Addressing the Gut-Skin Axis: A Root Cause Approach to Chronic Skin Conditions

In this episode of New Frontiers, Dr. Kara Fitzgerald sits down with Dr. Valerie Gershenhorn, a leading expert in functional dermatology and a Clinical Team Member for Diagnostic Solutions Laboratory, to explore the profound impact of the gut-skin axis and autonomic nervous system on chronic skin conditions like acne, eczema, and more. Dr. Gershenhorn shares her comprehensive approach, including the use of functional testing, targeted nutrition, and specific supplements to address the root causes of skin issues. Clinicians will gain valuable insights into how gut health influences skin conditions and practical strategies for discovering imbalances with GI-MAP testing, and how to correct these findings in clinical practice. This episode is a must-listen for those looking to deepen their understanding of the connection between gut and skin health. ~DrKF

In this episode of New Frontiers, Dr. Kara Fitzgerald sits down with Dr. Valerie Gershenhorn, a leading expert in functional dermatology and a Clinical Team Member for Diagnostic Solutions Laboratory, to explore the gut-skin axis and its profound impact on chronic skin conditions like acne, eczema, and more. Dr. Gershenhorn shares her comprehensive approach, including the use of functional testing, targeted nutrition, and specific supplements to address the root causes of skin issues. Clinicians will gain valuable insights into how gut health influences skin conditions and practical strategies for discovering imbalances with GI-MAP testing, and how to correct these findings in clinical practice. This episode is a must-listen for those looking to deepen their understanding of the connection between gut and skin health.

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Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. Of course today is no exception. I am excited to have this opportunity to learn from Dr. Valerie Gershenhorn. I’m going to give you her background. The topic is going to be extremely interesting to you. I think we’re going to be shifting our framework a little bit today. But first, her background, and then we’ll dive right in. Dr. Gershenhorn is a clinical team member for Diagnostic Solutions Laboratory. She attended New York College of Osteopathic Medicine, where she graduated in the top 5% of her class. She then went on to complete an internal medicine residency at Mount Sinai Beth Israel in New York, where she became chief resident. After staying on for a chief residency year, she earned board certification in internal medicine. She then completed her dermatology residency at Lehigh Valley Hospital and earned board certification in dermatology and she’s been practicing dermatology since 2006. Dr. Gershenhorn feels aligned with integrative dermatology because she believes that the skin is a “check engine” light for what’s happening in the body.

Dr. Kara Fitzgerald: I love that—the skin as a “check engine” light. Welcome, Dr. Gershenhorn, to New Frontiers.

Dr. Valerie Gershenhorn: Thank you so much. I’m so honored to be here. Thanks for having me.

Dr. Kara Fitzgerald: We’re going to be doing a deep dive into the gut-skin axis and really, I think, learn a lot from you and your perspective. We were dialoguing prior to me hitting the record button and I could tell immediately that this was going to be an opportunity for some expansion of my thinking, especially with you really deep diving into the gut microbiome and skin conditions. So let’s just start, first of all, with how you assess somebody with a skin disorder. How do you think about it?

Dr. Valerie Gershenhorn: Yeah, it’s a great question. So I want to give you the big picture, like zooming out a little bit. The skin is arguably the largest organ of the body. Some people say the extracellular matrix and the lymphatic system are.

Dr. Valerie Gershenhorn: But let’s agree with the concept that it’s one of the, if not the largest, organ. But if we look at our organs and organ systems, they’re all made of tissues, and these tissues are made of cells. So if we really want to look at somebody in the true picture of optimal well-being, it should be on a cellular level and even more granular, on a mitochondrial level. The mitochondria are in every cell of our body except red blood cells. They’re the powerhouse that makes energy and helps us to facilitate all of the reactions that happen on a second-to-second basis. So I try to look at somebody that walks into my office on a holistic and yet cellular level. We have systems in our body that are drainage pathways. We have the colon, where we excrete bowel movements, hopefully 1 to 3 times a day. And then we have our liver and bile duct system, where we have detoxification happening in phases one, two, and three, where we’re excreting.

Dr. Valerie Gershenhorn: And we have our lymphatic system, which is like the sewer system of our body. We have our lymphatic system which will drain toxins while we sleep, specifically from our brain. So we have all these systems, and I like to look at people in the context of how these systems are functioning for them. I always ask questions about their detoxification or drainage pathways. For the colon, are you having 1 to 3 bowel movements a day? When we were in medical school, we learned it’s okay to have a few a week, but just because it’s common doesn’t mean it’s normal. If we’re not getting rid of toxins, then we’re recirculating them through the body. I have a multitude of screening questions I ask about their colon health. Are they bloated? Do they have gas? If they do, that could be a digestion issue, and we want to really look under the hood at their digestive markers. We look at their liver, which has 500 jobs, one of which is to take glycogen and break it down into glucose.

Dr. Valerie Gershenhorn: So if they can’t fast without getting irritable, if they can’t metabolize their caffeine or alcohol well, and they get jittery or easily hungover, these are screening tools for me. The truth is that our blood work, although valuable, sometimes misses that window. When we see parameters that are out of normal in blood work, we may have really exceeded the time in which we can help people in a preventative and more proactive versus reactive and reductionist way.

Dr. Kara Fitzgerald: And what about lymphatics? I mean, what kind of questions do you probe?

Dr. Valerie Gershenhorn: Yeah. So I ask about excessive cellulite. Do they have lots of cysts or lipomas? What I’ve learned in the root cause world is that our body is magnificent and always working for us. Sometimes we might feel a mess, but the mess is really a message that we need to look at the real story behind it. When people cannot get rid of toxins through their lymphatic system, sometimes I’ll see they’re getting lots of lipomas or cysts and have lots of cellulite.

Dr. Valerie Gershenhorn: They have lots of swelling. They wake up puffy. What I see a lot of with lymphatic issues is post-surgery. If people have had surgical procedures, we know that scars will disrupt the movement of the extracellular matrix through the fascia. There is a technique I’ve utilized and learned called neural therapy. It’s a 100-year-old therapy started in Europe and it uses procaine, a local anesthetic. You inject it into the scars. People who are far more experienced than I, and have been doing this for three decades, are using it for more chronic illness, even cancer. But I use it in my office as a scar therapy. If there are scars, we inject the procaine, which helps to open up that circuitry and allow for better flow. It’s amazing for the parasympathetic nervous system. I have patients that come in and say they’ve never felt more relaxed. What I want to add on that I missed, is that even before talking about that drainage pathway, I ask, how is this person’s autonomic nervous system? Are they always in a fight-or-flight state where they can’t heal? Are they in a freeze mode where they just can’t get out of whatever trauma, emotional or physical, they’ve suffered? Because we can never heal a body that isn’t in a more balanced autonomic nervous system state.

