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Beyond Topical: Integrative and Naturopathic Dermatology with Dr. Julie Greenberg
Welcome to Beyond Topical, a series of interviews with experts in a variety of fields that extends the discussion of skincare to explore some of the multitude of other factors that affect skin health. Because while supporting skin with well-formulated and strategic products such as the ones we make at Marie Veronique is imperative, there’s more to the equation.
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"The biggest thing is around the concept of hormonal acne. Almost all of my female patients come in saying that their acne is hormonal. It's not that hormones are not involved, but fundamentally it's not the hormones causing the acne; it’s the gut."
- Dr. Julie Greenberg
At Marie Veronique, one of our goals is to help our clients understand just how important the skin system is, not just to our appearance, but to our internal health as well. While our focus is obviously the skin, our work is ultimately about helping anyone who wants to “look” better also “feel” better — in essence, to obtain one’s healthiest skin. We eagerly learn from and engage with leaders in holistic and integrated healthcare because we want to bring to light that it’s just as important to use this information as it is to use highly effective topicals.
On that note, we’re pleased to bring you this interview with Dr. Julie Greenberg, a licensed Naturopathic Doctor (ND) and Registered Herbalist RH(AHG) who specializes in integrative dermatology. She is passionate about natural skin care and believes that many of today’s chronic skin diseases can be healed by using evidence-based alternative treatments.
Dr. Greenberg’s journey has taken her from a successful career in finance (she holds a B.A. in Economics from Northwestern University and an M.B.A. from Stanford) to becoming a healthcare warrior after receiving a diagnosis of Hashimoto’s hypothyroidism that made her rethink everything she knew about health. When a leading endocrinologist wrote her a prescription and told her that there was nothing more they could do for her, she knew there had to be more to the story — and a better way to heal.
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What made you interested in the skin, and why did you specialize in this area specifically? Why did you choose naturopathic dermatology (ND) vs. studying dermatology in medical school? You have an MBA, which is interesting as most wellness providers don't — what made you pivot?
After the MBA program I was feeling tired, and was diagnosed with Hashimoto’s. Honestly before then I had never thought of going into medicine. This was my first experience with a major health issue and the healthcare system. It was overwhelming, traumatizing, and not helpful. So I became more interested in alternative health. I read The Omnivore's Dilemma and began thinking about why we are eating and drinking things that are not real food. It blew my mind.
I also became really interested in thinking about all the things we put on our skin — and how many of them are endocrine disruptors which can interfere with our health. I started making my own skincare products and basically just became really obsessed with the skin. I had never heard of naturopathic medicine and my sister introduced it to me and it really resonated. I realized I didn't want to prescribe medicine to suppress symptoms, I wanted to actually get to the root of the problem. So I chose to get trained on herbs via the ND route but simultaneously did everything else I could in the dermatology realm. I attended dermatology grand rounds because I really wanted the training on root cause but also the insight into western dermatology. Bastyr, where I attended four-year naturopathic medical school, had a great relationship with University of Washington’s medical school and I was lucky enough to get sponsored to be able to come in and see patients with the residents.
Do you collaborate with other medical and healthcare practitioners? What types of practitioners do you like to work with for skin clients?
I only treat dermatology complaints but that ends up with me treating the gut as that is truly the root cause. However, I am not a PCP so I do not treat other issues. As far as working alongside dermatologists, I have not found that to be very successful. Most dermatologists want you to go on a prescription, but my patients come to me because the prescription has failed. So they are ready to get to the root cause. In the cases where a patient has something like ulcerative colitis, their PCP will want them on injectables, which manage the pain, and then I will treat the acne. So that is an example of how we can work synergistically. The idea of collaboration is a good one but conventional and alternative doesn't always work well together. For example, a conventional nutritionist doesn't align with my stance and it can start to get confusing if there are too many cooks in the kitchen.
What are some common things you think people get wrong about acne?
The biggest thing is around the concept of hormonal acne. Almost all of my female patients come in saying that their acne is hormonal. It's not that hormones are not involved, but fundamentally it's not the hormones causing the acne; it’s the gut. I have done 100s of gut microbiome tests and there is a clear dysbiosis pattern in acne clients, over and over again. For example, looking at research on indigenous populations you can see they do not have acne. They have hormones, but they have no acne. You just can't just dump it on hormones. The pattern I see is: H. pylori bacteria, protozoa, and then candida. Three different organisms specific to acne, not all inflammatory conditions. Additionally, I never run a food sensitivity test; it's just not helpful.
