Skin is Health’s Magic Mirror: Meet Dr. Trevor Cates | Big Bold Health Podcast Ep 17
December 12, 2019
James Maskell: Hello and welcome back to the Big Bold Health Podcast—we are making health personal. In this series, we are talking to female physicians, female health leaders who are charting our journey from a disease-based system to a health-based system, and all that entails. Super excited to have here, Dr. Trevor Cates, here with us. She is not only a naturopathic doctor, but a leader in the space of skin health. And you know, it’s interesting, Jeff and I were looking through all the answers that people put on Big Bold Health, as what does health mean to them? And we’ve got quite a few that were talking about skin.
James Maskell: I know that this is a really important thing to a lot of people. So, one of the things I wanted to ask you, I think it’s become more and more clear for anyone in our field, and probably further afield, that skin health is a function of overall health. I would love just to dive in from your perspective as to how that works, and what is the range of things that you’re working with when you’re working with people in these areas?
Trevor Cates: Yeah. I like to call skin our magic mirror that gives us great clues about our overall health. It’s our largest organ, it’s right on the surface of our body. So, it’s this amazing tool that we have that gives us information about our health, but so often it’s ignored or covered up. The typical approach to skin is often to use a more suppressive approach. Conventional dermatology, suppress the symptom, cover it up. Or for women, wear makeup—what are the tricks of wearing makeup to cover up the different blemishes? But actually skin is giving us information about what’s behind it, the root causes behind it, and when we ignore it we miss an opportunity, and we also sometimes delay health issues. Or actually prolong health issues, rather than fix them right in the beginning.
James Maskell: Yeah. So, give us a couple of examples of, you’re probably diagnosing everyone when you walk through an airport, right? But what are some things that maybe most people wouldn’t know that you would see and say, “Hey, you might want to think of this.” Just based on your experience of pattern recognition and treating these kinds of issues for what, a decade or more.
Trevor Cates: Let me back up for a second and explain why I really wanted to focus on this, because I have my own personal journey with it and I really experienced, as a child, how much skin can play a role in our lives. I struggled with health challenges and skin issues as a child. I had allergies that showed up a lot as eczema, and hives and little bumps that would appear on my skin. And, I remember really well how much, it was not only tough physically—the itching and the sensations that I would feel—but also how embarrassing it was as a child to have, especially when it’s on your face.
Trevor Cates: Over the years, when I talk to patients and they tell me about their skin… I think people that don’t have skin issues oftentimes think, “Oh, it’s just skin. It’s really not that big of a deal.” But anybody that has a chronic skin issue knows how debilitating it can be, and how it can impact you on so many different levels. And so, I think it’s really important. And, I know that when I was working in spas and I was doing a two week weight loss program in The Waldorf Astoria, and people would do the two week weight loss program, at the end of it they would say, “Dr Cates, I’m amazed I’ve lost all this weight, but what surprises me is my skin. I didn’t know it could look this good.”
Trevor Cates: And, what I realized is that so many people weren’t thinking of skin in this way of it being an outer image of health and that it’s also an opportunity—when you look at it, it can give you really great information about what’s going on underneath it. That’s why I ended up writing my book, Clean Skin from Within, because of my experience, why I even got into this field of medicine. What led me here was my skin, and I knew early on, and I realize it’s a message that needs to get out to more people.
James Maskell: Yeah, absolutely. Jeff, I know this is not something that’s banging our wheel-house, but probably I know you’re super passionate about finding easy ways to understand the body more clearly and so, this must be right up there.
Jeffrey Bland: No, when I first met Dr. Cates here a couple of years ago, I immediately was inspired by her message. Obviously, first of all, she’s a great example of what she’s teaching, but secondly, she really communicates this model so elegantly. I said, “this is an individual who really can help teach people about something that’s actually quite complex.” If you really study skin and subdermal physiology, it gets pretty weighty, and there are all sorts of things going on—matrix metalloproteinases, and all these things that cause inflammation, and things that we who love the biochemical piece parts really get into.
Jeffrey Bland: But for the person who suffers from a skin problem, it’s just so simple as Dr. Cates was saying—I can see it every day. I can’t hide it easily, and it’s not like something I can just put my clothes on if it’s on my face, or hands, or arms, it may mean something that’s going to travel with me, which in some ways is a reminder, isn’t it? It’s a warning sign, which is what you’ve used so effectively to, it’s like a behavior modification tool because that person can see how effective their program is in doing something that’s beneficial. So, I think you’ve harnessed it so beautifully.