Dr. Valerie Gershenhorn: So that’s a really important factor. And that’s where neural therapy is really a beautiful remedy for me. The lymphatic system is so important and it’s often missed. I find a lot of my young women with cystic acne, sometimes their gut testing comes back pretty good, yet they’re terribly constipated. We move the needle when we address their lymphatics, helping them have better bowel movements through methods like rebounding, dry brushing, infrared sauna, or castor oil packs. These approaches add a beautiful dimension to the healing modalities.

Dr. Kara Fitzgerald: Interesting. That’s super interesting. I’m just taking some notes, if you see my head drop down.

Dr. Valerie Gershenhorn: Yeah.That’s great.

Dr. Kara Fitzgerald: That’s really interesting. So, first of all, let me just ask you, and then I want to ask a couple of clarifying questions. When somebody comes into your office with a skin condition, which I’m assuming the majority do because you’re a dermatologist, are you immediately thinking: A) They have some type of autonomic nervous dysregulation. Do most cases present that way? And B), Some sort of drainage issue or detoxification imbalance? Are these two foundational pieces that most people presenting with conditions like cystic acne in premenopausal and adolescent years or classic eczema or psoriasis might be experiencing? Do you think these foundational pieces are playing a role in the majority of cases?

Dr. Valerie Gershenhorn: Yes, I am. There are always going to be outliers where their autonomic nervous system, no matter how many questions I ask, they haven’t had childhood illnesses or trauma, whether it be “little t” trauma or “big T” trauma. We all go through things. It’s not that I’m looking for the major trauma points. So there are these very rare cases where they don’t seem to manifest that, at least the first time I ask. But for sure, drainage is almost always a factor. Someone usually has something with their colon, and if that’s the case, we typically look upstream to the liver and then the lymphatics, which can affect the skin.

Dr. Valerie Gershenhorn: So, yes, I definitely feel that 99.9% – 100% have drainage issues, and maybe close to 98 to 99% have some sort of autonomic dysregulation. They carry emotions heavily and struggle to move on from things. We’re living in a world where there’s so much toxicity, not just industrial chemicals but also emotional toxicity. It’s a highly emotionally driven era that we are living in right now and people carry that, which manifests physically for many.

Dr. Kara Fitzgerald: Yeah. Okay. We’re going to touch on some cases eventually, and I want to see how you apply this framework in practice. I can imagine some of my patients— I live just outside New York, here in Connecticut, though I’m in Mexico a lot of the time. Here in Connecticut there’s a very different personality type who might not be inclined to do inner work to get rid of their eczema.

Dr. Kara Fitzgerald: You know? And one of the things I’ve found is that inner work often comes after we’ve addressed everything else. They may eventually surrender to the idea that their constant stress state is preventing them from achieving their final goals. They are very goal-oriented, so doing that inner work often happens eventually.

Dr. Valerie Gershenhorn: Absolutely Kara. I agree with you. I try to meet people where they are. From the first conversation, I can intuitively sense certain people’s energy, but I meet them where they are because I don’t want them to think that this is something unattainable or unsustainable. We plant the seeds with those conversations. To be honest, we wouldn’t be where we are if we weren’t driven, Type-A personalities.

Dr. Valerie Gershenhorn: And yet, I know where I need to work harder, such as sitting down and taking time to eat instead of eating behind a desk while doing charts. I know that. That’s why my patients are my greatest teachers because they show me what I need to work on. I have compassion and empathy, and I aim for 1% improvement every day. That’s all I ask for. The action steps are long, but they don’t need to happen all at once because there’s no finish line. Every day, I work to repair what I need to repair from these 51 years of life. I completely understand and do meet people where they are.

Dr. Kara Fitzgerald: I like this framework. It’s interesting to me, and I’m excited to learn more. You’re at Diagnostic Solutions, and as a clinical team member, I’m sure that you’re a really valuable member of the team over there. I know all of them.

Dr. Valerie Gershenhorn: There are a lot of brilliant people on that team.

Dr. Kara Fitzgerald: There’s a lot of brilliant people. Yeah.

Dr. Valerie Gershenhorn: I’m learning from them. They are really unbelievable.

Dr. Kara Fitzgerald: But you’ve got something cool to bring to the table as a dermatologist. As I mentioned offline, I teach at the Institute for Functional Medicine and specifically address conditions like eczema, among other things. I consider a handful of cases with skin disorders that I’m thinking about. I know and acknowledge and talk about there being a gut connection. Certainly we see eczema rising in individuals exposed to lots of antibiotics, and we know gut damage and dysbiosis are part of the puzzle. We know that their skin microbial imbalances are also a factor in the pathogenesis of these conditions.

Dr. Kara Fitzgerald: Not just eczema, but really all skin conditions. I acknowledge that I’m aware of it and perform stool testing on all my patients. However, I have this broad stroke understanding. I believe you’re about to teach us more granular information that could be potently actionable. So let’s discuss common skin conditions like cystic acne, or acne in general, eczema, which is ubiquitous, and psoriasis, which can be super challenging to resolve. Let’s talk about what we’re seeing on the GI-MAP and how your approach integrates with this information. And then we’ll take it from there.

Dr. Valerie Gershenhorn: I love gut testing, and it’s my first functional test of choice. For acne, I frequently see H. pylori, or Helicobacter pylori. As we know, this is a gram-negative bacteria that can wreak a lot of havoc because it resides in the gastric mucosa, which is a very hostile environment. It can cause a lot of disruption and creates urease, which is an enzyme that buffers stomach acid.

Dr. Valerie Gershenhorn: And in doing so, there is hypochlorhydria, and we can’t properly break down food and absorb the nutrients needed for cellular mitochondrial function. This can lead to downstream digestive issues like low elastase and high steatocrit, which affect their downstream digestive markers. If we can’t digest that food and it’s sitting there in our stomach like an anvil, we are going to have symptoms and lack nutrients to absorb. This creates a more hospitable environment for parasites, which can show up for these acne patients, as well as candida overgrowth. I’m seeing a lot of that together.

Dr. Kara Fitzgerald: Can I walk through real quick. I just want to get some definitions. For acne, you frequently see H. pylori. Do you see H. pylori with virulence factors, or is it present with or without them?

Dr. Valerie Gershenhorn: I conduct my own tests for my patients and assist practitioners. The virulence factors I often see are virB and virD, which are not particularly virulent unless you have cagA. So, for me, that’s what I’m seeing. Again, I haven’t been on the team for years and years, so I’m sure others have seen more virulence factors, but I haven’t encountered them much.

