The following is a transcript of Season 1, Episode 7 of The ND Will See You Now, a podcast by the Institute for Natural Medicine.
On this episode of The ND Will See You Now, our host Anna-Liza Badaloo talks with Bryant Esquejo, ND, a holistic acne and skin expert who practices in Los Angeles, CA. Dr. Esquejo uses his expertise in both digestive and hormone health to get to the root cause of his patients’ skin conditions. From chronic, stubborn, and painful acne to eczema, Dr. Esquejo’s naturopathic methods have helped scores of patients feel more comfortable in their own skin . Listen through to learn about unexpected potential causes from nutrient deficiencies, gut dysbiosis, and even Polycystic Ovarian Syndrome (PCOS). Plus, learn about how Dr. Esquejo successfully collaborates with Dermatologists and MDs to provide his patients with integrative care options in California.
DISCLAIMER & EDITOR’S NOTE: This transcript of a podcast interview has been edited for clarity. The opinions of the host and guests on this podcast are their own and do not represent INM. This podcast and its respective transcript and social media posts do not constitute medical advice; and, are not meant to diagnose, prevent, treat, or cure any conditions or diseases. This podcast and its respective content are for educational purposes only. Consult your doctor before implementing any changes to your care. If you would like to find a naturopathic doctor (ND), please see our Find an ND directory.
Anna-Liza Badaloo (ALB): Hi there, and welcome to the Institute for Natural Medicine’s podcast, The ND Will See You Now. On this podcast, we speak to naturopathic doctors across North America about their whole-person approach to health, what patients can expect, and why their work is so very vital to patients’ health.
I’m your host Anna-Liza, and today I am just delighted to speak with Dr. Bryant Esquejo, a California-licensed naturopathic doctor. He has a private practice at Jupiter Naturopathic Wellness in Los Angeles, California. Dr. Esquejo specializes in adjunctive, integrative gastroenterology (that means digestive health) and endocrinology (that means hormone health). If that wasn’t enough, he is also the co-host of the Holistic Beauty Podcast. Dr. Esquejo, it’s such a pleasure. Thanks so much for joining us today!
Dr. Bryant Esquejo, ND (BE): Thank you so much for having me on. I’m really excited for this conversation!
ALB: As am I! Let’s get right into it. So, you’re on a podcast today. But you have a different side to this podcasting situation too, because earlier this year you and your colleague (naturopathic doctor Marilyn Merola), launched the Holistic Beauty Podcast. For those folks that haven’t heard it, it’s a really cool podcast. What you and Marilyn do, is empower and educate people to improve their skin health using a more natural approach. The way that you do this, is by uncovering deeper root causes of skin conditions. Folks, just to give you a sense, so far you’ve covered quite a few topics such as the role of hormones and adult acne. And yes, adult acne is a thing. You looked at the links between gut health and skin health, you’ve taken some deep dives into topics like eczema, and the importance of skin protection. Bryant, can you tell me more about some potential root causes of skin conditions?
BE: It all depends on what the skin condition is, right? We spoke about that a lot on the podcast. But from what I see a lot in my practice, gut health is so important to look at. But going back to what a naturopathic doctor does, we really want to figure out the root cause, identify that root cause, and treat that root cause. And like I said, gut health is one of them.
But there’s so many other things that I want to figure out when patients first see me in office. In regard to underlying causes, let’s take acne, for example. In regard to acne, we know that gut health is linked to acne. However, there are some things that happen on the skin level, but also things that happen deeper from within. So usually when a patient sees me for chronic, inflamed, deep, painful acne, that tells me that something else is going on, other than what they’re putting on their skin. And of course, skincare does play a role in some acne.
But these underlying causes could be hormones as well. We know that hormones play a role in the development of acne. Beyond that, we also know that diet can change acne causing hormones. It’s really interesting. When we look at other nutrients, supplements can play a role as well. Some supplements are basically nutrients, but at a higher dosage.
