Webinar Replay | "The skin from inside" with Dr. Hertoghe, Dr. Gaviria and Manon Pilon

So I'm happy to introduce to this uh webinar um with John gavier and John um John is a dermatologist. John, can you um introduce yourself? Because I think you do a lot of very interesting things. You talk me about plants in the mountains and research and and you're a dermatologist, so I would know more like to know more about you, and I think the audience also.

Good morning everyone. I'm very happy to share this morning with you. With people all from all over the world in this webinar. I am John Gia. I am a dermatologist. I did my studies here in Colombia in the biggest hospital for the skin in the world because in our hospital, 30 years ago, we had 1,000 patients per day only for skin diseases. It's an amazing place, totally huge. After that, I went to Paris to make my MSD, my Magister in skin molecular biology. And from that time until today, I'm still working in deep research in antioxidants. 25 years ago, and 14 years ago, we started our research in microbiota, micro-iot, and microbiome. Means all the mixture between the oxidative stress and the world of uh of microbes, of microbot. Okay.

Um, John, I think you're in Colombia. That's important to know. That's why you're talking about good morning, because here it's good afternoon. Um, I'm personally um Terry Herto and um I'm um working in hormone therapy since many years. Can you come? We have problems with the screen here. Um, and I worked, wrote a lot of books, and I'm passionate. And we're going to do a very special session here. Is that we're going to look at pictures of people that have been sent, and we're going to look at questionnaires that are uh questionnaires of uh actually uh filled in by the same patient or doctor of the patient, and we're going to comment. And John has complete different reports as I have, but they can be complimentary and give you news. I need to have my picture here. Yeah. Okay. Okay.

Um, so um, and I need to be able to go on the PDF. Yeah, because here, share screen. Okay. So we'll start by sharing the screen here. Um, here, and exactly, is it this one? It's here. Yeah. Okay. So our first case is patient case is, and here's the question here. Um, John, would you comment on this? Because it's you who designed this case. It's a reduced form, but at least we do have some information here.

Yes, the most important information for us is what happened with the childhood of our patients. Means for us, it's very important to understand and to know if patients has born but about C-section, cesarean section. Because when you have this kind of burn, you lost the opportunity to build your microbiota in your childhood. After, we ask about the question about uh the breastfeeding because it's very, very important for us to build a well microbiota. And we ask about as well the illnesses in the childhood because when children have a lot of antibiotics, they have a lot of problems or um with with their microbiota. So in this patient, fortunately, and we know some information very useful. For example, right now, they have a diagnostic of of um of Hashimoto thyroiditis.

Means, can I interrupt you one moment, John? John, they have asked me to explain for people for translation that they need to click on the icon below interpretation to get the French or the Spanish uh as um Spanish. I let you say it, John. About interpretation icon below. So let you continue.

Okay. Talking about these patients, he has very interesting findings. First of all, dry skin, Hashimoto thyroiditis, sleep no restful, and level stress with in eight. And this this stress level is an eight out of ten for us. And when patients um said they have a very high, high stress level, that's a very, very bad thing because cortisol, we are going to talk about that because cortisol is a very bad hormone against our microbiota. Uh, and this patient as well, only makes one time per week exercise. Means she has a sedentary life. And and is a very special finding as well. Her energy, her energy, her vital energy is only until 4 p.m. When we see this kind of thing and the rash with seborrhea, means very dry skin, we start to think about the capacity of the skin to produce the normal moisturizer. And because we have a normal moisturizing way inside our skin, and we can produce our natural moisturizers because of the interaction between our skin cells and our microbes, our bacteria in the skin and in our gut. So when we see a girl from in in their 50s with very dry skin, we have to suppose a problem in the thyroid hormone. And second one, a problem in their in their micro-iota. What's here our finding? He, she don't have energy. So if she don't have energy, it's because for us, she could have a mitochondrial dysfunction. And the origin of mitochondrial dysfunction is the dysbiosis. And dysbiosis is an illness of our microbiota. H, for us, it's very important to improve this mitochondrial dysfunction and this dysbiosis using probiotics, for example, and combining probiotics with food supplements based on SOD, super oxide dismutase, selenium, and zinc. That's is our our approach to improve our patient. And as well, we are going to use on their skin a mixture. In um, in first of all, stop the use of soaps because soaps are alkaline, very alkaline. And the good skin could be acidic. And that is very important to keep an acidic pH in our skin to have a well-functioning skin enzymes and in our skin microbiota. And second one, we will use um in our patients ammonium lactate. Ammonium lactate 12% is the best way to improve all the cornification process. This is the name we gave to the process to have a good skin every day.

Cornification process. By mouth, or is it something you put locally?

No, it's locally. It's locally. Ammonium lactate, uh, on after bath, using our wet skin. We need to combine uh ammonium lactate with uh with water.

Okay. Good. So there's probiotics to give, ammonium lactate locally, stopping soaps for the skin because there's a rash in this person. I show it to you here. You see this rash? Okay. Now, you see interesting things that are also hormonally interesting. What are the hormones often deficient, lacking in people with rashes? It can be cortisol that can be lacking in this person. And one indication of that is that she has also brown pigmentation here. When you have Addison's disease, a lack of cortisol, you generally have um uh low cortisol, but you have an increase of secretion of ACTH that colors the skin more. The knees are more colored like here, the elbow folds are more colored, and there's dark circles on the eyes. So she has that. That can be also the case.

So, um, we look here also. I don't know much more about the hormone when I look here at the skin because it's mostly a rash that is examined. But when you look at the skin here, it's very thin. And a very thin skin is typically for low IGF-1, low growth hormone. These are also treatments that can be given that thicken the skin, but that make also the person better. If I look at this person, uh, just with the skin, what would I say? I would say that you see these brown spots, that's typical osone spots. And then these rashes, that's allergy. Um, I would say that this person actually is burned out. When you have low cortisol, you feel burned out. And when you have low growth hormone because the thin skin, you have generally a lack of recovery. You can sleep 12 hours, 14 hours, but you don't recover. Your sleep is superficial. It's not a good one. You stay tired. This person can have exhaustion because of those two deficiencies. And don't remember exactly her age, but I think it's in the 50s. Or not 56. 56. 56. So there's also, of course, menopause, and she's not taking, I don't think she's taking treatments for that. So let me look back here. She's taking vitamin D, but she does. She's taking desiccated thyroid. So the thyroid looks good, but basically these um doses are very low. So it could be that she has a low um level because she has Hashimoto thyroiditis. And like John said, she has very dry skin, that's typical for low thyroid function. So probably her dose is not enough. So probably the treatment includes here increasing the thyroid uh dose very slowly and taking maybe very small doses of natural cortisol. Unconditional food is good. If she, it's sugar, sweets, milk products, that doesn't in grains like bread, it doesn't work with cortisol. It's, I would say, I would even um contradict taking cortisol when you have bad food. You really have a food necessary foods like in the paleolithic type times. So it's, it's a food that is not with processed foods and not with a lot of bad carbs as we are used to eat. And because of her age, there is generally the levels of growth hormone and IGF-1 about half to one-third of it were at age 20. She needs that sort of treatment, including the female hormones that make her skin less dry. The main reason for dryness of the mucosa, for example, the dry eyes, is a lack of estrogen. So these treatments should be treated in these women to feel better with certainly a better food. We, for example, people who are on thyroid treatment, they should not eat proteins in the evening because when you eat proteins in the evening, they accumulate in the stomach the whole night, and there's a certain process of amino acids getting all the night in the liver, and it slows down the most important reaction of the thyroid, which is a conversion of T4 that is not very active to the thyroid normal T3 that is very active. So you, people eat proteins in the evening, and most of us do that, they generally wake up a little swollen in the face, with puffy eyes, and little stiffness due to low thyroid function. Even if they have good thyroid treatment, it cannot completely be improved. When you look here, there's exaggerated hair loss. If it's diffuse hair loss, it's a lack of thyroid. If it's on the upper scalp, it's a lack of estrogens. In general, dandruff means that she probably doesn't have such good food. That's a sign for yeast infection. So I would advise really stopping any milk products and any grains that are not sprouted, like we have sprouted bread in Europe. I don't know if you have that in Latin America, but basically it would be better to have um um avoid that foods that are not sprouted, so seeds that aren't sprouted. So I think this will be better because this is probably the top of the iceberg. When you look at this, do you want to comment any other things, uh, um, John, or we can go to the next one?