Dr. Kara Fitzgerald: So, just the presence of H. pylori is cluing you into a probable underlying cause of the acne.

Dr. Valerie Gershenhorn: Yes. There was a study involving 100 patients with acne vulgaris and 100 healthy patients of the same sex and age. When they measured fecal H. pylori antigens and serum H. pylori antibodies, the study found that higher levels of these indicators correlated with more severe acne. The severity was categorized as mild, moderate, or severe, with higher levels of fecal antigens and serum antibodies corresponding to more severe acne. So yes, I’m seeing that. The way that I was mentored with Dr. Julie Greenberg through her root cause mentorship, is that any level of H. pylori should be addressed, not just high levels. That is what I’ve used as my template and it’s really been successful for me because H. pylori causes so many downstream effects.

Dr. Valerie Gershenhorn: So if you were to look at the GI-MAP, and you look at the commensals, or the good bacteria–

Dr. Kara Fitzgerald: Before you jump into that I just want to clarify for everyone. So, elastase– Just define that and then steatocrit. We’re mostly talking to clinicians here, so they know. But you’re really seeing this cascade of events where H. pylori is present and it’s shutting down adequate stomach acid, which may or may not be symptomatic. It’s a thing, even if it’s within what the reference limit of the lab would consider okay, it’s significant for you. And this is having this downstream cascade on elastase and steatocrit. Please define that and then discuss what you’re seeing on the rest of the test.

Dr. Valerie Gershenhorn: Absolutely. So, adequate stomach acid will signal the other digestive markers, two of which are on this GI-MAP. There’s steatocrit, which is a measure of fat in the stool. We like it below detectable levels, and sometimes it will be much higher. And then elastase is one of the many pancreatic enzymes that’s secreted. That will be lower than optimal. We’d like to see it above 500, but it will either be frankly low or below that 500 level. When we see that, we normally see patients who have bloating and gas, floating stools, undigested food in their stools, and just a whole host of other digestive issues.

Dr. Valerie Gershenhorn: I find that addressing H. Pylori upstream really helps with that. And then our commensals, or good bacteria, tend to show up in high levels. Even though they’re good, we want them at normal levels—not too high, not too low. We’ll get a lot of those bacterial phyla, specifically the categories like Bacteroidetes and Firmicutes. They represent 85% to 90% of our good bacteria, and they will overgrow in the presence of H. Pylori too because of digestive issues.

Dr. Kara Fitzgerald: And how are you addressing the H. Pylori?

Dr. Valerie Gershenhorn: I usually do an herbal combination. There’s obviously room for practitioners who want to do the antibiotics, and there is a resistance gene category, so you can see if there is resistance to fluoroquinolones or any of the other antibiotics used for triple therapy. But I personally use a combination of remedies like mastic gum and different things that have DGL (deglycyrrhizinated licorice) in them, and zinc as well as extra mastic gum. And I also employ berberine when it’s appropriate, if there’s no interactions for the patient.

Dr. Kara Fitzgerald: What would those be? What are you concerned about?

Dr. Valerie Gershenhorn: For berberine I’m very careful if somebody is a diabetic and they’re on hypoglycemic agents, I don’t want to employ berberine without real caution because it can lower blood sugar. For some people, it can also lower blood pressure. And it’s just a very short term, 2 to 3 months.

Dr. Valerie Gershenhorn: But it’s a great antimicrobial, so it’s great for acne in that sense as well, but specifically, I use it for H. Pylori. I also like to use biofilm disruptors because we know that a lot of pathogens create biofilm under which to hide from our immune system, as well as from the protocols and remedies we employ. So, I do like to use biofilm disruptors like black cumin seed oil, N-acetylcysteine for some patients, and different enzymes. It depends. I do that for about 60 days, generally speaking, and see how patients are doing. Some of the protocols can be robust, so I try to meet patients where they are. Some people don’t want to take six different supplements a day, which is understandable. We reassess where they are based on that and, again, based on the rest of their GI-MAP. If they have Candida overgrowth as a result of H. Pylori also causing hypochlorhydria or various other issues, or if they were on antibiotics, that could happen, then, my next step would be to address the Candida.

Dr. Kara Fitzgerald: How are you helping with digestion? If you’re really clear on hypochlorhydria here, it’s kind of a narrow path to walk if you decide to actually use HCl, or if you’re using bitters. How are you walking that journey? And then are you adding digestive enzymes for that low elastase, for pancreatic enzyme exocrine support?

Dr. Valerie Gershenhorn: Excellent question. Yeah. So, when somebody has H. Pylori, I don’t employ HCl just because it will hide deeper into the gastric mucosa. So, I’m very careful about that. First, I start with just the organic nature of how we should be eating—in a calm state, chewing our food properly, and allowing digestion to start properly in the mouth. Really, just making sure we’re careful about not eating in a hyper-sympathetic state, right? And then I address it usually with enzymes that have a combination of different pancreatic enzymes like lipase and things of that nature. Sometimes I’ll use brush border enzymes if someone’s elastase and steatocrit looks great but they’re still complaining of bloating and gas.

Dr. Kara Fitzgerald: Such as what? Diamine oxidase or…? Yeah, what do you use?

Dr. Valerie Gershenhorn: No, I don’t do that, although that is excellent. I have yet to do that unless somebody is really manifesting high histamine symptoms or they have histamine producers on their GI-MAP. Certain organisms are more prone to producing histamine, like Morganella, Citrobacter, and Klebsiella. I see that a lot with my psoriasis patients. Believe it or not, I see a lot of the inflammatory bacteria that show up on page three with opportunistics. A lot. But there are a lot of great brush border enzymes like lactase, sucrase, maltase, and all those. One particular company I use has that, but I also….

Dr. Kara Fitzgerald: You can go ahead and name them.

Dr. Valerie Gershenhorn: Oh yeah, Klaire Labs (now SFI Health) has a great brush border enzyme. I didn’t know if I was allowed to say that.

Dr. Kara Fitzgerald: No, you can. And I want to let everybody know that we will put a GI-MAP Sample Report—any of the DSL labs we talk about today—we’ll pop sample reports onto the show notes so you can track along with us.

Dr. Valerie Gershenhorn: Yeah, absolutely. And you know what I love for bloating, which also has activity against H. Pylori, is the herb meadowsweet. It’s really lovely and interesting. It’s liquid, so it’s easy; they can just have it with their meals. So, I find that through this whole journey, learning from so many really amazing mentors, the process and—you know, no one patient will look the same.

Dr. Kara Fitzgerald: Tell me where you get meadowsweet and how you dose it. And you’re using it for some of the fallout of hypochlorhydria, the gas and bloating, etc.?