Beyond that, we know that certain nutrient deficiencies have been linked to acne as well. It’s really trying to figure out what is what for the patient right in front of me. That’s why I like to have a really comprehensive intake with the patient and try to sleuth out and sieve out what the potential underlying causes are, and get the appropriate labs for me to understand, OK this is the actual root cause. Let’s treat this root cause and see how your skin health changes with addressing that root cause.
ALB: That’s a lot of stuff that I imagine many people might not have thought about. You mentioned diet. Maybe that’s the low hanging fruit, for people thinking about not great foods, like processed foods with high sugar, high fat, that kind of thing. The hormone angle and the gut health angle are really interesting. When we look at root cause, these really are causes deep within the body.
I like the way that you’ve described when a patient is coming in to see you. You’re really taking the time to investigate, if you will. As you said, it really depends on the patient in front of you. It’s very individualized. But you’re doing things like doing lab tests and taking a thorough patient history. It’s good that you’re going into that process, knowing that some of these things could be root causes. You have a sense of what to look for based on your experience, but you’re also waiting to see what that testing reveals.
That takes us to the next stage. Let’s say you do your assessment, you have your testing back, you now have a lot more information with which to proceed. Now that you’ve given us a very good sense of what some of these potential root causes can be, can you give us a sense Bryant of how you may use naturopathic medicine to address these root causes?
BE: The really cool thing about naturopathic medicine is that we’re basically holistic and integrative medicine experts. Holistic, meaning that we do want to treat these underlying causes, but we have the opportunity to treat these underlying causes with integrative options. In the state of California, it’s very different in regard to integrative medicine. We mainly rely on our natural options.
In regard to these natural options, it could involve diet. There are some really interesting diets that have been linked to acne. So, the overconsumption or just eating too much of simple carbohydrates like sweets, or even certain types of breads, pastries, all of those can shift hormones and therefore play a role in acne. There’s also what is in dairy. Dairy has a protein in it called whey protein, which is also a supplement. Whey protein can trigger hormone changes that can lead to acne as well. There’s some really cool literature that speaks about how whey protein is linked to body acne, usually acne around the trunk or the abdomen. That’s something that I might focus on with patients from the get-go; it’s going to be diet. And then if the labs end up showing nutrient insufficiencies, we’re going to address that as well.
There’s some really cool science saying that vitamin D deficiency has been linked to acne. We don’t really understand what’s going on just yet. However, some researchers are suggesting that vitamin D plays a role in the inflammatory response. We know that when people experience these red, painful lesions or red, painful pimples, it’s usually an inflammatory response. That’s what they’re thinking could be going on. When somebody has low vitamin D, they have higher levels of inflammation. In addition, we also might check zinc. If somebody’s labs show that they have some zinc deficiency or insufficiency, we’re going to replete their system with zinc.
Beyond those labs are some other labs that you might end up doing with patients as well. Some other underlying causes of acne include Polycystic Ovarian Syndrome (PCOS). Polycystic Ovarian Syndrome is a condition where people can experience symptoms of high testosterone like cystic acne, but they can also experience facial hair growth, body hair growth, head hair loss, and it usually takes place in females. In addition to those symptoms, they also experience changes to menstrual periods. Usually, it’s going to be irregular or absent cycles. If somebody does fit that picture in their labs and their workup indicates that there is some PCOS picture going on, we can address that with many options. There’s going to be nutrients that can help drive down blood sugar, which has been linked to PCOS. It can be diet, but also certain supplements.
And then there’s so many other things beyond PCOS. Specifically, gut health. There’s a lot with acne in regard to gut health when I do see patients, and their labs show that they have some dysbiosis. Dysbiosis basically means imbalance. We have a lot of options to bring their gut health back into balance. It’s really looking at how the gut bacteria is, and how do we modulate that.
