← Derm Approved
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- [00:00]
Dr. Taz
I think gut health is the foundation of health. 75 to 80% of inflammation usually begins in the gut.
- [00:05]
Dr. Sheila Farhan
Tell me your thoughts on peptide.
- [00:07]
Dr. Taz
When they first came on the scene, I was like, wait, what is this? I don't care how old you are, we have to check hormones.
- [00:12]
Dr. Sheila Farhan
I think you've said this in the past about biohacking culture.
- [00:16]
Dr. Taz
I just get tired when I hear the word. I don't know what to say.
- [00:19]
Dr. Sheila Farhan
I'm Dr. Sheila Farhan and welcome to Derm Approved. Your insider access to skin that looks and feels its best. NAD supplements and peptides. Everyone's taking one. What's actually working, what's safe and what's just hype. I have Dr. Taz, triple board certified physician, integrative medicine expert and one of the leading voices in longevity. I'm so excited that you're here because we're going to dive into all the things.
- [00:47]
Dr. Taz
Let's do it.
- [00:48]
Dr. Sheila Farhan
Yes. Yes.
- [00:49]
Commercial Narrator
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- [01:22]
Dr. Sheila Farhan
So you know we go way back.
- [01:24]
Dr. Taz
Yes.
- [01:25]
Dr. Sheila Farhan
And you've even, yes, you've even helped me, you know, with some of the things I have gone through and I really feel like you're one of the trailblazers in integrative medicine and kind of the east, west meets east and now people are really understanding that that is what our body really needs is mix. You know, not necessarily only one side, but the mix. Was there a specific journey or what made you. Was it something in med school? Obviously they teach us them allopathic western side, but I feel like both of us are really kind of similar in that sense. But of course you've been trailblazing it for years.
- [02:03]
Dr. Taz
No, I love it. I'm not the quack anymore. It's amazing. Well, you know, my whole foray into this was accidental. We've talked about it before, like I was an ER doc, I was going to go off and do an ICU fellowship. This was not the walk I thought I was going to walk, but through sort of like med school residency and then working that first job, you, you know, I just started to get sicker and sicker, started to have a lot of symptoms that were, you know, you could dismiss them at first, like just tired and gaining weight and foggy and then having, you know, weird rashes and ultimately progressed to hair loss. And as the years kind of ticked away, it just got worse. Nothing got better. And I'm, you know, like so many busy young women, I tried to ignore everything, but it became obvious when you could see my scalp and. And of course, I became super self conscious about all of that stuff. So finally, like, my now husband and my mom and others were like, okay, you need to go figure something out. And I started a journey of seeing lots of different physicians. I was like 28 at the time, and it was very disheartening. And I was categorically dismissed multiple times as being somebody who is super anxious or somebody who was depressed, you know, and given anxiety meds, giving. Given antidepressants, all these different things. I saw specialists, endocrinology, rheumatology, finally went to a hair loss specialist, dermatology, and everyone's answers were either anxiety, stress and depression or a medication of some kind. And the final medication I took was one that had side effects and dropped my blood pressure. And on a particular day when I took the medication and went to workout and did all the things, I bottomed out, had a vasovagal episode, as we call it, and ended up crashing my car. And that was sort of like the end for me of that experience, which had now gone on for probably a year to 18 months somewhere in that timeframe. And so in my attempt to get answers for me, I found holistic medicine, which we're never taught or told about through med school and. And went through that kind of weekend conference. I found Chinese medicine and really became fascinated by it. You know, I. They really had a really unique way of thinking about the body in terms of energy, how the physical, mental, and emotional all connect. They would try to diagnose that, they would guide people and put them on their path. So, you know, signed up to take Chinese herbal medicine and acupuncture and became an herbalist and an acupuncturist. Now, mind you, I'm not doing anything with these skills at this point. I'm really just trying to get myself better from there. Found the integrative medicine, which I think you've done too, right? Yeah, the fellowship in integrative medicine with Dr. Andy Weil. And finally kept staring at it, looked interesting, and finally just jumped the gun and signed up for that. So that was 2006. So through those periods of time, those years, like from probably 2001 to about 2006, I was able to figure myself out over 20 years ago, exactly 2001 to 2006. And this is no Google. This is no, like, social media or Instagram. There are no influencers. We didn't have that world. But essentially I figured out that I was pcos, I was gluten intolerant, I had a thyroid issue, I had high androgens, and so really was able to piece together like a diet food supplement and actually went on bioidentical progesterone, which helped me quite a bit, and a little bit of thyroid hormone. So anyhow, so I'm better, but all these people around me over those five years now are like, oh, my gosh, what are you doing? What was different? What happened? Blah, blah, blah. Well, I finished the fellowship in 2008. My husband graduates from dental school in 2008, and he is gung ho on starting his practice. And he's like, I think you need to do something with this. Just take the back of my dental office, see a few patients. You don't have to worry about anything. I've got the overhead. I love this. You know, just, you know, you share your knowledge with the world. And it was really just a passion project. And I was like, oh my gosh, this sounds great. I'll do 8 to 10 ER shifts because we were starting a family. And I'll do this a couple days a month and life will be so easy. I'll be home every day by three, and I'll pick up the kids and it'll be good. And, you know, we went off into the world and that was our plan. But the best laid plans, as you know, are not quite wet. So we had one child. I quickly was pregnant again with the second child, closed on the space, started these practices. I blew up pretty quickly, you know. And you know what I realized? It took me maybe a year to two years to realize that my experience that I had had was an experience that people were having everywhere. And so, you know, as I listened to story after story and worked really hard, it used to take me so long. Back then. I didn't have a mentor, I didn't have any of these things used to take me so long to do, like a treatment plan, all this other stuff, you know, there were a number of patient experiences where I was like this. I can't do this halfway. Like, I need to be all in, you know. So anyhow, I came to the realization That I, this can't be medicine light. I have to be 100% in. So I start winding down the ER. My last year shift was in 2012. And I commit to growing this and building it into something literally an empire. I don't know about an empire, but I commit to building it, you know, to something that truly would be a medical home for people where they could get their answers, they could have a team. And, and we were handling the whole body because trying to do it like in pieces, I felt like wasn't serving the patient well. So that's what got me into this whole world to begin with.