Dr. Valerie Gershenhorn: Yeah. I get meadowsweet from Herb Pharm. It’s a liquid in a dark glass bottle, and the directions are to take four full droppers a day, but I just have them take one full dropper with each meal.

Dr. Valerie Gershenhorn: I reserve this for people who are having a lot of bloating and gas and have H. Pylori, and don’t have elastase or steatocrit levels that are out of range generally. Or I employ it even if they do, just as an extra for H. Pylori as well, because it is really powerful and it’s great for bloating. So that’s the population that I use it in.

Dr. Kara Fitzgerald: Okay. And with low elastase, you will use pancreatic enzymes?

Dr. Valerie Gershenhorn: Yes, I will. I usually use digestive enzymes. If I can name names, then Pure Encapsulations has one, and there are many great ones. There are many great ones. It’s just as practitioners, we get used to certain brands and regimens. They have one that’s Digestive Enzymes Ultra without betaine—they have it with and without. So I use that (without betaine). And then for people who are vegan there are some vegan-friendly brands because they wouldn’t be able to take ox bile and things like that.

Dr. Kara Fitzgerald: And then if you see any evidence of fecal fat—so if that’s up at all, even if it’s within the reference limit, you’re thinking that’s abnormal. Are you using a digestive enzyme product that just has lipase? I mean, how are you thinking about that?

Dr. Valerie Gershenhorn: Yeah. So with steatocrit, at first, I always ask them if they are on a ketogenic diet. What’s interesting too is knowing—and that’s hard with any of these tests because they don’t really ask, how long before this test would it affect you if you were just doing fat bombs for a short period of time, or if you’re just eating a high-fat diet? Those are the gray areas that I think need attention, for sure. But if somebody does have a very high steatocrit, then I really want to dig deeper. Do they also have a high anti-gliadin antibody, which is a marker for gluten sensitivity? And then do we need to investigate if they have celiac disease? Are they not absorbing fats properly for that reason? So it’s really looking deeper. But if it’s just a standalone steatocrit without the anti-gliadin, then I generally would give them ox bile, which I really love, especially for my patients who are constipated.

Dr. Valerie Gershenhorn: It really helps with that, and it’s a great antimicrobial. It’s also great for psoriasis for a lot of people. So that would be great, as well as a digestive enzyme that has lipase.

Dr. Kara Fitzgerald: Okay. Okay. Cool. Yeah, that’s a good thing to rule out, that they didn’t just have some mega amounts of fat that morning and then collected their stool specimen, and we’re just seeing the evidence of the fat bomb in their fecal bolus. You definitely want to rule that out. That would certainly influence some people. I just want to say, coming back to your original thinking around autonomic nervous balance, you’ve brought it home in a very elegant way. We can’t digest if we’re in a sympathetic dominant place, so that, of course, links the whole gut-skin axis. We’ve been leaning, talking a little bit more about acne, but the key right now is that we’re going to be hard-pressed to effectively digest and our whole alimentary canal is going to be off if we’re eating in a stressed-out space, not to mention malabsorption, and so on.

Dr. Kara Fitzgerald: Can you just pin down some patterns? I think you mentioned acne and a little bit about psoriasis and eczema. I want to understand what you’re seeing on the tests for each of these.

Dr. Valerie Gershenhorn: Absolutely. Do you want me to go back to acne with what I’m seeing mostly?

Dr. Kara Fitzgerald: Can you just bang it out? Sort of move through a cheat sheet—grab your pencils, people.

Dr. Valerie Gershenhorn: On the GI-MAP, what I’m seeing a lot for acne is some level or high levels of H. Pylori, high commensal bacteria as a result, but for most people, sometimes I’ll see low commensals, but it will be mostly high with H. Pylori. Then I’m seeing some opportunistic growth with acne, but not a significant grouping of inflammatory overgrowth. I see strep on 99% of the GI-MAPs, regardless of the diagnosis. I also see more Candida in acne patients than in most other conditions. Occasionally, I’ll see a parasite and some disrupted digestive markers, as we mentioned—steatocrit or elastase. A lot of acne patients also have high anti-gliadin, so I always try to rule out celiac. So that’s for my acne cohort.

Dr. Valerie Gershenhorn: For my psoriasis patients, H. Pylori is hit or miss—not a lot of high levels, but some presence is there. I see a lot of low commensals and I see a lot of inflammatory overgrowth. This is where I see most of my Pseudomonas, Klebsiella, Citrobacter and I also see Candida.

Dr. Valerie Gershenhorn: In my psoriatic patients, I often see low secretory IgA.

Sometimes low secretory IgA can be a marker of hyperpermeability in the gut. But other times, from all that inflammatory pathogenic exposure over a long period of time, depending on when I catch them, secretory IgA will be really on the lower end.

Dr. Valerie Gershenhorn: For my eczema patients, I’m seeing a lot of markers of gut hyperpermeability. I see low Escherichia in the commensal section because we know that species lives in the mucus layer. I see below detectable levels of Akkermansia, which also lives in the mucus layer. This particular bacteria eats up our old mucus and signals the goblet cells to produce more mucus to protect our lining since it’s only one cell thick. So, I see a lot of low commensals for my eczema patients.

Dr. Valerie Gershenhorn: I also see a lot of inflammatory overgrowth, but not to the degree that I see with psoriasis for some reason in my cohort of patients. But I do often see a lot of histamine producers on that opportunistic page — page 3 —things like Citrobacter, Klebsiella, and less often Morganella, but quite a bit of Citrobacter. So we know that these histamine releasers could be contributing in some shape and form to the itch-scratch cycle in eczema. Additionally with eczema, I see that a lot of the digestive markers are off, and secretory IgA is low. When anti-gliadin is very high, I’ll see high secretory IgA. Usually that’s the pattern I see. Sometimes calprotectin will be high if there’s inflammation in the colon. That’s the general gestalt of what I see. Of course everyone is different, but that’s what I’m seeing.

Dr. Kara Fitzgerald: Just give me a snapshot. We’re going to dive into some patient cases in a minute, so if it’s redundant, we can put a pin in this question until then. But I want to hear a basic idea around how you’re approaching these—like, we talked about acne. Although I have a question on what you might be doing topically for acne. But also, how you’re addressing folks with psoriasis and eczema given those GI-MAP findings.

Dr. Valerie Gershenhorn: Sure, let’s discuss a case I had with a psoriasis patient. He was in his 60s and he had tried various topicals and didn’t want to do systemics or biologics. He had tried a specific laser that we have for psoriasis, but it didn’t work for him. So, he wanted to look deeper under the hood. We did a GI-MAP, and it showed that he was lacking commensals, had a little bit of H. Pylori that we worked on—not high—and had high opportunistics that were inflammatory: Citrobacter and Klebsiella. He also had digestive issues. He was very committed and willing to do the work. He changed his diet tremendously. I work a lot on diet.