Yes, for us, when when sleep does not generate rest or reparation, the problem that must be seen in the production of neurotransmitters and the corresponding dysautonomia. Dysautonomia, I don't know how to say in English, but for us, this is one of the effects, the final effects of the dysbiosis in our patients. For that, it is very useful to improve all the micro-iota to improve their capacity to rest. H, when when when the sleeping, after the sleeping, and there's an indication that there's a dysbiosis also because of Hashimoto thyroiditis, that is often a consequence of a bad microbiota. I also think that she wasn't drinking enough water. May I just look here? Um, between, between four glasses of water, that's insufficient. And then you, the everything works not as good. I just am working on a presentation on appetite, for example. You have more appetite, and you eat badly, wrong foods, when you don't drink enough water. So I think water should be at least one liter and a half to improve.

Now, let's look at the other case. Maybe you want to introduce it, John?

The other case. Oh, yes. Is a, for me, as dermatology, is a very special case because she has, he has, is a male, 33 years old, and um, an illness named hidradenitis suppurativa. Is an illness affecting the special glands in our skin in the areas as axilla, groin, and in these places, we develop a lot of huge buttons full of of um, as, as the name says, suppuration, a lot of expression of um, a yellow production of uh, of of a very bad smell, very bad smell sebum under the skin. This is an and a painful nodules, painful nodules for the patients as well. He has overweight. It's very common in this kind of patients. And the most important thing for us, he never had the habit that used to consume a good, good level of vegetables. And when people didn't have from childhood a good level of vegetables intake, they will have by default and dysbiosis. And they, they have dysbiosis, they can't make the training of our immunological system because it's our microbiota, the main teacher of our immunological system. And when you have a bad micro-iota, you will have a very bad immunological system because your micro-iota is the teacher of your immunological system. So to have a well immunological, immunological training, you have to have a very, very well micro-iota. And for that, you have to eat a big salad every day because the most important food and the most important nutrition factor for our micro-iota is the vegetables, fruits, and vegetables. And this guy never took a good level of of vegetables in their diet, in his diet. Um, um, I want to see. Ah, it is very, it is very common in this kind of patient with they have as well irritable colon. They have problems with their colon because they have a big dysbiosis, a big colonic dysbiosis. So they will have this kind of patients, a lot of intestinal symptoms and intestinal manifestations as, as colon, irritable colon. And the last one, wait, I'm going to see in my, in, because here you see to see a little bit down and, ah, and we can see how his immunological training had a bad training, a training because he has an allergy and against against shrimps. When you have any kind of allergy, the problem is not your genetics, it's your training of your immunological system. And as I told you, the main teacher of our our immunological system is our micro-iota. This is very common in our patients, patients with problems in the skin as suppurativa, with very bad immunological system, with allergies, different different allergies, and very low level of vegetable intakes. This is the patient I'm showing. See other things. So he has overweight. He also not doesn't drink much, very few.

Can I take over now? Or do you have still some things to say about the maybe the the blood disorder that he has? Or?

Okay, then, then I will take it over. So when I look at this patient here, I can give more information. First, we see that he's overweight. So overweight can be that he eats too much, has too much appetite, but it also can be due to the fact that he, his body composition is not good, lack of muscles, more fat. And that is typical for hormone disorders. You see that the hair is getting a little short. That can be a lack of testosterone, not an excess, a lack of testosterone in a too high, too much dehydroepiandrosterone. You see also he has more brownish complexion. And I don't see the eyes, but I have the impression there are dark circles on the eyes. That means that his adrenal glands do not work well. So he will have a lack of punch and a lack of capacity to adapt to stress because of low adrenal glands with low cortisol, low DHEA, and things like that. He does have a lot of body hair growth when you look at that, because there's also even on the feet. So he probably compensates a low cortisol by making more adrenal androgens. Those hormones can give more body hair growth. You see here he has dark circles in the eyes as typical for low cortisol. He has also pigmentation spots, and they are a little irregular. And that's different with the typical pimples with people with red hair have, for example. That's typical for adrenal deficiency. He doesn't make enough cortisol. He makes to stimulate the adrenal glands to to make more cortisol, but it's not enough. Um, um, okay. The skin, because the body hair, it's more difficult. You see he has also, what is called scleritis. And scleritis is typical for a vitamin B2 and B6 deficiency. So he's maybe not eating enough meat to get his vitamin B's. So we need to check that. And I don't know about these conjunctives, because that would also give important information. Um, here you see dark circles under the eyes and inflammation. Can also be low cortisol. When you look here, you see that he has an imbalance. You're almost sure to find in his blood low testosterone and high estrogens, high estradiol. So people with more fat tend to make more breast development because the um, the fat converts the male hormones to female hormones, and that gives this sort of outlook. And so there's likely that in his, uh, food, he eats, drinks a lot of coffee or alcohol. So alcohol or coffee convert testosterone or stimulate conversion of testosterone to estrogen. So it feminizes the body as you see here. And the, the fat tissue here, abdominal, can be also due to low testosterone or low growth hormone. He certainly is lacking growth hormone because his skin is a little bit sagging here, and and his breast little sagging. So growth hormone deficiency is almost sure, but that is the case in almost any person who has um, obesity. So you see also that every scar is very branched. That's typical for Addison's disease. It's a disease where people make enough cortisol, so they get very stressed, and then the body reacts to try to stimulate those adrenal glands by making more ACTH, and that gives this irregular pigmentation. There's a brownish color of the skin, but there are places where there's more pigmentation, and and especially the scars, that's very typical for cortisol deficiency. In excess, you see also that there's a little um, excess fat accumulating. You're almost sure that with high dose, not a low dose of growth hormone, you will decrease that, even if you don't change the food. But there's certainly some food adjustments to do. I'm also not sure he sleeps enough. If you don't sleep enough, you don't make enough of the good hormones, and you have also an excess appetite. You have to know that um, 60 years ago, people were sleeping one to two hours more, but now with TV, internet, we're not sleeping enough, and that disbalances our imbalances our hormone levels. So you see here, um, so how can we reverse this situation? Well, we first have to decrease the food intake, but not excessively. And the food intake should be enough proteins and not vegetables, and not too much fruits, but certain vegetables and, and meat and things that are not processed would be good. Meat cooked at low temperature. And you see also that there's, for example, a bloating upper belly. So this is almost sure that this patient eats in the evening proteins, meat, fish, maybe in big quantities, and that's not the right moment. The best moment is in the morning, breakfast, or at lunch, but not in the evening because then the food stays too long in the stomach, and then you're in a flat position, and the food cannot evaporate, and then certainly a dysbiosis just only because of them. So proteins in the evening is never good. In the past times, long time ago, ancestors didn't eat in the evening proteins. They never found bones in the ashes of the campfire, and that means they never ate meat or or foods where you can have bony structures remaining. So I think this patient will improve quite a lot, but he needs to get on a good treatment with a good food first, a good um, microb, the micro should be well cared for, not eating proteins in the evening and eating more that in the morning. And then, uh, needs testosterone, growth hormone, a blocker of testosterone to estrogens, stop the coffee, and stop the alcohol that he might be taking, and give and take some thyroid hormones, and that already will improve him greatly. Um, well, that's it. Um, if you, you see also the feet, this is, um, a brown, yellowish accumulation. So he has too high levels of beta-carotene in his blood, not enough vitamin A because the thyroid is slowed down by low thyroid function. You also see that it, um, the tone of its soles are not tonic. That's typical for low growth hormone. And you also these swollen feet that are more swollen, probably in the morning, is typical for low thyroid function. They're also a little bit swollen here. There are a lot of little lines here. That's typical for testosterone deficiency. And what it's very typical for Addison's disease, low cortisol, is the brown creases here. So they get too brownish, and then the nails don't look good. That could be low thyroid. Okay, that's too much estrogens, not enough glutathione here. So we can already see a lot by looking at the patient. Of course, this has to be confirmed in tests, but it's almost sure that those that what I said will be um confirmed.

Here's a lawyer. Maybe you want to introduce this.

Yes, this is, you know, it's very common in our patient right now. When we ask about the salad consumption every day, and they say, oh yes, I eat salad every day, but small. And the quantity is very important to understand how is the function of of our biological system because human being needs a big salad at lunchtime every day. In fact, we need vegetables at least twice or three times per day because vegetables are the main, the main food for our microbiota. And as we know today, microbiota is kind of axis of all over our biological system. For that, they have a very special way to make the diagnosis of dysbiosis. Is the flat, the flatulence fast after meals? Because when you have flatulence fast after meals, means you have a kind of communication between your microbes, between your stomach and your colon to start the production of methane, of different gases. In this level, it's not because the normal production of fermentation, no, it's a signal, a signal to who arrives from the stomach to the colon to have a fast flatulence, a fast flatulence after meals. And the other way, they have an abdomen distension, frequently abdomen distension, frequently means she has a dysbiosis. And when one person has dysbiosis, means they don't have the enough microbes to produce the neurotransmitters. And in this patient, it's very special because she is sat with anxiety and depression. Today, we know is the new way to understand the depression. The this, the start of the depression is in our gut, but no in the tube, in the content of the tube, means in our microbiota, because the capacity of our microbes to produce all, all our neurotransmitters, key, our our combustible, our gasoline for our brain. And fortunately, fortunately, our patient, she did exercise at least four times per week. That's very important thing because the main modulator of our microbiota is our diet, is what we eat. But the second most important modulator is the exercise. We have to make exercise at least three times per week, at least to improve all our biodiversity in our our microbiota. And and we have to eat enough vegetables every day. It's not, it's not enough when people say, oh yes, I eat salad every day, but and a small one. A small one is not enough. The human being, I repeat, have to eat a big salad at lunchtime, at least.