- [07:39]
Dr. Sheila Farhan
Yeah, yeah. I love that because you use your own story and so many people can relate to you. And even as a dermatologist, I have so many patients coming in to me because you really go through the gut and stress and that all connects to skin.
- [07:55]
Dr. Taz
Yes.
- [07:56]
Dr. Sheila Farhan
And for me personally, you know, I, I do take insurance at my practice, but I also have a concierge type practice as well. And I like to merge the two, but for people, people don't necessarily always want, they want different tools in their toolbox and you're able to offer that. And what's great, I think is you were trained allopathically as an MD and that really we have that in the bank.
- [08:22]
Dr. Taz
And I think that's important training.
- [08:24]
Dr. Sheila Farhan
That's really important training.
- [08:25]
Dr. Taz
Even my ER time, honestly, like, I know medicine, you know what I mean? I know the body, I know medicine. And there is something to the rigor of that training and the experience of that training that continues to serve me well today. So I'm not trying to dismiss it by any means. What I am advocating for systemically is that we just expect expand the toolbox and the model to include many of these other modalities, many of these other ways of thinking, you know, we do better by women, we do better by children, you know, and we just, you know, take a deeper approach and get away from this sort of volume based approach and over specialization approach where, you know, and you've read all the studies, you know, primary care has been obliterated, you know, and you don't have a lot of people wanting to do primary care. So at the end of the day, we really need to change kind of how we're approaching what we're seeing.
- [09:20]
Dr. Sheila Farhan
Yeah, And I saw it on my back, like on as a patient too, because I had some back issues, got an mri, have a slipped disc. A lot of people have slipped us, but the primary care actually sent me two referrals. One to a neurosurgeon and one to
- [09:36]
Dr. Taz
pain med, pain management, which is another slippery slope.
- [09:40]
Dr. Sheila Farhan
Exactly. And what am I doing right now? Pt, you know, massage, acupuncture, soft wave, ultrasound, you know, all these other things. But because I knew that that wasn't what I had to do, that was kind of my last resort. But I kind of saw that on that end and I'm like, boy. But you can't blame the primary care either because it's almost CYA on their end. You know, like if someone has high cholesterol and you tell them take a supplement and they don't take the supplement, they get a heart attack or something like that, does it fall on the primary care doctor?
- [10:13]
Dr. Taz
Right.
- [10:14]
Dr. Sheila Farhan
So I always say, and I don't know if you probably agree with me, but like, health insurance really is, like, for when you're sick, it's catastrophic insurance. Yeah.
- [10:22]
Dr. Taz
It's acute care. Right. If you get into an accident, if you need a major surgery. But it is not built today to really take care of the day to day of our bodies and what we need.
- [10:32]
Dr. Sheila Farhan
Right, right. Yeah. Agree. Yeah. You know, obviously there's a huge uptick in your field. And I have a longevity clinic in my office that I love. And I love offering patients, like prescription strength supplements, which you've been doing for years and years, because not everyone wants a prescription, a pharmaceutical prescription, say, for their acne first. Maybe there's some other ways, you know, we can treat it with supplements, especially when it's hormonal or when it's stress related. So talk to me about, as far as, you know, we'll get into the peptides and nad. What do you feel like are the most important internal drivers of general health, but also skin health that people should be really focusing on?
- [11:14]
Dr. Taz
Well, I think there are probably four, and I think you already mentioned a couple of them. I think gut health is the foundation of health. And I think that. I mean, it was a big part of my story personally. But I think if we don't have a healthy gut, if we're eating inflammatory foods or foods we don't break down very well then. Or we're just not absorbing nutrients because our gut's not in a good shape, it's gonna show in your skin. Right. So, you know, a lot of acne is related to candida or candida overgrowth in the gut, or even small intestinal bacterial overgrowth. We see that all the time. We see rosacea. Right. I'm sure you see that. And that, to me, too, is a Bacterial issue, you know, causing a lot of that redness and irritation there. You know, we know that early wrinkling and fine lines and some of these. Those type of things are related right back to diet and collagen production and protein and things like that. So I think, you know, the state of your gut health is fundamental in determining the second piece of your puzzle, which is inflammation. And the gut inflammation, you know, cascade is intimately connected. I mean, we say something like 75 to 80% of inflammation usually begins in the gut and is very much related back to gut bacteria and things like that. So to me, the gut and the inflammation, you could see separate out or you could put them together. They're so tied up. I think the next one is hormones. Understanding your hormones and your hormone balance and what's going on there, we know that that is related to skin health, related to hair health. My hair was directly connected to what my androgens were doing, my dht, my free testosterone. I'm still sensitive to that stuff to this day, so many years later. So, I mean, I think that that's another place to look and still stay on top of. And I don't care how old you are. I know you've heard this something different from others, but we have to check hormones. We have to understand what our hormone pattern is and what it's doing. It's going to help you with targeting, you know, your dermatology regimen or food with so many different things that you should be doing. And then the last one is one maybe I haven't talked as much about, which is cortisol and stress hormones. I think what I'm seeing more and more in practice is sort of this hum of higher cortisol. And that cortisol in turn is disrupting the hormone pathway, is driving inflammation, it's impacting the gut and the motility of the gut and all the things. So, like, those are four things that I feel like are the foundation before you start, you know, reaching for a lot of the, like, fun stuff that's out there right now.
- [13:40]
Commercial Narrator
Right.