Dr. Kara Fitzgerald: And that ties into the question I was coming to.

Dr. Valerie Gershenhorn: Yeah. I’m very sensitive to the nutritional challenges we face because it’s complex. Early in my career as a resident, I focused heavily on diet. Some people were open to it, but others, especially those with a history of disordered eating or resistance to restrictions, would shut down. So again, it’s about knowing the person sitting in front of you. In this case, he was willing, so I knew I could guide him. I emphasized adding more fruits and vegetables, but in a manageable way. For me, managing inflammation is the key for any diagnosis, whether it’s eczema, psoriasis, acne, or urticaria, whatever it is. Inflammation is the key.

Dr. Valerie Gershenhorn: So for me it’s about glucose balance. And if we’re eating our veggies and fiber first, followed by protein and fat, and saving carbohydrates for last, which can be more challenging than you would think, then we have less glucose and insulin spikes. We’re avoiding the roller coaster of highs and lows that can lead to acne, inflammation, insomnia, and mood swings. That’s a really important part of my protocol. Food is medicine, and if you’re not willing to give up certain foods, like pizza, I’m okay with it. Because I don’t want to lose you just because you don’t want to give up pizza. But I will tell you to eat a big bowl of veggies beforehand. These are the strategies we worked on with him, and within three months—which is one of the fastest I’ve seen—he was clear and extremely grateful.

Dr. Kara Fitzgerald: Where was his psoriasis, and how severe was it?

Dr. Valerie Gershenhorn: He had psoriasis covering about 15-25% of his body surface area, primarily on his arms and legs. He now sees me every three months to check in, and show me that he’s still doing well. Of course, there are times when he slips—like smoking—but it’s about progress, not perfection. We work with what we can. It’s not about perfection because I’m not perfect. I try hard every day. So I don’t expect any more from others because that would not be fair. But he was just so willing and able and his results were so fast.

Dr. Kara Fitzgerald: That’s awesome. Psoriasis covering that much surface area can be really difficult. So, you worked with him on diet, and it sounds like it was a step-by-step, reasonably doable plan, rather than a more hardcore approach that I might enact with my patients. What were some of the key interventions, supplements and therapeutics that you added beyond diet?

Dr. Valerie Gershenhorn: Because his commensals were low, I made sure he was tracking his fiber. I aim for 35 grams of fiber per day for adults so I gave him a list of foods to buy, such as vegetables, fruits, and avocados. For instance, one avocado can provide 13 grams of fiber. He also added chia and flax seeds to his morning smoothies to keep things simple and fit his busy schedule. He’s a very active, hard working, accountant. He’s always on the go so I wanted to keep things simple to fit his needs.

Dr. Valerie Gershenhorn: For supplements, I recommended a spore-based probiotic because his GI-MAP showed no deficiencies in Lactobacillus or Bifidobacteria. To address the inflammatory overgrowth, I use biofilm disruptors like black cumin seed oil. And then for his Citrobacter, I love a blend of herbs including clove, oregano, and thyme. Intestin-ol by Ortho Molecular makes a beautiful blend.

Dr. Valerie Gershenhorn: I also included binders for a lot of people, but it depends because sometimes binders can sometimes cause constipation. So we want to be careful because the goal is to eliminate toxins and die-off from the body.

Dr. Kara Fitzgerald: Which binders do you use?

Dr. Valerie Gershenhorn: I actually love CellCore. I’m not sure if you’re familiar with that brand. They are independent, not on FullScript, and they use fulvic and humic acids, which are more adaptogenic and less likely to pull nutrients from the body compared to charcoal. So I don’t necessarily need to keep them away from food and other binders. Occasionally, I use Quicksilver or Biocidin Botanicals G.I. Detox, for their combination of modified citrus pectin, charcoal, and things of that nature. But I’m careful with these, because a lot of people have trouble with them.

Dr. Valerie Gershenhorn: In his case, his Faecalibacterium and Roseburia, two commensals that produce a lot of butyrate, were low. So I included a butyrate supplement in his protocol. I like Tri-Butyrin Supreme by Designs for Health and also Butyrate from Body Bio, so I use that in a lot of protocols. Butyrate is so powerful on every level of our health, but specifically for feeding the enterocytes and helping with a lot of inflammation and gut lining health. That was the basic protocol for him. And like I said, now he’s on a vitamin and mineral complex, and occasionally if he slips off, he knows–

Dr. Kara Fitzgerald: What are his triggers when he does slip?

Dr. Valerie Gershenhorn: His work schedule is very demanding, so he sometimes doesn’t have time to have his meals ready to go and ends up grabbing quick, less healthy options. Also, he loves to be active, but during busy periods like tax season, he misses weeks at the gym because of his workload.

Dr. Kara Fitzgerald: Ah, tax season and such.

Dr. Valerie Gershenhorn: Exactly. What’s beautiful is that his body is now trained and he now knows and understands his health blueprint and how to stay on track. It’s not about being in my care indefinitely…

Dr. Kara Fitzgerald: The role of the doctor as a teacher. This is a perfect example. He knows what he needs to do.

Dr. Valerie Gershenhorn: He’s very committed and willing to put in the work. As they all are. I think it’s not about them not wanting to be committed, but for some people that autonomic imbalance makes it difficult for them to follow through because they are so under that fight or flight canopy. Even with guidance it just feels so hard.

Dr. Kara Fitzgerald: Has he been able to cut back on smoking? I’m sure he’s paying attention to that.

Dr. Valerie Gershenhorn: He pays attention and we talk about it. He does try, but I think the stress, instead of eating, the smoking is his way of coping. Despite that, he is working on it. And like I said, his results have been outstanding. I do obviously talk about smoking cessation.

Dr. Kara Fitzgerald: Of course. It’s impressive that you’re able to make such a difference in spite of that very profound toxin exposure, and continue to care for him and have him get really good results without any layer of judgment. I recall a patient from my early days, when I was just finishing school. I worked in a pain center and a lot of people who are chronic pain patients start smoking as one of their survival techniques. I encountered that quite a bit. We managed to get him off all his medications because he was so extraordinarily committed. We really turned his world around, but smoking was the last challenge. But we were able to at least address the toxin exposure by using nutrients to address the damage from smoking.

Dr. Kara Fitzgerald: There’s always an entry to everything that we’re working with in clinical practice. And it’s really about honoring the human that we’re working with and not judging them. I remember a doctor from my training who would just give people the boot. We probably all know people like that who will only work with a certain demographic who will adhere without fault.

