Summary: 

Dr. Maria Azizian joins Dr. Megan Lyons on Wellness Your Way to discuss her journey into functional medicine and the connection between the gut and skin health. Dr. Azizian explains how she transitioned from a traditional surgeon to a functional medicine practitioner, driven by a desire to understand the root causes of her patients’ ailments rather than just treating symptoms. She emphasizes the importance of personalized medicine and the role of testing in identifying underlying issues.

The conversation delves into the connection between the gut and skin, highlighting the gut’s role in the immune system. Dr. Azizian explains how a compromised gut can lead to the absorption of toxins, which can manifest in various skin conditions, including acne, eczema, and rosacea. She discusses the impact of diet on gut health and how identifying and eliminating food sensitivities can significantly improve skin health. The podcast concludes with a discussion of Dr. Azizian’s book, “Clear Skin Diet,” which explores this connection in detail and provides practical advice for improving gut health and achieving clearer skin.

Full Episode:

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Transcription:

Dr. Megan Lyons: Thank you so much, Dr. Azizian, for coming on wellness your way. I’m very happy to have you here.

Dr. Maria Azizian: Thank you. I’m so happy to be here. Thank you.

Dr. Megan Lyons: Of course, you have such an interesting background and I’ve read your formal bio to the audience, but I’d love to just hear in your words about you and how you got into this line of work.

Dr. Maria Azizian: Yeah, thank you. I think that my story is similar to actually a story of many conventions. Doctors, you know, surgeons, primary care doctors, any kind of internal medicine. When you practice medicine for a certain time, at some point you want more meaning that you want to understand why your patient is getting a certain disease, certain condition. So because you’re used to treating it, and I call it, sometimes it’s basically just treating symptoms without getting deeper. Of course there are exceptions. Being a surgeon, usually I would see the consequences of, you know, bad lifestyle or bad food or stressful life, et cetera, like ulcers, you know, perforated intestines, you know, very bad diverticulitis, et cetera. So just like other doctors, you know, from, again, any specialty can relate to that. Like, you want to find out what you can do to prevent that. And that’s what brought me to functional medicine, which is, I’m just going to say for your audience, it’s a personalized medicine. It’s a medicine that’s based less on medications, actually very minimally on pharmaceuticals, but it’s based on listening, on learning about the patient, patient’s story and helping them with supplements and very state of the art testing. Testing is very big part of functional medicine because you can’t just treat something without knowing what you’re treating. And it’s very personalized, meaning that something that helps one person may not work. The same treatment plan may not work for another person. So I went and became certified at the Institute of Functional Medicine. It was actually quite a journey. I mean, for me it was not so long in a sense of. I did like that four year program, like in a year and a half, which was very intense. But I loved it so much, honestly, it didn’t feel like it was too much. But it’s a very rigorous program where you learn to look at medical issues from the perspective of functional medicine in a different way. And at the end it becomes this wonderful blend of our core medical knowledge, you know, from medical school, from surgical residency in my, you know, in my case, obviously my experience of all these, you know, 20 plus years of experience as a surgeon. But now there is a new layer where you see all these issues in a new way. And that brought me to creating, also opening functional Medicine Clinic. So. And that’s where I am.

Dr. Megan Lyons: That’s amazing. And you’ve just released a couple months ago a brand new book talking about the connection between the skin and the gut. And we know in functional medicine the gut is the root of almost everything, but very few people actually connect the skin and the gut. So I’d love to just dive in there and have you explain how those two are connected.

