5 Gut health habits that improve eczema, acne and psoriasis | Farzanah Nasser

Dr Rupy: You have these amazing skin transformation images that you sent across to me of patients you've seen with eczema, psoriasis, acne, even hair loss that you've treated with a functional medicine approach by focusing on the gut. How is it that the gut is so central to skin health?

Fazana: Gut health has an impact on every single system of the body and so when you're working with something, the first thing you want to do is obviously look at the foundations, right? What are they eating, how are they eating, their lifestyle, but then straight after working on all of that, the first thing you want to look at is gut health because what happens in the gut doesn't stay in the gut. It's not Las Vegas as Dr Fasano said. It has an impact on the entire body. And when you see the different skin conditions, you don't know all the time what to do, but you know that if you start working on the gut, if you correct things, if you improve the way they digest their food, if you improve things like short-chain fatty acids, so when you have fibre, you produce short-chain fatty acids. These produce anti-inflammatory compounds that are calming and anti-inflammatory for the skin. You know that in the gut, if there is an imbalance in the gut, if you have problematic microbes in the gut, they can have an effect that can impact your skin health.

Dr Rupy: Let's dive into one of these skin conditions. And one of the most drastic ones I saw was eczema. Now, I'm looking at this image for folks listening on the podcast of a young lady's skin who's got quite severe, I would say moderate eczema on one side of her face, including her eyelids, so very sensitive areas of the skin. And then the transformation picture, which I don't know how long is afterwards, where she's you would never guess that they're the same person. And this is all from a functional medicine approach focusing on the gut. So when you see someone like this, and perhaps there's someone listening to this with mild to moderate eczema, perhaps they've had it their whole life, how do you approach this?

Fazana: We start with the basics. So we would have an initial consultation and before we have an initial consultation, they would fill out a three-day food diary. So I know exactly what they're eating. And one of the things that we will do between the first consultation and the second consultation is to support the food intake. So we will be putting in things that are going to be more supportive. So it might be things like liver support, you know, putting in foods that support the liver, so things like greens, like berries, antioxidants, you know, eating the rainbow. We would be supporting digestion. So, you know, make sure you chew your food. Mindful eating. How many of us are just like eating on the run, like chewing our food two or three times. We're supposed to chew each mouthful 20 to 25 times. That helps break down the food. Our stomach doesn't have teeth. And we also want to break down the proteins, help break down the proteins in our food as much as possible. So chewing your food, getting the good things in, hydrating, you know, and also like habit stacking. So yeah, if they're already having like water, maybe we'll change that to herbal teas and have things like nettle tea, which is supportive of the liver, which has minerals in it. But it's just looking at what they're already having and just trying to fill any nutritional gaps. Blood sugar balancing the meal. This is huge. So, you know, that can help calm things down just by making sure when you eat your meal, you're not just having carbs. But for example, so if you're having a piece of toast in the morning, what you want to do is you want to have like almond butter or like avocado and eggs, just some healthy fats and protein with whatever you're eating to stabilise like the glucose curve. So that impacts your skin health as well. So just like refining what they're eating, how they're eating, you know, can they take like 15 minutes? When you do take the time to eat your food and eat, you know, eat your food, you start to salivate, right? When you take, when you go through, when you're when you're more mindful, you will start to salivate, right? When you salivate, you start to produce more enzymes in your saliva that help you break down the food. Like if you put a piece of bread in your mouth and you hold it for a little while, it'll start to taste sweet, right? Because you're starting to break it down with the enzymes. And digestion is a top down, you know, with your eyes, then your mouth, then it triggers to your stomach to produce more stomach acid. Also, when you're on the go and you know, if you're eating on the go and you're rushing or you're eating when you're stressed, you know, you're in the car and you're stressed, your body can't differentiate whether you're stressed because you're just stuck in traffic or your kids are annoying you, or if you're running away from that sabre-toothed tiger. And so it doesn't send, it doesn't produce stomach acid so that you can break down your food. It's sending, you know, energy to the periphery so you can run away from that tiger. So all these things, you know, have an impact on the system. So the way you eat, what you eat, combining your foods, that's where we would always, always start.

Dr Rupy: So this, for a listener, and for me, this all sounds very basic, but it's almost like the 80/20, right? Like if you fix these things and you do some very simple practices, you can have these pretty drastic results. So at this point, you before you've even seen this person and done the consultation, you've done a three-day food diary, you have a broad understanding of what they're eating. And you mentioned a few things here, liver support that I want to dive into a little bit more, chewing, hydration, what are you drinking? So are you drinking sugar drinks? Are you having lots of caffeine? Are you having some things that might be triggering for a skin condition like eczema in this case? Blood sugar balance, which is basically the balance of your meal, so making sure you're getting all different macronutrients and there's not an imbalance of each of each of those and how you're eating as well. Are there any other things that I've missed here in terms of what you can do before?

Fazana: So there's also an intake form that they will complete, so I know a lot of information about what's going on. But we also look at like bowel habits. So the idea is we correct all the foundations between the initial and the second consultation. So we have a good foundation to work on. And between the initial and the second consultation, they will complete, once we've met, they will do a stool test, which will come back for the second consultation. So ahead of that, we're just preparing the foundation. So if there is anything we can work on, everything, we can start straight away. So the other thing we always look at is bowel habits. You know, how often are they going to the toilet? You know, when they do go to the toilet, what is their stool like? Is it sinking? Is it floating? The colour, the consistency, is there mucus? All these things give an indication of what is going on in the gut and what the environment is like. And it's stuff you can already start working on. So for example, if someone is constipated, you know, they are holding on to toxins, right? And they're not eliminating them. So then it's working with supporting a regular, a daily bowel movement. So that might be including, you know, a few more, like a little bit more fibre. It might be walking, it might be, you know, making sure they're hydrated. Lifestyle is really important too, working on the nervous system, right? We're all, there's no escaping stress. We're all stressed, but the way we manage stress is really important, right? Increasing our resilience to it. So having like little micro habits throughout the day that can support a calmer nervous system. So, you know, it might be, you know, put your alarm on every two hours and just, you know, take a couple of deep breaths. It might be like humming is amazing. Like that's like just 90 seconds of humming, you just feel, you know, you just put your hand on your chest, hum, close your eyes and you just you feel your entire nervous system calm down a bit. There's these little acupressure studs that you, you know, you can press on and that works on the vagus nerve too. It helps to calm. So whatever works, but you know, gratitude journaling. That's really helpful. That's calming, you know, increases feelings of happiness. So working on the nervous system as well. So it's the food, the gut, the bowel habits, the nervous system, all of those things initially.

Dr Rupy: Liver health. Why is liver health so important as one of the first things that you see and what foods exactly support liver health? You mentioned a couple.

Fazana: All plant foods are going to be really supportive, but it's really like the greens, the bitters. So bitters help support with bile flow. So anything that has a bitter taste and it's actually one of the tastes that we don't have a lot of anymore, right? People have gone more for sweet, there's not as much bitter. Bitter helps stimulate digestive juices so you can help break down your food better, but it also helps with the flow of bile. So foods like kale, like saffron, like turmeric, olive oil, apple cider vinegar. So these are foods that you can actually use as starters. These are very, you know, olives, all these foods are actually in a lot of countries part of a starter or an antipasti. So a really nice way to start your meal. And it's really easy. Like even if you have some watercress or rocket, those are two great bitter greens, just drizzle some extra virgin olive oil and some apple cider vinegar. You've got a really lovely meal that's going to support your liver, support the flow of bile, going to help with, you know, digestive juices, break down your food better. Like food, like it's magic, right? Like you know, like how amazing. First you're eating like the broccoli and you're absorbing like the nutrients from it. Then it's binding to toxins and helping to remove it. Then it's feeding your good microbes and crowding out the problematic ones. And the compounds are helping your liver to help you detox better. I mean.