- [13:41]
Dr. Sheila Farhan
And you said that a lot. You're like, okay, I'm not against peptides, but. But let's make sure gut stress, like all those are in check before delving into some of the additional things. They don't technically replace it, but, you know, and that's why also I think that while peptides are great, they definitely need to be managed by a provider, a physician, because you need to know the lab work, the state of the patient first before adding some of these Other things. And so as far as the cortisol gut issues, what are some of. Like, I know there's so many labs, but what are your thoughts on, for instance, like, can someone check their cortisol and how, you know, there's a blood work that's in the morning, there's saliva. Now what are your thoughts on those?
- [14:30]
Dr. Taz
I mean, everything we named, like looking at your gut. Inflammation, hormone balance, cort, cortisol. Those can all be checked.
- [14:38]
Commercial Narrator
Yeah.
- [14:39]
Dr. Taz
And you can start with like very basic labcorp or quest panels to check these things. They just have some nuances. So, for example, cortisol, if you're going to use traditional labs to do that, you want to do a first morning cortisol. That's the best way to kind of really gauge, because after that, cortisol is supposed to go down and kind of bottom out as you get towards the latter part of the evening. So that's one way to do it. You can look at something called an RT3. When RT3, which is a part of a thyroid panel, is high, that's another sign of having higher cortisol. So those are some of the. And then DHEA is another sign when that's too elevated. You can look at that. That can be associated with high cortisol, too. Again, these are all objectively measured. Objectively measured, traditional labs. Your provider just has to order them,
- [15:25]
Dr. Sheila Farhan
you know, which technically, in your normal wellness visit, it's not there. It's not there with your primary care because technically it cannot be billed. Not saying that your physician won't do it, but it is a little bit more into the weeds, right?
- [15:39]
Dr. Taz
It is. And there are ways to code things, and sometimes you'll have to work with your provider on that. But then when we get to inflammation, same thing. You can start with LabCorp and look at a white count. There are inflammation markers like a CRP, a SED rate. They're deeper markers like a TGF beta interleukin 6. So there is a way to measure some of this stuff. Hormones we talk about all the time. You can measure them in blood? Absolutely. I usually just tell patients to put be consistent with the day that they're measuring it, whether it's day three or day 19 or day 21. So that, you know, lab draw to lab draw, kind of what's happening there. And you can look at those numbers and really get a gauge of what's going on along with the metabolites. And I talk about this a lot in the Hormone shift, which is the book I wrote in 2023, which really has lab panels. It has everything in it to help you understand what's happening there. So those are some of the things that you can actively test now if you want to go deeper. And yes, there is a slew of functional medicine testing, integrative testing, everything from microbial testing through stool, looking deeper at hormones and nutrients, whether through saliva or urine or some of these other things. It's all there. But again, like, to knock that information because it's sort of out of the realm of normal. What's considered normal, I don't think is fair.
- [16:58]
Dr. Sheila Farhan
Yeah. All of those labs you mentioned, I myself get them done. But awesome. Yes, good. Yeah. And it's again, not through a standard primary care physician.
- [17:09]
Dr. Taz
You have to do it on your own.
- [17:10]
Dr. Sheila Farhan
Yeah, I gotta do it on my own. But. But they. They really do offer. It's nice to see that objective. Of course, our body tells us everything if we're feeling stressed or not feeling right. I think you've said this in the past about your thoughts and maybe your thoughts on like a biohacking culture.
- [17:29]
Dr. Taz
Yeah.
- [17:29]
Commercial Narrator
On the Internet.
- [17:30]
Dr. Sheila Farhan
Tell me, tell me about it.
- [17:31]
Dr. Taz
Biohackers. So I just get tired when I hear the word. I don't know what to say. I just feel like it's a lot of energy. I feel like it's very like bro culture too, to a certain extent that we're going to game this, you know, and. And figure this out. You can biohack if you'd like to. I think at the end of the day, we all have to live a real life from day to day. So it's trying to understand the two or three things that you really need to be doing to keep yourself kind of healthy and consistent. Consistent. And to move that number, whether it's your biological age or your emotional age or any of these ages, to move them kind of in the right direction. So for me, biohacking is not my favorite word. If it means optimizing your gut and optimizing your nutrients and your hormones, I'm all for it. But I don't think we have to make this a competition against ourselves, which is what that word comes kind of
- [18:25]
Dr. Sheila Farhan
feels like counterintuitive, really. You know, you're like, stressing yourself out to exact.
- [18:30]
Dr. Taz
I have patients say that they're like, I'm exhausted from just like all the stuff I'm supposed to do in any given day.
- [18:36]
Dr. Sheila Farhan
Yes. I think a more appropriate. Which longevity has been kind of o. Almost overdone. But it. Longevity is a. I think a great Space and whether it's the integrative, you know, part of and holistic part of it, which really it is. And longevity doesn't necessarily mean that you're going to live longer. I think you've mentioned this even on some of your podcast episodes. Can you tell the people, what does longevity mean to you? Longevity medicine.
- [19:06]
Dr. Taz
Longevity medicine is interesting because now that's a word being thrown around quite a bit. But I think it's about. It's more about vitality and energy. I would actually call it more about how do you. It's almost like the Chinese medicine concept of qi. Right. How do you build energy, how do you replenish energy, how do you keep the key determinants of your health where they need to be energetically for a long period of time. So again, that means optimizing your gut, really getting your nutrient status where it needs to be, helping things like your liver, which does slow down and get a little bit more sluggish, has less tolerance for environmental triggers and. And toxins, like supporting your liver. Building muscle, because we know muscle helps with blood sugar balance and insulin. And everybody, and I mean everybody, after they cross kind of 50 or so, starts to have issues with blood sugar and insulin, which then in turn leads to poor metabolic health, which then in turn leads to cardiometabolic disease. You know what I mean? We can see these.
- [20:06]
Dr. Sheila Farhan
Yeah.