Okay. Good. So when I look at this patient, there's been the thyroid has been uh taken out or part of it, about four years ago. And she's taking, uh, uh, is a, um, thyroid medication that only has one thyroid hormone, that is the precursor to the most active thyroid therapy. Patients like this, with part of the tissues taken away, do much better with the T3 and T4 preparation. So there would be a switch to a more efficient therapy would already help and improve. Now, this patient is 63 years old. So she is menopausal. She needs menopausal treatment. She needs estrogens and progesterone. And don't worry if there, it's well balanced. If the patient doesn't have breast pain, that's a sign of imbalance, too much estrogen. It should not increase the risk of breast cancer. If, in fact, she gets breast cancer, she will get more less severe forms of breast cancer. It's more protective. So she needs more hormone treatment here. Homeopathic medication can help, but not enough. It, it, it is really, you need to have more efficient therapy. So when we look at the patient here, you see that she has her cheeks that are less firm here. This lack of elasticity of the cheeks is typical for um low growth hormone. Growth hormone is the elasticity hormone. And without growth hormone, we shrink, or we get loose tissue, we get more fat, and we age quicker. When you look also at her um, the eyebrows, I think she put some color here. I'm not sure, but it looks like she put some color here because there's not enough eyebrow. The lack of eyebrow in the inner side would point to a testosterone deficiency. The lack of eyebrow that is certainly here, uh, on the outer side, that's a lack of thyroid hormones. And the middle eyebrow that is thinning, that is a lack of growth hormone. So there's a lack of growth hormone here, and and lack of thyroid here. I, when I look at the skin, if I can enlarge further, it looks also there's an irregular pigmentation. It doesn't show up so easy here, but when we make it a little smaller, we do have this impression. Probably also low cortisol. Her adrenal glands are not as they were before. But there's a lot of folds and lines. So she not only needs growth hormone, but she needs IGF-1 treatment combined to reverse that. She needs to have a menopausal treatment, which she doesn't have. You see also the thinning of the lips is very typical for lack of growth hormone and IGF-1. So this is partly reversible, this aging. You just need to give the the treatments. Also, the little folds here, um, I sometimes in people who are very aged face, I do micro-needle injections. So I do very small injections with a microneedle gun, and I put that on the skin, and that helps. And then six months later, there are still 50% of their wrinkles due to the treatment, if they have at the same time, treatment from the inside. Also, food has to be um, improved because often people who have a lax body have a bloating belly. And so you need to improve the food by various cases. I don't know enough information here to be sure, but there's also lack of protein. You see all these little folds. The little folds is lack of vasopressin. And the dark, the sharp folds is also due to the lack of water, lack of vasopressin. You see also that the eyebrows are too thin here. I don't think she thinned it herself so much. The lips look good here, maybe a little bit thin here. They could be low growth hormone. There's little irritation here. That could be indicating maybe a wrong food intake, like milk products, or can also find be a rash. Beautiful jewel here. And if I look here, you see here on the sides, fat accumulating. That's typical for low growth hormone. Growth hormone improves that as a therapy. You see that there's a little sagging, a little bit here. Can also be low growth hormone. And the hands, it could be that the hand tone is not enough. That would also be not too soft. That would also be a lack of growth hormone or IGF-1, even more. The breast, difficult to tell here, but you see that also the muscles on the back are not so tonic. Should be more tonic. Growth hormone can improve that. And a little testosterone. Woman, when you look at the skin here, it's, it begins to be a little brownish here. That's typical for low cortisol. With more ACTH, it's a little darker here. That's also typical for low cortisol. And you see how thin the skin is. That's a combination of a thin skin, mostly due to low, low IGF-1, but also can be low female hormones and dehydration due to lack of vasopressin. So this person is really needs water. H, there's not enough water in her. And and you see also how thin the skin is, the tone here. You see also these brown creases, typical for Addison's disease. Why the creases get brown? Well, these people have actually a tint all over the body, but they wash their hands. They never go in the creases to take out the skin. But by washing the hands, they rub out the skin here on all the place except in the creases. So this is a mark of what remains after washing your hands. And you see these creases, that's more difficult to be sure. It could be found many deficiencies, but it's here that we see vitamin A deficiency cracks. These fissures, it's typical vitamin A deficiency. It is also found in thyroid deficiency. And the flaky skin is typical for a lack of omega-6 fatty acids. So she needs borage oil or evening primrose oil. It's not enough. She probably, it's also a sign she doesn't eat enough vegetables because otherwise she would have enough of these omega-6 fatty acid oils. Polyunsaturated. You see also the pigmentation, little irregular. Adrenal deficiency, generally in these patients, that regularizes with treatment. So basically, this patient needs some adrenal hormones, even cortisol and DHEA. I never give cortisol without DHEA, and I always suggest these patients avoid sugars and sweets and grains because otherwise the treatment doesn't work well. You also see little lines here. That's typical for growth hormone deficiency. And you see that they're little whitish the nails. So probably the feet are cold, and that can be due to low thyroid function. So she needs some thyroid hormones, very slowly increased because of, you know, deficiency. She needs the menopausal treatments like female hormones and testosterone. And she needs cortisol and DHEA. And if she has low blood pressure, she probably needs even aldosterone. Aldosterone is also water, a hormone that retains water. Vasopressin doses of desmopressin are about 50 micrograms in the morning, 100 micrograms in the evening, sublingual to take, and that would be good treatment.

Okay. Next patient case.

FM is a female. She has an an retinal detachment in the in her right eye, means a complete loss of sight. And as well, diabetes, arthritis, and dry skin. For us, when we see a patient with these three diagnoses, we say she has an immunological senescence. Immunological senescence, to easy understand, is a kind of immunological system very old, very aged. And just because diabetes is a model of of quickly aging. And as well, she has sleep not restful, depression, she's sad, and the level, the stress level is eight in a, in a scale of eight from 10. Means she has very low levels of neurotransmitters in her brain. Means she has and dysbiosis because the main production of neurotransmitters are in our microbiota. As well, she never did exercise. As I told you before, the main way to control our microbiota is the diet, and the second way is the exercise. No energy. When people said no energy, you, you have to think the first, the first thing is mitochondrial dysfunction. And the origin of mitochondrial dysfunction is H, the dysbiosis. Why mitochondrial dysfunction? Because when you have dysbiosis, you have a very bad level to improve the absorption of micronutrients. Means all the absorption of micronutrients depends on the capacity of microbiota to process these micronutrients to to arrive to the blood from the from the intestinal lumen. And she has at 74 years old, an exaggerated hair loss. We have to talk in this moment about estrobolome. Estrobolome is the repertoire of genes of the intestinal microbiota capable of metabolizing estrogens. We are talking about about a very new field, the microbial endocrinology, the capacity of our microbes to make the intervention in the different hormones and the different enzymes between the hormones, as the um, as the estrobolome. When when we talk about estrobolome, we are talking about about the capacity in the women to improve all the metabolism of estrogens. And finally, she has the typical, the typical symptom of dysbiosis is the problems in the colon, the colon with a lot of symptoms, irritable colon. For her, we need to stop the dysbiosis using probiotics. And this dysbiosis gives a new problem, is a new oxidative stress. We, we made an an an an torment of oxidative stress. Oxidative stress is a big problem. You have to improve using SOD, super oxide dismutase. And we use as well selenium, zinc, and curcumin. Lipo is a new molecule, very useful in people who has um mitochondrial dysfunction to improve the oxidative stress inside the gut, inside the intestine.