Dr. Maria Azizian: Yeah, you’re exactly right. Because it’s not actually was quite recently, just a few years ago in conventional medicine, I have to say that people would say, well, if you have acne, for example, it doesn’t matter if you have, you eat junk food, you know, fast food, pizza, it doesn’t matter which, even intuitively, if you’re not a medical person, that just doesn’t sound right. And of course, when you have that now functional medicine knowledge background, or even if you’re somebody who just reads a lot about like Dr. Hyman’s books, for example, he’s like the very prominent person. He’s actually one of the leaders and he’s one of my mentors. I don’t think he knows me personally, but one of my mentors at Institute of Functional Medicine. So you, even if you’re not a specialist per se, but you are somebody who reads a lot, you understand that this just doesn’t make sense. And then we dive in that what is the role of the gut? And as many people know, but not as many as there should be, gut actually is in charge of our immune system. 70% of our immune system, 60 to 70 depending on the literature that you read, is housed in the gut. So when your gut is not functioning well, when it’s not defending you, then let’s say you eat like the same fast food. You eat a bad burger with, you know, all kind of badness in it. And the gut cannot protect you from the toxins in it. So when you’re young and healthy, it could because your gut is strong. But as time goes by and that time is variable for each person, for some person, for some people, it could be like you could be 25 years old when you start having gut problems. For somebody else, it could be 55. So it’s, it’s, it’s genetically different. And also exposure, if you’re eating bad food once a week, it’s different from if you’re eating it every day. So at some point, if your diet is suboptimal and Diet is one of the biggest factors, but not the only factor. What happens is that your gut is letting these toxins and badness get through. And now it’s getting absorbed in your blood. And when it gets absorbed, then all kinds of things happen. I often say that my book is called Clear Skin Diet Unlocking the secret link between Food Sensitivities and Skin Health. But it could have been, for example, something like Migraine Free Life, unlocking the secret link between, you know, headaches and between food or whatever the condition. You can insert, like, I don’t know, arthritis. You can insert neurodegenerative conditions such as Alzheimer’s, Parkinson’s. So. And it would still make sense. Depression and anxiety. You know, there’s a big connection. So why I chose my. My topic, because in some ways, skin is very interesting and it’s very exciting. You see issues from the skin. And a lot of patients could tell me, they say, well, I, for example, overindulge during Thanksgiving, and now I see this flare up. So even patients know that, because people who are more or less tuned in to their bodies could see the connection. And what happens, yes, year after year of our gut not filtering the badness that creates. That’s the definition of leaky gut. When there is a high permeability, and not to get into details, but there is special tight junction in the gut, and when they are compromised, then all kinds of unfavorable toxins will go in. And also there is a problem with absorption of nutrients, for example, a very basic thing that you may not be able, let’s say, absorbing vitamin D. Well, and even if you take it orally because of your gut issues, and then that leads to one of the. I mean, there are many consequences of that, but one of them is dry, flaky skin or hair loss, for example. Zinc is very important. Adequate zinc is important for healthy hair. And if you don’t have enough zinc in your diet or, well, in supplements, if you’re not taking enough, then what happens that you may have some hair loss. So there’s so many things like that. And we can talk a lot about eczema and psoriasis and rosacea. There are lots of connections with that part, but there’s also how it affects the immune system. That’s a totally different topic. Where we have our inflammation, how all of this is causing the foods are causing inflammation, and inflammation are the cytokines. I don’t want to bore people, but they’re called Interleukin 2, Interleukin 6, TNF Alpha so all of these cytokines get triggered by a variety of things. Number one is bad food. Number two, of course, number two, three could be stress, could be surgery, could be infection, you can have a bad cold and that can really throw your immune system kind of out of whack. It could be a variety of stressors, but usually in functional medicine, number one, for most people, it’s the food that is suboptimal. Unfortunately, and honestly, most people, most of us, including myself, I’m not perfect. We’re guilty of that. You know, we don’t always adhere to a whole food diet. So that’s why in that book I am tying in different foods. I have multiple foods that I go into, like dairy and chocolate and caffeine and how it affects the skin. And it’s interesting that for example, caffeine, it can cause you to be, you can be flushed from that. But also at the same time in some other people, caffeine can aggravate bags under your eyes. So it’s very. And when I was researching that book, I actually learned a lot too. You know how it is when you’re author yourself and when you research it, you learn more. I was like, wow, this is so interesting. So, so I have it by foods and then I talk about the different skin conditions and talk about testing and at the end provide a template of a healthy diet, which is a template that could be used for most people because there are staples of healthy diet. So that’s basically the gist of it.

Dr. Megan Lyons: Oh, I love it. You give so much great information in there and I want to touch on several different pieces. So to recap, there are multiple things that cause this intestinal perme between stress and food sensitivities and low quality food and antibiotics and all these kinds of things that are common in our modern lifestyle. And then the intestinal permeability can cause lack of absorption of nutrients. And your example, if you’re taking vitamin D, you might still not be able to utilize it if you have intestinal permeability. All of that was really, really great. And I think the audience is now nodding. The one, one part that I want to follow up on is when you said, okay, intestinal permeability causes eczema and psoriasis and acne. How does that happen? How does a body know in one body intestinal permeability causes eczema and another body, intestinal permeability causes acne. What’s going on there?