Dr. Valerie Gershenhorn: One thing I’ll add is that I once heard a podcast with an herbalist who I really love, and she said for people who smoke who are inhaling, it’s almost like grounding. That’s what I think of instead of being quick to say we’ve got to make this person stop cold turkey. Maybe that’s their way of grounding and connecting with breath.

Dr. Kara Fitzgerald: And taking the minute or two off from whatever it is. It seems to me that smoking often comes with a lot of stress elsewhere and it is a grounding and it’s a moment’s escape from whatever else is going on.

Dr. Kara Fitzgerald: Comments on eczema and what you’re seeing.

Dr. Valerie Gershenhorn: For eczema, I’m seeing a lot of pediatric cases, and they’re pretty resilient because they haven’t been on the planet as long as we have. I see a lot of eczema patients will have some level of H. pylori and low commensals, similar, in my experience, to psoriasis. Where they differ is that they are going to have more of a hyperpermeability picture. This includes below-detectable levels of Akkermansia and Escherichia, low secretory IgA, sometimes with high calprotectin.

Dr. Valerie Gershenhorn: For these patients, I focus on the findings from the GI-MAP, but I also add a lot of gut support. If we look at eczema based on pathophysiology, we have that filaggrin protein and in some cases, genetic mutations. We’re not checking for mutations, but we know that even if they don’t have those mutations, in times of flare, their filaggrin will be depleted. We know that at a cellular level filaggrin breaks into glutamine and histidine to create natural moisturizing factor (NMF). And so I do employ the glutamine and histidine for several months in patients—

Dr. Kara Fitzgerald: Oh, very interesting. Orally?

Dr. Valerie Gershenhorn: Yes, orally. I see that really helps. There was a study that showed that histidine can achieve results comparable to mid-potency topical steroids.

Dr. Kara Fitzgerald: Oral histidine?

Dr. Valerie Gershenhorn: Yes. Some patients see about a 34% improvement, which is quite significant.

Dr. Kara Fitzgerald: That’s outrageous. So, you give oral histidine and glutamine to support the skin’s production of natural moisturizing factor. Gosh, if my team can get a nice little skin schematic up there so people can see moisturizing factor and what it does and how it’s produced, that would be awesome.

Dr. Valerie Gershenhorn: Yeah, that would be great. And I learned that from my brilliant mentor, Julie Greenberg.

Dr. Kara Fitzgerald: That’s pretty fascinating.

Dr. Valerie Gershenhorn: Yeah, she was amazing.

Dr. Kara Fitzgerald: Obviously, anyone who is familiar with biochemistry is going to know that histidine is a precursor to histamine, so are you using this in these patients (with histamine challenges) or is it contraindicated?

Dr. Valerie Gershenhorn: It is, some patients will ask because they’re so well versed and smart, but I haven’t seen any issues with it so far. It’s quite fascinating.

Dr. Kara Fitzgerald: Interesting. And are you using ceramide topicals? I wanted to ask you about topicals, so we’ll start here. Are you using any topicals in these eczema patients as well?

Dr. Valerie Gershenhorn: I do use a lot of topicals and I’m very cautious about ingredients. We’re using so many commercial brands that have a lot of these chemical-based ingredients, so I try to move the patients away from that. First of all in my baths I use apple cider vinegar or tea versus bleach baths, which is what I was taught in residency. I use that to balance the pH, because we want to get the pH back to a more acidic level of 4.5–5.5, which helps produce antimicrobial peptides. I also use hypochlorous acid sprays, colloidal silver sprays, and I love the more organic herbal remedies that are available.

Dr. Valerie Gershenhorn: There’s a brand called Ora’s Amazing Herbals that I love. There’s Active Skin Repair. I do a lot of layered approaches to this. I love neem, which is a beautiful antimicrobial, and they do have a topical oil. I love neem oil for my eczema patients, my psoriasis patients, and sometimes for my patients with seborrheic dermatitis on the scalp, although I’m careful with it on the scalp because of its interaction with Malassezia species which loves oil. But for some people that’s excellent. Those are the things that I’m employing a lot of, just to help with that barrier.

Dr. Valerie Gershenhorn: Eczema is tricky because you can have terrible reactions one week and then the next week you’re better and the skin barrier has to slowly and gingerly be improved, so I make sure we patch test everybody. They put it on unaffected skin for 12-24 hours, and then on a small area of affected skin before applying it all over.

Dr. Kara Fitzgerald: What do you patch test for specifically?

Dr. Valerie Gershenhorn: I patch test anything new that I recommend, like Ora’s Amazing Body Butter.

Dr. Kara Fitzgerald: You just have them do a little patch test themselves to make sure they’re not reactive.

Dr. Valerie Gershenhorn: Yes. And then there are two beautiful things I’ve seen great results for, and you’re going to laugh at the first one. There’s a toothpaste called Revitin, made by a biological dentist, Dr. Gerry Curatola. It contains probiotics and CoQ10, and I’ve used it for a lot of pediatric and adult patients on their eczema topically and they have great results. Maybe because of the probiotics.

Dr. Valerie Gershenhorn: I also love ozonated oils. There’s a company called PurO3 and they make ozonated castor oil. Ozone can smell a little so I have people store it in the fridge. Anything that’s cold is great for eczema. They put that on and it can really help with any sort of over-colonization, Staph in particular, which we see a lot of in eczema. I failed to mention that with the GI-MAP, a lot of Staph aureus. So I work on that with the topicals, with the ozonated oils. And then, because we know that Staph aureus lives in the nostrils, I do treat that as well.

Dr. Kara Fitzgerald: And what do you do? Do you have them use the ozonated oil locally, or do you have –

Dr. Valerie Gershenhorn: I prefer colloidal silver nasal spray or propolis nasal spray, things like that for treating the nostrils. With kids it’s hard, so you might have parents apply it on a napkin and then gently place it in the area. They don’t like their nose sprayed. I don’t like it either as an adult so that’s what I do as well. This approach also helps with facial eczema and even acne, particularly if there’s perioral dermatitis I really focus on the nose. What I did not mention before that is so critical and is a huge part of what I do is looking at oral health.

Dr. Kara Fitzgerald: Yes. I was thinking about that.

Dr. Valerie Gershenhorn: Our mouth is the start of the gut. I always ask about mouth breathing and snoring and we work on that, either initially without doing anything else first, or alongside other treatments. Because if I can’t fix your oral health, you swallow 2000 times a day and you’re mouth breathing, so we’re going to be back where we started from.

Dr. Kara Fitzgerald: That’s exactly right. I know for some of my refractory conditions, you know, we can have an H. pylori reservoir. Wow.

