In Conversation with Dr. Amy Shah, MD
Dermadry Segments: Dr. Amy Shah, MD
During Hyperhidrosis Awareness Month, Dermadry sat down for an interview with double-board-certified Dr. Amy Shah, MD to learn more about her first-hand experience diagnosing and treating her hyperhidrosis patients.
In this interview, Dr. Shah guides us through her educational background, and her experience in integrative medicine and her expertise in health & wellness. She reflects on why excessive sweating (hyperhidrosis) is a highly stigmatized medical condition and the common symptoms she sees in her hyperhidrosis patients. She opens up on the obstacles and challenges that her hyperhidrosis patients face in their daily life, particularly in social settings.
She shares her expertise in the fields of integrative medicine, wellness, and nutrition and how these can help us better understand and treat excessive sweating. Listen to her discuss her tips and tricks, opinion on traditional aluminum-based antiperspirants, and her insight on how hyperhidrosis (palmar, plantar, axillary, and craniofacial) can affect quality of life.
Watch the full video to hear her treatment recommendations, whether lifestyle and dietary changes can impact hyperhidrosis, and what factors, such as age and sex, can affect sweating levels. Thank you to Dr. Amy Shah for taking the time to speak with us and help us raise awareness of hyperhidrosis, and available treatment options!
About Dr. Amy Shah, MD
Amy Shah, M.D., is double board-certified medical doctor and wellness expert specializing in food allergies, hormones and gut health. Dr. Shah graduated Magna Cum Laude from Cornell University's world renowned school of nutrition. She went on to receive her Medical Doctorate with Distinction. With training from Cornell, Harvard and Columbia - She helps busy people transform their health using cutting edge nutritional and medical science.
Watch the Full Video
Amanda: My name is Amanda Colapelle and welcome to Dermadry segments. On today's episode, I am joined by Dr. Amy Shah. She is a double-board-certified medical doctor and wellness expert. Thank you very much for having us today.
Dr. Amy Shah: Thanks so much for having me, Amanda, so excited.
Amanda: So are we! So before we begin, we're going to go through the questions a little bit about your journey and also hyperhidrosis.
Dr. Amy Shah: Great.
Amanda: How did you first get into integrative medicine, wellness, and nutrition? Tell us a little bit about your journey.
Dr. Amy Shah I mean, it was because of my personal crisis that I got into it. As a physician, I did nutrition as an undergraduate. Then I went to medical school, but I never learned how to take care of myself and how to keep myself healthy beyond the office visit. So when I got in my crisis where I had fatigue, joint pains, and bloating. I just couldn't think straight, and my mood was awful, and I was anxious—I was having nightmares every night. I think I knew I had to make a change, but I didn't know how to, because I was busy in my life, there was no extra time.
One day, about 10 years ago now, I had a life-threatening car accident on my way home from a late meeting, trying to pick up my kids and, you know, any parent can relate to that feeling of being late for a pickup for your children, but then you're also drawn by your work. I knew after that day, after the car was completely totaled around me and I was so lucky to get my life back, that it was time for me to make a change in my career, in the things that I studied, and the things that I talked about, I needed to live the life the way I had always imagined, and I need to talk about it. So while I was fixing myself, I started to teach about it and talk about it, all the research that I was doing, I started to share it. And here we are, about 10 years later, and wellness and integrative medicine is a huge part of my practice.
Now, I still practice some clinical medicine, but a lot of my practice is wellness, education, and integrative medicine.
Amanda: Well, thank you very much for sharing that. And I think right now that's what we need, wellness in every sense, physical and mental. And we're really grateful that you also take care of that and you're able to teach your patients and other individuals about that.
Dr. Amy Shah: Yeah, it was a long painful journey, but I think I have a lot to share.
Amanda: What is your wellness philosophy?
Dr. Amy Shah: My wellness philosophy is that instead of always getting input from the external world, We have to start to tune in to our internal world and to the natural signals. So the signals coming from inside your body, the signals of sunlight and darkness, and start tuning out the artificial signals, the email, the social media, the news segment, and all of those inputs—caffeine, alcohol, all of those inputs that are drowning out our own body. So, wellness philosophy is to tune more inwards rather than outwards.
Amanda: That's actually really well put. What was your first experience with hyperhidrosis? Either learning about it or actually diagnosing a patient.