Dr. Maria Azizian: That’s such a good question. Because that’s really is the, that’s What a lot of my patients ask me because there are people. And we know. I’ll actually use a different example first. Like, we know people now less and less so. But people who smoke, they smoked all their lives and nothing happened to them. Right. And they never got lung cancer. And then we have somebody who smoked, I don’t know, for two months. Well, I’m exaggerating. But for two months, and then they got the lung cancer. Right. So there are. So their genetic component is very important because if we have smoking and now we’ll move on to food. We have, let’s say, processed food. And I actually just did a video on my YouTube channel about processed food. There’s just so much about it that it’s like a rabbit hole. It can get into more and more. But you eat processed foods every day. Right. And for somebody, it would be a chronic joint pain. So. And their skin could be totally fine. So this processed food triggers your inflammatory cascade. You start secreting all these inflammatory cytokines at the same time. Now, you are not absorbing the nutrients at the same time. Your histamine may be kicking up in some ways that. In some ways it will show on your body. So you may have some, maybe no skin issues or minimal skin issues, but for you, the main thing is your joint pain. And every day you complain of joint pain. Well, you don’t understand that it’s from the food because you’ve been eating it for years. So you just accept that. I have this. I am a chronic, you know, I’m a person with a chronic arthritis or whatever the diagnosis is. So joint pain, and it could be like several joints, could be one joint. So that’s. That’s this type of situation. And the same with skin. When we see people with eczema, and some people, unfortunately, could have. Can always have a little, like, smoldering eczema just a little bit. Always someplace. If you look close on their body, there’s a little area. But some people could be eczema free, and then something happens. It could be like change in their diet. It could be stress that starts that inflammatory cascade. So the question is why? In one person it is, you know, joints, for example. In another person, it’s skin. Nobody knows. I think that’s more our genetic predisposition. So some people, and like I said, like migraine. Migraine is a very common reflection of a leaky gut. And on that topic also, mood swings. Mood swings are very. And even, you know, kind of lay people know that mood swings are related to foods that we eat. So why in one person this happened that we will know when we start having personalized. Well, genetic testing. Genetic testing is always personalized because as we learn more, like for example, there is a wonderful genetic test. There’s so many good tests, but wonderful genetic test that looks into how specific person absorb metabolizes medications. And that’s very important. And we’re not talking about only psychiatric medications or some obscure medications. We’re talking all medications, such as, for example, medications for heartburn, proton pump inhibitor, such as, for example, acetaminophen or Tylenol. So how do you metabolize it? Because you could be a good metabolizer, fast metabolizer or slow metabolizer. And for some people, maybe they need a little higher dosage because they metabolize in a certain way. And some people need less of a dosage because they’re slow metabolizers. So there’s so much interesting about that. But since I what I find out now that I’ve been for a few years now in functional medicine and see lots of patients in our functional medicine clinic, I do understand, unfortunately, functional medicine, I mean, it does have. The main problem is that those tests are not covered by insurance. They are not. That exception is a gut test, which is covered by Medicare, I have to say, which is a blessing. That’s very nice. But all other tests, like genetic tests, why isn’t it done? It actually can save so many lives. And there is not to go on a tangent, but some people, the way they metabolize opioids, like they really, they should not be given or they should be given minimal dosages. And because of that we have all this opioid crisis and everything else. And these medications and morphine and opioids, they do have a black box warning based on your genetics. So but we don’t know that. So ideally, as I say, like in an ideal world, I really would like that it would get started with when a baby is born, they do get their, it’s like their genetic card. So they know that this baby can’t have this, this baby because at the end a lot of people get. Not on purpose, not purposefully, but poisoned by the chemicals by pharma. And some of those medications are great medications. I don’t want to say like all the Medicaid. No, they’re not. Of course, especially antibiotics. Antibiotics are extremely important. Yes, they do lead to leaky gut because they do kill your good bacteria. Right. But at the same time, antibiotics are very important. So if you look at the whole picture, so you have these medications that are. Some of them are very good, some of them are okay. But at the end we just give it sort of without discrimination to people. Well, we have to adjust it to a specific person. That’s really what personalized medicine is that we say, well, I could have given you this medication. But I see genetically you can’t metabolize it, so it’s not going to work for you. So. And there’s so many things like that in functional medicine that. So it starts with that and then we would know why you get the skin problem, the other person gets a migraine, the other person gets depressed after they ate, whatever. And interesting. I also want to add with food sensitivities and it’s in my book that food sensitivities are not immediate. So usually you can eat something and it may take up to three days for you for that to actually, for those antibodies, it’s IgG antibodies to actually act up to cause a symptom. So it’s not easy to see cause and effect. It’s not like an allergy that’s instantaneous and most people know their allergies. So. Yeah. So it’s kind of my way of answering that question. I wish we had more genetic information and not only but more personalized information. Then we would know why. Why is this person developing these symptoms?

