Dr. Matthew Zirwas ([37:36]):

Right. So the, there are several, it’s mostly studies in animals that had, that have showed this, but that if you want to make an organism allergic to a, a substance by far, the best way to do that is to damage the skin and then rub that substance on their skin. And when you do that, there is a, your immune system in your skin is totally different from the immune system and your intestines. And so, anything that your immune system sees in your skin, it is much more likely to react to it by becoming allergic. And so that, and that just has to do with the way that your immune system processes the substances. So now when it goes into your mouth, your immune system is seeing it via the immune system in your intestines. It processes it in a totally different way and that makes you less allergic to it.

Dr. Matthew Zirwas([38:38]):

But the with infants, it really comes back to if, if they, if you have normally functioning intact skin, you can rub food all over your body and it doesn’t get to your immune system because the proteins in food, which are the, that’s the part that people become allergic to are way too big to get through the skin surface. But if you’ve got eczema so that your skin doesn’t work the way that it’s supposed to, as a barrier, that food that gets on the surface of your skin, those proteins are able to penetrate into your skin and get down deep enough to where your immune system can see them. And so that’s why little babies were typically started off by having eczema. And then they develop the food allergies after they have the eczema because that inflamed eczema skin and they’re probably, the reason babies get so much eczema amount in their face is because of all the drool and drool is bad for your skin also.

Dr. Matthew Zirwas ([39:42]):

So, the drool, so they’ve got, they’re genetically prone to eczema, the drool in the irritation as president get the eczema on their cheeks. And then whenever they eat, they’re getting it all over their face. And so, because they had, they have eczema or the drool was able to cause the rash. Now because there’s the rash, the skin isn’t working too as a barrier. The protein is able to get in and then their genetically overactive immune system has a, a this really strong reaction against the food. And it’s also why then like I said, as they get older and they stopped getting food on their skin because they get better at hitting their mouth, their immune system starts to get retrained that no, I shouldn’t be allergic to the food. I should actually be anergic. So anergic is the opposite of allergy. And so, as they continue to get the food into their mouth instead of under skin, it re-educates their immune system so that the food allergy goes away.

Dr. Matthew Zirwas ([40:44]):

And it’s one of the dangers of, so like we just change, right? For years we’ve been telling parents, don’t let your kids eat peanuts, not let your kids eat peanuts. And that turns out the best way to prevent peanut allergies, to have your kids eat peanuts. Right? So, and that’s exactly why, because if you get the peanut in your mouth so that it, your intestines are where your immune system is seeing it, your immune system learns that it’s safe. But if you’re getting the peanut on your skin, then your immune system learns it’s not safe.

Abby ([41:15]):

Interesting. That’s so yeah, I, that’s the, that’s the first time I’m hearing that. I mean, I’ve heard about the part, you know, eat the food early on to prevent allergies, but interestingly about putting on your face, it actually absorbs into and creates the allergy. So, I’m glad that you shared that. All right. So, I know you need to go now. So, I want to leave our viewers and listeners with maybe a lot of them are going to ask, how can they find you? How can they learn more about what you do or get in touch with you or even maybe see you for an appointment? So, do you do online consultations or only in person?

Dr. Zirwas ([41:56]):

Only in person. Largely because that’s a medical legally, right? You’re, you’re state of Ohio. You’re only allowed to do I’m only allowed to be a doctor for people who are in the state of Ohio, whether it’s telemedicine or not. Plus, I just can’t do it. Like I cannot be a good doctor to someone via internet because I need to feel their skin. I need to touch their skin; I need to take a good look at all of it. And I can’t do that via the internet.

Abby ([42:33]):

So, do people ever fly into see you? Sometimes,

Dr. Matthew Zirwas ([42:36]):

Yes. I do have that happen. To be honest, I don’t like it because the expectation, which I totally get of like, okay, I took a day off work, I got a hotel room, I paid for her, I paid for flights, like whatever. I would have expectations like this if I did that to go see some doctor and like I’m good, but I’m not, that’s my life’s in the background. It just, I, it’s rare that I can fit. It’s rare that I, I just feel like I can’t live up to that expectation. It just is too, is too hard. And then if it’s somebody who I’m like, okay, let’s try this and then I’m going to see you back in six weeks. Like, I’m not going to expect somebody to like fly to Columbus every time. I want to see them back. Like, it’s just really hard to take care of people that way. So, I don’t, I don’t like doing that.

Abby ([43:37]):

Yeah. I have another doctor where the same thing happens and he doesn’t like that either. When people fly in from other countries or you know, same thing that you mentioned. So where can people find you? Work in the, find your studies

Dr. Matthew Zirwas ([43:51]):

If they so my practice is a, if they Google, say Matt Cyrus in Columbus, Ohio they’ll find my [inaudible], they’ll find my office. And there’s a lot of a lot of lectures I’ve given over the years our online as a sort of educational materials that I think anybody can, can access. You know, there are probably a little more medical Lee’s right. So right their lectures that I’m giving to other dermatologists and healthcare providers. But you know, I know I’ve had a lot of patients over the years who have listened to those told me they found that really helpful and that kind of stuff.

Abby ([44:33]):

Okay. That’s great. And lastly, I know there was something you mentioned that you know, you have your own products, so,

Dr. Matthew Zirwas ([44:39]):

Oh, yes, yes, yes. So, I have a product called Aseptic MD. It is a cleanser and a toner completely, totally unique, right. So, it’s based on a molecule called chlorine dioxide, which has been in use for about a hundred years in water treatment facilities. But it is a really effective antiseptic. More importantly though, it is a very mild exfoliator. And so, it is sort of, most exposed creators are either acids, so lactic acid by cholic acid, things like that, or abrasives. So, you know, things that are rough, which right are, are bad for people with eczema. But I thought whenever we were developing this, that the Aseptic part of it was going to be really helpful, that it would work really well to, to eliminate allergens and bacteria on the skin. And it does help with that, but it doesn’t make a bigger difference than I thought.

Dr. Matthew Zirwas ([45:38]):

But where it does make a huge difference for people with eczema. I’m sure you’re familiar with keratosis pilaris. So, the little bumps, they’re usually not itchy, but they don’t look good on the back of the arms. People often get them on their thighs. It is the first thing that I have found in 20 years of being a dermatologist that actually works pretty darn well for keratosis pilaris. So, it’s a cleanser. You just use it with the, you know, a washcloth. You don’t like scrub; you just wash a little bit. If it’s going to make a difference, typically within two weeks these keratosis pilaris will be dramatically better. You would get it at asepticmd.com. So, a S, E P, T, I C, md.com. I think it’s about 25 or 30 bucks for a bottle of the cleanser. It was one of the things as my partners were like, we were developing it. My partners of course, wanted to price it at like 50 bucks a bottle. I hate, like we priced it at the absolute minimum. We could possibly price it without way out of business. My wife, he was also a dermatologist. It was her idea to begin with.

Abby ([46:44]):

Oh, amazing.

Dr. Matthew Zirwas ([46:45]):

But the, it does work for the keratosis pilaris just as a, as a normal wash.

Abby ([46:50]):

Awesome. All right. Thank you so much. I think that a lot of people will have appreciated you for being on the show today. So, I just want to take the time to say thank you and for just, you know, really listening to your patients and doing what you do. Cause I think it’s really rare to find, you know, someone like you who actually listens and doesn’t take the authoritarian approach. So, thank you for that.

Dr. Matthew Zirwas ([47:11]):

Thanks, Abby, I really enjoyed today’s discussion, so thanks. And I’m sure we will continue to be in touch.

Abby ([47:17]):

Yup. For sure.