Trevor Cates: Thank you. And, it really is oftentimes a first sign that something’s out of balance. Like for example, hypothyroidism, it’s oftentimes one of the first signs of hypothyroidism, low thyroid function, is dry skin. People will sometimes be putting on more moisturizer and trying to do things topically rather than why is my skin dry? Then when you combine those with, of course, the other symptoms related to that, then you can see what that is. No, I think that oftentimes people will have a skin issue, cover it up, just kind of ignore it, and then realize they’ve got some other big health issue going on.
James Maskell: Yeah, it’s interesting because it’s actually a similar process to things inside the body, right, the suppressive strategies. But ultimately, I think with skin, is there a different incentive to deal with it? Because it’s so face forward, it’s kind of like a function, your personality is very tied up into it. What are the incentives to fix your skin problems that don’t exist in internal medicine?
Trevor Cates: Right. Well, certainly it’s the first thing that people see when they meet you, or a lot of times with doctors especially, more functional medicine or naturopathic doctors, we’re going to look at the skin is one of the first things that we see as soon as you walk in. Certainly, it does motivate a lot of people. I think that’s one of the reasons why I wanted to focus on that, because it was a way to kind of open the door for people to say, they come in and say, “Dr. Cates, what products should I use for my skin? I’m at the spa, what should I use?” And I’m like, “No, we need to get to the root cause first and then we can talk about what skincare products you should be using.”
Jeffrey Bland: Let me jump in here, because I know that you probably use this in languaging to some of your patients. The two major companies that are selling the fastest growing medications right now, which are the immune suppressive drugs, Humira and Enbrel. These are what are called TNF alpha blocking drugs. They block inflammation at a core level and then they create other problems because they so suppress the immune system that you get opportunistic producing infections.
Jeffrey Bland: At first, these started off as drugs that were approved by the Food and Drug Administration to treat arthritis or forms of that. More recently, however, the drug companies being smarter, said, “Well, what other conditions are associated with the same kind of inflammation we have with arthritis, so we can get other kinds of indications and sell it to other people, through other specialties, like dermatology?”
Jeffrey Bland: So, now we see these drugs, Humira and Enbrel, being repositioned with clinical trials for eczema and psoriasis. Now we said, well, hold on, I thought that was an arthritis drug, and now you’re saying it’s a skin drug. It’s a beautiful example of what you’re talking about that it really starts inside.
Trevor Cates: Yeah. And so, often that’s what I was seeing in my practice was I would get these patients later in their lives, but they would give me this history of, “When I was a baby, when I was a child, I had eczema. I was given topical steroids, I was given these things to suppress it. Suppressing it. Then that wasn’t as much of an issue.”
Trevor Cates: “Then I got older, and I got asthma, and then I started using an inhaler, and so then I got through that period of my life, and now I have autoimmune disease.” Because they never addressed the issues with the immune system at an early age and the inflammation that was going on internally. And, if people can get that early on, when the skin is oftentimes that early sign of that, they can prevent a much tougher health condition.
Jeffrey Bland: So, that, I think you just stated it so elegantly, why we call this The Big Bold Health Podcast. What we want people to understand is that we don’t need to be apologists about asking questions about health. There is a lot of us that are feeling when we go to the doctor, we only want to ask questions about disease, because that doctor is skilled in the art of disease. They may not be so skilled in the art of health.
Jeffrey Bland: The things that you’re talking about are preemptive of disease, that really are the root causes for dysfunction that we call ill health. So, what you are really doing, I think, is championing why we think big and bold about our health is so important. We want people to be more assertive, we want them to not be apologists about saying, “Okay, I know you can cover it over, but where did it come from? And what can I do about it? And I’m prepared to take those steps, but I need the tools. I need the explanation.” And, that’s what you’ve done so beautifully, not just with your patients, but with your writing, and your podcast, and so forth. Do you feel this is spreading? Is the message getting across? Are you seeing receptivity?
Trevor Cates: I am seeing changes in dermatology and the dermatology world, and I think part of what’s happening is there is information coming out, some research coming out about the skin microbiome that’s really showing a lot of what we’ve been doing has not been really working. Now, all these antibiotics that have been used for many, many years, both topically and internally for dermatologic conditions have created dysbiosis issues, not only in the gut, but also for the skin.
Trevor Cates: The skin microbiome is—you probably talk a lot about the gut microbiome and people know about the diversity that we want in the gut—but the skin has its own group of bacteria, viruses, and fungi, all kinds of things that live on it, and it has this balance that it needs to be healthy. So, what we’ve been doing with all the antibiotic use has disrupted that, and now we’ve created something a lot of people are experiencing, leaky skin, kind of like leaky gut, that people have talked about.