Dr Rupy: Yeah, it's like a polypill.

Fazana: It's just yeah. Like it's literally a polypill. It's magic. Like food, magic. It's amazing. Yeah, it's incredible.

Dr Rupy: Okay, so I want to bring it back to eczema.

Fazana: Okay, yeah.

Dr Rupy: So you've done this three-day food diary, you've optimised a few things, very, very simple strategies. You then do a stool test, which is really interesting as like almost like the first call. Does everyone get a stool test in your opinion? Should everyone have a stool test if they have these issues?

Fazana: Um, yeah, so everyone I see does a stool test. Um, I do one like try to do one every year generally just to keep on top of things and see how my gut is.

Dr Rupy: Like every year or something?

Fazana: Yeah. Um, it gives you a lot of information. So, like we said, like what happens in the gut impacts all systems of the body, right? We know it's associated with healthy aging, skin health, mental health, all these things. If we have an opportunity to look at what's going on, like it's, you know, we can access a lot of information. So a stool test, first of all, looks at different different parts. So we first of all looking at digestion. It's looking at how well are you producing digestive enzymes. It's looking at your ability to break down proteins. It's looking at your ability to break down fats. Then it looks at inflammation. So it looks at calprotectin, which is a marker of inflammation in the gut. This is something that, you know, your GP can do as well. It looks at secretory IgA to look at your mucus, you know, membranes in the gut, how how healthy they are. Then it looks at short-chain fatty acids. So when you eat fibre, it feeds your good microbes and they produce these anti-inflammatory compounds called short-chain fatty acids, also known as postbiotics. Um, and they are the fuel of your colonocytes. So the the gut lining, they help, the gut has a very fast turnover and so this fuels this and keeps it nice and healthy. When you get enough, it, you know, it has an anti-inflammatory effect throughout the body, right, affecting everything else. So we can actually measure them and there is no upper limit with short-chain fatty acids. And then it gives you the breakdown.

Dr Rupy: So the more, the more you have, the better.

Fazana: Yeah. You can't have too many, you know, you're only going to be able to eat get as much as you can eat, right? But there is no upper limit to something like that. I think that's the probably the only the only marker in the stool test where there is no upper limit. And then it gives you like, you know, what the percentages of the different short-chain fatty acids, so like butyrate, acetate, propionate. And then it looks at beta-glucuronidase. So this is really helpful for someone who is struggling with hormones to see where they where that where that enzyme is. So that's the enzyme we talked about just now. Then it looks at your good microbes, the problematic microbes, the ones that, you know, we know can be problematic. So it looks at those levels. It looks, you know, it looks at oral health. So your mouth is the beginning of the gut, right? So the microbes that you have in there can get go into your gut and some of them can be quite inflammatory. So it's looking to see if the what you get an indirect picture of what's happening in your mouth. But if you have good stomach acid, they they shouldn't come to your gut anyway. So that we look at that. We look at, you know, important species like Akkermansia, which is important for metabolic health. It basically gives you the good, the bad, digestion, absorption, inflammation.

Dr Rupy: So you got a stool test, you've got some basic bloods, someone's come in with eczema of this severity, then what are you, what are the next steps thereafter?

Fazana: The other reason the stool test is really important is because like if there are five people in the room and they all have eczema, they will have them for very different reasons.

Dr Rupy: Let's underline that. The reason why someone might have the exact same condition, in this case, eczema, can be vastly different. What are the potential differentials that go through your mind when you see someone with eczema?

Fazana: So I always think food sensitivity, I think gut health, I think liver.

Dr Rupy: Because this is so different to my traditional training. I wouldn't have gone through any of those. Maybe food sensitivity or allergy, absolutely. But I would be thinking contact dermatitis, genetic, air pollution or some sort of irritant. I mean, I've already said contact dermatitis, so something within their home environment that could be triggering it. And the other big one for me is stress, which, you know, you would cover on yours. But gut and liver, that wasn't on my radar when I was a like conventionally trained, or during my conventional training, those were definitely not things that I think we fully appreciated.

Fazana: Yeah. No, I'm not a doctor. They will go to the doctor first. They'll have the diagnosis and these are the things that they will cover with their doctor, with their GP. And it's only when that hasn't resolved the issue and they're trying to get a little bit deeper is when.

Dr Rupy: Well, in a lot of cases, we won't resolve the issue. We'll give you a management plan that might involve using a gentler washing powder, trying to remove dust mite and mould from the house, maybe being wary of certain pets, and steroid cream. You know, we're we're and steroid cream can be really, really effective, particularly in the acute phase and, you know, dampening down that and treating any issues as a side effect of eczema that could be skin infections and the like.

Fazana: Yeah. But I think with when it's mild eczema, I think that all those can be really helpful. But I think I see the people where it's really bad. Like it's not just, you know, a little bit of steroid cream or, you know, just trying to manage it or support stress. I see it when it's quite bad. And so, yeah.

Dr Rupy: Okay. That's why they, yeah, we dig. Yeah, we go upstream to see why.

Fazana: Totally, yeah. Yeah. So when you when you describe what functional medicine is to your patients that have seen the GP, maybe had steroid cream, and it's not getting better, how do you describe your approach? It's trying to get to the root cause. It's trying to look upstream to find out why did it happen in the first place? What has imbalanced your immune system? What has caused the imbalance in your body? It's always trying to find why, ask the question, like dig, constantly digging like why, what caused that? What are you reacting to? Why did that happen?

Dr Rupy: Yeah. And and a functional medicine approach definitely focuses on the gut and all these other things that I think are blind spots for a lot of us, right?

Fazana: We start, yeah, so we're always digging. So we'll, you know, do the foundations, then we look at the gut, we'll look at food sensitivity can be really helpful with skin health. You know, we'll see what we're we'll see where we get to, right? It can take like a few months. And if things aren't getting better or things are like 80% better, which is still great, like 80% better is amazing, then we look a little bit deeper. So then we'll be looking at viruses, we'll be looking at mould, we'll be looking at dental, like trauma, there's, you know, finding someone to work with to look at all of these things that are impacting the body.

Dr Rupy: Can we talk a bit more about food sensitivity?

Fazana: Yes.

Dr Rupy: Because this gets a bit of a bad rap. And we've certainly had folks that think it's complete scam and waste of money and there's a whole bunch of companies out there that really aggressively do paid marketing online. And my impression, putting my cards on the table, that I think food sensitivity can be useful in the right hands and with the right advice, but I certainly don't advise people to go and do food sensitivity testing on their own because of just the it's a minefield with the information that you get back. So how do how should we approach food sensitivity and what even is it?