Dr. Megan Lyons: It’s so interesting and I think over the next I’ll call it 10 years, we will completely change the game in this. Right now I’m in some people running a handful of genes that I think might make a difference to them, but there’s no chance right now for a reasonable person of just doing the whole genome, every single. On every single person. So I think we’re going to rapidly advance in that area. But you touched briefly on food sensitivities and since that’s a major part of your book, I’d love to go there next. You explained a little bit in there between food allergies and food sensitivities, but I’d love for you to touch on that again, just clarify the difference for people and talk about what someone might feel or see in their skin if they do have food sensitivities.

Dr. Maria Azizian: Yeah, yeah, definitely. Just a few sort of differences between food allergies and food sensitivities. And sometimes even people in the medical industry forget and use them interchangeably. But there are two different things. Because food allergies, it’s an allergy that you’ve had usually since childhood, not necessarily. Sometimes people grow out of certain than childhood. Allergies usually it’s quick. And with most allergies, unfortunately, they are capable of causing a significant symptom, such as, for example, anaphylaxis, where your whole body shuts down. Basically you faint and you need EpiPen and you need to be in the hospital. But allergies could have these very strong repercussions for you. And most people know. Also with, with food sensitivities, you don’t get anaphylaxis. Thankfully, you never get such dramatic. It’s more like a chronic smoldering whatever it is. And so that’s one thing. The second thing, as I mentioned, is the timing. Allergies work right away. It could be like within minutes in and like you eat it. Like you eat strawberries, you’re allergic and you have whatever rash or you know, like swelling that immediately with food sensitivities you can eat and then it may take two days, may take three days, and you wouldn’t even know why. You suddenly have some rash, for example, or you have itching. Itching is one of the things that people complain. And the hardest thing for a physician, for a medical provider to diagnose is itching without nothing to see, like there’s no rash, there’s nothing and person is itchy. There could be million reasons for that. So, so another difference is that allergies, unless you grow out of them in the childhood, they don’t go away. They, they just there for your whole life. Let’s say you’re allergic to shellfish and you will always be allergic to shellfish. Very rare exceptions, they are very rarely with food sensitivities. You can definitely grow out of them after a certain time that you stay away. Once your gut is fixed, like you fix your gut with a good diet and staying away from your trigger foods, food sensitivities can go away. And that’s wonderful. Another difference between food allergies and food sensitivities is that dose dependent with allergy doesn’t matter. Like if you’re allergic to peanut butter, you know, like you can sniff it and that’s why they have that label. Like this product was made in a factory that handles peanuts. Because even if there is just the dust from peanuts, for a person with peanut butter allergy, that could be devastating. While with food sensitivities, actually in many cases you can get away with small portions. Let’s say, like if you eat maybe, I don’t know, 20% of your usual whatever you eat, let’s take strawberries. Like you Instead of eating 10 strawberries, you just eat two. You can get away with that in many cases. Again, everybody is different, but there are more dose dependent. So food sensitivities are more manageable and they are more reflecting actually our lifestyle and eating habits. While allergies, they’re more complex. There, there’s a genetic component, there is lifestyle component. There is as you know, like if you were born vaginally or C section, if you C section, you’re a little bit more prone to. So allergies are a little bit more complicated. But with food sensitivities I think there are more manageable. But the problem with food sensitivity is that there are harder to diagnose because it’s not. You have to be very tuned in. And most of us was just running around everyday life, we’re not as tuned into our body to say, well, three days ago I ate this. Well, who remembers that? So it’s harder that way. Yeah.

Dr. Megan Lyons: Yeah. That’s interesting. And so I’d love to talk about the diagnostic process of food sensitivities because I’m not opposed to food sensitivity tests. I literally ordered one this morning for someone. So I do it sometimes, but I tend to be somewhat skeptical because oftentimes when I know someone, just intuitively know someone has intestinal permeability. Then we do a food sensitivity test and there are like 50 foods on there. And I’m like, okay, 50 foods are not actually the problem. The problem is intestinal permeability. And so is it the chicken or the egg? That makes me hesitant to run a food sensitivity test just on everyone. But I’d love to hear your perspective because you love food sensitivity tests, I believe. And so talk to me about why it’s useful and try to sell me a little bit on using food sensitivity tests.

Dr. Maria Azizian: Well, I’m not trying to sell food sensitivity testing to anybody, including to the patients. Why is that? Because everybody is different. When I look at the patient who, for example, specifically asks for food sensitivity, my first question to myself actually, should this patient first get a gut test?