Trevor Cates: And, so many of these eczema—especially atopic dermatitis—these inflammatory skin issues, we’ve damaged the barrier function that the skin has. Our skin works like this barrier to the outside world, that’s one of the biggest functions that it has. But with all that we’ve been doing to it, it has actually broken down that barrier. So, now it can’t function the same way, and it’s totally completely inflamed, it doesn’t have right balance of microorganisms.
Trevor Cates: And, I’ve heard at some of these more integrated dermatology types of conferences, I’ve heard this, people talking about this, this conversation is starting to happen of, “Okay, we’ve kind of done things, maybe not the best way, so what else can we do to support the body and support skin?”
Jeffrey Bland: Fantastic.
Trevor Cates: Yeah.
Jeffrey Bland: So, I know there is a controversial area that many people are now grappling with as it relates to skin health, and that’s sun protection and sun damage, that kind of balance. And, people are now hearing that these SPF containing sun creams get absorbed, and that maybe that’s not so safe either. So, how do you counsel people in the light of this?
James Maskell: It also kills coral reefs too. You’re like, well, if it’s killing coral reefs, do I really want to have it on me? So, what’s the balance there?
Trevor Cates: Yeah. So, here we are trying to do a good thing, and usually medicine is, and developments of technology and products, we’re usually starting with a concept of wanting to do a good thing. We’re trying to protect the skin from sun damage, from premature aging, from skin cancer, but with all of the chemical sunscreens, the problem is is that, well for one—there are actually a number of reasons why sunscreens could be a problem—but one of the big ones is that they have endocrine disrupting chemicals and many of these ingredients, like oxybenzone, is one that’s in a lot of chemical sunscreens.
Trevor Cates: And so, we are exposed to so many of these endocrine disrupting chemicals, these hormone disrupting chemicals in the environment, and our air, and our water, and our food, and now also in our personal care products including sunscreen. So, here we are trying to do a good thing, and exposing ourselves to these hormone disrupting chemicals that will actually bind the hormone receptors, mimic them, or change the way that they function. So, that can lead to… now, we’re seeing the changes, and I’m sure you all talk about the changes that we’re seeing in certain diseases and these hormone related diseases.
Trevor Cates: We’re seeing more of these thyroid disease, certain types of breast and prostate cancer, and infertility, these kinds of things. So, we look at sunscreen and the last thing you want to do is try… and you’re doing a good thing… is add more hormone disrupting chemicals into the mix of it all. I think there’s that, then what else? Because the products don’t just sit on the skin, they get absorbed. We don’t absorb them like we do if we ingest them, but we do absorb a lot of the ingredients that we put on our skin.
Trevor Cates: What else? What else are we doing? All of the ingredients, if you look at the label of your sunscreen, what is in there? Do you want that in your body? And so, what I usually tell people is to, when we look at sun protection, I think it is still important to protect our skin from the sun to a certain extent. Of course, we’ve got benefits from vitamin D from sun exposure; we need that for a healthy immune system. We also know that getting outdoors in the sunshine feels good and it increases endorphins—there are a lot of health benefits to it.
Trevor Cates: So, of course, I’m not going to tell people to stay out of the sun. Hey, I live in Park City, Utah. I bike, and I ski, and I run—I enjoy the outdoors. I’m not going to stay out of the sun entirely, but there are things that we can do. Trying to stay in the shade as much as possible, especially during the middle of the day when the sun rays are the strongest, wearing hats and protective clothing, I think could be some of the best things.
Trevor Cates: And then, when you’re looking at using sunblocks, look for one that is a zinc oxide based sunblock with a tint, because the tint also adds some extra protection. So, zinc oxide seems to be the safest of all of the different options that I’ve seen. And also, I think we need to try and stay away from the sprays and powders, because I’m concerned about when we inhale these substances, especially if they’re nano sized, that means they’re really, really tiny particles. I’m concerned about when we breathe those in getting trapped in the lungs.
Jeffrey Bland: Well, this is what Big Bold Health is all about. You’re giving us big, bold ideas to protect ourselves and I think that life is all about balance, isn’t it? I think that’s what we’re learning. And so, asking the right questions so we can find the right balance as we’re moving forward on our own trajectory—each person has their own aspiration of health and that’s what we’re trying to validate in Big Bold Health is, you want to be healthy? What is your definition of health? Then let’s give you the tools that you can achieve it. Let’s not give somebody else’s recipe; let’s give you the tools that you need.