There are also dietary options that we can do. We spoke about simple carbohydrates and dairy. But in regard to gut microbiome diets, there are some really cool studies saying that eating 30 different plants a week (3-0) can support healthy and diverse gut bacteria populations. In addition, there’s some really cool science that says, high fat, low fiber diets can increase somebody’s risk for gut bacteria imbalance. So, it’s really looking at, how do we increase their fiber? How do we support their gut microbiome with diet? And if that doesn’t end up helping out, or if their labs show very extreme bacteria imbalance, we might do some antimicrobial herbs. There are a lot of herbs that can be used to help bring bacteria back into balance. If somebody is experiencing more severe gut bacteria imbalance, and they’re not responding to these herbal antimicrobial treatments, I may refer them out to a provider who can prescribe pharmaceuticals.
ALB: You’re correct, that was a lot of things that could be linked to this. You’re pointing us to some evidence-based research. So yes, this is what you’re seeing with your patients and what you’re using, but there’s a really strong scientific background. You’ve mentioned things like simple carbohydrates, and the dairy and the body acne link is really interesting, because we tend to not think of these skin conditions in terms of where they manifest, it might just be ‘acne’. That’s interesting that there’s some separation there.
I want to pick up on a couple of things that you mentioned, because you mentioned gut dysbiosis. And you explained that for us a little bit, which I’m glad you did. I wonder if you can get into this link between that and the 30 plants a week? And I’m glad you said 3-0, because I wasn’t sure myself there. Can you get a little bit into this gut microbiome? You’ve explained to us that when we look at dysbiosis, essentially what’s happening is that we have a community in our gut of various different bacteria. And sometimes when things get imbalanced, skin conditions can result. Can you give us a bit more insight into the role that gut dysbiosis may play, and what you’re hearing and seeing from your patients?
BE: This is a topic that I’m so passionate about. The gut microbiome, if you guys don’t know, is basically all of the microbes naturally found in the gastrointestinal tract or the gut. It’s going to be from the mouth all the way down to the butt, honestly. In regard to these microbes, it can be bacteria, viruses, and so much more, basically all these microscopic things.
But these changes, from what I’ve seen the literature, have been mainly focusing on the actual bacteria in the gut. And what they’re seeing is that certain gut bacteria overgrowths have been linked to acne. In regard to acne, it’s basically a gut bacteria imbalance, there are really strong links with that.
It’s also been linked to eczema as well. In regard to eczema, what they’re seeing is that there’s actually a depletion of gut bacteria that’s necessary for making supportive post-biotics, which are basically bacterial byproducts. In regard to rosacea, it’s been linked to that as well. What studies show is that people with rosacea are more likely to experience H. pylori infection. H. pylori is a bacteria that could grow in the stomach and play a role in burning sensations such as ulcer-like symptoms or heartburn symptoms, but it’s also been linked to SIBO, which stands for Small Intestinal Bacterial Overgrowth, which can look a lot like Irritable Bowel Syndrome, or IBS.
Going back to your question about 30 different plants. There’s some really, really cool science, I think the actual study was called the American Gut Project, if anybody wants to look it up. It’s a really cool study. In that study, what they saw was when that eating plants (whether it be fruits, vegetables, and it’s also herbs and spices), you can get all of these pretty easily in your diet. Having 30 different plants a week supports diverse gut bacteria populations. And diversity is not only key for gut health, but from what I’ve said earlier, it’s really supportive for skin health as well, because there’s that link between gut and skin, which is so interesting to me.
I tried to figure out if I could get 30 different plants a week, and I was surprised. I basically did a 30 plants challenge for myself. In that first week I said, I’m going to see how much I could get. And I was surprised that I got 25 different plants! I said, oh, I just have to add five extra plants this week. So easy! And the easiest way for me to get those 30 different plants was making smoothies every morning. I posted about that on my Instagram a lot, how making smoothies is such an easy way to get these plants into your diet. In my smoothies, sometimes I go pretty extreme, and I get 20 different plants because I add so many different spices. Honestly, it’s so easy to add different spices like turmeric and black pepper. People ask, why do you put that in there, is it gross? I say, no, you don’t taste it at all! But you still get those 30 different plants. 30 different plants are building healthier, diverse gut bacteria populations, and gut bacteria populations have been linked to gut symptoms, but also skin health.