Dr. Megan Lyons: Yeah.

Dr. Maria Azizian: Do they get gut test first? And in some cases I actually talk them out of food sensitivity. Why don’t we start with the gut? Because it will give us sort of the whole information and then we can do food sensitivities too. So. But I like food sensitivity by itself because it’s. How can I say it nicely? It’s an easy way. Yeah, because you can do elimination diet. Yeah, it’s hard for some people. I’ve done it a few times myself. And honestly, I have to say it wasn’t as bad as I thought it wasn’t as bad. So. But it’s still, it’s a strain. And some people, for health reason maybe hard to do, they have to be very monitored. So it becomes a chore. It becomes not only they’re being deprived, but in today’s day and age when the access to, you know, medical care is not as robust as we talk, they. Somebody, let’s say with diabetes, may have. May need a closer eye. Doing an elimination diet. Yeah, because they, you know, like with the glucose fluctuation. Because somebody has to make sure that now they’re not hypoglycemic, that they’re not bottoming out. So it becomes a little bit of a chore. So food sensitivity testing is sort of the easier way out because you don’t want to do any. But the gold standard is always an elimination diet. So when you eliminate foods, I’m just for your audience, just saying you eliminate food ideally at least three weeks. I mean, sometimes we say two weeks is okay, but ideally it should be three, four weeks. And it should be that your provider should know about it. You should, and just be just doing it. If you have chronic conditions, if you’re completely healthy, you just want to know for just because that’s fine. But if you have any chronic issues, you have to be supervised by your medical provider. And then so you eliminate lots of foods like you eliminate gluten and dairy. Shellfish. There are bunch of food categories, eggs. And so it’s somewhat of a. It’s a good diet, but it’s very restricted diet. And then let’s. You did it for three weeks, you start reintroducing each food group one at a time. So let’s say you reintroduced eggs. And you actually, with eggs, you should do separate egg whites and egg yolks because they’re two different sensitizers and allergens. So and you say, okay, I’m starting to eat egg whites. And then you absorb how you feel. Do you have your symptoms back? And if it’s all okay, like for two days, then two, three days, then you reintroduce the next food. You have to do it slowly in small amounts. And that’s how you find that. Let’s say you reintroduce chocolate and suddenly you have your rash, your eczema or whatever, your IBS is back, you reintroduced, because that’s another GI Symptoms are so prevalent. So then, you know, so that’s basically is the gold standard. But food sensitivities make our Life easier. And with food sensitivities, they’re often graded. So we have highly reactive foods, then less reactive and mildly reactive. And I do of course, recommend to our patients to stop highly reactive foods and like the top two and then sort of the bottom two, like they, they can eat a little bit because it’s just too hard. Like you said, some people can have lots, although I sometimes see people have not done not as many as they thought. But I think that food sensitivity is a good adjunct to gut testing. Yet again, sometimes expenses are such that the patient’s budget is that they can’t have two tests. So we sort of decide what. And that’s the beauty of personalized medicine. What does the patient want? If the patient says, I know I probably have a leaky gut, or, or I don’t care if I have something, I just want to know what I’m sensitive to and I don’t want to do an elimination diet, then we can do food sensitivity because what is the purpose? It will have good outcome because the patient is motivated. And most people who come into our clinic, at least they’re very motivated. So the person is motivated, so they will do it. And I’m not going to push them to have a gut test because of my intellectual curiosity. Of course. Yes, the gut test gives you more information in general about everything. Your pancreatic enzymes, you know, it looks at your inflammation, looks like if you have any component of inflammatory bowel. There’s so many interesting things, and I’m not even talking about bacteria, viruses, you know, fungi, all of these things. So. But again, I would not force it on the patient. But if my personal preference would be gut test first and then if there any sort of, if there’s any need, we can do food sensitivity. So. So yeah, I mean, it’s, it’s sort of. I think it’s all evolving and I don’t, I can’t. It. I actually have that in my book. What is first, like you mentioned, is it food sensitivities that are causing leaky gut? Leaky gut cause and food sensitivities. I think it’s bidirectional, like both, like feed, feed off each other. You have maybe some foods that you eat too much of. And especially actually you get sensitized to foods that you eat a lot of and the foods that you like. That’s very sad. So the foods that you constantly eat, let’s say, you know, let’s take eggs again. You eat eggs. There’s so many people who are sensitive to eggs. I See it all the time. So you eat eggs every day for breakfast, and sometimes during the day, you may have a san salad that contains eggs and a bunch of other things. So you become sensitized day after day after day. So now, on food sensitivity, like, it’s, it’s. It will show up on food sensitivity, but the egg sensitivity, because you overdid it, and our body doesn’t like too much of anything, you. You’re causing gut problems. You’re affecting this gut permeability. It gets worse now. It gets worse, and it creates more food sensitivities with other foods. So I think that’s probably how it works in terms of when you look at the research, at the data, there is no clear answer. Which one comes first? Yes. But let’s say if you were. If you underwent a serious surgery and you had, you know, like, resection of your, you know, whatever, small intestine or large intestine, then. Yes, then. And the gut issues would cause food sensitivity because you had a significant. You had an injury, you know, by definition, any surgery, because you had it for a reason, it will cause complete change in your gut microbiome. So now essentially, you will develop more likely. I shouldn’t say you will, but you’re more likely because you’re not in a good shape. Your body is weakened, your gut functioning, everything has been completely messed up. You’ve been on the antibiotic in the hospital, all of these things, of course. So then the gut will create food sensitivities. But I’m sure it’s like the other way around, too. So.