Dr. Valerie Gershenhorn: Yeah. So oral health, just making sure that they are taking care of their mouth, tongue scraping, things of that nature, but also if they have a history of root canals, and… What does their mouth really look like? Biological dentistry is really where I love to have people be evaluated, but it’s a very expensive roadmap.

Dr. Kara Fitzgerald: And it can be an overwhelming treatment plan. I’ve been putting a lot of attention into oral health, especially recently when I’m building out plans, and I have to be extremely mindful of the treatment plan. What would be your top 1-3 priorities? You already said tongue scraping.

Dr. Valerie Gershenhorn: Tongue scraping and making sure you’re flossing every night. You’d be surprised, right? Brushing your teeth well. But I also say that if they could see an airway dentist, at least, just to see if it’s safe for them to do mouth taping. Or, if they are snoring, then they should consult with a sleep specialist and have a sleep study because we’re not going to make any major improvements if we don’t start in the mouth. Biological dentistry is very expensive, and I get that. I have a lot of people who come to me after doing all that, so they’ve done the hard work. But for those who haven’t, I never just tell them to go right to a biological dentist. I know that it can be very costly and overwhelming.

Dr. Kara Fitzgerald: What toothpastes do you love?

Dr. Valerie Gershenhorn: I love Revitin. I personally also use Auromére. It’s a company that uses a lot of neem. And so this is the thing—there’s so much conversation and controversy about xylitol. Is it good? Is it bad? So a lot of these have xylitol, and I try to just kind of be in the middle ground and I do personally use some things with xylitol. Revitin doesn’t have any of that and I also like Auromére because it has neem and really good ingredients. Those are my favorites right now, but there are so many good ones out there that are non-toxic.

Dr. Kara Fitzgerald: Awesome. That’s helpful. The more we talk, the more questions I have for you. It’s going to be a two-day podcast. What about topicals for acne, out of curiosity?

Dr. Valerie Gershenhorn: This is a topic that I’ve really tried to explore. And again, I owe so much to the mentors in my life. I learned a lot about ingredients as pore cloggers, whether you have acne or not. Even for my own skin, I suffered with acne as a teenager, but I’ve always had large pores, and even certain ingredients that say they’re non-comedogenic can still enlarge pores and really do damage.

Dr. Valerie Gershenhorn: I was able to learn about all of these from this particular practitioner who put out a pore clogging list. I can give you the name of it so that your listeners can tap into it because they can just hand it out, and patients can put stuff in. I started using this company called CLEARSTEM. They have beautiful ingredients that are not pore-clogging. They’re great for all skin types, but specifically, their target market is acne, and I’ve seen really great results. Now, not everybody’s going to react well. I’ve had maybe one person who didn’t love the products, and it made them worse, but I love their product line for acne.

Dr. Valerie Gershenhorn: If you want more accessible, affordable options, I also love Vanicream facial cleanser. That’s one of my favorites because there are no comedogenic ingredients. For some people—not everybody—oil cleansing is great. So like Argan oil or Abyssinian oil, that’s what I use to cleanse my face. And then there are topicals that have niacinamide and zinc as well.

Dr. Valerie Gershenhorn: So those are really the mainstay of what I use. But mostly it’s the CLEARSTEM line because it uses certain actives, like mandelic acid to help unclog pores. It also uses reishi, hyaluronic acid, and turmeric—lots of anti-inflammatories– so I really like their products for that purpose.

Dr. Kara Fitzgerald: Your skin, by the way, for anybody who’s listening and not on YouTube watching along with us, I want to say her skin is perfect. I mean, I realize we’re on Zoom, but your skin is glowing.

Dr. Valerie Gershenhorn: Thank you. It’s far from perfect, but I worked really hard. Before I knew better I was a teenager who suffered from acne. I was on all the antibiotics and I even took Accutane, right? And so that’s what drives me so much to help others avoid things that could potentially cause problems later on.

Dr. Kara Fitzgerald: Interesting. Was that part of your motivation to go into dermatology?

Dr. Valerie Gershenhorn: That was part of it. Yeah, that was a huge part of it. They want to tell us that this is not a medical condition. I have a private practice that’s all holistic, but then I work in a medical practice that takes insurance, and insurance companies do not understand that this is a medical problem. It’s a psychosocial problem. It really impacts young people and older people. You don’t want to leave the house. It’s hard to show up and be who you are because of the way your skin looks. Your skin is a window and that’s a big driver for why I did what I did.

Dr. Kara Fitzgerald: Yes, I appreciate that.

Dr. Valerie Gershenhorn: People are crying in my office. It’s so heartbreaking.

Dr. Kara Fitzgerald: Yes, that’s right. There’s a case that I present when I’m teaching at IFM. This young boy—actually, I released a collection of case studies, and his case was in the book back in 2011 so it’s been quite a while. He had eczema that made him profoundly self-conscious. It just reminds me—concurrent to that case, I had a girl in my practice back then. I was in a residency in Atlanta, and she had the same, almost disfiguring eczema. It was so, so severe. He refused to go to school. It was so profoundly anxiety-producing for him. They ended up taking him out of school and homeschooling him. They were desperate and flew around the country wherever they could—to Mayo and the top clinics—and were prescribed really potent classes of meds to attempt to turn it off. But yeah, I appreciate the pain that’s frequently not acknowledged with skin conditions.

Dr. Valerie Gershenhorn: Yes. It stops you from being who you really are inside, right? It really dims your light and you miss opportunities. It’s really profound, so it’s a big deal and we have to honor the psychosocial aspect of skin disease of any kind.

Dr. Kara Fitzgerald: I want to circle back. We’re really at time here, but I’ve got just a couple more questions. We’ve gone through some cases, and this is a font of pearls today. Just really interesting, incredibly useful. I think people are going to like this quite a bit. But additional labs — we focused on the GI-MAP so far, but you’re doing other testing. In fact, you actually use organic acids as well and find those panels to be useful. So I’m curious what you’re looking at when you use Organic Acids testing, but also more broadly, some of the standard labs beyond what we’ve talked about.

Dr. Valerie Gershenhorn: Let’s start with the standard labs because they’re easier to get done for some patients and a little bit more affordable. I do love to look at the CBC, the complete blood count with differential, because there are some clues when you look at optimal ranges rather than the reference ranges.

Dr. Valerie Gershenhorn: For example, if someone is at the lower end for white blood cell count—if it’s not between that 5 to 8 range, which I like—it could indicate a pathogen. Let’s say they don’t want to pay for a GI-MAP, or it’s just too expensive for them, so you just do blood tests. If their white blood cell count is below a five, even though it’s still in the normal range, maybe there is some pathogenic issue, so you could try some empiric herbs if they are amenable to that.