- [20:06]
Dr. Taz
So for me, and then brain health, of course, Course. So brain health, bone health, heart health, you know, hormone health. But all of those are almost like individual points to really vital energy or qi and replenishing that so that you can continue to be productive and vital going into your 80s, 90s and even beyond.
- [20:26]
Dr. Sheila Farhan
Yeah.
- [20:27]
Commercial Narrator
So with longevity and biohacking growth factors, peptides are certainly having a moment in skincare. My patients are always asking me about them. So as I guide them through what to look for for a product is they need to be derm recommended and there needs to be some type of science or clinical backing because peptides are great, growth factors are great, but we need to make sure that it's actually doing what it claims, so actually going through and penetrating the skin and doing what it needs to do. And I'd love to recommend Medicaid Liquid Peptides Advanced MP Serum. It's clinically proven to diminish the appearance of expression lines in 10 minutes and deep set wrinkles in eight weeks. Medicaid's Liquid Peptides Advanced MP Face Serum is powered by the GF mini protein, which mimics the function of natural growth factors but penetrates deep into the skin to visibly improve the appearance of skin structure over time. Medicaid was actually founded by two scientist brothers 15 years ago on a mission to simplify great skin. What I love is that Medicaid creates everything in house in their lab located just outside London. Following strict EU guidelines, all Medicaid products undergo clinical testing, which I love as a dermatologist and have amazing before and afters. Derm Recommended Discover Medicaid Liquid Peptides Advanced MP Serum online at Medicaid US that's M E D I K and the number 8 US use code dermaproved for 20% off your order. What I tell my patients is consider sunscreen just part of your morning routine. Not just whenever you feel like you're going outside or hiking. It just should be your cleanser, your morning skincare routine. And then end with your spf. And then of course, you can put makeup on top and every time you're out and about, you know, reapplying every two hours. So what I usually do is I'll apply it in the morning and then if I'm out and about, maybe midday, I'll apply it again. And then if it's super sunny and I'm driving back home and I have a pretty long drive, I'll apply it again. Or even just physical sun protection, right? Like a visor, things like that, because the sun still goes through the windows. You know, we have uvb, which is the big contributing factor to skin cancers, but we also have uva. And UVA is the one that is more responsible for aging. So the fine lines and things like that. I'm sure you guys have seen that like insane photo of the truck driver where his left side was. So sun damage. Like obviously this is just showing you that he didn't have the window down the whole time. It was through the window that you're getting that sun damage as well. So SPF and my book is a must every single day. And honestly, Eltamd, if you haven't heard of them, you've been living under a rock. Because they are people's favorite. They really are. I've been working with them for years. If you didn't already know, ELTAMD is not only the number one dermatologist, recommended and trusted professional sunscreen brand, but dermatologists use Eltamd personally more than any other sunscreen. And I can definitely vouch for that. Eltamd sunscreens are formulated with ingredients to help protect and correct UV damage across skin types and skin skin concerns. Eltamd sunscreens are formulated with ingredients to not only help protect you from sun damage but also correct UV damage across all skin types and skin concerns which I love as a derm. Visit www.altamd.com to shop and learn more.
- [23:52]
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- [24:56]
Dr. Sheila Farhan
And with that, the longevity space There are certain treatments, ingredients, molecules that people love, those being peptides and nad.
- [25:10]
Dr. Taz
Everyone's talking about peptides right now. I know.
- [25:14]
Dr. Sheila Farhan
So tell me, and I've heard you talk about this before, tell me your thoughts on peptides.
- [25:20]
Dr. Taz
I like them. You know, when they first came on the scene, I was like, wait, what is this? What's happening here? You know, it wasn't necessarily the first person talking about peptides, but peptides are sequences of molecules, amino acids put together that seem to have regenerative capacities. I'd be super curious from a derm standpoint which ones you're seeing the most benefit with. But as we started to wrap our heads around this and try to understand it a little bit better, they do have a place in the toolbox. And we are seeing some really great things with, I think where I push pause and I get a little bit concerned is where people can just kind of like go online and order whatever peptides you want without looking at, you know, critical lab numbers, without an overall picture of your health. So for example, you know, one of the ones we love is something called BPC157. It's both oral or injectable peptide that can help with gut health, with inflammation, with joints and all this other stuff. Right however, if you've already got rampant inflammation from maybe food or hormones or for something else, and you think BPC is going to take care of it, that's not really a good strategy, is it?
- [26:31]
Dr. Sheila Farhan
Almost masking it's going to mask or
- [26:34]
Dr. Taz
it's just not going to work very effectively. Right. So instead, walk first through, like the gut hormone inflammation component of things, then layer that on. So we'll, for example, layer glutamine with bpc. Glutamine rebuilds the gut lining. BPC might help the inflammation, will modify the diet. Do we get the result that we want from an inflammatory and from a gut health standpoint. So that's one way of really taking a more holistic approach to peptides rather than like, oh, I've got all these peptides I'm doing, you know, right now, all at all at one time, you know.
- [27:08]
Dr. Sheila Farhan
Yeah.
- [27:08]
Dr. Taz
The other part, you know, like a lot of the ones like Ipamorelin, you know, tessamorelin, aod. Well, what do those do? They indirectly work on the pituitary to improve growth hormone secretion. Right. So growth hormone will, first of all, in the right place, be amazing. You'll build muscle, good skin, good hair. But too high, right. Then it becomes problematic. It actually becomes pro inflammatory and can trigger, you know, sort of this drive towards cancer and other diseases down the road. So you kind of need to know where your growth hormone levels are before you start something like, like this. The other thing that can happen with those is that, and this actually happened to me is that those particular peptides, because they're increasing growth hormone, can also increase testosterone. If you are sensitive, if you're androgen sensitive and sensitive to something like testosterone, well, those are going to work against you. So when I tried them, for example, literally within 72 hours, I had again that, like, weird hair, the crackly hair, the weird skin. You know, it was starting to come back, but because I could recognize it quickly, I stopped it. So, you know, this is just showing, like, it's important to have a holistic approach. You can do some of these, but you also want to make sure somebody's helping you and guiding you and you're following certain numbers. But in terms of the ones I like, love bpc, love nad dramatic changes with injectable nad cognitive health. Love something called Dihexa, which also helps with cognition. That's one that we're using a little
- [28:37]
Dr. Sheila Farhan
bit more of injectable. Is that one an injectable?