Dr. Megan Lyons: Yeah, really interesting. You first of all perfectly described my personal situation. The first time I ran a food sensitivity test on myself, I think it was 2014, around then. And the four things that came up as high sensitivity for me were eggs, almonds, spinach, and oranges. And what was I eating the most of? Eggs, almonds, spinach, and oranges. And so I was super bummed out, but it helped me realize exactly what you’re saying, that if you have some kind of intestinal permeability, inflammation, altered gut function, something like that, and then you overdo it because I was eating, let’s say, almonds, maybe almond butter and almonds as a snack, and almond milk and almond flour, all that stuff, I was just perpetuating the problem. So I think that was a very important part of what you said. And then circling back to the beginning of that answer, you made a very compelling case for food sensitivity tests, being that it is easier and more direct than an elimination diet. For some people, that just feels overwhelming and not doable. And we always want to do what will motivate the client to take action. So I appreciate your answers on that, but you did mention somewhere in there, you said dairy and chocolate and caffeine. So I’m wondering if there are common triggers for some of these skin issues that you study so much that might tip people off if they’re not yet ready to do an actual test or an elimination diet. What common triggers can they watch out for?

Dr. Maria Azizian: Yeah, there are certain common triggers that are more common for skin, and I’m sure there are some that are more common for other conditions. Maybe, like, I don’t. Don’t know as well as. Because I’m focused on the skin in this situation. I do focus a lot in our clinic on skin and on gut issues like IBS and like, all kinds of diarrhea, constipation, sibo, et cetera. So. But I’m sure that you can look, for example, at anxiety, depression. I’m sure there’s certain foods that are like. Can be pinpointed. But for skin, like, the biggest, you know, the biggest ones are dairy eggs. That’s unfortunately big. Gluten is very big, unfortunately, again, so. And those are. And soy products also. It’s good to get rid of them. Caffeine also, but caffeine, not as strong. But I noticed that the dairy, eggs and gluten, those three are very commonly affecting the skin, very commonly in people, again, who are prone to. And it could be. Again, like, it could be somebody who, like, sometimes we see cases like that, somebody with whatever skin condition, let’s say, some bad psoriasis. And when we talk about things that. About eliminating. That’s very hard. It’s very hard, even if it’s these three groups, because that’s a lot of. It’s hard. And that’s, you know, it’s a step for a patient. It’s not easy. And for us, when we are patients, to do this, because. To eliminate this for how long, that seems it’s very difficult to do. But when people do it, when they are motivated, they actually do it for real. Not like. Like they’re just hiding and kind of sneaking things, right? You know, here and there, like, it actually always helps. And dealing with chronic conditions, be it intestinal conditions or be it, let’s say, migraines or joint issue, whatever we’re dealing with, it’s not always a complete fix. Because if it’s your vulnerable. Let’s say your vulnerable area is skin, so something happens that’s where you feel it first, that’s where you will see it. Or you will get a migraine right away. You tired, you will get a migraine, somebody else is tired, they will have flare up of their eczema. So it’s almost like a lifelong commitment. So the question is, do you have to always stay off like dairy, gluten, all of that? It’s hard. I think that if you’re committed and if you can do it, that’s great. But I would not, I don’t require it of my patients to do it forever because it’s a very big step. And to do things forever, it will be a turn off. I don’t think people would want to do it. So we start with that to see the correlation, to see how does it feel not eating, especially gluten. A lot of times when people stop eating gluten, it’s like their whole world changes. They feel so much better. Everything. I see it all the time in our clinic. People come in and they say, oh, you know, and I know already. They already told me the skin is gone, whatever, much better. And then they say, and by the way, I have so much energy and by the way, the pain in, let’s say my hand is no longer there. Well, I didn’t even know that they had a chronic wrist pain or something like that because they forgot to tell me that. But, but they notice that there are chronic, multiple other chronic issues. So with functional medicine, that’s really a golden nugget that whatever happens, you will get better. Will you get 100% better? Nobody knows because some people may not get 100%. It may not be possible. If you have 10 chronic conditions, let’s say you’re 85 years old, you had 10 chronic conditions. Can we make them better? Yes. With food, with supplements? Yes. But can we eliminate them at this stage of medicine? Less likely. Like you can’t really, you can keep them at bay, decrease chronic pain if they have chronic pain, whatever the skin, debilitating skin issues, we can work on that. So basically it’s, that’s what I like about functional, that it always does good and it always basically delivers. Just degrees are different from a person to person.