Dr. Amy Shah: This is funny because when I first started to learn about Dermadry and hyperhidrosis, I remember learning about it in medical school, but it was such a small topic and something that was part of a very, very large subject and we barely spent more than maybe five minutes on it. And then I saw actually it was a family friend who came to me for help. He said that it was very embarrassing for him, that he had hyperhidrosis of his palms. And when he was going for interviews, he would have to shake people's hands and, you know, pre-COVID,shaking hands is a part of every single interaction in business and education, in sales and everything. It was significantly affecting his life, his confidence, people would tease him about it and he didn't feel comfortable really talking to his own physician about it. He came to me as a friend physician, and then I read the stats that, you know, up to like 40% of people do not talk to their physicians about this problem, even though the prevalence is between one and 13% in the world.
For these people it's very embarrassing and affects the quality of light and most physicians, frankly, are not educated enough on this topic to be able to give them solutions.
Amanda: And that's what we're trying to do. All of the month of November, 2020 is dedicated to hyperhidrosis awareness month. And this is why we're trying our best to really just put that out there and educate people, not just the ones who are suffering from hyperhidrosis, but also those that don't know about the condition to also be aware. There's a lot of them that suffer from anxiety and we want to be aware of that so we know how to respond.
Dr. Amy Shah: Absolutely.
Amanda: Going into that topic actually, how has hyperhidrosis research evolved throughout the years, especially even with your patients.
Dr. Amy Shah: This is a great question. I think that there are such limited options for hyperhidrosis and there's very little research that comes to the forefront with this. Some of the solutions don't work. Many of the solutions are quite expensive and most of the solutions are not accessible by the patient themselves. So, unless they go to see a specialist and unless they get the specialist who prescribed a procedure or a treatment they're kind of powerless.
And so that's why I was so excited to see that there was an FDA approved [cleared] treatment that a patient could buy themselves and try themselves. It's so empowering to be able to do something that is medically sound, but that the patient does not need to disclose to multiple layers of people to be able to treat.
I think that was the biggest breakthrough to me about this technology is that it's safe, it's effective, and it's FDA approved. The patient does not have to have any interaction and does not have to feel the anxiety or the stress of going through multiple layers of practitioners to obtain this.
Amanda: And that's also what we're trying to get into, even when it comes to diagnosing hyperhidrosis. A lot of patients don't know. In the medical field sometimes it's overlooked. So, that's why it's really important what we want to get into when it comes to diagnosing hyperhidrosis.
So, leading into that question, how do dermatologists diagnose hyperhidrosis? Or how do you do it?
Dr. Amy Shah: That's a great question. So, there's not a lot of practitioners who do this test, but there is a gold standard test called “the sweat test”. And this test is able to diagnose primary hyperhidrosis pretty well.
One of the main tests that people use is the sweat test, where you use the starch and iodine mixture and the areas that turn blue are signs of hyperhidrosis. Since this is a test that people can get at their specialist's office. But you don't necessarily need the test to know if you have it. People sometimes think that they need to be diagnosed to be able to find solutions, but I think that if you're someone who is suffering with hyperhidrosis, if it's something that's significantly impacting your life, there's no real downside to trying a solution like this.
Amanda: That is perfectly well said. Going into the taboo subject, excessive sweating is regarded as taboo, because people do not feel comfortable talking about it, even with their patients or with their doctors or with their friends and family. How does a patient usually approach you to this topic?
Dr. Amy Shah: That's a great question—most of the time they don’t. As you know, almost half of patients don't approach their physician. Sometimes it ends up being something that's revealed. when talking about something else, maybe talking about confidence, or talking about finding secondary causes. So, some people will say, “I think I'm sweating more than I should be. I'm trying to look for a cause” and often we'll search for some secondary causes for this, be it medications, be it thyroid or hormonal issues, and various other things. And if the workup is negative, then we consider primary hyperhidrosis.
Amanda: And what would be secondary?
Dr. Amy Shah: Secondary is from a medication, from a treatment, from a medical problem that is separate from this condition, that causes excessive sweating. So there's a number of conditions that cause you to have an excess of sweating and that would be considered a secondary hyperhidrosis.
Amanda: Okay. Yeah, that's what a lot of our patients also talk to us about. Some of them are from medication. Some of them are hereditary. So it really depends. It's really case by case.
Also, a lot of your work focuses on health and inflammation. Why do you think that this is an often overlooked aspect of our health?