- [28:39]
Dr. Taz
That one is oral.
- [28:40]
Dr. Sheila Farhan
Okay.
- [28:40]
Dr. Taz
And then for more metabolic health, we like mot c Using a lot of that, you know, so. So these are some of the ones we're bringing in, but again, kind of rounded out in this model.
- [28:52]
Dr. Sheila Farhan
Yeah. Because it is almost, you know, everyone's doing the stacks. My issue is, well, first of all, people are buying them online, and they. You don't know the purity of the. You know, there have been some testing on some of them. Some of them have lead. Some of them have only, like, 2% of what they see say it is. So definitely making sure that you're getting it from a provider that is a prescription from a 503B pharmacy. That is really, really important. And most likely, if you're getting it from a physician, a provider, you know,
- [29:21]
Dr. Taz
they've done their due diligence. I mean, we spent I don't even know how many man hours on it, like, months, like, grilling, trying to figure it out. Trying to figure out, like, where do we get it? Well, first we had to make the leap of, like, okay, do we want to do this? And then it was, okay, where's the best source? And then kind of like vetting our sources and making sure they were 503Bs, right? So, I mean, there's definitely a quality issue. And I think. I think they have a place. There's a safety issue, a quality issue. And then also the other part is, come on, guys, do we really want to be injecting ourselves constantly, all the time? There's got to be, you know, there's. I feel like it should be used to a point, and then you should stop for a period of time. You know, you have to cycle through them. You do need to take breaks. But this constant, like, injecting yourself over and over again. I do have people that burn out on that. They're like, I'm just tired of giving myself shots, you know?
- [30:13]
Dr. Sheila Farhan
So there has been actually people in the hospital from reticrutide, because it works. I mean, that one's not even fda. That is not one that I even give patients at all.
- [30:22]
Dr. Taz
Right.
- [30:22]
Dr. Sheila Farhan
But people are on it, and they lose so much. There's electrolyte imbalances. And what's crazy is one of. One of the girls at my office, her husband is a firefighter. Almost every night, they're getting called in because someone's injecting themselves with something they got, and they're having a reaction.
- [30:39]
Dr. Taz
Really.
- [30:40]
Dr. Sheila Farhan
It's a. It's. It's a common. It used to be elderly with their. You know, with. With their bracelets, and now it's like, oh, we got another injection. Shot? Yeah.
- [30:50]
Dr. Taz
Mm. Oh, wow.
- [30:51]
Commercial Narrator
So.
- [30:52]
Dr. Sheila Farhan
So I think that we're not hearing about all of that. And again, we're not saying that the spat is just. If it works for one person, it doesn't mean that necessarily will work for you.
- [31:00]
Dr. Taz
There needs to be some guidance. I don't know how you feel about it, but really, you can go online and order whatever you want and inject
- [31:08]
Commercial Narrator
it into your bloodstream, Inject it into your body.
- [31:10]
Dr. Sheila Farhan
Oh, my gosh.
- [31:10]
Commercial Narrator
It's kind of scary.
- [31:11]
Dr. Sheila Farhan
That's terrifying.
- [31:12]
Dr. Taz
I mean, even as a physician, I couldn't even get my head wrapped around this stuff until I'd done a lot of research and a lot of work, you know? So I don't know. I think that from a consumer standpoint is concerning. And I would warn everybody that, yeah, they're great, but everything, a hormone, a peptide, a GLP1, they all have a sweet spot. And it's really important to have somebody that can help navigate that sweet spot with you.
- [31:36]
Dr. Sheila Farhan
Yeah, absolutely. So we can. I mean, again, they are the future, but again, like you said, they need to just be managed. It may not be right for you.
- [31:44]
Dr. Taz
Right.
- [31:44]
Dr. Sheila Farhan
I've seen that you have the oral peptides, and obviously there's oral. Oral semaglutide now. So we do know peptides can be formulated in a way that it's bioavailable in the gut. For me, I'm like. For me, I'm like, I kind of want to try BBC 157.
- [32:03]
Dr. Taz
Oral, oral, injectable, oral.
- [32:06]
Dr. Sheila Farhan
Tell me about it. How's the bioavailability? I know that you offer them to your patients from whole plus.
- [32:13]
Dr. Taz
We do. So we like the oral BPC for gut issues, for systemic inflammation. But if you've got a localized, like, injury, like a frozen shoulder or a bad knee or something like that, we haven't seen the benefit with orals that we do with the injectable. So that's just something to keep in mind. But from a gut standpoint, from an inflammatory standpoint, we love it. The other one I like, that's oral is something called kpv. And one of the things I've talked about for a really long time is sort of this epidemic of candida or an overgrowth of yeast. The in. In the gut, we are finding that KPV seems to help seal up those tight junctions in the gut lining and does seem to help reduce candida. So for a lot of my high yeast patients, it would apply to you with, like, your rosacea patients, maybe, or even some of your Bad acne patients.
- [32:59]
Dr. Sheila Farhan
Yeah.
- [32:59]
Dr. Taz
Like, you know, we will do some probiotic balancing. Well, first of all, diet wise, you want to take out sugar, you want to take out alcohol, you know, you want to take out processed food foods, because those typically make Candida worse. And then we will add in some probiotics to help balance out the yeast load. Then if they're really in a bad shape, like, I have a lot of patients that have Candida, but. And they have it under control, but then they'll go on a vacation and, you know, it's off again. We may treat with Diflucan or something like that. And then we'll transition to using something like kpv, you know, maybe for four to six weeks, give it a break, and then bring it back. So again, there's a great way to like cycle and like help it. But I love those oral ones at least the bpc, the KPV lorazotide is another one. Pentadecapeptide is another one. Those are all really great for the gut.