What are the most common skin conditions and/or symptoms that you see in your practice?
The two most common: eczema and acne, and a smattering of rosacea and psoriasis. Those are the major skin issues. The symptoms are rashy skin dysfunction.
Does that change or evolve? For example, do you see any skin trends, and do they change each year or frequently?
During the Covid pandemic we’ve seen a slew of hand eczema, which happens when the skin’s pH is disrupted. The easy fix there is to use products that are pH balanced (ed. note: like Marie Veronique’s Balancing HypoTonic) and to avoid those that alkalize the skin. Additionally, when people think of acne they think of teens, but most acne patients are adults. Eczema is also on the rise.
We know that most of the skincare industry is still miles behind current research. What are your thoughts on the skin care industry?
I think of consumers similar to how I think of defensive driving. You are out there on the road but think that people are going to cause an accident. Consumers need to look out for themselves. In the generalized skincare industry in the U.S., the laws do not protect consumers. The ingredients are cheap and will harm the skin. There’s a lot of “greenwashing” — companies trying to make consumers think they are making healthy products. Sunscreen is often greenwashed. Look for zinc oxide. But note that all big companies have thrown zinc oxide in their sunscreens, but also include bad chemicals hiding behind the zinc oxide. I hope that in the future years we will have more laws to protect consumers, but right now anyone can call anything natural. As a consumer you need to read ingredients and be educated. Buyers beware.
What do you look for in a skincare product?
Read the label! Look for plant-based products – ones without preservatives and emulsifiers. I want plant-based oils, not ones from the petroleum industry.
People are afraid of oils and they should not be. They are wonderful for the skin. What they don't realize is that oil is in every moisturizer and lotion but there is also an emulsifier. I use oils on all my acne patients.
In the courses you teach, what is most important for your students to take away?
The courses I am currently teaching are for lay people, but next year they will be for licensed healthcare professionals. I want them to understand what is driving their disease with science-based evidence. We do not get operating manuals for our bodies and we get no explanation when things go wrong. People want to know why. Consumers are rightfully getting angry at suppressive medication — they want to know WHY they are still breaking out as an adult. I’m hoping to give answers to those questions. What is driving symptoms at the root level?
What are some practices you personally implement to keep your skin healthy and your body feeling good?
I use lots of plant-based products and try to keep my skin acidic. Skin is naturally acidic. The best anti-aging tip is to keep the skin pH at 4.5. In terms of diet, fiber is the number one thing. Get enough on a daily basis.
If you have a healthy gut you have healthy skin, so fostering a diverse and robust gut microbiome is critical. Mix things up, seasonally. Eat lots of plants. Eat the rainbow.
What is your perspective on topicals, and how much can they do for the skin? How imperative is it to treat the internal body in relation to skin issues?
Topicals can do a lot for the skin, but what you are using really matters for overall health. The average woman uses 150 chemicals a day, which, when absorbed into the bloodstream, impacts the organs. It is imperative to use healthy topicals on the skin.
Is your approach different when working with adult skin issues vs. working with children and teens? If so, how? What is your first recommendation to parents whose children have symptomatic skin (specifically eczema)
Teens are pretty much adult-ish, so I treat them the same as I would an adult. Eczema is different. Babies and toddlers are different from adults.
The first thing I suggest is to test your baby's gut microbiome and fix it. Naturopathic dermatology is all about connecting dots. That's the whole point of it. We have lost the idea that it's one body and that we need to keep coming back and tying it all together. All skin conditions are 100% connected with the gut.
Read more about Dr. Julie Greenberg and her integrative and naturopathic dermatology practice here.
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Postscript:
Connecting with experts in the greater skin health community like Dr. Greenberg and learning new insights into the root causes of common skin disorders is something we prioritize at Marie Veronique.
Our products are formulated (with safe + clean ingredients) to help compensate for deficiencies caused by internal imbalance. They effectively help minimize unwanted symptoms and support healthy skin function so that one can focus on healing their gut and the associated imbalances. Essentially, we work hard to make products that truly work so you have one less thing to worry about.
If you find yourself battling breakouts, as Dr. Greenberg mentioned, the root cause is likely in the gut. So while you seek professional help for a path towards healing, you can support your skin with this regimen that will support a healthy skin microbiome, keep the skin acidic, and regulate inflammation.
AM
Everyday Coverage Tinted Sunscreen SPF 30
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Spot Treatment: Intensive Repair Serum
Note: If you don’t have acne but suffer from eczema or dermatitis, just swap out Treatment Oil for Barrier Lipid Complex.
Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.