Fazana: So food sensitivity test is looking at an immune response. It's looking at your IgG to different foods that you eat. And the reason it gets a lot of bad press, not everyone, yeah, it gets a lot of bad press is because people just say it just tells you you have a leaky gut. It just says, you know, your gut is leaky, these food proteins are getting into your bloodstream and causing an immune reaction. So yeah, it generally, I would never do a food sensitivity unless you have a skin issue because when you have a skin issue, you don't realise how hard it is. Like it's so there's shame, right? This is how you present yourself to the world. I mean, I've had, this is how I got into it. I've had my own, I've had, I've dealt with psoriasis and there's fear around it as well, right? Like is it going to get worse? Is it going to flare? There's it's a really, you know, it's a hard. It's like really hard. And so if you can target those foods that are driving it ASAP and bring down a little bit of inflammation, of course you're going to do it, right? So I do it so I can see the foods and usually it's like, oh yeah, I thought that might be an issue. And then you pull out those foods. So with one girl, she had a dairy sensitivity and she kept trying to have kefir because the kefir company said, no, no, it's going to help, it's going to help. It's only when it came up on a food sensitivity that she was her reaction was through the roof. You know, and then you take it out and things calm down. And so if you can pinpoint which foods are causing the issue and pull them out, then it makes a difference. And then you feel better too, right? But then like you say, working with someone is really important because you don't just pull the foods out, you then have to support digestion, right? So the problem is you're not breaking down your food proteins, which is why they're getting in and there's something going on in your gut usually as well, right? Because you're going to have a bit of a leaky gut. So if you're not breaking down your food proteins and they're getting into your gut, that's causing that immune response, right? So if you take out those foods initially, and then you swap them for other foods, you're going to get a reaction to the other foods, right? So what you want to do is you want to take out those foods that are causing the reaction so that inflammation calms down, but then you also want to make sure you are chewing your food, mindfully eating your meals, including bitter foods, maybe including a digestive enzyme to help you break down those food proteins so that it doesn't happen again. And at the same time, work on that gut and the gut environment to heal it and to calm the inflammation and to heal that. We all have some leaky gut, you know, when we eat and stuff, but just if it's, there's something going on, you want to calm and heal that. So it's a it's a process. But for skin, food sensitivity can be a blessing. Like it can make such a difference.

Dr Rupy: So the controversy around some of these IgG tests, so IgG being immunoglobulin G, it's something that can be raised if you've shown to have a sensitivity to certain ingredients, is if you do have leaky gut, which we'll define as intestinal hyperpermeability, which is a normal process that occurs when you consume food. It's the way in which nutrients pass from the gut into the bloodstream. But the extension of that process, i.e. if the leakiness, quote unquote, is extended for a long period of time, you get an exaggerated immune response because you're getting the molecules that shouldn't be in the bloodstream, in the bloodstream, and you get it's a dose effect, you get loads. And that's where you have this triggered immune system, gut inflammation that can spread throughout the body and can manifest in skin conditions of various thoughts. The sort of controversy from my perspective around this is if you already have a gut that is leaky for whatever reason, it might not be related to certain foods that would be flagged on an IgG test. It's just the gut itself. So I might have, let's say, an allergy to dairy, and I'm having loads of dairy in my diet, but my food sensitivity will also say you're allergic to oats and strawberry and pineapple and spinach and other sorts of grains, but really that's the impact of the leakiness as a result of dairy in this sort of hypothetical scenario. Do you see what I mean? So what how do we navigate that? Because I think that's the trap that a lot of people fall into.

Fazana: It's they're usually ranked how high the the issue is. And so the ones right at the top, you'd want to you'd maybe take out the first the top five or 10. And yeah, I mean, it has a life of half life of 21 days. So even if you take things out for 21 days, and then you start working on things when you reintroduce it, it should have less of an impact. But you may you wouldn't take everything out if there were loads of things. And sometimes you see things, I think on one of mine, I think almost everything was there. And you you just take out maybe the things that you're having every single day that are appearing there, or you work with, you know, you'll maybe choose 10 or you'll see which ones are the the big ones that you're having at every single meal, like dairy every single meal all the time and swap that for something else while, but also while working on supporting the gut lining, right? And healing that and supporting that, not just in isolation.

Dr Rupy: Because like a, to steelman the other approach, someone might say, well, why don't we just focus on the basics before we start taking food out, which can lead to food restriction and an unhealthy relationship with food. Why don't we start with, okay, let's get you chewing, let's get you sat down to eat, let's get you, you know, getting a balanced meal, let's get you a rainbow diet, let's increase your fibre gently, and then let's see, you know, before you're doing these sort of skin sensitivity, food sensitivity tests and see how your skin reacts that way, rather than going into a food sensitivity test that can be erroneously interpreted.

Fazana: Yeah, no, that's why you need to have someone to to make sense of it for you, right? But like if there's a little bit of eczema, I think that's okay. But like when it's really, when it's really, yeah. But also it depends like, for example, if you know that it's histamine, right? Like they're eating certain foods and they're high histamine foods.

Dr Rupy: What is histamine? What is histamine?

Fazana: So we have an immune cell called a mast cell. And mast cells release histamine and histamine can have different impacts in the body and one of them can be it can aggravate skin and drive like eczema and inflammatory skin conditions. And so there are some foods which are higher in histamine and if you notice that the foods that they're eating are high histamine foods, pulling them out can be really helpful. But also, like you say, you don't always want to pull things out, right? If there's an issue around foods, you would never do that, right? You can't do that. So it's it's really individualised. So with histamine, it might be maybe pulling out some initially, but it also is stabilising the mast cell so that it's not releasing as much histamine. So we know foods like watercress, moringa, they can reduce histamine by about release by about 40%.

Dr Rupy: Really?

Fazana: Chamomile tea, nettle tea, um, it yeah, so all these these all help to stabilise mast cells. And so including, you know, foods that are low histamine, but also histamine, mast cell stabilising foods can be really, really helpful.

Dr Rupy: I don't think I've come across that before. So watercress, moringa, what was the other thing you said?

Fazana: Watercress, moringa, ginger, turmeric, nettle, is very antihistamine, chamomile.

Dr Rupy: So these are all foods that were like, because I I had eczema when I was a kid, right? As a lot of Indian boys do. My mum pulled out all of these. Just going through the list now. She had ginger, she gave me chamomile, I probably had turmeric in all the food. Nettle tea was a big one. That was, that was, that's really interesting. I've heard of that, but I didn't realise it was because of the histamine balancing effect. I thought it was from a liver perspective.

Fazana: It's it's good for your liver. It's got nettle tea, it's full of minerals. Like it's got B vitamins.

Dr Rupy: Yeah, it's got yeah, and it's got minerals.

Fazana: It's so, it's one of those, it's it's got so it has so many benefits. Like even with chamomile, it's a mast cell stabiliser, but it also helps with your blood sugar after a meal. It also is calming. Like food has so many.

Dr Rupy: Every time I talk about nettle in this podcast, I always I always think I've got to go to a field and just with my gloves and grab a whole bunch of nettle away from the walking path, make sure it's super clean and then start making nettle soup, nettle tea.

Fazana: Yeah. I mean, I have to do that too. I say that every I say that all the time too. But there is a little bit of a fear because I used to get stung by them all the time that I think there's fear there as well to like go yeah, foraging for nettle.

Dr Rupy: You've got to get the thick gloves. Yeah, yeah.

Fazana: But I would I should do that too, but.

Dr Rupy: And what about histamine foods just before I bring the audience back to 30,000 foot view?

Fazana: So it's a lot of the aged foods. So things that have been lying around for a while. So it's like a lot of the good foods too, which is ultimately why you want to work on finding out why, getting to the root cause, supporting the mast cells, because it's things like fermented foods, they're high histamine, aged foods, leftovers, things like strawberries, there's like, so it's all all of the health a lot of the healthy foods. So ultimately, these are not foods that you want to exclude from your diet. But reducing them and then putting in the antihistamine foods short term. Everything is always short term. The game, that's what which is why you want to work with someone. It's always short term because ultimately we want to get everyone back to eating everything because as we know, that's where the magic is, getting in the colour, getting in the fibre, getting in the diversity. That's what we need for ultimate good health. So this is all short term.