- [33:47]
Dr. Sheila Farhan
Got it.
- [33:48]
Dr. Taz
They kind of get there. Whereas the injectables work a little bit better systematically.
- [33:52]
Dr. Sheila Farhan
Okay, that makes, that makes a lot of sense. Noted. Noted on that. Yeah, tell me. So nad, there's a different, a lot of different forms. I've kind of played with the idea. I do offer them in my office. Which type are you? I think it's just, we do it in the iv.
- [34:06]
Dr. Taz
Okay.
- [34:06]
Dr. Sheila Farhan
Yeah, but people hate sitting for an hour with an IV with Myers and then you add an NAD in there. So tell me like what you, you said there's an injectable. I'm super interested. Tell me more about it.
- [34:17]
Dr. Taz
We're doing take home injectables of nad. We supervise the first one in the practice. And same issue. Like, we looked at the IVs and we just hesitated. They're super long. Need a lot of monitoring. Great for the sick person or for somebody on the kind of the extremes again, but not really practical or realistic for kind of the everyday person just trying to optimize. And so these take homes have been a game changer. We like them. So we will do the first few shots in the office. They'll take home the rest. And they're not at a dose that would cause any cardiac issues or things like that. But for patients with brain fog or low energy or even ADD or adhd, they've helped. They've definitely helped. So again, NAD is helping replenish that mitochondrial energy. If we can rebuild mitochondrial energy. Right. In a more aggressive way than maybe Taking an oral supplement, then it's been something that people have really liked.
- [35:15]
Commercial Narrator
Have you seen the reports?
- [35:16]
Dr. Sheila Farhan
Because again, too much of something or not being the right candidate for it. So nad, if you have an indolent cancer.
- [35:24]
Commercial Narrator
Yeah.
- [35:25]
Dr. Sheila Farhan
You have to be careful about that. It could possibly really rev it up.
- [35:28]
Dr. Taz
Yep, I have seen that. I've seen that report also. For anyone with cardiac issues, it can rev that up. Careful. People with anxiety, sometimes it makes it worse. So again, that's why you. Again, it needs to be supervised where you try like a low dose or a test dose and then you kind of gradually move your way up to a bit of a higher dose.
- [35:47]
Dr. Sheila Farhan
Do you think there will be any changes? Like we'll look back and be like, oh, that was a trend. What are your thoughts on looking back at peptides?
- [35:54]
Dr. Taz
I mean, that can always happen. Right. Because we're seeing that with GLP1s. Right. We're getting a little bit of the GLP1 backlash now, where everyone was super excited about it, everybody was on it, but now we're hearing about how many side effects were suppressed, like in terms of not being reported. Changes in vision, changes in gut health, thyroid disturbances. So now we're hearing more about that. Right. Because it's been, what, three or four years? They've really, you know, hit the market. So I think, I mean, I think it's true of anything. Right. We never know what we're going to find. I mean, look at hormones, right? Like for years women were told not to take hormones and now 20 years later, it's the best thing.
- [36:34]
Dr. Sheila Farhan
Yeah.
- [36:34]
Dr. Taz
Now people are running out of estrogen patches, you know, so you just never know where science will take us and where people's experience will take us. Yeah, I think we just have to be open to it. I think that's where good monitoring and tracking things makes a difference. Because let's say you're on something. Long term research says, hey, it wasn't really that helpful, but you've been monitoring it along the way. Well, we can catch that on you, the patient.
- [37:00]
Dr. Sheila Farhan
Yeah.
- [37:00]
Dr. Taz
Faster than we're going to wait for another study to come out or for another consensus type statement.
- [37:05]
Dr. Sheila Farhan
Yeah, yeah. Speaking of the GLP1s at my office, you know, I do offer I microdose and we do full doses too. And it's tremendously helped my patients. The GLP1s, we do tirzepatide and semaglutide and I do the injectable and the oral. And my patients with pcos.
- [37:24]
Dr. Taz
Game changer.
- [37:25]
Dr. Sheila Farhan
Game changer. Now It's a lot easier to get the tirzepatide just online prescription, non compound. But when it was over $1,000, patients that were obese that you know, they weren't able to get it covered cause they didn't qualify, we offered to them. And then that slippery slope of I do have patients who are like doing it for metabolic optimization. We microdose. I always keep their weight, their goal weight. And I am very. Cause that is kind of a slippery slope of like people loving, loving to be skinny. Because everyone says they look great, you know, until they don't. Until they don't and they have muscle wasting, they can't pick up their luggage.
- [38:04]
Dr. Taz
I mean are you seeing it with the face falling and the. Yes. Oh wow.
- [38:08]
Dr. Sheila Farhan
So that is very specific. And that. Yeah. And that actually that we will see in the aesthetic space that the muscle, the fat pad wasting and the aging that we'll get in the face actually outweighs the anti inflammatory benefit. Benefits.
- [38:25]
Dr. Taz
Got it.
- [38:26]
Dr. Sheila Farhan
That there will be like a detriment to that. Of course some people look great with less fat on their face, but everyone holds it really differently. It just depends. Depends on your genetics. I have seen a huge uptick in like doing sculptra procedures, lasers, you know,
- [38:41]
Dr. Taz
because they're losing it so fat. But then you're injecting.
- [38:44]
Dr. Sheila Farhan
Yes, I know. So there's definitely a fine line. And you know, everyone's saying it's anti inflammatory. I'm doing it for optimization. And I think there's definitely a truth to that as well. Even some people said that it helps, you know, their joint because it decreases inflammation. Helps. Some people it makes their gut worse. Some people it makes their gut better because maybe they're not eating those foods that perhaps cause the IBS or SIBO to get wild. So what's their place in your practice?