Dr. Amy Shah: Great. In summation, honestly, is your immune system, being active. So the immune system being active, sounds like a good thing, right? So yes, inflammation is a good thing. If you have an ankle that you twisted today on your way to work, you want that inflammation there to fix the problem. Now the problem with inflammation and a too-active immune system is if it's chronically active and affects every or many, many different parts of your body. You don't want to have chronic inflammation. You want the inflammation to come in, fix the problem and leave. You don't want the immune system to have a low grade activation. So, how I explain this to people is: if you're eating something, for example, that's foreign to the body, your gut bacteria will tell the immune system, “Hey, there's something foreign here, I want you to come check it out”, and your immune system goes and checks it out and that's considered inflammation. Now if you're constantly eating processed foods, terrible foods, medications, dyes, your immune system is constantly being contacted and that is inflammation. Our body is not supposed to be in constant inflammation mode, it's supposed to fix the problem and then settle down. And so, this is why I think it's so important to change your diet, and change the way you live. You don't want to be calling the troops for every little thing that happens in your body. You want some of it to kind of work smoothly. And how does it work smoothly? With whole foods, with sunlight, with good rest, with exercise and the very things we know that make our body run better. Inflammation happens when we're eating poorly and we're taking in substances that are foreign—alcohol, and stress really.
Amanda: And that's actually a perfect segment to my next question. There are the mental and physical symptoms, but beyond the physical symptoms of hyperhidrosis, how can excessive sweating affect patients mentally, socially, professionally, etc. What are the common things that you see or hear?
Dr. Amy Shah: Amanda, exactly the example I gave you when I first heard about it. My patient and friend had lowered confidence, had more anxiety, had stopped himself from taking opportunities because of this fear of someone commenting or feeling grossed out or questioning his health status. So he would be so hesitant to shake hands with someone new, he was anxious about it. He would think about it for hours before the actual interview, instead of thinking about the interview itself. And then he would apologize constantly when people would come up to him and congratulate him for something. Or he would say, “I'm so sorry about my hands”, and I think about the impact that has on someone's psyche. I think that was the most, that's the most sad and concerning part of this.
Amanda: And linking back, speaking of one of the founders of Dermadry and how the product came about, well one of the reasons was because has severe hyperhidrosis and he was in fear of shaking hands with people, even like for a job interview or even just casually in a social setting, it was so difficult for him to do so. So now that there are treatments out there can actually help that, it’s really cool how things have progressed.
Dr. Amy Shah: Yes. Very exciting!
Amanda: Do you believe that diet plays a role in hyperhidrosis, as we mentioned before?
Dr. Amy Shah: I think diet plays a role in everything. Diet is our biggest mover in health. I think that if you eat a low inflammation, high vegetable, and plant fiber diet, you can improve every part of your body. That's my belief.
Amanda: So going into that, for example, if someone eats. Spicy foods or sugars or processed foods, does that actually increase or impact your sweating levels in any way?
Dr. Amy Shah: That absolutely does. Spicy foods, processed foods, sweet foods, unhealthy trans fat foods—they all can worsen the condition for people who are dealing with this problem, yes.
Amanda: And what would you suggest to eat or to lay off on, when it comes to eating habits and hyperhidrosis.
Dr. Amy Shah: That's a great question. I would encourage an increase of whole fresh foods, vegetables and fruits, and fibrous foods and taking out some of those spicy processed, sweet, and unhealthy foods out of the diet to improve the condition.
Amanda: That's actually really informative. And how about when you were explaining about alcohol? What do you recommend is the “perfect” dose, let’s say on a weekly basis for someone that is suffering from hyperhidrosis?
Dr. Amy Shah. Alcohol is a double-edged sword, right? Because there are many anti-inflammatory benefits as we know about red wine in the studies of the Mediterranean countries. However, it can quickly escalate into a negative dose or value. So I say three drinks for women a week and five drinks for men a week is the absolute maximum that I recommend for people with or without hyperhidrosis.
Amanda: Usually people say one glass of wine a day!
Dr. Amy Shah: No, no, it's, it's really crazy because moderate alcohol consumption is interpreted so loosely. Meaning that so three to five drinks for women and five to seven drinks for men.
So for a man, the max you should be having is one drink a day and a woman it should be just one drink a day, a few days a week, three to five days a week.
Amanda: So is there a reason why?
Dr. Amy Shah: So you find that there's real anti-inflammatory benefits from drinking. However, what they found is that the people who are on the extremes, like someone who's drinking a lot, and someone who's not drinking at all, there's a big difference. So the people who are drinking a lot have negative outcomes, and the people who aren’t drinking at all aren't getting negative outcomes, but they're not really getting the benefits of alcohol. There's this very small, sweet middle spot, that here in the modern world, we often miss, because we are so used to having drinks with dinner or drinks at a social event, and it's very, very easy to go over the three to five drinks a week for women, for sure.