Dr. Valerie Gershenhorn: I also like to look at the breakdown. Sometimes if their eosinophils are a little higher, could it be a sign of parasites? If their monocytes are a little higher, could there be a hidden viral issue? I also look at a comprehensive metabolic panel to check their liver function and glucose. I really like tight glucose control—I like it a little below 90. But I also love checking insulin because nobody checks it in conventional practices and insulin is the first sign of metabolic dysfunction or imbalance before your glucose or hemoglobin A1C goes up.

Dr. Valerie Gershenhorn: I like it tight, between two and five and if it’s not there, then we work on the order in which to eat your food, and then maybe institute some supplements that could help, or just work more on their diet first before any supplements are introduced. Those are the basic labs. I do like to check a full thyroid panel. I think it’s important to know if they have antibodies and how to support their thyroid with nutrition and certain nutrients like selenium and zinc, etc. I also look at ESR and CRP as inflammatory markers that are nonspecific but still important, as well as vitamin D levels.

Dr. Valerie Gershenhorn: For organic acids, I like it most for the nutritional component—how are their B vitamins looking? What’s their glutathione reserve? Sometimes it helps me with fungal organisms if we see some markers. Those are the basic things I like to look at for most people.

Dr. Valerie Gershenhorn: There will be occasional women who need more support, so I’ll do a DUTCH test, which is the comprehensive urine hormone test. That helps me look at their cortisol as well as their breakdown of sex hormones. You can go all day with functional testing. I guess it just really depends on the patient in front of you, what their budget is, and what their needs are. But yeah, I try hard to explain that I’m never guessing because, based on your history, symptoms, and even bloodwork, we can make a beautiful protocol. But having a little more data can always help us.

Dr. Kara Fitzgerald: That’s helpful. Do you employ elimination diets with your patients? Do you use food allergy or food sensitivity testing with your patients?

Dr. Valerie Gershenhorn: That’s an excellent question. Part of my pamphlet that I give out to everyone in the office for nutrition covers a broad look at dietary guidelines and a food list. On the back page, I mention elimination diets.

Dr. Valerie Gershenhorn: I talk about doing an elimination diet for the big culprits—gluten, dairy, soy, eggs, and for some people, corn, soy, eggs and alcohol. I work with them and based on how motivated they are, I say we can either eliminate all of them for four weeks and then reintroduce one at a time, or we can eliminate one at a time for four weeks and then reintroduce it. Now, if someone has eczema, I really emphasize how dairy can be an issue. For acne, I always discuss eliminating dairy and wheat. For some people with acne, even meat can be an issue because it releases the amino acid leucine, which can elevate mTOR levels—another part of the pathophysiology of acne, where it produces more oil and less turnover of cells. We do talk about diet, and a lot of people who are committed and open will easily eliminate gluten and dairy and see some results.

Dr. Valerie Gershenhorn: But I will tell you, I have a lot of people who do the same and don’t see results. I try to explain to them that sometimes it takes time. The results might not be what you’d expect—they could be really subtle.

Dr. Kara Fitzgerald: Yeah, that’s right. I agree. And that can be challenging. It doesn’t necessarily turn around remarkably for everyone. It’s, to your point, a continuum.

Dr. Valerie Gershenhorn: But to answer your question—I don’t employ food sensitivity testing, primarily because of the expense for patients.

Dr. Kara Fitzgerald: So you just have them deal with the big groups.

Dr. Valerie Gershenhorn: Yeah, I haven’t been convinced of its utility yet. But I know a lot of practitioners do it, and I think it’s great. Some people come in with those tests to show me, and I definitely look at them, but it’s not something I do.

Dr. Kara Fitzgerald: It can be motivating to have the data points.

Dr. Valerie Gershenhorn: It can be.

Dr. Kara Fitzgerald: Although then you have to do some fast talking if there’s a normal finding and you actually want them off that food.

Dr. Valerie Gershenhorn: Exactly, exactly.

Dr. Kara Fitzgerald: Well, listen, we’ve covered a ton of stuff. Again, I want to encourage people to head over to our show notes page because we’ll have the transcription there and you can search on it if you want to go back to find a product or a protocol that we already addressed. We will have some tests up there so that you can look at them and we’ll pull together a summary for everybody as well. So we’ll just really try to make the show notes as rich as possible for you because you’ve just really shared a lot today. I think you’ve really shared some interesting perspectives, and I appreciate the work that you’re doing. It really makes a lot of sense.

Dr. Valerie Gershenhorn: Thank you. I appreciate you too, Kara.

Dr. Kara Fitzgerald: Anything else you wanted to add that we didn’t get to touch on?

Dr. Valerie Gershenhorn: I want to just tell practitioners and people that are taking their own healing journey themselves, whether it’s patients or practitioners listening. I think the human body is magnificent. I think it’s always working to help us, and we just have to recognize the symptoms as the story that it’s trying to tell us, and just don’t stop until you find some root cause. And I don’t say that it’s easy, but I just always tell my patients that the first step is they have to believe that their body can heal. And that’s kind of my message that I want to add.

Dr. Kara Fitzgerald: Yeah, I think that’s a great message. And I think it’s a great point for us to end on. Where are you practicing, by the way? I wanted to ask you that. Where are you?

Dr. Valerie Gershenhorn: So I’m physically in an office in New Jersey, but I have licenses in New Jersey and New York to see virtual patients for my root cause practice.

Dr. Kara Fitzgerald: Okay, okay. So if we can put your contact information on if you’re taking patients.

Dr. Valerie Gershenhorn: Yes, I am.

Dr. Kara Fitzgerald: There’s no doubt in my mind that’s a question with some folks. Okay. So we’ll put your clinic contact on as well. So Dr. Gershenhorn, again, thank you for joining me, and to be continued.

Dr. Valerie Gershenhorn: Yeah. Thank you so much.

Valerie Gershenhorn, DO, is a Clinical Team Member for Diagnostic Solutions Laboratory. She attended the New York College of Osteopathic Medicine, where she graduated in the top 5% of her class. Dr. Gershenhorn then went on to complete an internal medicine residency at Mount Sinai Beth Israel in New York where she became chief resident. After staying on for a chief residency year, Dr. Gershenhorn earned board certification in internal medicine. Dr. Gershenhorn completed her dermatology residency at Lehigh Valley Hospital and earned board certification in dermatology. She has been practicing dermatology since 2006. Dr. Gershenhorn feels aligned with integrative dermatology because she believes that the skin is a “check engine light” for what is happening within the body.

Email: valerie.gershenhorn@diagnosticsolutionslab.com

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