Okay, I've noted that. All I see also again, not drinking enough water. Three and four glasses is not enough for the body to function well, for blood to go everywhere in the body. Dehydration is really something that should be avoided. Now, when you look at the skin of this person, uh, you see very prematurely aging. You see the little fine lines due to a lack of water in the skin. And here, it's almost sure that she has to go off into the bathroom at night and during the day, polyuria due to a lack of vasopressin. So she needs vasopressin. See that she's 64 years old, but this is very not elastic enough. That's lack of growth hormone. So she surely is missing two hormones here. You also have some pigmentation that shows that the adrenals are not as they were before. But there's a lot of folds and lines. So she not only needs growth hormone, but she needs IGF-1 treatment combined to reverse that. She needs to have a menopausal treatment, which she doesn't have. You see also the thinning of the lips is very typical for lack of growth hormone and IGF-1. So this is partly reversible, this aging. You just need to give the the treatments. Also, the little folds here, um, I sometimes in people who are very aged face, I do micro-needle injections. So I do very small injections with a microneedle gun, and I put that on the skin, and that helps. And then six months later, there are still 50% of their wrinkles due to the treatment, if they have at the same time, treatment from the inside. Also, food has to be um, improved because often people who have a lax body have a bloating belly. And so you need to improve the food by various cases. I don't know enough information here to be sure, but there's also lack of protein. You see all these little folds. The little folds is lack of vasopressin. And the dark, the sharp folds is also due to the lack of water, lack of vasopressin. You see also that the eyebrows are too thin here. I don't think she thinned it herself so much. The lips look good here, maybe a little bit thin here. They could be low growth hormone. There's little irritation here. That could be indicating maybe a wrong food intake, like milk products, or can also find be a rash. Beautiful jewel here. And if I look here, you see here on the sides, fat accumulating. That's typical for low growth hormone. Growth hormone improves that as a therapy. You see that there's a little sagging, a little bit here. Can also be low growth hormone. And the hands, it could be that the hand tone is not enough. That would also be not too soft. That would also be a lack of growth hormone or IGF-1, even more. The breast, difficult to tell here, but you see that also the muscles on the back are not so tonic. Should be more tonic. Growth hormone can improve that. And a little testosterone. Woman, when you look at the skin here, it's, it begins to be a little brownish here. That's typical for low cortisol. With more ACTH, it's a little darker here. That's also typical for low cortisol. And you see how thin the skin is. That's a combination of a thin skin, mostly due to low, low IGF-1, but also can be low female hormones and dehydration due to lack of vasopressin. So this person is really needs water. H, there's not enough water in her. And and you see also how thin the skin is, the tone here. You see also these brown creases, typical for Addison's disease. Why the creases get brown? Well, these people have actually a tint all over the body, but they wash their hands. They never go in the creases to take out the skin. But by washing the hands, they rub out the skin here on all the place except in the creases. So this is a mark of what remains after washing your hands. And you see these creases, that's more difficult to be sure. It could be found many deficiencies, but it's here that we see vitamin A deficiency cracks. These fissures, it's typical vitamin A deficiency. It is also found in thyroid deficiency. And the flaky skin is typical for a lack of omega-6 fatty acids. So she needs borage oil or evening primrose oil. It's not enough. She probably, it's also a sign she doesn't eat enough vegetables because otherwise she would have enough of these omega-6 fatty acid oils. Polyunsaturated. You see also the pigmentation, little irregular. Adrenal deficiency, generally in these patients, that regularizes with treatment. So basically, this patient needs some adrenal hormones, even cortisol and DHEA. I never give cortisol without DHEA, and I always suggest these patients avoid sugars and sweets and grains because otherwise the treatment doesn't work well. You also see little lines here. That's typical for growth hormone deficiency. And you see that they're little whitish the nails. So probably the feet are cold, and that can be due to low thyroid function. So she needs some thyroid hormones, very slowly increased because of, you know, deficiency. She needs the menopausal treatments like female hormones and testosterone. And she needs cortisol and DHEA. And if she has low blood pressure, she probably needs even aldosterone. Aldosterone is also water, a hormone that retains water. Vasopressin doses of desmopressin are about 50 micrograms in the morning, 100 micrograms in the evening, sublingual to take, and that would be good treatment.

Here's a case of no pictures, but just a questionnaire. But there's additional information here. Would you feel comfortable to do this, or would you want me to do it? But I think you have enough information based on your questionnaire to give some tips.

This patient has a big problem because she has a severe menopause, and the hormone replacement treatment is not giving results. Why? Because of the microbial endocrinology. Because, pay attention, she has an sleep not restful, she has anxiety, anxiety and depression, very high level of stress, no energy. No energy means mitochondrial dysfunction. Is our, is like our former patient, exaggerated hair loss. Means she has a big dysbiosis. And when people have this big dysbiosis, the hormone replacement treatment doesn't work because the problem of estrone, you don't have your main friends, your microbes, and the genes in your microbes to improve all the the general metabolism of estrogens. In this girl, we can see how is important a good microbiota in one patient because she has the bad answer to the hormone replacement treatment, and she has a very, very bad life because of symptoms in her menopause. We need to improve her, uh, her microbiota using the the probiotics. And we need to stop the oxidative storm. The problem is a big oxidative storm after dysbiosis. And once we stop this oxidative storm, the all the microbiota can rebuild using the different, the different strains of probiotics to make a new ecology system inside our intestine.

Okay. And so you would suggest concretely, what sort of treatment to stop the storm of oxidative storm?

Oxidative storm, we use SOD, superoxide dismutase. It is available in the US market and in Europe as Glysome. It's the only patented product with this molecule. And we mix um a molecule developed here in the huge center of research here in Colombia. We have in neutral, it's a kumato-lipo. I don't know how to translate in English. It's a mixture between curcumin and lipo, but it's not the, it's not curcumin. It's a new molecule. And we use always zinc and selenium, always, always. And magnesium at night in these patients. Selenium and magnesium.

Okay. Good. So this person is suffering from anxiety and somehow depression, and she doesn't respond to the treatment so well, although she's taking thyroid hormones on a low dose because she probably doesn't tolerate and was thinking she could stop due to the swelling. U, because she, you have to have enough thyroid hormone to not swell with cortisol. So basically, this patient is having a very intolerance problem. What I usually do, there are two things that really block the efficacy of the treatment, and that's first, a wrong food intake. For example, U, you have low thyroid because you're eating proteins in the evening, or you are eating sugars and are bread, and that blocks the action of some hormones. You're drinking alcohol. So there's a wrong food intake. And also, we have a big problem, and I, and here we're going on another level, is that many people have a tendency to retain their emotions. And to retain emotions, what you do is you contract muscles now, and you have a tense body. Now, when you um, get hormones, they give more power to your emotions. So if you don't accept some emotions, you don't want to get angry, you don't want to be anxious, or whatever, you have to retain the emotions, and you tense your body, and you don't react well to hormones. So I, I, you, what I say to people, I say, look, express your emotions inside of yourself. You don't need to express outside. Just express them inside. And you can feel that your, uh, liver is angry, for example, or sad is crying. You can feel that your nose is sad and crying, your nails are sad, your cells are sad. And then after 5, 10, 15 minutes, it goes away, and you feel relaxed, and you feel better. And and then you can respond better to treatment. So people who retain emotions do not do well on on the hormones, and they have to do what is called what real medicine is, body, mind, and soul. They also have to take care of their mind and their soul. And and it's possible, and it's very easy. I just wrote a book recently that will get out on this that will explain how to do it. But basically, it, it's don't think it's difficult to change drastically. That's, I think a legion or something we believe, and then we end up by not being able to do things. But when you once you know how to, it is really easy, and it's worth to to work on these aspects. This person will not do enough with hormones if she doesn't do also some psycho or spiritual improvement, and that will help. Now, here's said also, is prolactine. Is it needed? Prolactin is a completely different molecule than progesterone. They do have some similarities, but not in action. Prolactin long improves the short-term memory if you take it in the morning, not if you take it in the evening. And progesterone calms you down, makes protects you against breast cancer, for example. There, so they really have to take progesterone if there's a progesterone deficiency, which there is at at menopausal age. She probably has to do better. Apply the estrogens two times per day in small doses on a larger surface, not on a small surface. So transdermal estrogen can penetrate and during 24 hours can slowly be released. There's probably several little tricks that can be made to improve the things. And then we also give often, say to people, avoid some food that inflame your body, and those are the histamine releasing foods or histamine released foods. Basically, it's the preserved foods, really, and some other foods are always a little problematic. So we ask them to reduce that amount of food, and then they do better. There are a lot of things that can be helped in this person. Question is, melatonin oil instead of tablets could be a good solution too. There's a melatonin and Mano. There will be another speaker who will talk about melatonin oil, what it can do. It's also a way if you don't tolerate by mouth, because it gives adrenal deficiency, you can take it on the skin and improve your skin. So there are really many, many things that can improve a person like this. But of course, I need to have more information. I don't have any pictures, so I don't know so much. And based on the questionnaire, it's a little too, too short to to give more information.