Amanda: That's super interesting. And also the fact that even caffeine could play a role in that. That's something that a lot of people didn't know about before.
Dr. Amy Shah: Yeah. We can definitely exacerbate it as well.
Amanda: Wow. For those who sweat excessively, are they in a higher risk range when it comes to minerals or vitamins. Do they have deficiencies or more deficiencies?
Dr. Amy Shah: That's a great question. Our body is really good at managing our sodium and potassium balance. And so we can sweat and pee and, lose many, many electrolytes without much of a problem, as long as we're eating and drinking adequately. Now, if you are in an environment that is quite hot and you have hyperhidrosis, that is something that I would be concerned about.
Amanda: Okay. So what, what would be some foods or nutrients that would actually be able to help hyperhidrosis?
Dr. Amy Shah: In the setting of sweating or it just in general
Amanda: In the setting of sweating.
Dr. Amy Shah: Yes, so in the setting of sweating, you always have to worry about loss, there's many, many drinks that are electrolyte based that can help you replete your electrolytes. You can find electrolyte water. For a lot of people who have this problem, if they're exercising outdoors, there's special tablets that you can take electrolyte tablets that you can take along with water to make sure that you're able to keep your electrolytes up. Now, remember that our sweat is not just water it's made out of electrolytes. And so when we are sweating, we are constantly losing those electrolytes and so if you are suffering with hyperhidrosis, and you are exercising or it's very hot, you have to make sure that you're not only adequately hydrating, but also repleting your electrolytes.
Amanda: That's actually a really good point. I was actually speaking to one patient a few weeks back and they were actually bringing that up and seeing how thirsty they were. And they didn't understand if it was linked with the hyperhidrosis. The studies do show that it is linked.
Dr. Amy Shah: Yes.
Amanda: Switching gears a little bit. What would be the effects of aluminum salts found in traditional antiperspirants? it's been very debated for a very long time. Do you think they're harmful for the body?
Dr. Amy Shah: That's a loaded question, and I'll tell you this. Okay. I'm a physician and I read all the science. Yet, I don't use traditional deodorant myself. Now, I'm not telling you that we have definitive science that argues against it. Most people believe that the dose is so small that no one should worry about it. However, personally, I chose not to, because of the fact that in my mind, unless I was convinced that there was no problem with it, I was not going to use it.
So, I guess how I would say it's a personal decision. There is no right or wrong answer. I think the jury's still out.
Amanda: Okay. Yeah. There's a lot of, even like a lot of back and forth when it comes to that topic and we were just interested to know what your thoughts were on it.
Dr. Amy Shah: Yeah. So, I mean, like I said, I wouldn't, you know, I never want to be a fear-monger and I never want to tell the whole world is using these products to stop. But I do think that you should do your own research and, you know, like I said, I chose to not use them.
Amanda: What would your thoughts be on tap water iontophoresis, such as Dermadry as a treatment option for hyperhidrosis? Getting away now from the entropy antiperspirants and other treatments.
Dr. Amy Shah: Amanda, I'm so excited about tap water iontophoresis. I think it is something that can change lives and that's why I'm so excited to be talking about things like Dermadry and treatments that use iontophoresis because it's safe and effective, in an FDA approved way. I think the reason why I keep emphasizing FDA approved to people is that there's a lot that goes into approval. We don't approve things very easily anymore. It has to go through many, many layers of processes and I’m excited that we can offer people a treatment that they can do at home, and that's effective and easy.
Amanda: Actually, linking to that question, because it is an at-home treatment we really recommend for patients to have a treatment schedule. We believe that it does play a role in increasing self-esteem and self-confidence and research has shown that. What are your thoughts?
Dr. Amy Shah: A hundred percent. I agree that, you know, you have to be on a regular treatment schedule to really see a difference. And I think that keeping up just like we do with any health habit—having something become a habit and be regular has a huge effect on not only giving us results, but also giving us a sense of routine and increasing our confidence or lowering our anxiety.
Amanda: That's exactly what our goal is, and that's why we try and always try and maintain that: three to five times a week, and then you could get up to six weeks of dryness. There's also some people that have used it at a perfect consistency, and they actually have two to three months of dryness, which relieves them a lot.