- [39:12]
Dr. Taz
So same we use them and we have them. And again it's with a guarded sort of stacked approach. Right. So it's like is the gut microbiome where it needs to be? So for example, one of the biggest issues we'll see in our population is shifting towards like a deficiency of Akkermansia, which is a bacterial strain that goes down especially with women going through hormone shifts. So like we may want to rehab that. We usually want to put our patients on glutamine, which protects the gut lining and we usually use digestive enzymes to help them digest their foods a little bit better.
- [39:45]
Dr. Sheila Farhan
Yeah.
- [39:46]
Dr. Taz
So as far as dosing goes, you know, I have to watch and filter for the Person who just likes to be thin. To be thin. And we're looking at body composition and I'm looking at hunger. Like I need you to be hungry. Like you should be eating every four hours or so. I think if you're not, that's problematic.
- [40:03]
Dr. Sheila Farhan
Right.
- [40:03]
Dr. Taz
And that's going to put you sort of in this category of not having stable blood sugar, also having, you know, like just a lot of erratic, you know, metabolic shifting when we take you off of it, if you can come off of it. So for us, it's a lot about, like, you know, fundamentals first, healthy eating, spacing of meals, that's appropriate gut support, and then adding just the babiest dose to begin with, depending on the patient. Right. Someone has a lot to lose, that might be.
- [40:33]
Dr. Sheila Farhan
Sure.
- [40:34]
Dr. Taz
And then when we get stalling, the other thing that's been fun more recently is that when we get stalling out at a particular GLP1 dose, then adding something like a Motsi or one of these peptides can help us overcome that stall without actually, like dialing up on the dose of the medication. So our practice philosophy is how low can we go?
- [40:56]
Dr. Sheila Farhan
Yes.
- [40:56]
Dr. Taz
In terms of a GLP1, the number of peptides you're on, the number of ejections you're doing, how much hormone you're taking, how low can we get away with? Right. And once we can get to that really low do dose, then we're like, can we wean it to where you're not doing it every week? Maybe you're doing it every 10 days, maybe you're doing it every two weeks. Hopefully you're resetting your habits as we go along with that. But things can change. People have come off blood pressure medications, off cholesterol medications. You know what I mean? They've come off hormones when they've needed thyroid hormone because they've been able to fix what's going on in their body. So all of that is possible. But, you know, this idea that you're going on a GLP1 and you have to be on it for the rest of your life, I feel like that's only true and true of other medications when you're not taking the holistic approach.
- [41:47]
Dr. Sheila Farhan
Yeah, no, I totally agree. And I think the fact that you're trying for the patient to be on the lowest thing ever, and whether that's the low dose spreading, you know, spacing out the weeks, that is something that we do as well. And I think that's a great, great way to do it. One other thing about the GLP ones They do decrease your kind of your dopamine, like, your. Your excitement for wanting to eat out and stuff, like. Yeah. So I think that's one thing that people also have to kind of take into consideration. Like, do you want that for the rest of your life? Although, like, I love, again, it's been life changing. Love the GLP ones, but it just needs to be balanced.
- [42:25]
Dr. Taz
It needs to be balanced.
- [42:25]
Dr. Sheila Farhan
Yeah, yeah, yeah. You see a lot of acne and hormonal, like, hormonal acne.
- [42:29]
Dr. Taz
And what are your.
- [42:31]
Dr. Sheila Farhan
Your big things with that? Is gut like one of those. One of those big things, or is it actually hormones?
- [42:36]
Dr. Taz
It's both. You know, there's the gut hormone connection.
- [42:39]
Dr. Sheila Farhan
Right.
- [42:40]
Dr. Taz
Again, I mean, I had bad acne too. Mine was high androgen. So it's finding the foods that are not working for you. It's understanding if you're not getting the fat that you need to balance out the gut bacteria and then understanding the hormonal profile. So people that have, like, super high androgens will either do herbal things like berberine or inositol or even saw palmetto.
- [43:03]
Dr. Sheila Farhan
Is that dim? The second one? No.
- [43:04]
Dr. Taz
Inositol is like more of a blood sugar balance. Oh, God. There's a huge relationship between that and androgen. So we'll do those things to, like, level out the androgens. And if it doesn't work.
- [43:14]
Dr. Sheila Farhan
Yeah.
- [43:14]
Dr. Taz
You know, then we'll might move on to a spironolactone.
- [43:16]
Dr. Sheila Farhan
Yeah.
- [43:17]
Dr. Taz
Or so. Or like a Win Levy or one of those.
- [43:19]
Dr. Sheila Farhan
Oh, yeah, those are great. Yeah, those are. Those are my wheelhouses.
- [43:22]
Dr. Taz
Those are your.
- [43:23]
Dr. Sheila Farhan
What are your thoughts on Dim for the cruciferous?
- [43:25]
Dr. Taz
Okay, yeah, well, dim is. Remember, we're using it for estrogen dominance. Right. When the hormones are not breaking down and not being metabolized effectively. So we've had success with it. There are a couple. There's dim and dual three carbinol, which is I3C. And then there's calcium glucarate, which actually helps the pathway where you recycle estrogen and, you know, the bad metabolites on board. So we'll play with some of those different ones to see which ones really make a difference at the end of the day in terms of, like, calming down.
- [43:52]
Dr. Sheila Farhan
Yeah.
- [43:53]
Dr. Taz
You know, estrogen dominance, which is a very real pattern today for everybody.
- [43:58]
Dr. Sheila Farhan
Adult adults, kids. Gosh, yes. The amount of women I see for adult hormonal acne is insane. So for the people out there, because I do play around with some of the supplements with them before I Put them on spironolactone.