Dr Rupy: Yeah. Totally, yeah. This is why I have an issue with food sensitivity tests because they're freely available, they're very easy to, they're cheap as well, relatively cheap. So people are like, oh, I'll do that. I'll do a quick sensitivity test. And then they come back and then they have this report and everything is flagged as amber or red. They don't interpret it correctly. They feel that because they have a sensitivity, they must restrict everything. And it leads to the opposite of actually what we want to achieve, which is exactly what you said, variety, colour, the rainbow, and more fibre. And so that's why I'm always a little and I I've been sent so many of these food sensitivity tests. When I was working in the NHS as a GP, but also like now we get loads and colleagues and friends that send me these tests and I'm like, dude, don't do that. Please don't do that. Like work with someone before you start taking these foods out. And you know, erroneously, some people might actually feel better when they take some of these foods out, but it might not be the entire collection of foods. It could just be like the few, you know.

Fazana: Yeah, yeah. And then ultimately other foods, if you don't work on stuff, other foods will then start to be an issue. But do you do you see why how it can be really invaluable?

Dr Rupy: Oh, I see it. Absolutely.

Fazana: If you have if you actually have like a skin condition.

Dr Rupy: Absolutely. I absolutely see the reason behind it because, you know, I've done functional medicine training. This is something that crept into my practice. I see it anecdotally with colleagues. I I hear patient stories from the ones that you tell us as well. You know, it's it can be a very useful tool. You even had, you know, Ben Brown, you know, Ben Brown from the nutritional medicine institute. He again sees the value of these, but again, it has to be in combination with a practitioner because they can lead to these restrictive eating behaviours. And I don't think it's binary. And if you go on social media, it's either the best thing or an RD, someone registered dietitian saying they're the devil, don't go anywhere near them. You know, I really don't think it's binary, but I think it it requires context and nuance.

Fazana: Yeah, no, definitely. If you don't use them correctly, you're just going to reduce and reduce and reduce your ability to eat a variety and diversity of foods.

Dr Rupy: Yeah, yeah, absolutely. Okay. Um, let's bring us back to 30,000 foot. So we've got eczema, you've done the stool test, done the bloods, you've checked to see whether there is any food sensitivity and we're looking at histamine foods as well. And I feel like, you know, I'm doing this in a very methodical way because I think some people have heard little snippets of these online when they're trying to deal with their own eczema or psoriasis or whatever the skin condition is. I should cut out histamine foods. I should do a food sensitivity test. I should do a stool test and it'll tell me what to do. And actually, I want to give people the holistic package of things that we should actually go through methodically rather than just little piecemeal because it can lead people down the wrong path, right?

Fazana: Yeah, absolutely. 100%, 100%. Yeah.

Dr Rupy: So you optimised a whole bunch of these things and and then what happened with this patient?

Fazana: It took a long several months, but her skin really cleared up. Like it really cleared up. It went from quite inflamed and inflammatory to the most beautiful, flawless, literally the most flawless skin. But it's not an overnight, it was never, it was not overnight. It took about eight, it took eight months.

Dr Rupy: Eight months, yeah. Yeah, yeah. But you'd wait long for that miraculous change.

Fazana: It slowly starts to get better, right? As you clear. So depending on what's going on in the gut, right? As you start to rebuild it, improve it, and then also crowd out anything that's there that you don't like. You never want to do, you want to do things gently. You don't want to overburden the body. You don't want to overburden the liver. You don't want to feel like trash. Like so people like detox, you feel like, you know, you don't feel good. You should never feel like that because that means you're doing things too quickly. And you don't want to feel like that. You want to do things very slowly and gradually so that your body can, you know, support you correctly through the process as well.

Dr Rupy: You mentioned earlier digestive enzymes. So we're moving on to another sort of topic that gets talked about quite a bit in the social media sphere. So what so talk us through the importance of healthy digestive enzyme production and why that might actually have downstream consequences on the gut, which can lead to skin problems.

Fazana: Yeah. Okay. So, digestion is a top down, right? We look at our food, we start to smell our food, we start to salivate, right? Chew your food, you start to break down the food. When you do all of these things, sit down, be present, take a take a couple of deep breaths that calms the nervous system, allows blood to flow to your stomach so that you can produce more stomach acid. Okay? Then when you eat your food, you can break it down better. And the more acidic your gut, then it that the acidity, the the chyme that leaves your stomach triggers to your pancreas to produce digestive enzymes, triggers to your gallbladder to release bile, right? So the more relaxed you are, the better you're allowing blood to flow to your stomach, the more mindful you are, you're producing more saliva, which is helping this whole process, right? And then you eat your food, chew, chew, chew, 20, 25 times, right? Breaking down the food, right? When you break down the food, also include bitter foods, right? So include all those bitter foods because that further helps stimulate bile and, you know, secrete bile to help you break down your fats. The better you do this, the better you break down the food. Okay? So in our food, we have like little pieces that need to get broken down. And that way they they don't cause an issue, right? It's only when we're not breaking down our food correctly, and we still have protein pieces in the food that if that gets, you know, if you have an issue in your gut, or you have a leaky gut, and that gets into the bloodstream, that's what causes the issue. So the better you can break down your food, the less of an immune response you're going to elicit if you have issues in the gut, if you have a leaky gut, if you have a compromised gut barrier. So just taking the time to do these things makes a huge difference because you're breaking down your food better. You're breaking down the proteins in the food better so they can't cause an immune response then. And so not only the mindful eating, the taking the deep breath, including the bitter foods that we discussed, there are things like, you know, bitter tinctures which are amazing as well, that you can do and enzymes if you need them, but that would always be under the guidance of someone. And that's usually short term as well, while you're working on something to ensure that you're supporting it optimally.

Dr Rupy: If someone does all that stuff and they're still having issues, how would you recognise that they might need digestive enzymes and what digestive enzymes would you start with?

Fazana: Bitters, apple cider vinegar, extra virgin olive oil, watercress, rocket, olives, starting with that, all supports it as well. Then, you know, if you needed more support, then you get bitter tinctures. So, A.Vogel does a nice one, which is quite nice. It has nice ingredients. Pure Encapsulations do a digestive enzyme. Thing is, you really want to work with someone. So for example, if it has something like stomach HCL, so the one I really like is the one by Pure, digestive enzymes with HCL, but you don't always need that. And if you have H. pylori, that can be contraindicated too. So you do want to work with someone to make sure it's okay to take. But that those are the two that I that I like and that I use. And so if you have H. pylori, that's going to be reducing your stomach acid anyway, right? And that's going to affect have a knock on domino effect on the entire gut. So I mean, if there is.

Dr Rupy: In that case, you definitely don't want to be taking hydrochloric acid.

Fazana: No, exactly. It's contraindicated. So you don't want to do that. If you don't, then that can be really beneficial because it's breaking down the food better, right? So if you have a skin condition, that can be really helpful. But it's contraindicated if you have H. pylori.

Dr Rupy: We've been talking about this through the lens of eczema, but you've got some incredible transformations with psoriasis, your own, acne, and even hair loss as well. So how how does this playbook affect those and and what are some unusual root causes that you've come across?

