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Tessa Zali
This episode is brought to you by Amazon. Sometimes the most painful part of getting sick is the getting better part. Waiting on hold for an appointment, sitting in crowded waiting rooms, standing in line at the pharmacy. That's painful. Amazon One Medical and Amazon Pharmacy remove those painful parts of getting better with things like 24. 7 virtual visits and prescriptions delivered to your door. Thanks to Amazon Pharmacy and Amazon One Medical Healthcare just got less painful. Foreign welcome back to the Treatment Room Podcast. I'm your host, Tessa Zali. I am a licensed esthetician, acne specialist and NASM certified health and nutrition coach. I am recording this episode in the morning, which I think I need to do. I feel like I have the most energy fresh in the morning. I'm having a little no sugar added grapefruit juice and my coffee today. I've been obsessed with this brand. Not sponsored, but shout out for anyone who wants to try it. It's called Purity Coffee and it is a mold and mycotoxin free organic coffee and they have all different types of coffee. Light, medium, dark, decaf. I chose the decaf and I like to brew it like the night before. So it's cold in the morning and I added a dash of pistachio milk from the brand Three Trees and it's just so delicious. Okay, so before we get into the episode today, a little background about me, if you're not familiar. I started my business in 2020 and my business is an all virtual acne care and corrective skin practice. I started my business when the pandemic hit and facials closed and people no longer had access to those treatments. And I think for a long time, like I mentioned in the last episode, I think in office treatments facials were really the way most people thought they would achieve the best results with their skin. Like up until 2020, I think we really look to those treatments as the main way to treat acne. And I think a silver lining of this pandemic was that it really changed the industry and how we look at treating skin. And I think we now understand that the majority of your results really come from what you do at home. So my program, which is done virtually, is intended to help guide you in all the areas that I feel are most important for achieving your skin goals. So that includes topical skin care programming, creating a program just for you, customized to you, your skin, your skin needs, your skin goals, and really marrying this with the right nutrition and lifestyle support to get you results that are sustainable. Like I want you to understand through my program how to take care of Your skin and how to optimize your lifestyle and what you're putting on your face every single day and night. I just feel if you can go this route it is going to be just such a healthier and more long term solution for you to treat your skin versus you know, a short term band aid, a medication that might have long term side effects and consequences. I just think if you, if you can learn how to take care of your skin, it's just, it's crucial. Like I think we should all learn how to do that and having professional guidance I think is really necessary with a lot of skin issues just because if we'll talk about some things in this episode that I think are really relevant to getting your skin clear. But yeah, I just think a lot of people need the hand holding. There's so many small things that I find in my client work that end up being super game changing. So that's a little bit about my program. I will link my website. It's just Tessa Skin in the show notes for anyone who's interested in working with me one on one. I am accepting new clients right now and I would welcome anyone to join my program who is struggling with their skin and just wants my support. But for today's episode I want to talk about my favorite topic, acne and I want to share some little spicy hot takes. I, I see a lot of misinformation online and on social media about acne and I think it's generally so well meaning. But you know, sometimes I disagree and I'm not one to leave a comment in, you know, but if I can share a counter argument here and you know, help somebody, I think it's, it's productive. So I never intend to undermine anyone. I just want to share, you know, my thoughts and some things that I think could help somebody on a clearing journey. I know it can be really frustrating. There's so much information online you don't know what to, to believe. And again, I think if you are feeling confused like that, sometimes you can just feel more lost the more information you absorb from different sources. So I actually think finding one person you trust, whose work you respect, whose transformations you've seen you believe in, I think trusting that one person versus getting lost in all the noise can actually yield you a much better result. So again, would encourage anyone to join my coaching program. But let's get into the acne myths and misconceptions from my pov. Okay, the first one I'm seeing this shared by dermatologists, by estheticians, and really, you know, savvy professionals who are super well respected, they know what they're doing. But I think this myth, it's kind of the perfect example of like something rooted in fact, where the game of telephone is kind of manipulated. It and okay, so the myth is basically that bacteria in the outside world doesn't affect acne, so you don't need to