Dr. Megan Lyons: Yes. Oh, that’s so fantastic. I have so many other questions for you on many other topics and we’re going to have to do around two sometime because we won’t get to them. But I want to quickly get your gut, take pun intended on one thing. Then I’m going to ask you about your health habits and ask the audience or ask you to share with the audience where to find you. But the gut take is this. I think you’re going to hate it because it’s oversimplifying, and I realize that. But if I were to tell someone, just to start with one thing, if it was more acne, I would say dairy or sugar. And if it was more eczema or psoriasis or something like that, I would say gluten. And that’s not for everyone, but that’s just a one place to start. What do you think about that? What’s your gut reaction?

Dr. Maria Azizian: Honestly, I would speak with the patient first and I’m glad. Thank you for reminding. Sugar.

Dr. Megan Lyons: Sugar.

Dr. Maria Azizian: I forgot to say sugar. Sugar is one of the big ones. Ones for all skin conditions, for everything. Sugar is a bad guy. Now. Thank you. I did not mention that. But I would speak. I would not ever generalize that. I just can’t. Because for some, let’s say I’m dealing with somebody who is deeply depressed.

Dr. Megan Lyons: Yeah.

Dr. Maria Azizian: Sad, whatever. Something bad happened or nothing happened. It doesn’t matter. The person is sad and depressed. And now here I am, you know, forcing. I say, like, don’t eat, whatever. But maybe the whole pleasure, the only pleasure in their lives is like they’re eating, eating a. Whatever cookie. One cookie per day. Or let’s say they’re binging on 10 cookies. So what I would do, probably would. Like, I would. And I always actually do that in real life. I adjust it. So I would say, why don’t we start by going from 10 cookies to, like, two cookies? Like, again, two cookies is not good for you. I’m not advocating for this, but it’s better than 10. Right. For me, I noticed that both as a surgeon where a lot of times I would have the last word because I say. And that’s how it will be. Just because by definition of how surgery works. Right. But in functional medicine, it’s not like that. And I like it because there is a dialogue. So I like both. I like in a situation where I could assert because I know, you know, as a specialist, I know. But in this situation, this is somebody else. It’s a partnership. So, like, I wouldn’t say, like, stop eating well, I can say whatever I want. They’re not going to listen.

Dr. Megan Lyons: Yeah.

Dr. Maria Azizian: You know, so I would gauge by the patient and let’s say we discovered that it’s, you know, gluten, sugar, and this whole cookie. Yeah. I would just go. Let’s say why don’t we just go down to two cookies and of course, I’m not a psychiatrist or, you know, counselor, but we all, as medical providers function that way all the time. And I would say, what can we do? Can we create any other dopamine, Happy. Something, maybe some new hobby, or maybe just walk around, like, go for a walk for like 10 minutes. It’s so cliche, but it does work. Just being outside, just, you know, like just breathing air. That actually does work, as cliche as it is. Well, that’s why it’s a cliche, because so maybe like, you go from 10 cookies to two cookies, and instead of those eight cookies in between, you go for a walk. So each person. And that’s what I do. I tailor to each person. Like, I don’t. Like, generally. Yeah, everybody knows don’t eat, don’t eat this people all know that. That I don’t eat processed foods yet. We all eat processed foods. Sometimes we go to restaurants. Most of the food is processed. So I try not to do. Give. Well, some advices I do give. But in terms of don’t eat trans fats, like, something like that, don’t smold, you know.