Yes. Has another patient.

Yes, pay attention, my dear. The we have the last three patients with common symptoms who always refer them to psychiatry. This patient is a doctor. And when we ask them to all our patients, an exhaustive research like the one provided by our questionnaire, we found a list of molecular alterations. For that girl, is our colleague, our doctor. Fatigue, decrease of memory, move up and down. She's always at. And pay attention, during her childhood, she had constipation, means she is dysbiotic from the childhood. Tonsillitis, an otitis, means she had a lot of treatments with antibiotics. People think antibiotics don't have any side effects except the allergy. No, no, no, no, no. The main side effect of antibiotics is they, the antibiotics destroy our normal microbiota. Because one antibiotic is very useful, it's a very useful tool in our medicine right now, but we can't use antibiotics every day for everything because antibiotics has this very powerful side effect, the destruction of our microbiota. For that, she has today abdominal distension, and she had no diagnosis of burnout. What means she has, she had, and she has an mitochondrial dysfunction. And the origin of mitochondrial dysfunction is dysbiosis. Once we improve this problem using antibiotics and antioxidants, just because of the power of antioxidants to stop the oxidative storm, we will have a new reburn of our biology from the molecules. This is the power of these nutraceutical products. We improve the patients in the.

Molecular level, yes. Um, but she's taking some of those nutrients that you're talking about, like magnesium, uh, like zinc. Here, desmodium, that is something to, um, that also improves the function of the, the gut. So she's taking a lot for her, um, thing, but she still remains with problems.

It was interesting that you said constipation is always a mark of dysbiosis, because I didn't know that. That it was specifically in childhood. So it's interesting for me to learn. I also see, how can her gut be good with just four glasses of water per day? She's four or five glasses, not enough. She has to drink more water.

And, uh, she has stretch marks, pimples, or bites having long-lasting residual marks. That means that she doesn't have enough anabolic hormones to recover from those pimples and slight wounds or stretch marks, leaving long-lasting residual marks. Typical for a lack of growth hormone, lack of zinc also. But basically, anabolic hormones like testosterone and even estrogens. And had laser hair removal, probably she had an excess of hair.

So this person, um, let's look at her. And if I see a person like this from far, I know and I can feel it. She has a background, uh, fatigue due to a lack of female hormones. Actually, that's why her face doesn't have the good color. She has very deep eyes in the orbit. So she's lacking water. She's not drinking enough water, but she's also cannot retain water sufficiently. And some people who have to go to the bathroom too quickly don't drink water, and then they're even more dehydrated. And that's probably her case.

So, synchronized in orbits, la a phase of pressing, memory is not good in those patients. She needs to have some a small dose of desmopressin, the synthetic derivative of vasopressin. We don't have the natural one because I prefer always natural ones, but basically we have to be with that. The, you see the sagging cheeks, typical of low growth hormone, but it's almost sure. People were saying cheeks have also bloating belly. So there's also a problem of dysbiosis that John talked about. So you see also the lips are very thin here. That's typical for lack of growth hormone. So she's lacking growth hormone. Growth hormone will very strongly improve this person, except that if she has adrenal deficiency, and we have to look if she has brown spots. And she does. She will not tolerate the growth hormone so well because growth hormone decreases cortisol. So you probably have to supply hydrocortisone, that's the bioidentical cortisol, two times a day, 10 milligrams, for example, to tolerate the growth hormone. The growth hormone will make a big change in this person, will make her recover and feel much better. It will also make her more spiritual because people with hormone deficiencies are often people who have too many complaints to be able to fulfill their spiritual destiny enough. So you are, you, when you get hormone treatments, you are free of parasitic emotions, and that makes you better do better your job, do better your private life, do better your spiritual destiny.

You see also the skin. There's a lack of vasopressin gives this orange peel skin, more or less dehydration, lack of water. And you see all these sagging and droopy eyelids. Very good picture actually here, um, as typical for growth hormone deficiency. There are some possibilities is reversing this by injecting the growth hormone around the eyes, every three months for a year, for example, will improve about 50% to 70%. Less of this. Um, uh, here you see the hair looks, it's difficult to tell. Looks a little thin. Can be lack of growth hormone, NF1. I need to touch the hair often to be. And then you see here she has a bloating lower belly. A bloating lower belly is usually due to a wrong food intake. You don't eat the Paleo, the food that exists since millions of years on Earth. You're eating milk products or dairy products, or you're eating, uh, bread or whole grain bread, for example. And that's is difficult to digest. So it stays longer in the lower, in the small intestine, in the colon. So basically, it's also a problem. You see also this thin skin, lack of vasopressin and lack of water, also lack of desmopressin. So here we have more information. You see, yeah, that's typically also there's a little sagging here, beginning, and little fat accumulation, lack of growth hormone. More like, you see also these brown spots, age spots. She's lacking cortisol. The feet, you see all this flaky skin. That's typical for lack of, um, fatty acids, omega-6 fatty acids, that you find in borage oil or in evening primrose oil. But to reverse that, you need maybe four to five grams or improve the, the vegetable intake. I think the best thing is to do like John says, eat vegetables, eat salads, whole big salads, because there's, um, the omega-6 fatty acids in it. If not, then you have to take supplements.

You see also that is little yellowish. That's typical in people with thyroid deficiency. They don't convert enough, um, their, um, provitamin A, beta-carotene, which has yellowish color, into vitamin A. So they accumulate the, the beta-carotene on the skin. Even the skin of the face is done a little bit more yellow, and the hand palm more yellow. But you see it more on the feet. If you look at the face, for example, it should have give an impression there's a more yellowish skin. U, I don't see it here, um, but here maybe here maybe there's more yellowish. Picture is not good enough to be sure, but you see all these folds, lack of growth hormone for sure. There's also a fantastic hormone that I cannot get, but I did work a time with C-reactive protein that is makes your skin completely, um, tense again, but it's not on the market anymore. So if anyone of the audience knows where to get it in an easy way, it would be good. Um, so that's for this patient. So this patient needs slightly thyroid hormone, probably, but mostly growth hormone and IGF-1 and menopausal treatments, and maybe also a little cortisol with DHEA, and who knows, maybe some estrone. But that I need more. I need blood pressure measurements and things like that.

This is another case of a patient. I'll try to make it smaller so you can have the whole here. 48. Yes, this 48-year-old patient. She, he, his consultation is because eczema dermatitis. Means when when one people has dermatitis, it's because she has no bad luck. Oh, what a bad luck I have because I have an eczema and I have a dermatitis. No, my, the problem is real, a very bad training of the immunological system. And I told you, first, the main teacher and the main trainer of our immunological system is our microbiota. And he had as well a severe acne during her adolescence, which means she had a bad, bad metabolism. Yeah, bad metabolism of about their their androgen hormones. Right now, he drinks alcohol frequently. That's very bad for our microbiota. And he had flatulence, fast flatulence after meals. Means she is as well, she has a dysbiosis and an abdominal distension. When you have dysbiosis, abdominal distension, fast flatulence, allergies to food, and you have an skin eczema, you need to retrain your immunological system. Means you need to change the teachers. You need to change your microbiota. You need to make an update to your microbiota to improve. And that is possible to do. And we, we did that in our center, in our research center. Center, we say we can't take the problems with our immunological system and we can make a new training in all our immunological system to avoid this kind of allergies and and re-reactions, as the formation of autoantibodies in autoimmune diseases. The origin of autoimmune diseases are and the problems in the microbiota. And we can improve a lot of patients in this kind of diseases if we know how the problems in the microbiota are occurring. And we can improve all of them. So how do you improve a case of retraining the microbiota? Can you give some small tips? They give an idea. Yes, first of all, first of all, we have to stop the oxidative storm. As I, as I said, the first molecule we use is SOD, superoxide dismutase, because it's the main antioxidant tool, the main antioxidant enzyme of our system. After that, we make the different mixtures using minerals of selenium and and zinc. And we use, for example, cranberry. Why cranberry? Because cranberry improves all the different ways the signaling between the bacteria in our microbiota. And we use omega-3, and we use alpha-lipoic acid, and this new molecule, lipo-curcumin, and the, and the, different antioxidants that works as antient molecules, as the different flavonoids, and all these kind of flavonoids could have has a powerful, a powerful, um, possibilities to improve this oxidative storm, as ferulic acid, as, uh, even vitamin C and vitamin and vitamin D, uh, to improve all this oxidative storm. And as well, we give to our patients the mixture of probiotics using Bacteroides and Lactobacillus, the two different big families of probiotics. And, um, Saccharomyces boulardii is is one of the most important ways to rebuild and build a new ecology system in our microbiota. Okay, thank you. That's very precise.