worry about it. And professionals will often share, acne is starting in the pore. The bacteria is starting in the pore. So don't worry about excess bacteria. That is not the true cause of your acne. And this is where, you know, nuance is so important to understand because, yes, it's true. Acne starts in the hair follicle due to a pile up of skin cells, oil, and the resulting bacteria that creates inflammation. And that's the start of the acne process that is the true cause. And, you know, those things are the cause, the oil, the retention, hyperkeratosis, the inflammation in the pore. But it does not mean that triggers can't exacerbate acne. And we do know exposure to propionibacteria, even outside the follicle, can exacerbate acne. So the example that I'm thinking of that was shared by a dermatologist was that basically we've gotten too crazy about bacteria. And this dermatologist said, you, if you are struggling with acne, if you're an acne sufferer, you do not need to worry about changing your pillowcase so often. She said, just change it a quote, unquote, normal amount of times. And I think for the viewer seeing this, it's like, yeah, I don't want to do. I don't want to be a crazy person. I don't want to, you know, adjust my lifestyle or, or do extra things to care for my skin. Like, it doesn't seem fair. And I think that advice is super appealing to the masses, but I just couldn't disagree more. And I also think we just have to acknowledge, like, if you have acne, your life is probably going to look different than your friends. And I always have this conversation with my clients because I think we just need to acknowledge it. It's like any health, you know, for me having autoimmune conditions, I have to, I have to have a different lifestyle. My life does not look like most people I know in their 30s. But I don't want to live an average life. I want an optimal life and an optimal result. And that requires some extra legwork. It requires being aware. It requires Lifestyle and nutrition modifications. I cannot neglect my skincare routine. Whereas your average person can, can get away with that, can get away with falling asleep on the couch without doing their skincare. For an acne prone person, one night of doing that can have consequences. So let's just be real. Let's acknowledge the reality that if you have acne, your life is going to look a little different. And it doesn't mean it has to be harder, it's just different. It's all in your attitude and when it comes to bacteria. To say that you shouldn't be considerate of bacteria because the bacteria is originating in the pore, it's just not good advice. If you are acne prone, you need to be aware of things that can add fuel to the acne flame. There's so many ways in which this can occur, from dirty makeup brushes or sponges to touching your face throughout the day or when you're at the gym holding a cell phone or tablet to your cheek. And the pillowcase is surprisingly one of the biggest influences I find in the lifestyle that can exacerbate acne. So when I heard this advice to not be proactive about changing your pillowcase, I was just like, no, I have to say something. And there was a really interesting study that actually showed us one week without changing the pillowcase carried an average of 3 million colony forming units of bacteria per square inch. This is 17,000 times more than a toilet seat. And I will just tell you in practice, I see a true difference, even from those who are good about changing their pillowcase, changing it every couple of nights. When I get somebody in the habit of changing their pillowcase every single night. It is a difference maker. And I do see more acne when people are not changing their pillowcase enough. Say they're changing it once a week and they often sleep on that side. I do see exacerbated acne and this can partially be due to friction and pressure, but bacteria is a huge influence. It can really exacerbate that inflammation. So I actually do recommend being proactive about changing your pillowcase and I don't recommend just changing it a normal amount of times. Again, if you have acne, your lifestyle is going to look a little different and that is okay. But I would recommend getting a stack of pillowcases. They don't have to be silk or anything bougie, just cotton washable pillowcases that are not scratchy. And if you have more than a couple, you won't have to be doing laundry as much. And you can Simply keep a little stack in a drawer. I always tell my clients, just get in the habit of changing it out before you go to bed. Like before you climb in bed, change the pillowcase and you have peace of mind knowing you are sleeping on a clean slate. And you know when, when people get microneedling treatments or lasers done, you know, the medical professionals always remind, or at least in my experience when I get these treatments, like the medical professional often advises somebody to change their pillowcase. And I think it's the same thing for an acne prone person. We can build up so much bacteria even with one single night's use of a pillowcase. There's bacteria from our skin, there are skin cells, millions of skin cells being shed overnight. There's sweat, there's drool. A lot of us are working out and not washing our hair every single day. There's hair product residue, makeup, skincare, pet dandruff, airborne particles. There's Demodex mites, so many things. So I just think being