Dr. Megan Lyons: Right.

Dr. Maria Azizian: Like basic things, but other things, you have to be very gentle because people could be turned off and it. It can seem so much to do. It can be so overwhelming. Most people, and this is something I’m sure, you know, they’re happy to take supplements. Like, you tell them to take whatever supplements. They will take supplements, but yet they have difficulty letting go of certain food they can take in, but they don’t want to remove. So that’s why when you remove something, you have to give them some. Like, it could be emotional. It could be a suggestion. It could be just spending time with extra time with the patient, whatever it takes. Or it could be a supplement. Sometimes it’s like, you’re not going to eat this, but instead I recommend you take this supplement. So it’s a. The emotional connection is very important here. So I don’t. I’m kind of like almost the opposite of being a surgeon in. And I love it because it’s a totally different side of me too. I really kind of get a, you know, feedback from the patient. Like, that’s how I. I do the treatments. Like, I try to think that’s a personalized medicine. Yeah.

Dr. Megan Lyons: Yeah. I love that perspective so much. Thank you for sharing both on the personalization and on the emotional connection with food, because it is real. We can see all the research we want, but there is that emotional connection to food for so many of us. I would Say all of us, that makes it an art, not just a science. So I appreciate that. And you’ve touched on personalized medicine and personalized health. Health so much that I’d love just some insight into you as a person. What’s one thing that’s important for your health, physical, mental, emotional, whatever that we haven’t discussed today?

Dr. Maria Azizian: I think one of the biggest thing for me and for a lot of type A people like me is actually adequate sleep.

Dr. Megan Lyons: Yeah.

Dr. Maria Azizian: Because a lot of us, like, we keep doing and doing and doing. And honestly, both men and women in today’s society, like constantly working or constantly thinking. Our, like, we’re constantly in that mode while first of all relaxing. We all should be having time to relax. And actually once you get started, it’s not that hard to do. Like, if you, if it becomes part of your regimen, you. You can do it. If you really like, schedule it with yourself and getting adequate sleep. Meaning not only that you go, like, not too late, but also that you really can turn off what’s happening during the day. That’s one of the. I find it myself. And again, like lots of my colleagues who are similar to me in, you know how, like biogenetic, like bioenergetically, they’re similar to me. Like, I could see that that’s a common issue because you just, you’re just wired to constantly just be doing something, but it’s okay not to be doing something and what are you doing instead? You always have to do something and instead you are relaxing and that’s okay. You are relaxing. So that’s. I talk a lot with my patients. I try to implement with myself. I’m not always successful. Of course. It’s very hard sometimes, you know, because you want to just finish everything. You know, was the family, was the work, was this and that. So, yeah, so, but that’s, it’s coming along amazing.

Dr. Megan Lyons: Well, great job. I know it’s. It’s always harder to do it than it is to say it, but it sounds like you are practicing what you preach, which is amazing. I am very confident people will want to get their hands on your book and your work and potentially even work with you. So tell the audience where they can find all of that information.

Dr. Maria Azizian: So, yeah. So my book, of course, is, like we mentioned, it’s called the Clear Skin Diet, unlocking a secret link between food sensitivities and skin health. It’s available on Amazon. And also I have my YouTube channel, Dr. Maria Zizian, where I talk a lot, a lot about everything actually functional medicine. I do talk a lot about food and, you know, processed foods, like, as mentioned, vitamins and minerals and all kinds of things. So that’s a YouTube channel. And I have my Functional Medicine Clinic. Well, I also have a skin cancer clinic, but that’s more like a brick and mortar clinic in Cape Cod. But our Functional Medicine Clinic actually is online tool. It has a virtual component. It’s all set up with, you know, zoom and all that stuff. And I see patients in the states of Massachusetts, Vermont, New Hampshire, because that’s where I’m licensed. So it’s called Mindful Medical Functional Clinic. Just, it’s all one word. Mindful Medical Functional Clinic. A little long, but it expresses what the clinic does. So, yeah, so that’s. That’s about that.

Dr. Megan Lyons: That is so wonderful. We will link to all of that, your book, your YouTube channel, and your clinic, all in the show notes. So audience, please scroll on down and click those links to HEAR More from Dr. Azizian. And thank you so much again for your time and your wisdom today. I really appreciate you sharing with us.

Dr. Maria Azizian: Oh, thank you so much for having me. I truly enjoyed. We had such a nice conversation. It was very interesting for myself, too. Stimulating. Thank you for wonderful questions, and thank you for having me again. Thank you. Of course.

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