Um, here you have him, um, on the skin. You see that these large folds, that's lack of growth hormone. And he's missing some thyroid hormones because here it's a little missing. And there's also very small, little folds. So you probably have a low vasopressin. One of the worst problems with aging that most frequent also is that many people who are aging have to go to the bathroom often. They have to go to the restroom, urinate and urinate. And so at night, I sometimes had patients having to urinate nine times at night because of this lack of vasopressin. So you can correct that by giving vasopressin or synthetic derivative, desmopressin. You see also that eyes are deep in the orbit. So this man is profoundly dehydrated and needs desmopressin next to the growth hormone. He also needs growth hormone, testosterone, because at age 48, almost no man has enough testosterone compared to age 25. With being very careful that he doesn't get acne. So we need to be a little careful there. And you see also that these lunulae lines on on the nails is typical for low growth hormone. And if I look at the hands, you see also the skin is peeling off. That, um, maybe you can, uh, comment more on this, uh, skin that is peeling off like this. I don't think it's sunburn. Um, but you see here also skin peeling. When I see this, the two main hormones that improve the skin is, uh, thyroid hormones and cortisol. And I don't know always why, but it does really this thing. I'm almost sure it goes away when you put this patient on this treatment. Of course, I check my deficiencies with lab tests and things like that, which I don't have here now.

You look here, the hand looks also a little bit yellowish. So it's accumulation of beta-carotene, provitamin A, and that is not converted into vitamin A enough. And that's typical for low thyroid function. You see it looks also yellowish here, yellowish skin, accumulation of beta-carotene. He also eats therefore a lot of, I would say, um, beta-carotene containing foods like avocados and papaya or other foods that have or carrots. That's almost sure. You see also these nails here that have lines, low growth hormone. And this peeling off skin, um, that can be, I believe, corrected by, uh, correcting the food intake, the microbiota, and certainly also the hormones, especially thyroid. You see also here, um, it's getting a little fatty here. So it can be due to a lack of, um, testosterone or growth hormone. Little, little fatty, but not very. He doesn't have so much muscles. So it's maybe lacking testosterone for a man. And that's it, I would say. So you see also sort of lordosis that is stronger. You find that more in thyroid deficiency. I would say he needs thyroid hormones. He needs probably to be checked for the adrenal hormones. And he needs some, um, testosterone and growth hormone in this case. It looks older on his face than he looks on his body. And you see it here. And when I suspect like wrinkling like this, I always think that belly is bloating. It's not so much bloating here. It is a bit, but not much. But he must have some times where he bloats more. He eats probably in the evening proteins because it's swollen above the belly. So that should be asked to switch more to protein intake in the morning rather than evening.

This is, um, again, a case. This is, this is a case we, we see very frequently in our consultation. Women with very low libido, no sex drive, and cysts on her breast, very tired from childhood, no energy from childhood, lack of motivation, endometriosis, gastritis with treatment against H. pylori, tonsillitis, otitis. Means she had a lot of antibiotics during her childhood. And right now, she has a problem, name in the molecular knowledge, a mole, a problem in in the molecular mimicry. Why molecular mimicry? When we are talking about libido, because the molecular mechanism related to carbohydrate mimics involved processes where peptides or other molecules mimic carbohydrates in interactions with cellular receptors or antibodies. Means right now, we are talking about receptors. This mimicry can be crucial in various biological context, influencing cellular responses and signaling pathways. This is, this is very important because we think the problem could be just the level of hormones, but sometimes it's the way to these hormones to act in the receptors, in the cellular receptors. For that, the studies have dealt into the structural basis of the peptide-carbohydrate mimicry because it's an interaction between peptides and carbohydrates, highlighting the intricate molecular recognition processes involved. When a peptide mimics a carbohydrate, possibilities to improve our molecular mimicry, improving our cellular responses and the responses of, of, uh, biological responses of all our patients.

Okay, um, here, of course, there are a lot of, uh, things that make you think. There are still hormone deficiencies. All these symptoms here are typical for low testosterone. And this patient or physician should be, uh, take an intramuscular testosterone injection once a month, something like 50 to 70 milligrams per day with enough female hormones to counterbalance with maybe finasteride, which is a blocker of the conversion of testosterone to dehydrotestosterone. The woman doesn't virilize, but she can have an amazing result. This is a person, patient who is typically, in a certain sense, collapsed. And this intramuscular testosterone treatment makes wonders. The body gets firmer. It's very good for the arteries. The higher the testosterone levels are in women, the less atrophies they are. With this injections, the levels are higher than the upper limit, but it's worth doing because you don't get any side effects. If you're, uh, able to add here finasteride, which is a blocker of the conversion of testosterone to dehydrotestosterone, like maybe five milligrams in this case for, uh, the dose I propose of 70 milligrams, 75 milligrams of testosterone enanthate, that's the best, or cypionate once a month. That will be amazing.

Now, the problem is, she does a lot of cysts. So to, uh, reduce and make disappear the cysts, it's possible to put iodine, 5% solution on the breast during a year, year and a half, and it will go away. The cysts will disappear. It blocks the proliferation of new cells, and all cells die out of the cyst. So the cyst disappears. Even if you have the severe endometriosis, more complex, in my experience, is due to inflammation of the bowel also. So you have to calm down the bowel, improve the bowel, maybe go to Colombia to get your bowel checked and improved by John. But basically, next to better food intake, microbiota and improvement and gut, you there's generally low cortisol, low testosterone. So they don't ovulate well. And there must be a balance that has to be changed. It's not so difficult, but there's a lot of progesterone to give in these patients within the endometriosis. When you give them, so the progesterone she's taking is probably not enough, but it's a slow release form. So maybe it works better. But slow release forms of hormones, you only absorb half of it. So you probably need to take more than double dose to get enough. DHEA is extremely little, and testosterone increases cysts and gives breast pain because it converts a lot to estrogen. So again, you need an action of, I usually always use bioidentical progesterone, but in this case, I would use, what we have here in Europe, and I think also in Latin America, is dydrogesterone or defaston, that has a 24-hour action. It decreased the breast cancer risk by about 26%, so it's very safe and it helps. So you need, in this case, exceptionally a synthetic derivative that stays long in the blood. She takes a lot of good complex. I take also prodomgia neuro for my brain, and I can tell you my memory is extremely short. So she's really helped consciously. But when we look at her, so let me see her age again, 56 years. She looks quite firm for her age. There's little lack of growth hormone. There's probably some adrenal deficiency here. The hair is flat, so there's not enough estrogens. But if she has more estrogen, she gets more intramural fibrosity. That's why you need a much better progesterone for this woman that will permit her to go on high amounts. You see this body is not tonic enough. That's typically when people are lacking growth hormone. Also, the eyebrows are thin. That's not enough. You need to improve that with the hormones.

Okay, so we look here at the face. You see these lines. If I do mesotherapy here with injections of growth hormone, IGF-1, this reduces by half. And if you have a treatment from inside, it keeps on during six months. So each time you inject, you can reduce it by, let's say, 40 to 50%. You see also that the skin, it maybe sometimes a little fatty. So you have to be careful with testosterone, but it can be due to low estrogens. And she's low estrogens, but so, so it's, it's not so difficult to treat her. But again, you need a good progesterone that stays 24 hours in the blood. And the micronized progesterone, the bioidentical, the natural one, says 16 hours on 24, so it's not enough for this patient. Also, there's a sharp wrinkle here, makes us think there's a lot of, um, lack of water in the body. You see sharp sunken eyes in the orbits. It means low vasopressin. You see also that this is a little weak here, so the skin is thinner and not elastic enough, low growth hormone and low IGF-1. There's a difference between IGF-1 and IGF-1. IGF-1 thickens the skin much more, and growth hormone gives elasticity to the skin. So you need at a certain age, I take at my age both of them. You need both of them to reverse what you see here. The eyes, they look to be well hydrated. So I wouldn't say there would be estrogen deficiency in it. There's some blood vessels in the sclera, the white area. That's a sign of vitamin B2, B6 deficiency. So it could be that this woman is not eating enough red meat, for example, or meat in general, because there's a lot of vitamin B in it. And she should take a supplement of vitamin B. You see also these darker spots that are irregular, adrenal deficiency. Many people have adrenal deficiency because I believe that our life and our food is so stressful that the adrenals don't work enough at a certain, at certain age. So it's not a wonder. This looks slightly swollen, but I'm not 100% sure. And that could be due to low thyroid hormones. You see also these little folds, certainly lack of vasopressin. The larger folds is lack of growth hormone. So most of that is reversible or at least improvable. You see also here the skin, it's little droopy here. Droopiness of the belly. It's not, it's almost sure lack of growth hormone. That's that's sure. There's some more fat here. And you see also the skin is a little thin. So I don't think she eats so much vegetables because there's looks like it's lack of omega-6 fatty acid deficiency. Also a little bit more yellow, so some thyroid hormones may be useful. So it's normal that at her age or above age 40, many people are multiply hormone deficient because the glands don't stay stable. Even with a good microbiota, with my good microbiota, you can improve the situation, but sooner or later, you, the glands here and where and and there's a little problem here, uh, that has to be treated here. Same, um, I'm not sure about the quality of the picture here. The hands look quite tonic actually here.