ALB: Wow, I really appreciate hearing about how you personally challenged yourself to do this. And that’s a really good tip, actually two good tips. First, that smoothies are a nice, easy way to do that when you’re looking at that type of quantity. Also, herbs and spices count! We forget that they are also plants, or parts of plants. What a way to get that in and get 25 on your first go! That’s pretty good.
BE: I know, I was surprised!
ALB: To end off today, Bryant, let’s take a different tactic. You did mention earlier that based on the way that the laws are that govern naturopathic medicine and naturopathic doctors and physicians in California, you cannot directly prescribe pharmaceutical medications. That being said, you did mention that you work in an integrative fashion and a collaborative fashion with other types of healthcare professionals who can prescribe. When we think about how this impacts patients, I’d love to get a sense of that from you. When you think about how you’re collaborating with these other types of healthcare professionals, how are these collaborations directly benefiting patients?
BE: When patients first see me, I always let them know what their options are, depending upon the severity of their symptoms, but also what they prefer and what their goals are. Some patients definitely want to go a more natural route, other patients want to go more an integrative route. Integrative is combining or blending both natural and conventional/pharmaceutical options.
Given that a lot of my patients do want pharmaceutical options, I let them know and say in that in California, since I don’t have MD oversight (medical doctor oversight), I can’t prescribe pharmaceuticals. I let them know from the get-go. And they’re usually okay with that. I always let them know that we can refer them out to a dermatologist that I commonly refer to out in Pasadena, which is in California, where they can get pharmaceutical treatment. Depending upon what we’ve done, it’s a whole journey with a patient. Depending upon what we’ve done in regard to natural options, and then just really being frank and straight up with them and saying, we’ve done these natural options, you’re not getting the results you want just yet, or the relief you want. We can give it some more time, it might help out. But, it seems like your timeline is much shorter than what we were anticipating. I always let them know that the pharmaceutical option is available.
When I do collaborate with medical doctors or dermatologists (I also refer out to a family practitioner as well), they’re usually pretty cool with working with a naturopathic doctor, which is amazing. When I first started off in practice, it was here in California. I went to school in Portland, so I didn’t really know how things were here in California. In my head, I grew up here, I knew that people are pretty cool. They’re pretty chill, so I would expect them to be okay with working with a naturopathic doctor. I was honestly afraid because I didn’t know what that experience would be like. In Oregon, where I was doing my medical training, we could prescribe pharmaceuticals. We didn’t have to rely on medical doctors. Given that unknown aspect, I was anxious. But to my surprise, a lot of MDs are pretty receptive to naturopathic medicine. I just had to just break down what naturopathic doctors do, and what our training involves. And they became more comfortable saying, this naturopathic doctor is medically trained. He understands what pharmaceuticals are needed, and I would love to collaborate with him. It’s really cool to have a team of providers that I could reach out to and ask, my patient needs some more support, can you help them out? They’re usually receptive to that, and patients are happier as well.
ALB: That’s wonderful to hear. I like how you’re using the educational aspect. In many episodes of this podcast, we have stated the strong educational role, which we know is one of the principles of naturopathic medicine, Doctor as Teacher. Normally, we talk about that in terms of how naturopathic doctors are educating patients. But in this case, this is a really important other type of education, which is educating your colleagues that may be practicing healthcare in a method that is outside of the naturopathic profession. You’ve mentioned working with medical doctors, family physicians, and dermatologists. And after you do that education piece, after you explain to them, hey, this is what I do. They seem to realize that naturopathic doctors know what they’re speaking about. They know the pharmaceuticals, the impacts, all this stuff. It sounds like that’s what’s paving this path for you to work in this way that is integrative, by integrating natural therapies and naturopathic therapies with conventional ones, but also collaborative.