Jeffrey Bland: So, I think you’ve really shared some extraordinary insight for us. I know James is here, raising your daughter now, you’re going to be confronted in the Sacramento Valley with a lot of sun and what you’re going to be doing.
James Maskell: Lot of sun. Yeah. No, I mean it’s already, I can see what she learns from Mom and what would help in there. But I’m super glad, all the way through this journey, being a parent. Being in this industry for the last 15 years, having access to the brightest minds. What’s really interesting is a lot of the stuff that when I first moved to America in 2005, was like things that were only talked about in a very small number of people at these small medical conventions, like “Oh, you know there might be a downside to wearing sunscreen and these ones?” You know, it was just something that I wouldn’t talk about to other people I didn’t know, because it was just so out there.
James Maskell: Everyone’s talking about it now and there’s been such a shift in the last 15 years for people to really think, what am I putting on my skin? Where is it going? What is the effect on the ecosystem? All these things. What are these ingredients that I don’t know what they … I think that just the level of consciousness about these kinds of things is only going in one direction. It’s pretty exciting.
Jeffrey Bland: Yeah. I think Dr. Cates, you’ve done a really great job of helping us to understand how we fit into the system, right? Human beings are part, as you say, the sun. It’s part of a good part of our life, but it’s finding the right balance and the right things to do to manage your own … like some people are much more fair skinned and much more susceptible; they don’t tan as quickly, their melanin doesn’t provide the protection, so they have to personalize their own approach. They can’t use a formulaic approach. And, I think you’ve really helped open up the skin as a boundary as to how we might start taking charge of our own health. So, thanks so much.
Trevor Cates: Absolutely. And, I know you mentioned with your daughter, what she’s going to start being interested in, and personal care products and skin care products. If you think about how many skin care products we all use—especially girls and women—we use so many different ones. And, according to the environmental working group, we use an average of twen… twelve, sorry, twelve personal care products across men and women. That’s an average. Women typically use more than that and that exposes us to 126 unique ingredients. The problem is, is that there’s not a lot of regulation, especially in the United States, around the personal care product ingredients. In Europe, they’ve banned over a thousand ingredients. In the US I think it’s like twelve ingredients that have been banned now by the FDA.
Trevor Cates: So, it’s really up to the consumer to become educated and to be aware of what’s going into these personal care products. I mean really think about it. For girls, makeup also, but there’s deodorant, shampoo, conditioner; think about all the different personal care products you use. And, we’re getting exposed to these endocrine disrupting chemicals in this form, partly from the skin, and partly we’re breathing it in. The things that we spray in the air, powders and different things that we’re using.
James Maskell: We’re dealing with what? Three generations at least of transgenerational epigenetics, right? Of grandma’s special spray that she used to keep the mosquitoes off her, it’s unbelievably toxic.
Jeffrey Bland: Oh yes. And diethyltoluamide. Yes. really bad stuff.
James Maskell: And maybe some DET.
Trevor Cates: And, people look at ingredient labels and they don’t know what it is, because it’s DMDM hydantoin, did you know that that’s a formaldehyde releaser? Most people don’t know that, and it’s in most lotions. When you put something with these formaldehyde releasers onto your skin, it releases formaldehyde into the air. And, we know how toxic formaldehyde is; it’s a carcinogenic ingredient. These ingredients are releasing formaldehyde, but they don’t have to put formaldehyde on the label because it’s not actually formaldehyde, it just releases formaldehyde when you rub it in. So, it’s so hard for the public to really know, but luckily there are tools and resources to be empowered.
Jeffrey Bland: Well, I know your writing really helps to do a great job of bringing that more to the attention of the consumer. So, we are fully behind, Dr. Trevor Cates, and the Big Bold Health skin approach. So, thank you.
James Maskell: Absolutely. Well look, it’s been a great episode. I hope that if skin is important to you that you’ve learned something here. Definitely follow Dr Cates. Check out her book, Clean Skin from Within. Trevor, thanks so much for being here and being part of this Big Bold Health journey. And, if you’re watching this at home, please go to Big Bold Health; tell us what health means to you. We are creating these episodes on the back of all the things that you’re telling us health means to you. And you know, this personal view of health is moving forward very quickly. So, I’ve been here with my co-host, Dr. Jeffrey Bland, Dr Trevor Cates. This has been The Big Bold Health Podcast. We’ll see you next time.