proactive about the pillowcase changing, in reality, it's a small thing that can really pay big dividends. So that's something I actually would encourage that might kind of go against the popular norm. And the next point I want to make is a little bit similar and hear me out because this could be misinterpreted and I don't want to be misinterpreted. So you know how we often hear acne is not a hygiene issue. This is true. It's a little bit of a blanket statement though. So you do not have acne because you have bad hygiene. Acne is a disease of the poor. It's a malfunctioning pore and it involves excess shedding of skin cells retention, hyper keratosis. However, I think because people hear that blanket statement, they can neglect hygiene in certain ways because they kind of think, oh, that's not the cause like that, that isn't important. And again, I would argue that bacteria and hygiene is actually very important for an acne sufferer. I think it is so important if you have acne to almost think of washing your face, a.m. and p.m. as part of your protocol. That is going to be so important for removing excess skin cell buildup, removing bacteria, removing oil on the skin. And I think especially in the morning time, we have glorified not washing our face. And from time to time a celebrity will say they don't wash their face in the morning and you know, the article will be posted with a picture of the celebrity and they have perfect skin Obviously, usually this is because they have access to the best professional treatments, lasers, etc and they might do these on a regular basis. They have the best skin care products at their disposal. They're getting regular facials, they probably have the best nutrition, etc. Like they have a very high quality of life and you can see that article and just extract, oh, they must have perfect skin because they don't wash their face. That must be the secret. And I will tell you, I don't think it's the secret. I think you really want to get in the habit of taking care of your skin. We only have two opportunities to improve our skin, morning and nighttime. So I would take them. And the other thing I wanted to stress that I've said a million times, but just in case it reaches somebody new, if you sweat, if you go to the gym, if you work out, it is so important to have good hygiene after the gym and take care of your skin. I know we all want to go to the gym and then get home, make a meal, run an errand, do what we have to do. Most of us do not want to interrupt our daily life to do our skincare routine at the gym, especially if we're going to shower when we get home. But I will tell you just extra time that you are allowing bacteria to build up on the skin, especially when the skin is warm and moist. I know we all love that word, but it's really creating a little petri dish opportunity for acne to thrive. So if you are active in sports, if you're younger, if you're in PE or you do sports after school, or you're an adult, you go to workout classes or you're a personal trainer and you're sweating throughout the day during workouts. Just be mindful that it is really important to take care of bacteria on the skin and just ensure you're having, you know, good skin care practices after sweating and when you wake up in the morning and before bed again, you know you don't have acne because you're doing something wrong in the hygiene sense of things. But hygiene is really, really important to help you clear and maintain your skin. Okay, the next point I want to make is that sensitive skin and acneic skin are not the same. So I see this all the time with new clients. And one of the things I often see clients stressing to me is that their skin is super sensitive. And sometimes this can be a little teachable. Moment I ask them, what do you mean by sensitive? Are you experiencing frequent reactions to products like Stinging, burning hives, that kind of thing. And, you know, this skin type does exist, so it's important to know if that is something someone is experiencing. There are people who can just frequently react to products. Typically, if that's the case, they have kind of always been that way since they were younger. But I find when I try to clarify this with clients, usually they share. Well, no, actually, that's not really what I mean. I just mean my skin is frequently breaking out when I try new products, and that is generally just more so acneic skin. And it's a buildup happening within the pore. And you do want to be careful with the products you're trying, but it doesn't necessarily mean you have sensitive skin. And I wanted to clarify this because I actually think sometimes you can kind of limit your results if you're overly stressing. To an esthetician, my skin is super sensitive just because, like, you're thinking that's going to help me minimize my risks. That's going to help ensure that, you know, I'm not recommended too many products because sometimes people assume if they have acne, like, I just need the most simple routine. And I don't want to, you know, use actives regularly or exfoliate because I'm afraid that's going to make me break out or purge. And that can be a stage you go through. But. But typically it's necessary to use actives and exfoliating ingredients to clear out the pore. And I think sometimes people stress that they're sensitive because they've just never found a solution to treating their acne. They've never sufficiently