Fazana: I mean, like, for example, with acne, that was just literally over a three-week period, and that was including liver foods and blood sugar balancing meals. When you don't, when you have just carbs, that will raise your insulin, right, which can be a driver for acne. So simply blood sugar balancing your meals, like ensuring the protein, the fat with the meal is with stabilising your blood sugar, prevent the insulin, like the big insulin spikes, which has an impact on your skin because from that due to that mechanism, right? So something as simple as that and just getting in, you know, your fibre, your greens, that liver support. So like, you know, eating the rainbow, just those two simple things, three weeks, you can see the difference, right?

Dr Rupy: Yeah, I mean, the the transformation for this individual over three weeks is pretty stark. You know, you can still you've got some remnant scarring, which requires some other treatment, topically and lasers and and there's a whole bunch of other treatments for that. But the actual flares, I completely see how it's related to insulin and high sugar intake through the diet. But I don't want to give the impression that it's just like blood sugar balancing. I mean, we're optimising all these other things simultaneously, right?

Fazana: Yeah, yeah, yeah, all the same. Yeah, yeah. But but that, I mean, sometimes you can get 80% of the way with just a few things, you know, the mindful eating, chewing your food. I know sometimes it seems a bit woo woo, like, you know, chew your food, but if you understand the mechanism, it actually makes sense why, you know, it improves things as well. So mindfully eating, you know, getting in the fibre, the colour, you know, the rainbow, and blood sugar balancing your meals, they, you know, that can they can take you pretty far. They can make a huge, huge difference. And they're accessible to everyone, right? It's just the way in which you eat and what you're including on your plate.

Dr Rupy: Can we talk a bit about your own autoimmune journey and how optimising these elements of gut health, stress, simple things like, you know, hydrating, blood sugar balance, and perhaps some others allowed you to essentially put your condition into remission?

Fazana: Yeah, I think that's really just what you just said is really important as well, because with an autoimmune condition, you can't cure it. You can only put it into remission, right? Which means that you don't have symptoms and you function perfectly normally, but it doesn't it means that, you know, it doesn't mean that you can't get it again in the future. Okay, so that's with all autoimmunity, cannot cure it, but you can bring it into remission, right? So you your you don't have symptoms. So I got psoriasis when I was in my 20s and I really didn't think anything of it, but then it started to get worse and it started to spread. And I was given a steroid cream to use for it, but I didn't want to use a steroid cream, so I never I never used it. And I've I've had quite a holistic upbringing in the sense that my dad used to brew kombucha 30 years ago. And it would blow up in the fridge and we thought he was mad. Like we actually thought he was mad. And like I was taken to a homeopath as a kid. So my parents are quite holistic. But so I didn't want to be using these creams and be taking other things. So actually, that got me back to going back to school in my early 30s and retraining in nutrition and then doing my certification with the IFM. And so I did all these foundations, right? I cleaned up. I mean, we're all on a journey. I thought I was really healthy. Obviously, I wasn't. But it's a journey, right?

Dr Rupy: It's really interesting how people's own perspective of whether they are healthy or not is vastly different. I know that as a GP, when people used to come in and I used to ask them about their breakfast, and their response in a lot of cases, it was quite strange, was like, I I eat really healthy for breakfast. And when you dive a little bit deeper, someone's perspective of health could be, you know, a really balanced like oat meal with berries and yogurt and all the rest of it, or a special K. Because, you know, their perception of what was on the box was healthy and they, you know, it's it's just the way we've been led to believe that that is health. So it's really interesting like just hearing you vocalise it as well that I thought I was really healthy, but actually I was just having refined carbs.

Fazana: Yeah, I mean, I was having croissants and orange juice and I thought, yeah, that's so healthy, right? You know, like typical, right? In the morning.

Dr Rupy: Continental.

Fazana: Yeah, and I was just like, how and it's not chocolate. It's, you know, it's orange juice, like.

Dr Rupy: It's not Coco Pops.

Fazana: No, exactly. That was my thing. It's not Coco Pops. Um, but and so I was like, oh, okay. So then I started to, you know, blood sugar balance my meals, have, you know, I think my big first step was I started having porridge with apricots because apricots are good for iron. My iron was always low and almonds. So that was like what I used to have religiously for breakfast. That was my big shift and then blood sugar balancing. Then I worked on, I mean, it was slow, you slowly start changing things, right? Then I worked on my gut. And it got better, but it never was fully gone. Like it was still was still there. And so yeah, I did all the foundations. I ate slowly, started to eat better, blood sugar balance, got the plants in, mindful eating, stress reduction. So I used to be in banking and then I moved to nutrition. So like and I worked on my nervous system. I did all of those things. And I thought, well, maybe I'm just one of those, right? So it works on other everyone else, but maybe it's just me, right? And so I kind of left it for a little bit. And then I was like, no, I've got then when I did my functional medicine training, I was like, no, I need to dig deeper. I need to actually see what's going on. Um, so I went down the route of mould, dental, and then I did my viral panel. And when I did the viral panel, like zero is a negative, one to two was a positive, and for cytomegalovirus, I was 197.

Dr Rupy: What? Oh my gosh. Like it was off the charts. I was really, it was really, really high.

Fazana: Um.

Dr Rupy: Can you just explain to people what a viral load panel involves and.

Fazana: Yeah, so it looks at like about a handful of common viruses that we all get exposed to and it looks at the levels to see if that's something that your immune system is struggling with or not. So obviously mine was a little bit. And apart from the psoriasis, I didn't have any symptoms. Psoriasis was my symptom.

Dr Rupy: That was it?

Fazana: Yeah.

Dr Rupy: No fatigue, no skin issues, obviously skin issues. Brain fog, any other like digestive complaints, no. Wow.

Fazana: Nothing. Wow. It was just the skin. I felt really good apart from the skin.

Dr Rupy: Apart from the skin. Yeah, yeah, yeah.

Fazana: So, so you have this, you do your viral load, you find out CMV is off the charts.

Dr Rupy: And there is, um, Cyrex who work with autoimmunity, there there's there's an association actually between CMV and psoriasis. There is a noted.

Fazana: Yeah, between the two of them. And so then I was just like, bingo, here we go. So I took some, I got prescribed some herbal antivirals.

Dr Rupy: Why did you opt for herbal antivirals?

Fazana: Because they work on different level, they work, you get more benefits. So for example, I used a mix, it had lemon balm, which is antiviral, but it's also calming for your nervous system. I had licorice, which is antiviral and it's also helps with energy, right? Um, St. John's wort, so there's like a combination of different herbs. So it's a little bit gentler. Um, and they have other benefits from using those herbs as well. Um, and you can use them as teas as well, which is quite nice as well. So I took a tincture. And remember for everyone who has psoriasis, it's completely different. Everyone will have a different root cause and a different reason. But for me, when I took this, it was like a magic eraser. And literally over a couple of months, it just.

Dr Rupy: A couple of months? Oh, wow.

Fazana: Because you do it gently. It just it was it was like for me, it was like a magic eraser. It just slowly started to reduce, reduce and eliminate it.

Dr Rupy: And were you working with a dermatologist at the time?