And so I'm going to let 10 minutes here for, um, uh, another speaker, Mano from Canada, who's going to, um, talk. Mano, are you there? Yeah, I'm here. You're going to talk about melatonin and what it does on the cream. If it can be very practical, would be good. I think it will be practical. We hear you. You can hear me. Yeah, it's good. Okay, very good. So it's like a quick 10-minute presentation that I thought could be interesting because, of course, as we know, with the aging of the skin, if we look from the inside out, we know that we have a lack of fibroblast activity when we're older versus when we're younger. And the, what I would like to address the most is melatonin and the melanogenesis process. What happens is that, and this is some, some new discovery that we need to, uh, be mindful of, and more and more publications. That we know that, uh, we know that, you know, as far as the decline, when we talk about hormonal decline, that melatonin is also in the decline. And we kind of put it a little bit on the side. And I know you, uh, talk a lot about it, but it's incredible that we always think that, oh, it's produced by the pineal gland, but in reality, it is actually produced by our melanocytes as well. Of course, we need to be mindful of the skin and the impact of the skin. So this attribute, uh, concern and a discovery at the same time of the benefit of using, for example, melatonin topically. Uh, so by working, uh, with the melan, understanding the melanocyte, melatonin, sorry, is you understand that the dendrites here that distribute evenly the normally the pigmentation, in this case, will actually be hardened in time, and become, and this will affect the entire, you know, the entire process of aging. And of course, oxidation will take place. So I'm not going to go in detail about, you know, the difference between intrinsic, but let's look a little bit at quickly at the genetic versus, you know, what we can do as a lifestyle, uh, changes as an extrinsic aging. We talked a lot, and you, you did an amazing presentation, both of you, talking about the oxidative stress and how actually could impact the skin, but from inside out. Let's not forget the damage of UVA and how actually we can actually be, uh, interfering with UVA, and we know how damaging and aging it could occur to the skin. But just a quick side note, it's interesting based on, uh, body type evaluation, so personalization of aesthetic medicine, looking inside out. The body type based on your bone, your muscular system, and how it actually impacts on your skin. And I wrote a book many years ago, that was endorsed by both Robert Goldman and Michelle Delon, the American Academy of Anti-Aging, as well as Robert Goldman from the American Academy of Anti-Aging. And it's all about how we can actually classify and how you can actually make a difference in aging based on your body type. So if we take the ones that are more ample genetically, due to their genetic heritage, we'll have maybe a predisposition to cardiovascular disorder, we'll have a predisposition to rosacea, cellulite, everything to do with vascular. So if we know this in advance, we will treat the skin. And I love how, uh, Dr. John actually emphasized and said, there'll be different cocktails because of course, if you, you know, if you have a body type like this, whoops, versus a more of an ample type, you will treat it differently. So this type, the ample, will have more predisposition to rosacea, wherein actually when you look at their skin, on their normal eye, you see that there's no problem, but there's a development of telangiectasia taking place. So she will be predisposed to rosacea. So in one minute, I would say UV protection, mineral sunscreen. But it's quite amazing to see that there's a lot more cases of osteoporosis in North America because of the SPF. You know, majority of them use UVA UVB filter of 50. So we say use a 30, use a mineral form. And then if you have an angular type, that means you don't, you know, genetically speaking, with your genetic heritage, muscular and bone structure will be more angular, more, you know, petite. Your feet and hands always are cold, for example, thin waist, you can see straight shoulder. This particular body type predominantly, you know, you said that their nervous system is super solicited, their parasympathetic nervous system in the skin. We know that they'll develop a thicker epidermis, you know, a poor connective tissue, less collagen, aging faster, melasma, hyperpigmentation, and a fibrous cellulite. So the angular type is an interesting concept because yes, they will develop that thickening of the skin, and the skin cell turnover will take a lot longer before it actually turns over. And they will develop photoaging, I mean, aging of the skin. And their melanocyte will not be as functional. Therefore, the melanin, sorry, the melatonin content that is necessary for the oxidative stress throughout our metabolism or melanogenesis process and our skin, a good microbiota, and all function of the skin immunity will be affected. So this is why it's important to take all of this into consideration and all about personalization. So in conclusion, let's not neglect melatonin because yes, it could make a difference in your skin. So antioxidants topically affecting your melanocytes, but you need to get down there. So how do you do it? So to prevent the rosacea, there's so much publication out there that you can read and have an amazing time seeing the amount of impact of melatonin into the skin and how we can actually do prevention of skin cancer. We can prevent oxidation of the skin and also the formation or the damage of our cells. So it's, we see it in the skin. We know that it's actually synthesized from serotonin, and it's an enzymatic reaction, and it's not just produced by our pineal gland. So knowing this, it's quite nice to say, okay, what choices do I have? So some publications say, oh, we need 0.5% to maybe 0.3%, and some recent publications up to 12 and 15%. What is the right source? My answer to this would be, do your analysis. We research in laboratories for a long period of time, and we know the combination of certain oils put in the right system, as long as you reach into the basal layer where your melanocytes are produced to make a skin change, to prevent aging of the skin, to prevent oxidization. So I thought this would be just a good highlight for you today. Okay, so we'll go to the question and answers. Thank you, Mano. Um, I think if there's a question on your presentation, you will, uh, be able to give the answer, but we're going to give more chance to John to answer, and then maybe to me for the medical part. Okay, thank you for this present. Just, um, in my experience, melatonin works for everything. Even I had a, um, my sister-in-law, who is the twin identical twin sister of my wife, had skin cancer here. We put here melatonin here on the skin, and it was in a week's time or 10 days' time, reduced to one-third of the volume with the skin cream. So it really is helpful. It was just a small cream, but it was extremely helpful. So it was amazing. So she didn't, she didn't want to have a scar, so she didn't have a scar because it was so small after just a week or 10 days. Okay, let's go to the questions. I think we have question and answer. There's here Jabba says, when a woman takes DHEA and progesterone supplement and have, and it causes hair loss, how to stop the hair loss when they were taking supplements of DHEA and progesterone, especially if she wants to make a baby? It's not the progesterone, it's the DHEA that can give hair loss in women, and it's usually caused because there's not enough female hormones. So what I usually do is I make them stop two months, then take again half dose of DHEA, and be sure they have enough female hormones. I don't give DHEA without female hormones to women. Also in the premenopause, there are some questions about hormones here. I have a question that I think John, you can answer. Do you recommend more antibiotics to treat more dysbiosis along with probiotics and the other things you mentioned? I, I don't think you, no, in fact, we don't need to use antibiotics to treat dysbiosis. These dysbiosis, we can treat stopping the oxidative storm and doing in the same time probiotics because the probiotics have a strong capacity to produce new molecules against the bad bacteria inside, inside the intestine. So, and these good molecules are very specific, not as an antibiotic, is a wide spectrum, is against all of my mes, all against all of our bacteria. No, our probiotics, they produce their own molecules against specific bacteria inside our ecology system in our gut. So you don't do like certain nutritionists, they give sort of plant antibiotics like cistus or oregano or things like that. You don't do that. You give other molecules, or you also do some sort of plant antibiotic, or only probiotics? You do, oh, we use probiotics and antioxidants in different cocktails, in different contexts. It depends on each questioner, in our patients. What about ammonium lactate? Is it useful for mucous membranes too? No, unfortunately, it's just, usually, you know, ammonium lactate is a very old molecule, and today it's not famous because it's very cheap, and the pharmaceutical industry, they have a lot of different new molecules, very expensive. But ammonium lactate is a very old molecule, very useful, and I think I am the only dermatologist in the world using it. Okay, good. Um, at least we, we've learned that extra. We only have 10 minutes apparently for questions. There was some pressure. And, um, so answer your question. I noticed this patient is taking iodine 300 micrograms per day. Is that contraindicated in Hashimoto's thyroiditis? It could be part of what triggers skin problems. I don't think so. Normally, that iodine microgram can be, some people have allergies. So it could be a good idea to look and to stop iodine 300 micrograms in patients with, in the beginning, with the skin disorder, the rash that we saw in Hashimoto's thyroiditis. But, um, there are studies showing that iodine can trigger Hashimoto disease or decrease it. So there's some non-uniformity to it. So I, I think by treating the microbiota and giving the treatments that take out the Hashimoto disease, there will be an improvement of skin too. Typical treatments are