interrupted that acne process. And that's actually something you want to do. You want to find. At what level of exfoliation are you finding success with your skin and clearing? So you may not want to overly stress to your esthetician that you're sensitive if you're actually just acne prone, because that extra exfoliation is actually going to get your pores clear and help you maintain a good result. Okay, I feel like this next one, I could make a whole podcast. Let me know if you want me to do that. But it's this myth that moisturizer makes the skin lazy and that we need to dry out the skin as much as possible to achieve a result or get the skin clear. I really thought we left this advice in the 90s, but it's kind of making its way back. And this is actually, in my opinion, kind of like a little bit dangerous for people in a few ways and let me elaborate. So for one, moisturizer does not make the skin lazy. It doesn't slow collagen production, it doesn't inhibit your skin in any way. It is so important to take care of the stratum, corneum and the barrier. And so so moisturizers contain humectants that bind moisture to the skin. They contain emollients that help to smooth the surface of the skin, kind of smooth out that cuticle so you don't have rough, dry, flaking skin. And moisturizers lastly contain occlusives. Occlusives can vary and basically an occlusive just creates a sealant so the humectants and emollients can see stay in the skin. That occlusive is going to minimize trans epidermal water loss and just prevent water escaping from the skin. So in simple terms, when you apply a moisturizer, your skin is going to feel more comfortable throughout the day because you've applied hydrating ingredients and you're using a sealant to, to keep those good ingredients in the skin, whereas without it they can escape a little more easy and your skin can feel more dry or dehydrated. And I shared a reel this week because this little myth kind of had me in a tizzy because I just, I disagree with it so much and I want to get into some of the negative consequences I have seen from this type of messaging. So you guys know I have an acne care practice and half of my new clients. So I would say half of my clients are people who've haven't had professional guidance before, they've been trying to self treat. And then the other half are actually people who come to me from other acne care programs, programs where they're really advising and recommending intensive aggressive exfoliation without emphasizing barrier support. And something I've always said is that what we exfoliate, we must hydrate, we must replenish what we are taking away from the skin and resurfacing. We cannot expect our skin to handle constant resurfacing and exfoliation if we are not building the barrier back up. In this reel I shared, I showed some client examples, some before and afters and the before pictures. You wouldn't know that these people had spent thousands of dollars working with professionals to improve their skin. Their skin looks really unhealthy. And you can tell oftentimes when a client isn't using moisturizer or enough barrier repair products because not only do they have acne and they're not Getting the result of clear skin, their skin also looks very dull. So with healthy skin, it should reflect light, and the skin reflects light. It looks glowy. You know that phrase glass skin? Glass skin is a balance of exfoliation and barrier support. Like, that's how you get that glow. And I think that's something like, that's my signature with clients. Like, not only do I want to get you clear and, and help you get the acne under control, I don't feel like my work is done until your skin glows. It looks healthy and vibrant. And with these before pictures, you can see the bumps and texture on the skin, but you can also just see that the skin almost looks lifeless. It looks like it's been stripped and stripped and stripped without adding any beneficial ingredients to the skin. And I had a client this last week who came to me after trying a couple acne care programs. And she had been told not to moisturize her skin, not to cleanse her skin, not to use sunscreen. Literally, I, I couldn't even believe this. But the only skin care, like, I thought it was a mistake. When I looked at her intake form, the only product she was using was benzoyl peroxide. And I love benzoyl peroxide. I am not afraid to treat the skin intensively, but this has to be done in a safe way. You have to start with making sure the barrier is intact. You have to meet the skin where it is at to accelerate a protocol. And this client had been using the benzoyl peroxide for years. And benzoyl peroxide should not take that long to work. You know, it works pretty efficiently. It's the most effective ingredient we know of for the treatment of acne. And yet this client was not getting clear. And this is where I feel like the claim moisturizer makes skin lazy. I think it's actually the opposite. When you don't use moisturizer, you encourage those dead skin cells to proliferate. You exacerbate dry skin and flaking. And this lays like shingles on a roof on the skin. And this disorganization of the cornea sites just piling up can lead to more breakouts. And you're not able to accelerate an acne care program. You're not able to increase the exfoliation when the skin isn't healthy. Healthy skin responds better to treatment and to exfoliation. And healthy skin requires