Fazana: When I had the when I I initially had a dermatologist who diagnosed my psoriasis. And then I worked with it myself trying to support it with what I was doing with food, with doing my stool test. Then I did the viral panel. I saw a herbalist to get the prescription, the herbal prescription, got it into remission for several years. And then when I had COVID, because it's an autoimmune condition, you cannot cure it, you just get into remission. When I got COVID, it's a virus. So I got it all over again. Like it flared. So when it flared, it flared really badly. I did see a dermatologist so that she could see what it was. Um, took some scrapings, and yeah, I did use a steroid cream as well for a little while just to get it under control. And then I did the viral antivirals again. But it's a combination, right? You have to you do have to work with people. You do need to have a doctor. You do need someone to diagnose it. You do need to get it under control, in which case you might need like a steroid cream. I used like the smallest, I think I it was like a diaper cream. I gave me the lowest, lowest dose that I used just to get it under control. And when it was, then I took the the herbs because I know they work for me. And then I got it into remission again. But it's you do need to work with your GP or your dermatologist as well for sure.

Dr Rupy: Yeah. That's amazing. That is amazing. And and, you know, for someone who might have psoriasis that we don't and we don't believe it's virally related, are there any other sort of key things that you're like, bingo, that might be it, um, for a lot of other people listening? Because I'm imagining CMV might be out of the ordinary for psoriasis, correct me if I'm wrong.

Fazana: It might be out of the ordinary. I mean.

Dr Rupy: Is it in terms of one of the root causes of psoriasis?

Fazana: Yeah, yeah, it might be. I mean, there is that association. So it's been it has been it has been linked. But, you know, it might not even be viral. It could be dental. Like it's different for everyone, right? But it is one of those things, it is one of those, um, rabbit holes you do go down when it's not, you know, when you're doing everything else and you've worked on everything else, it is one of those rabbit holes that you do explore to see if that could be an issue or not. And like so now, you know, we're out in town, we're going out every day, like, you know, you are exposed to things. So I do like teas, right? So I'll do like licorice tea, which is great because it gives you energy. That's the beautiful thing about food. It has so many different.

Dr Rupy: I love licorice tea. I love it.

Fazana: Yeah. There's so many different benefits to it. So like, you know, including licorice tea, lemon balm tea, they all have antiviral benefits. I don't take the tinctures, but I'll use it as tea form to support my immune system when, you know, when you are exposed to things all the time, right?

Dr Rupy: I'm going to ask you to do something really hard, which is summarise for, so let's say someone's listened to this, they have a skin issue or an autoimmune condition that might be skin related. What should people be doing methodically to get to that root cause?

Fazana: Chew your food, mindful eating, blood sugar balance your meal, get 30 grams of fibre plus every single day and do something to support your nervous system. See your GP, get your vitamin D, iron, thyroid, liver, just full blood count, H. pylori if you've got anything going on, would be helpful. And then if you need to, see someone, if it's continuing, see someone that you can work with, um, if after doing that for a couple of months is not bringing you any joy, and hydrate. Yeah. You know, and then habit stack as well. So like make the hydration count.

Dr Rupy: I told you it's going to be hard. This is a summary and it's like an eight point summary. But I I get it.

Fazana: Like, you know, do the nettle tea, do, you know, um, it's never about taking out, it's always about putting in, right? So, um, so yeah. Yeah. Five things. Five things.

Dr Rupy: I I I honestly think people would benefit so much from just, you know, just doing those basics really well before you even get to functional testing and and all the rest of the stuff that we've talked about today. I think honestly, if people did that, it's huge. Uh, I want to get your hot takes on a few things that I know we said were controversial. Green powders. So are you a fan of green powders and what types of green powders would you recommend if you recommend them?

Fazana: I don't recommend a I don't recommend them. I do have a I do have a lot of people who come into clinic who are on green powders and they've always found a benefit on them. And I've never told them to come off them because I'm like, how do you how does it feel? They go, since I've been taking it, I feel better. So I've never taken them off a green powder. It's not something I generally, I mean, there's some greens that have targeted products that are made by supplement brands, like Biocare do a cleanse one, which is actually quite nice for the liver. It has things like nettle, it has good amounts of different nutrients, but it is for the liver. And that's quite nice. So I do like that. Um, but you know, they get a lot of stick, but I do like them because first of all, they're a great way to stay hydrated. Number two, like even some of the ones that have like loads of different ingredients.

Dr Rupy: Yeah, tons, like 100.

Fazana: Yeah. I know, which is why they get the stick because they're like, oh, it doesn't do anything because there's no nutrients. And like, I think something came out recently as well that said the green powder had no nutritional value or something.

Dr Rupy: I saw something that was looking at a big brand and it had high amounts of lead and cadmium. So there was contaminants.

Fazana: Okay, so we don't want that. We definitely don't want that.

Dr Rupy: So I think that's like first order principle, just make sure you're not consuming anything harmful. Second order is, okay, what's the actual nutritional value? I actually don't think we need to focus on the nutritional value of the green's powder because what some of the companies do is they'll add a multivitamin to boost up those numbers. So you look like you're getting 100% of all your, you know, vitamins and minerals and RDI and all the rest of it. But the nutritional value of like moringa blended with, I don't know, broccoli sprout powder, it's going to be low. It's going to be low. So that's to be expected. But I think the dosing is something that I do have an issue with.

Fazana: Yeah. No, no, no. See, I think that's why I like it. Because not because of, I don't I want low doses of stuff, but like we know and so many people people have products out as well, which tiny bits of lots of different different ingredients to support microbiome health, right? So from my perspective is, you've got loads of little little bits of ingredients. It might not have a nutritional impact, but it has the fibres and those fibres are feeding our gut microbiome and that's going to have an impact. So it's all about diversity and getting in as much diversity as possible. And that is probably a really easy hack in my opinion to get diversity. So I I I love them because of that. Yeah, they've got small amounts of things, but they've got loads of fibres and that's helping our gut microbiome. So it's helping us in a different way in feeding something that is so important and it's a little hack, I think.

Dr Rupy: Yeah, I I definitely agree on the fibre point. I think, you know, if you're taking a tablespoon of any green powder that's like freeze-dried and you're essentially getting the whole plant in an easy, you know, to combine with water format, you're definitely going to get some fibre. You'll probably get, you know, four or five grams of fibre, which is similar to some of the physical products with flax seeds and mixed seeds and all the rest of it. Where I'd like to where my preference is, because I'm a fan of green powders, but I prefer the ones with like eight to 10 ingredients rather than like 20 to 50 because I like to know that I'm getting a decent enough dose of the things like broccoli sprouts because we know that a certain amount of that broccoli sprout with all the sort of like extra entourage of those plant chemicals it has is genuinely having an impact on liver health and, you know, detoxifying and removing certain environmental pollutants for which there are studies at those certain doses. But I get your point about diversity.

Fazana: Yeah, so if you can't get 30, 40 plant points a week, it's just a little way that you can get the diversity in. I mean, ideally you want to eat the fruits, the vegetables and get all of it through that way. But if not, it's just a little for that reason, I think it can be a little bit a little hack to get in different plant fibres that you might not usually get. And you only need a tiny bit to feed those microbes. So in that sense, I think it's really, really great.

Dr Rupy: Yeah, yeah, I agree. If people are struggling with bloating or gut issues, what sort of kitchen items can they use to potentially help them?