high-dose selenium, high-dose vitamin D, and myo-inositol, and some hormone treatments. Let's go further. Is there any relation between Hashimoto, microbiota, necrosis, necrobiosis lipoidica? I don't know if you're familiar with it. Let's, let's go over the question. How to increase cortisol and how to increase IGF-1 by either giving supplements or eating better? [Music] [Music] See that that is a possible molecule to don't make a big damage again, you again your skin, but the good advice is don't use soap anymore, just water, just water. What is your normal value for IGF-1? You can find that in my books. Basically, for a woman, it's around 280 micrograms per liter. But it depends if she's tall, she needs higher amounts. If she's small, she needs smaller amounts. How to repair a skin after cortisol stop because the cortisol thins the skin too much? Well, you need to give anabolic hormones. If you give anabolic hormones, you have good food, it's better. It's also interesting that the higher the cortisol dose, the higher DHEA dose you give, the less tendency there is to wasting. So you can give high amounts of cortisol with high amounts of DHEA, blocks completely. So that's okay. Can you give advice how to treat pityriasis rosea? You can use ammonium lactate, it's very useful for that. You have to change your skin microbiota, and you can take vitamin A to help in the treatment of pityriasis rosea because it's a problem in the cornification of the skin in the last level of our skin metabolism. Okay, is a question maybe more for me. Would you start growth hormone in this patient from the beginning of the treatment plan? I would start growth hormone. I start growth hormone almost immediately in my patients, but always I give them cortisol if they are cortisol deficient. So I'm careful, being careful. Otherwise, it's not advisable. You start then growth hormone later, maybe six months later, in very small dose, if you don't connect the adrenal deficiency. The second patient is there also a liver gall bladder, probably giving his oily skin and hair. What would be your suggestion, John? I don't remember. Second, I don't remember. Okay, so let's go on. Maybe one more question. Can you please please repeat eyebrow sign that is low testosterone? That's inner side. But this, I have enough testosterone because my inner side is okay. I, that's so in eyebrow loss is lack of growth hormone. Lack is in the middle. And thyroid is, I'm not sure about the question. It's in Spanish. Maybe you can translate. So vasopressin, a hormone, you can take it lifelong if you have lifelong deficiency. And usually have lifelong. You can always stop after one year or six months or two years, and then you come back to the state you had before. You won't be worse. So you can safely take a hormone if you're in a safe dose and then for a while, and then stop it. Generally, you need to continue keeping the effects. You need to take the hormone. What types of exercise that help microbiota? Do you have all, all kind of exercise, but especially the strong exercise with with heavy, the first, I don't know how to say, resistance, resistance, okay, resistance. This is the more useful. There's a question in French. Can growth hormone be found in the food? In which foods? No, it cannot be found in foods, or you have to eat pituitary glands of animals, but then it's not so well absorbed, so it's digested. So you have to inject growth hormone. That's the only way it works. Okay, that's that's it. Thank you for now. My question now to you, do you see the difference between hyperpigmentation due to sun exposure and low adrenal function? Do these pigmentations look different? And if yes, no, not in my experience. It's the same. It's mostly people with adrenal deficiency, Addison's disease, that get those hyperpigmentations due to the sun. Of course, if you have sunburns, you have areas of no pigmentation and areas of pigmentation. It's a little different, but basically, there's very similarities, and it's mostly people with, uh, low cortisol to get most of this, uh, bad skin due to the sun. What probiotics specifically do you recommend? I think you told it Lactobacillus, but yes, but I have to say, probiotics is like antibiotics. You know, you have to know when and what kind of illness do you have to make the right prescription. It's not take probiotics like that. No, no, no, no. Anyway, you are very welcome here, but we are going to do and to speak especially in that world because it's an amazing, a new world full of different possibilities, but it's not so easy, is not so simple, but you have to know how to do it. Maybe one last question for you. Do you test SOD, superoxide dismutase, in blood before or not? No, because we, for that, we made our questionnaire where our questionnaire is more, is very, very precise to make what happens inside your body. And because the SOD is inside the cell, it's quite difficult to make a measure of the levels of SOD in blood. Okay, thank you. Thank you. Um, I'm going to show some other slides. Let me see here. Um, so just for you to know is that for, um, physicians who want to have training or even also, I would say, uh, there's a training program for physicians and also nutritionists that can be followed. So let me see if I can take that out. And, uh, there's a Cycle One of Evidence-Based Hormone Therapy. Very good training programs in video online, and also Reversing Physical Aging, that is the most sold model actually. Female Hormone Supplementation, Chronic Fatigue and Burnout Diagnosis, Melatonin, Testosterone Men, Testosterone Women. So there are seven models of the Cycle One. They are available in Spanish, and they are, I think I can say they're very good. You also have a second, where I would advise those who would start hormone therapy to follow this course. The Hormone Therapy Consultation, very complete. The Adrenal Hormones, where you get all the information. Psychological Disorders and Hormone Therapy. Longevity for people who want to live long. But very, very good courses. There's much more than three courses here. There are actually, I think six courses. There's a little error there. There are six. Sexuality, which is very good. And Oxytocin Treatment, Obesity. I'm just working on it. And I have also books. The latest book is Growth Hormone Treatment for Adults, that is, I think, everything you ever wanted to know to reassure you, but also to treat efficiently with growth hormone treatment. Hormone Handbook, which is the basic bestseller actually in hormone therapy. Atlas, the Testosterone Book. Reversing Physical Aging was interesting with a very, very big textbook with before and after pictures of what happens on the hair, the face, the senses. And here are all our sponsors that we are very thanking that they help us to disseminate the information by sending to the data bank the information. So that's really good. Um, and this is Neva Divers, products of Mano. And here is if you want to contact us, here you can reach this. You also have on the internet, John Gavier. Um, I think he has an internet, he has also website on Instagram, and he has very good lectures too. So please follow again. And then I want to, if you want updates, if you want to re-register, you can do here. I want to let, um, Manu, Emanuel Deni, give maybe last word to, uh, tell Manu, are you there? Can you give this last? Yes, thank you. Thank you very much for this very wonderful. Mano, am Mano. This was the gathering of two big names and shots that are very close to you doctors. We're very thrilled as a group together with Biso from the part of Latin America to give you more data. A lot of people were asking where the replay will be available. So be stay tuned because between emails and a lot of contacts, you will get the replay very soon by yours in the language you prefer, either French, Spanish, or English. So be stay tuned with us. And also, there's a lot of congresses. You will participate. Tii and John, could you mention some of them where you're going to be present at and lecturing in addition to your courses, books, and webinars? Well, I personally am going, or maybe John, maybe could first talk. I'll be in Santiago, Chile, in April, in the Congress of the National Society of Dermatologists. One week after, in Buenos Aires, in a special Congress to talk about SOD, superoxide dismutase. And in Cancun in September for a Latin American Congress of Dermatology. And in Cartagena, Colombia, in the Congress of the All Association of Dermatology, National Associations of every country in Latin America and Spain. Cat, when you have time to sleep? John, not much, I believe. No, because you work full time also in your office. So, um, I will be, I have the pleasure to give a workshop of two days in Frankfurt on the 20th and 21st of April. You can find that on our websites. Um, and I will be also on the A4M, that's the biggest American organization for anti-aging medicine. It's called more longevity medicine now, so we're changing the name. I'm giving also several lectures there, also some basic hormone therapy and and some very, I always give a cutting-edge presentation on growth hormone in this case. And then I will be probably also in December in Rome. And I have other things that I think Manu, you proposed that we would come in, I think it's Mexico in a Dermatology Congress around the 20th or 21st of October. So there are a lot of exciting moments. Then Cosmética, indeed, in October, this side of the world. This is very impressive. Thank you. We really hope because a lot of doctors are asking more and more Q&As. We took note of those and we will try to answer one by one because I'm sure there's a lot of interest. And I wanted to thank you both of you guys and the technical team and the translation people who were very, very connected today and helped making this translated in the right language to get the right information. So hopefully, this is not the only one. This was the first one, but we will be very glad to foresee more collaborations between parts of the world and getting from one side or to the other, from the hormones or the skin to the same conclusions, helping patients feel and live better. Thank you. Thank you, Manny, for your cooperation. Thank you, Mano. Thank you, John. Thank you, Gia, and other translators for the fight job. Bye-bye. Goodbye. See you soon. Gracias, John.