humectants, emollients, and slight occlusion to keep water loss from occurring. The other thing is when skin is dehydrated and dry and more skin cells and oil piles up, it also can't escape from the pore properly when the skin is surface dry. If you are an esthetician, you've ever tried to do extractions on a skin that has visible congestion, like you can see the blackheads, but you can tell the skin is so parched and surface dry, you can't get that oil out. Even if you're putting pressure on the follicle walls, it's not coming out because we need hydration to, to support that oil kind of flowing out of the follicle normally. So even with a lot of pressure, you can't get the extraction out. So in normal life, when somebody is accumulating oil and blackheads in the pores and their skin is so parched and dehydrated, it just becomes this, this kind of vicious cycle of more congestion and no release. So I'm just such a firm believer in moisturizer and barrier support for all skin types and especially acne prone people. So don't be afraid of moisturizer. If you have acne. Yes, you want to use the right ones. Yes, certain ones can exacerbate it, but generally moisturizing the skin is a key part of caring for healthy skin. And not to get too off topic, because I know we're talking about acne, but eczema is a prime example of this. So eczema is exacerbated when the barrier is compromised because kind of these little like cracks in the surface of the skin, they encourage more pathogens, more irritants, more allergens to have a pathway into the skin and that's where the inflammation starts, starts. So I just really believe in supporting barrier health. And the other thing I wanted to really state about some of these aggressive acne care programs that aren't prioritizing barrier health. It's not only negatively affecting the client's skin, it's also affecting their mental health. And I just wanted to touch on this for a hot second because I just, I feel it's very real. So when you are encouraging a client to use aggressive exfoliation and they are complaining and they're telling you, my face hurts, this doesn't feel right, my face is stinging and burning every time I do my skincare routine. And there are professionals telling people to push past the pain, to ignore it, this encourages people to disassociate from their skin and their body. They have to get out of their own minds and bodies to endure the protocol and to do what you're telling them to do. And I think this has immense negative consequences. It is so important for people to be tuned into their skin, to learn how to listen to their skin. Even in my program, I tell my clients, you know, I'm going to give you the roadmap. I'm going to be here for you. As we are going through this protocol, I want you to tell me if something feels uncomfortable. If you're having stinging or burning that lasts for more than five minutes, I want you to let me know. And it can happen in acclimation and on an acne journey. Like that's likely going to happen to most clients. And, you know, once or twice we can recover from here and there. Your skin can recover from it. Our skin is resilient. But it's that repeat pattern of constantly abusing our skin that starts to really encourage inflammation. And it also creates a negative association for the client with self care and with their skincare routine. And not only are they not seeing a result from this type of aggressive exfoliation, they don't enjoy the daily practice of self care. And they're already not liking what they see in the mirror. They're not liking what they're touching with their hands. For them to have an added layer of pain and suffering, like, not to sound dramatic, but it's so real. Like, I talk to so many people who break down and cry in their consultation because they're so frustrated and they have invested a lot of money, a lot of time, and it's more so about just like them feeling trapped in this experience where they're not getting a result and they have to live in pain every single day. And they just, it. It really clouds people's mental health. Like, it really takes a toll. You know, I've been in meetings where this is occurring with teenagers and their parent is there, like, really stressing just what their kid is going through. I've been in meetings where it's a wife and a husband and the husband is there, like, for backup because there's been so much mistrust in, you know, in previous experiences with professionals. And it can sound so dramatic to somebody on the outside who hasn't gone through struggles with their skin. But for somebody who constantly dislikes what they see in the mirror and is constantly experiencing pain from their skincare routine, it can just take over your whole day. It can become all you think about. So I just think it's so important to really stress any professionals listening. We. We need to listen to our clients. I'm not saying there's not going to be highs and lows on the acne journey. I'm not saying you can't run into moments where you have disposal discomfort with a routine, but we need to have an open dialogue with our clients. We need to be a safe space for them. We should be listening to people when they say they are not comfortable in the routine. And the last thing we should be doing is encouraging people to push past the pain on a regular basis. So I just wanted to really stress that and remind, remind you that you don't need to dry