Fazana: So a lot of it that we talked about, like just helping digestion in general is also going to help with bloating issues, right? So like if you're eating on the go and you're running, not running, but you're eating on the go, you're not you're just, you know, you're just swallowing your food, you're not chewing it. That of course that's of course going to make you feel heavy and bloated. So chewing your food, including the bitter foods, starting slowly, right? So if you're not eating a lot of fibre, you want to adjust, you want to give your gut bugs time to adjust. They're the ones who are eating the fibre. So you want to give them time to adjust. So you want to slowly increase it over a period of time. You know, if you're someone who doesn't tolerate beans again, you know, you want to maybe just have one and two, like do it really, it's not a race game. And actually, that's the beauty of it. Wherever you're at, there's benefits, right? So there was a really, one of my favourite studies, which is there too, it just showed that one piece of fruit or vegetable helped increase feelings of happiness, but you had to be consistent. So, you know, you might not be having like that 10 pieces of, you know, plant foods a day, but even if you have that one, it makes a difference, right? It was like there was a huge jump in happiness and life satisfaction just by having one fruit a day, but you had to be consistent. It's the same with increasing, you know, it's the same thing like increasing your fibre. You want to do it, you know, but, you know, it's not a race game. You know, just start wherever you're at, have a little bit, you know, and then wait a couple of days, have a little bit more. And also stay hydrated. That allows the fibre to flow through better, right? So, yeah, those are some that can be.

Dr Rupy: Root ginger for bloating.

Fazana: Ginger is great. It helps things flow better through your gut. So in that sense, it can be really, really good. So and it's everyone has it in their kitchen. Just grate a little bit. It doesn't have to be a fancy tea either. Just literally root ginger, you grate some, squeeze a little bit of lemon with it as well and it tastes really nice. It's hydrating and it does, yeah, it helps support the movement through your gut as well.

Dr Rupy: Umeboshi plums for bloating.

Fazana: Yeah, that can be really help they can be really helpful in helping you break down, digest, support the breakdown of food.

Dr Rupy: Are they bitter? Like what do they taste like?

Fazana: Yeah, they're a bitter food. And so that's why they're really helpful. So, Clearsprings, I think are one of the only people who sell them in the UK, but something a little bit different, but there's there's yeah, they can be brilliant.

Dr Rupy: How do you incorporate them into like at the start of a meal? Like do you just chop them up? Do you like how do you eat them?

Fazana: Yeah, so like you could just have at the beginning of your meal, you could add them into your bitter salad, just incorporating them.

Dr Rupy: After someone's eaten a meal and let's say they are prone to getting bloating, are there any specific movements or stretches that are very gentle that they can do after a main meal that can help with digestion?

Fazana: Yeah. So you can go for a walk. That can be really helpful for bloating, going on a 20-minute walk after you've had your meal. There are also like gentle yoga poses that you can do that can be really supportive as well. Really simply, just like hugging your knees into your chest and also just a spinal twist as well can be really nice and supportive too.

Dr Rupy: Amazing. We often get questions about tolerating beans. We have a lot of beans in our Doctor's Kitchen recipes and people often say, oh, it's too many beans, I can't tolerate beans. Do you have any tips to make beans more digestible for folks?

Fazana: Yeah, no, definitely. So first of all, if you're using tinned beans, if you rinse them out, that can be really helpful. Also, if you're cooking your beans from scratch, if you put them in a pressure cooker and you use a piece of kombu, that can be really helpful too because these things, the kombu can help break down the sugars that can cause you to react to the beans.

Dr Rupy: What's kombu?

Fazana: It's like seaweed. Yeah, you can get it dried in like, like Asian supermarkets, online, and you just add a strip and that helps break it down. So it makes the beans more digestible.

Dr Rupy: Does it affect the flavour? Does it make it salty?

Fazana: No, no, no, it doesn't do anything. It makes it actually tastier actually. So like I usually add that as a, so you can add like stock and seasoning to different foods. I like to add kombu like when I'm making rice and mushrooms and stuff because it just gives it a nice taste and flavour anyway. So anything it enhances the flavour, but makes it more digestible as well. And then also, you know, go slow and yeah.

Dr Rupy: When you say go slow.

Fazana: Like start with a little bit. If you're not if you're not tolerating it, don't have like a tin of beans in a sitting, you'll feel awful, right? Allow your gut time to adjust. But doing those things can be really helpful. Rinsing the can, using some kombu, pressure cooking, and just starting slow.

Dr Rupy: So if we're thinking about combinations of beans with something else to help it make it more digestible, apart from like pressure cooking them and rinsing them, beans and kombu, that's one to make it more digestible. Are there any other combinations?

Fazana: Yeah, no, definitely. So, you know, including them with like bitter foods, including fermented foods, if you can tolerate them, that can be really helpful as well. Also using different spices like asafoetida, like cumin can also help with the the digestibility as well.

Dr Rupy: Amazing. But also always starting slow, right? If you're not used to something, gradually building it up into your diet.

Fazana: What are some of the unusual high-fibre foods that you wish more people had in their diet? Chocolate.

Dr Rupy: Chocolate? Really?

Fazana: Chocolate's amazing. Raspberries, chia. I mean, it all.

Dr Rupy: Let's double tap on chocolate there for a second. So tell us a bit more about chocolate.

Fazana: Oh, chocolate is, I mean, chocolate's magic. We all love chocolate, right? But you want it to be a proper chocolate.

Dr Rupy: Yeah. I'm assuming you're not mean dairy milk.

Fazana: No. I think they've taken away chocolate from the name anyway now because it's got less than 24% cocoa solids, right?

Dr Rupy: I've heard about that. Yeah, it's chocolate flavour.

Fazana: Yeah, exactly. It's crazy. So chocolate is a superfood and chocolate is a high-fibre food. It's from a plant, right? It is a plant. But you want to make sure you have a good quality, right? So 70%, anything above that is really, really good. You're going to get a good amount of fibre. I try to go for 85% if I can. So there was one, so 70 or 80%, you're still getting fibre, you're still getting polyphenols, you're still getting all that goodness. But there was a study that compared 70% dark chocolate to 85% dark chocolate. And with the 85% dark chocolate, they found it had an impact on mood and how you felt as well. So that's why I try to go with the 85%. Yeah, higher. But, you know, anything that you can tolerate. If you love and you can tolerate the the darker chocolate, then cacao is amazing too. You know, like when in they do cacao ceremonies and it's just like 100% cacao that they put in just water and they mix that and they drink that. And that is like a nice hit of fibre and it tastes, I mean, it tastes delicious.

Dr Rupy: I have that all the time in the studio. Just with a bit of raw honey. So good.

Fazana: So good. But like, you know, wherever you are, just try to increase the fibre, I mean, the cocoa content. And 70 is a really good place to start with chocolate. And yeah, and it's delicious and we all love it. All the healthy foods actually, you know, all the good foods are good for you too. Like coffee's got fibre, matcha's got fibre, like they all they all have goodness in them.

Dr Rupy: Yeah, it's not just the polyphenols, it's the, you know, the actual fibres themselves. A revelation to me was how high in fibre avocado is.

Fazana: Yeah.

Dr Rupy: That's because I thought that was just mainly monounsaturated fatty acids, but it's surprisingly high in fibre.

Fazana: Approximately 5 grams for half an avocado.

Dr Rupy: Half an avocado?

Fazana: Yeah, which is huge, which is, yeah, it's an amazing high-fibre superfood. So like, you know, that will get you a sixth of your way there.

Dr Rupy: Yeah. And again, you can have it, you can add it to your smoothies, smash it on some toast, add it to the side of anything that you're eating. These foods are really easy to incorporate with, you know, it's not like like I said, it's not about an overhaul, it's just adding to what you're already eating and it really does add up, doesn't it?