- [44:12]
Dr. Taz
Yeah.
- [44:13]
Dr. Sheila Farhan
And then of course, like Win Levy is the topical. Which is, which is great. I mean, I'll do that before the spironolactone. In your personal practice, what are your top three or if you have one, that would be great. But what are your top three supplements for hormonal acne?
- [44:27]
Dr. Taz
Top three supplements for hormonal acne. First of all, a good probiotic to control the microbiome. Secondly, I will use saw palmetto to manage the androgens. And third, some sort of fat to support the skin barrier, whether it's evening primrose oil or high dose omega 3 silver. And then sometimes I'll add an anti inflammatory too, like a turmeric or some. Or something like that.
- [44:50]
Dr. Sheila Farhan
Coral. Oh, I love that.
- [44:52]
Dr. Taz
Yeah.
- [44:52]
Dr. Sheila Farhan
Love, love, love. So what's the one small daily habit that lowers cortisol that people often overlook?
- [44:59]
Dr. Taz
Just taking four deep breaths. Okay. Easy to do. You can do it in your car, do it anywhere. Four deep breaths in through the nose, down to the diaphragm and right back out.
- [45:09]
Dr. Sheila Farhan
Got it. Is there a certain, like, timing?
- [45:12]
Dr. Taz
I mean, I would just go on your inhales and you can count to four. If you count to four for every step. That's good enough.
- [45:17]
Dr. Sheila Farhan
Four and four. Got it. I agree. Breathing is so important and breathing the right way.
- [45:23]
Dr. Taz
Breathing down to the diaphragm. Yeah.
- [45:27]
Dr. Sheila Farhan
Yeah. Okay. What's the one longevity habit that gives the biggest return with the least effort?
- [45:33]
Dr. Taz
Weight training.
- [45:35]
Dr. Sheila Farhan
Yes, I do.
- [45:36]
Dr. Taz
I think building muscle helps with blood sugar management, which in turn helps with visceral fat, which in turn helps with everything else.
- [45:44]
Dr. Sheila Farhan
Yeah, osteoporosis. I, you know, I'm 11 months postpartum with my little, with my little guy. And my muscles are not like where they used to be. But I restarted weight training and I can actually start to pick him up out of, you know, because he's like on the lowest in the crib.
- [46:00]
Dr. Taz
Yeah.
- [46:00]
Dr. Sheila Farhan
And like my back was hurting when I was like, oh, I just needed to get stronger. And it doesn't need to be crazy.
- [46:05]
Dr. Taz
It doesn't need to be crazy. It's just like I would actually maybe I even would rephrase that and say functional movement, where you are working on some of our very vulnerable areas like the pelvic floor, the upper shoulder girdle. Right. The knees, the Achilles. I ruptured my Achilles a couple years ago. So I think functional movement that strengthens you so that any of the surprise movements, you slip down the stairs, you pick Something up, heavy. Whatever you do, don't take you out.
- [46:32]
Dr. Sheila Farhan
Yeah, yeah. I love them. So we kind of talked about this. For the acne supplements, if you had to strip someone down to only three supplements for longevity, what would they be?
- [46:43]
Dr. Taz
Three supplements.
- [46:44]
Dr. Sheila Farhan
I know, that's tough.
- [46:45]
Dr. Taz
Longevity, right. We've got to have a mitochondrial supplement. We've got to have an supplement for inflammation. And then we've got to have like just a general like workhorse. So the workhorses, I would say would be B and magnesium. They're my bookends. So a methylated B vitamin, multi B and a magnesium because they're both involved in so many different processes in the body, whether it's dopamine, cognition, hormones, you name it. And then I've got to pick. This is hard. Then I would probably put someone on turmeric or curcumin because it's anti inflammatory and it helps the mitochondria area as well.
- [47:28]
Dr. Sheila Farhan
And then on the flip side, what's the one supplement that people are obsessed with but you think is kind of overrated?
- [47:35]
Dr. Taz
So a lot around both creatine and urolifein A, I feel like I've not really seen as much of a benefit in those as I've seen in some of the others.
- [47:46]
Dr. Sheila Farhan
Good to know. Because creatine, everyone's talking about it like, especially for women. There's like specific female marketing for females. What is the urolithin supposed to do?
- [47:57]
Dr. Taz
It's also supposed to. That one's more for mitochondrial support too.
- [48:00]
Dr. Sheila Farhan
Oh, okay. And tell us for the people who don't know, like the mitochondrial supports, basically your cells work better.
- [48:05]
Dr. Taz
Yeah. Giving your cells the energy they need to function effectively.
- [48:08]
Dr. Sheila Farhan
Yeah, basically.
- [48:10]
Dr. Taz
Right. I'd rather do NAD and I'd rather do glutathione for those.
- [48:13]
Dr. Sheila Farhan
Got it. What's the one thing you wish every patient would start doing today? For long term skin health.
- [48:20]
Dr. Taz
Ooh. For long term skin health.
- [48:23]
Dr. Sheila Farhan
I know that's tough. Cause it's my field.
- [48:25]
Dr. Taz
Well, wear sunscreen.
- [48:26]
Dr. Sheila Farhan
Yeah.
- [48:26]
Dr. Taz
Wash your face at night. Love those two things. And exfoliate.
- [48:34]
Dr. Sheila Farhan
And then what about what's the one thing you wish every patient would start doing today, literally when they hear this tonight? For just health.
- [48:43]
Dr. Taz
Gosh. Just health. These are hard.
- [48:46]
Dr. Sheila Farhan
I'm sorry.
- [48:47]
Dr. Taz
It's the one thing they would do for just health starting today. Get rid of processed foods.
- [48:55]
Dr. Sheila Farhan
Yeah, I think that's a good one.
- [48:56]
Dr. Taz
That's the easiest one. Well, thanks. Thank you. Thanks for having me. It was good to catch back up. Yes, yes.