the life out of your skin to get a result. And it's kind of just, you know, I would say my approach is a common sense approach of balance. Just like you wouldn't go to the gym seven days a week, lift heavy, strive for PRs without proper nutrition, rest, drinking water, you know, we need to balance the work and the actives with the rest and repair. They are equally important. And you can't get a result without both. It's, it's a balance of pushing the skin in a healthy way and then also encouraging rest repair ingredients that help to heal. Okay. The last acne misconception I want to highlight is one about hormonal acne. And you know, I just don't love this label. I feel like it's a blanket statement. I feel like it's misleading. And I think a lot of times people are self diagnosing hormonal acne because they have acne that's inflamed and possibly cystic on the lower face and jawline. And hormones absolutely are influential for acne. If you've ever changed birth controls, if you've ever gotten off birth control, if you have pcos, you have likely experienced acne due to hormonal fluctuations. But I think oftentimes people use hormones as a bit of a scapegoat. And I just think my issue with it is it can prevent people from being proactive about adjusting their lifestyle or their skincare routine. And for one, at the end of the day, all acne starts with the clogged pore. So you can still treat hormonal acne using skincare. And I absolutely would consider that a necessary part of the treatment plan. The other thing I find is that the wrong cosmetics, makeup, skin care, bacteria, hygiene practices, dirty makeup, brushes, makeup, sponges, and diet, even sleep and stress, these things can all exacerbate hormonal acne. So I wouldn't think of hormonal acne as something you are just, you know, doomed to have. I think we also want to understand that hormones are something we can affect, and hormonal imbalance is also rooted in other aspects of our health. And I think one of the biggest ones I want to touch upon is the conversation about blood sugar. I think blood sugar is one of the keys to managing acne, and I'm going to back that up in a study I want to share. But I just think we need to be talking more about blood sugar. More people need to understand blood glucose spikes and how it can affect our health and our skin. There's a lot of new information coming out now that illustrates how important these blood glucose spikes are to our general health. And now we know it also relates to acne, which I'll get into in a sec. But I want to start with sharing a 2018 study that was done at Stanford, and this study was really revolutionary. It has changed how we look at blood sugar. We kind of previously thought, oh, blood sugar is not that significant, we don't need to pay attention to it. Doctors would, you know, kind of just tell the average person, you don't need to worry about blood sugar unless you are diabetic or pre diabetic. And so this study showed that normal, healthy people can experience diabetic level glucose spikes just in their daily life. People are walking around experiencing these extreme blood glucose spikes and it turns out, according to this article, that the level of sugar in an individual's blood, especially in individuals who are considered healthy, fluctuates more than traditional means of monitoring. Often these fluctuations come in the form of spikes or a rapid increase in the amount of sugar in the blood after eating specific foods, most commonly carbohydrates. There are lots of folks running around with glucose levels spiking and they don't even know it, said Michael Snyder, Ph.D. professor and chair of genetics at Stanford. The COVID spikes are a problem because high blood sugar levels, especially when prolonged, can contribute to cardiovascular disease risk and a person's tendencies to develop insulin resistance, which is a common precursor to diabetes. We saw that some folks who think they're healthy actually are misregulating their glucose, sometimes at the same severity of people with diabetes, and they have no idea. Guys, I'm going to get into the acne specific study in a second, but I wanted to just start with this one to kind of set the stage. So in the study done at Stanford, they took 30 participants. These are people who did not have diabetes, who were considered just healthy people. And they gave them three different breakfasts. They gave them a bowl of cereal with milk, they gave them a peanut butter sandwich and they gave them a protein bar. So every person consumed each of these breakfasts. With the trio of tests, they yielded some pretty surprising results. So after eating one or more of the meals, more than half of the group whose prior blood sugar test showed that they were healthy spiked at the same level of those people who were pre diabetic or diabetic. And what's more, nearly everyone spiked after eating the cereal, which cereal has kind of been the standard American breakfast. And if you grew up in the 90s like me, that's what I ate pretty much every single day as a kid before going to school, being in a classroom, being expected to learn and perform, being expected to excel in sports and clubs. Like, think of all the expectations we put on kids and think about, like, what are we actually feeding them? You know, kind of a side note. But anyway, this scientist behind the study said, right now we have information about people who do and