Fazana: Yeah, massively. I mean, I'm just looking at some of the fibre-rich add-ons for lunch and supper that you've got in your book. Like black beans are up there, butter beans, you know, just 80 grams, which is a portion, is 6. around 5 to 6 grams of fibre. So, you know, you can see how easily this can all compound to get to 30 grams in a day. And your, it's not really a plan, it's like, you know, you you've got like a formula for getting fibre into your diet regularly. Um, so it doesn't need to be like a short sharp thing. It can be like, you know, what you're trying to what you're intending for people to do is for this to be a a high-fibre plan for life. Yeah, it's for every day. That's the whole point is it's not it's not something difficult. It's something that you can incorporate. It meets you where you're at. And then even all the principles that we talked with, you know, like starting with just with like skin conditions and stuff, all those principles, the foundational principles are all written in that book too. Like how do you eat, getting the colour in, you know, improving your meals so they're blood sugar balanced. So it's, yeah, it's all there to meet you where you're at and make it easy. I think it has to be easy and accessible, right?

Dr Rupy: Yeah, totally. You've got this bit in your book about how not all fibre works the same, right? Because I think most people think about fibre, they just think of one thing. But what are some of the key differences in fibre types that you've come across and people should know about?

Fazana: So we know we want a diverse plant-rich diet because when we have a diversity, it's because it's feeding the different microbes in the gut and they all produce different compounds and they all help us in different ways, right? So we want to get all the different kinds of plants so we get that richness of diversity in our gut microbiome. You can, there are different fibres have different benefits, right? So for example, mushrooms, oats have a particular fibre that's called beta-glucans. Beta-glucans is really good for immune health, right? It really helps support, it helps with immune balance, it helps with cholesterol as well. So that can be really good. Um, you know, there's a particular fibre like GOS is a particular fibre that you can buy as a supplement as well. It's found things like belotti beans, chickpeas, you know, they're all from they're all in our plant foods. You can get them in supplement form too. And it's usually when they're taken in supplement form that they do the the studies, right? So one of the things with GOS, for example, it's shown to help reduce morning cortisol. Like if you have, you know, if you're very wake up very, very stressed, it can help modulate that a little bit. So they all look at different things and they can all help in different ways. But you want a diversity, right? So of of all of them to support the gut microbiome. But if there was something you were particularly challenged with, you might go for a particular fibre to help support you as well. One I use a lot in clinic is PHGG, partially hydrolysed guar gum, because there's studies have shown that over a three-month period that has reduced the pH of your gut and started to crowd out problematic microbes. And so if that's what we're working on, we want putting in a fibre that has that effect too can be really beneficial. One another one we talk about there is FOS, which we find in like things like chicory and artichoke and stuff like that.

Dr Rupy: Can that be problematic for certain people? Is it fructose or.

Fazana: Yes, yeah, yeah, it absolutely can. So that's that's not one that I would generally use generally because people do react to that. But it can be really good for for certain things that we are mentioned there like, but it tastes like candy floss.

Dr Rupy: Have you tried it?

Fazana: No.

Dr Rupy: Oh, you need to try it. You need to try it for your son. Yeah. It's brilliant. You get them in a tub, but it literally tastes like candy floss. And so when my kids were younger, I would just sprinkle it instead of sugar, I would use FOS. It tastes like sugar. It tastes like, honestly, you can eat it. It tastes so good. But if you do have gut issues and you are sensitive things to onions, garlic, chicory, you might have an issue with it. But then there is a drink called chicory.

Dr Rupy: Okay.

Fazana: And it basically is chicory roasted and then it's made into like coffee grounds.

Dr Rupy: Oh, is it the coffee alternative?

Fazana: Yeah, it's a coffee alternative. So like if you know you're trying to have less coffee, but it's a bitter food. So chicory is a bitter food. That's another great one to have as part of your bitter foods. But chicory is a bitter food. But if you can't tolerate FOS and you have a sensitive gut, chicory in my clinical experience has been tolerated by everyone, even with a sensitive gut. So it's a nice way to get FOS in, it's a nice way to get bitters in. It's a really lovely drink with a lot of nice benefits as well. But that's something you could add instead is like the chicory drink for the FOS, but it's about one gram of FOS though, but it's tolerated really, really nicely.

Dr Rupy: That's epic. And resistant starch is getting a lot of attention at the moment. What what exactly is resistant starch? Where do we what kind of foods do we get that in?

Fazana: So resistant starch resists digestion. So, um, basically it's in a lot of, um, it's in some foods, so like green bananas. It's in lot in cooked and then cooled foods. So if you take potatoes, you cook them, um, and then you subsequently cool them, the starches then become like crystallise and they become resistant to digestion. So basically that means it stays in your gut, right? The sugars, less of the sugars get absorbed into your bloodstream, so it's better for your blood glucose, but the um, it stays in your gut and then it becomes fibre for your gut microbes. So they eat that fibre and that can be really beneficial. So that's another way to get more fibre, you know, feed your gut microbes is to, you know, cook and then cool the potatoes, same for pasta. If you take your bread and you freeze it, it creates more resistant starch.

Dr Rupy: I freeze my bread all the time.

Fazana: Yeah. It lasts longer that way too, so it's better.

Dr Rupy: That's the main reason.

Fazana: Yeah. So you've got more resistant starch that way as well. So and so it feeds your gut microbes better and works more as a prebiotic that way too.

Dr Rupy: Very cool. So cool pasta, cooling potatoes, rice pudding, so like cool rice, does that make more resistant starch as well?

Fazana: Yeah, yeah. So rice as well. So rice, cooking, cooling. And when you subsequently, like if you heat it afterwards, it still stays as resistant starch. So you can like cook, cool and then reheat without an issue. But yeah, rice pudding, like kheer, we have a lot of that is amazing.

Dr Rupy: It's interesting because I've eaten sushi whilst wearing a continuous glucose monitor and it hasn't spiked my blood sugar as much as if I just eat plain rice. But I guess, you know, the caveat is I'm having sushi, so I'm probably eating a lot of other, you know, starting the meal with edamame and then I'm having, you know, some proteins in there as well. So but I guess cool, cooked and cooled rice is going to have that resistant starch effect.

Fazana: Yeah. And remember, all of us are different too. So our the way we respond to the foods is going to be quite different. But yeah, absolutely. Yeah, cooked and cooled, more resistant starch. So bread, pasta, potatoes, rice, cooked and cooled, creates more resistant starch.

Dr Rupy: Oats? What about oats? Like overnight oats?

Fazana: Yeah, so oats can be really great as well. And if you do overnight oats as well, that's a good one.

Dr Rupy: Big fan of overnight oats over here.

Fazana: Yeah, I love them in the summer. I'm like, they're brilliant in the summer. And then you can just batch cook them, can't you? And then you don't even need to worry about breakfast. You just make a staff, like a, make a lot for the week.

Dr Rupy: Yeah, amazing. Fazana, you're awesome. Thank you so much for coming in and talking to us about not only your journey, but skin health in general and sort of the blind spots that I think a lot of people have around how they can optimise their gut for improvement of not just skin conditions, but autoimmune conditions as well that we didn't have time to go into. And your book is awesome. The recipes are wicked. I love your recipes online as well. And me and my wife have already, you've probably seen it, we've already got some pages flicked down. Actually, one of them was the ultimate chunk cookies. So I'm going to take some of those back home for me and my wife.

Fazana: Oh, that's a different one actually.

Dr Rupy: Oh, is it a different one?

Fazana: That's a different one. We've got a lot of cookie recipes in there.

Dr Rupy: Okay, fine. Well, I'm going to do this one then.

Fazana: Okay, good. Yeah, yeah.

Dr Rupy: But thank you. Appreciate you coming in.

Fazana: Thank you for having me.