I want to end by asking you about that collaborative piece. When you’re working with these other types of healthcare professionals, that could be in a number of ways. It could be because there is something that needs to be prescribed that you’re not able to do, but it might also be a collaboration outside of that, because that is a fairly practical, logistical reason to collaborate. But there are others, right? To end off today, can you give me a sense of what this collaboration looks like from the patient’s seat, and what benefits they receive?
BE: When patients see me and they have this collaborative experience where they see me and another provider, a lot of them say, thank you so much for letting me know what my options are. There’s this big fallacy, at least here in Los Angeles, where natural is always right. And I always let my patients know, natural sometimes isn’t the best option, especially for your goals, and just being straight up with them. I say, pharmaceuticals are OK to use, and we could support you with naturopathic options so you don’t experience some side effects from pharmaceuticals. It’s really letting them know, you can do those pharmaceuticals. But I will help you out at the end of the day in regard to possible drug-nutrient deficiencies that might go on, or things that might affect your gut microbiome so that you could go on this pharmaceutical without experiencing much of these adverse effects. In having candid and true conversation with patients, they tend to be really happy and say, oh, these are my options. I feel, and patients say, that they feel more comfortable in regard to moving on with more integrative options. Does that answer your question?
ALB: Very much so. What I’m hearing from you is that it’s really about helping the patient make an informed decision about what their options are.
BE: Exactly. That’s what I was trying to say, in so many words.
ALB: And you did! Sometimes for patients, there can be some hesitation in terms of seeing more than one type of healthcare practitioner, especially if those practitioners have approaches or use modalities that are quite disparate, that are quite different. You can act as that bridge, if you will, between naturopathic and conventional medicine, and in fact, also a bridge between different healthcare providers to form that team that you described. So, the patient feels that not only do they have individual health care practitioners in their corner, but there’s a whole team that has their back at the end of the day.
BE: Exactly. And at the end of the day, one provider can’t provide everything, right? I let my patients know, this is what I’m good at. And this is what I can’t do given the laws in California. Let’s try to make a really great healthcare team for you to get to your healthcare goals.
ALB: That’s exactly the goal. We could spend a lot of time discussing these integrative and collaborative issues and getting more into skincare, but that’s about all the time we have for today. Thank you, Bryant, for joining us, because you’ve given us some really great information about potential root causes of skin conditions, how naturopathic medicine (as a standalone and also being integrated with conventional therapies, while you’re collaborating with other healthcare providers), helps center the patient and form that team, as you mentioned. Listeners, you can find a transcript of this interview, and also some links to learn more about Bryant’s work in the podcast notes. Bryant, final word to you. Are there any final notes you’d like to leave us with today?
BE: If you guys are experiencing any chronic issues, naturopathic doctors are really great at addressing those underlying causes. We can work with you integratively and holistically. It would be worthwhile to look into adding a naturopathic doctor to your healthcare team. That’s what I wanted to put out there. We’re trained in both pharmaceutical and natural options, so you get the best of both worlds. And you get a balanced perspective in regard to how you can get to your health care goals with different types of treatments.
ALB: That is the perfect note to leave it on today, Bryant. We have balanced health care, we’re hopefully going to have a balanced microbiome, and everything hopefully will be in balance for all of the patients that you’re dealing with. Bryant, again, thank you so much for joining us. It’s been such a pleasure to speak with you. And listeners, thank you for joining us as well. We’ll see you next time!
This article is provided by the Institute for Natural Medicine, a non-profit 501(c)(3) organization, partnered with the American Association of Naturopathic Physicians. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing healthcare systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following initiatives:
- Education – Reveal the unique benefits and outcomes of naturopathic medicine
- Access – Connect patients to licensed naturopathic doctors
- Research – Expand quality research of this complex and comprehensive system of medicine
INM's team is made up of naturopathic doctors and health journalists.