don't spike, who are super spikers, but we need to get smart about why it's happening. And he said, we saw that 80% of our participants spiked after eating a bowl of cornflakes and milk. And the scientist said, make of that what you will, but my own personal belief is that it's probably not such a great thing for everyone to be eating. And so I think this study really illuminated the ways in which carbohydrates can affect our health. And so what I would recommend, if you want to optimize your lifestyle and diet, I would recommend reducing your simple carbohydrate because intake things like white rice, pasta, bread, and try to prioritize more complex carbs, especially fruit veggies like sweet potatoes and squash. If you can tolerate beans and grains, sticking to those higher protein options is ideal and definitely prioritizing protein, ideally 1 gram per pound of your realistic goal body weight. And another one I find is really, really helpful is being mindful about eating right before you go to sleep, right before bed, especially if you have a sweet tooth and want dessert. Right before bed, try to stop eating three hours before bed and have a a fast between eating dinner and breakfast. Just giving your body a break and allowing the glucose to drop a little bit. And then in the lifestyle, exercise, especially resistance training, lifting weights, strength training, even pilates is an insulin sensitizer in your lifestyle, Try to reduce stress, get enough quality sleep and avoid smoking because all of these things can exacerbate insulin resistance. And next, let's go to the study from PubMed. This is from 2023 and they were basically trying to understand what role insulin resistance plays in acne. The study they did demonstrated that about 68% to 81% of acne patients had insulin resistance based on C peptide and Tai G index levels, as well as the mean of these two biomarkers. So they found that insulin resistance was higher among cases with acne compared to the control candidates who didn't have acne. And in conclusion, this study showed us that we conclude the majority of acne patients have insulin resistance based on these biomarkers, the C peptide and Tai G index levels. They found that these levels were significantly higher in acne cases. And what I really want to highlight is this statement in this medical study that says, we recommend encouraging the control of dietary risk factors that increase insulin resistance and metabolic derangement during the acne treatment period, as well as encouraging physicians to look for these biomarkers when assessing acne severity and following up with the patient about these biomarkers throughout the treatment course. A future study looking for a link between a high glycemic diet and the development of acne vulgaris is actually is also recommended. So basically, this study was telling physicians we need to be looking at glucose levels in acne patients. But if you've ever gone to see a doctor for acne, have they done blood work? Have they looked at insulin resistance as a potential factor that could be exacerbating acne? Have they provided nutrition and lifestyle recommendations to help you lower insulin resistance? I just think nutrition is such a key component of managing acne, and that is why I wanted to make sure it was part of my practice with my clients. I'm able to do diet recalls and really look at everything they're eating throughout the day. You know, glucose monitors, they're not perfect, but they are something that could help somebody to understand how certain foods are potentially spiking blood sugar. And, you know, this all might sound kind of crazy and, like, a lot, but I just think we cannot continue to ignore the internal side of acne. And I was on a mentorship call with a esthetician who's also an acne specialist. She wants to get her nutrition certification now. And she asked me, she was like, in how many cases are you finding that the nutrition is really helping people heal this condition? And I told her, oh, it's literally everyone. I feel that we must have more conversations about diet if, you know, if the client is willing to do so. That's another thing. They have to be willing and in a good place to discuss diet and nutrition. But, you know, I think, I just think it's, it's really important. I think we are slowly catching on to the role that blood sugar plays in general health, in inflammation, in the origin of a lot of disease. And I think acne is no different. So it's something I would encourage everyone to, to pay attention to. And if you feel like you are struggling with hormonal acne, if you're noticing at certain times of the month your acne flares up, yes, hormones can be, you know, the trigger, but blood sugar may be what is actually driving some of the hormonal imbalance. So it's something I would encourage everyone to learn more about and look into. That is going to wrap up this episode. Guys, thank you so much for tuning in. Please let me know if you like this episode by sharing the episode on social media. Share it with your clients, with your friends, with anyone who will listen. I love you so much. I just can't even tell you how much I appreciate this community and want the best for everyone. Health, well being and professional and personal development. I will talk to you guys in two weeks on the next episode and just love you so much. Please take care of yourself and have an amazing rest of your day.