Dr. Amy Shah: Honestly, I have to say to have an at home solution that is simple and easy. I mean, it's as simple as watching the YouTube video, reading the simple instructions, you know, tap water is all you really need, and a plug. And you could be doing this, three to five times a week, pretty easily while doing something else, watching a show, and really changing your life in a fairly significant way.
Amanda: Yes, exactly. And speaking about it, speaking about sweat in general. Do you think that there are factors such as age and sex that actually play a role in how somebody sweats?
Dr. Amy Shah: Absolutely. Gender and hormones, sex hormones, definitely have a play in how much you sweat. And age? Definitely as well. We see that testosterone, for example, that is found mostly in men or more in men, tends to increase sweating. And, this is why, you know, a lot of men have issues with hyperhidrosis. They have it in certain areas of the body. Whereas women tend to have it in other areas of their body.
Amanda: That's actually, a lot of studies have shown that and also with age. People tend to believe that just because you're an elder may not have hyperhidrosis, which is not necessarily the case.
Dr. Amy Shah: You know, a lot of people choose Botox as a treatment for hyperhidrosis. And the problem is it's painful, it's expensive, it wears off quite immediately. And it requires multiple visits to a medical practitioner. And therefore I, personally, would really prefer to send patients home with it, this kind of item, where they can do it themselves. And if they need additional treatments on top of that, That's fine. It can be additive, but maybe they can just manage it on their own at home, in a safe and easy way, and less expensive.
Amanda: Yeah. And that's actually one of the reasons that a lot of patients also choose Dermadry. They feel like the product does work, it is a cheaper option for them, and that is easier to use and they enjoy it. Being at home, using the treatment.
Dr Amy Shah: Yes.
Amanda: Research has shown that certain countries, particularly Asian countries have a higher prevalence of hyperhidrosis. Why do you think this might be the case?
Dr. Amy Shah: That's a great question, Amanda. I think that genetics plays a role in hyperhidrosis, of course. We know that people with different genetics around the world have varying rates of all different conditions. And so it's not surprising to me that your genetic predisposition will change your risk. Beyond that, could it be because there is so much heat and humidity in those places? Perhaps that plays a role, but I do think a lot of this is genetics.
Amanda: There was also a study that we have seen. This study actually shows that in certain countries, for example, in Asia, sometimes when it comes to even shaking hands, if you are sweating, sometimes you might not be able to get the job. That is overlooked and sometimes it can be a problem.
Dr. Amy Shah: Yes. It’s like you said, you know, in the world, handshakes and hyperhidrosis not only becomes an uncomfortable secret, it becomes a secret that you share with each person that you interact with. And it can be quite embarrassing if you're not ready to share that information.
Amanda: That's very true. And there's also another type of hyperhidrosis that is kind of unspoken of. It's basically for the face, the head and scalp area, which is called craniofacial hyperhidrosis. And this is actually troubling because it's not an area that you can actually hide. We'd want to know what you think about this condition and what you would recommend for your patients that do have craniofacial hyperhidrosis.
Dr. Amy Shah: This kind of hyperhidrosis is maybe the most embarrassing, because you cannot hide it with clothes, and you cannot wipe your hands on a towel. Like, you know, there's many patients with hyperhidrosis who carry towels with them at all times. So, right before their meeting to shake hands or whatever, they can, or they can change their shirt. But with craniofacial, you cannot hide it. It is there. If you're female it's extremely distressing because of hair and makeup. It ruins every single aspect of a new meeting if you have this problem. Um, so I really do feel for the mental and emotional aspects of this.
Amanda: And that's such a taboo topic that people don't like to speak about. And yeah, we're trying to find solutions on how we can help the people that do suffer from that condition. What are some useful tips that you can share for those who are suffering with hyperhidrosis?
Dr. Amy Shah: If you're suffering from hyperhidrosis, don't be embarrassed. There are many thousands of people just like you. As we talked about, the incidence is between five and 14%. There are so many more people that have it that don't even talk about it. So make sure you feel that you're not alone. Make sure that you talk to someone, a provider, a physician, that you feel comfortable with. Please, the only way you can get help and improve this condition is by talking about it.
And the other thing is to know that there are solutions. I think one of the big misnomers is that you can't do anything. And I think that, you know, a lot of people feel helpless and to know that there's a solution like tap water iontophoresis and various other solutions to this problem. It should empower you to go and seek this out, talk to someone you trust about it, see what your options are and choose an option. You don't have to live like this.
Amanda: And that's actually, what we're trying to do, it’s our goal, especially during hyperhidrosis awareness month, we really want to spread the word and let people know that it's okay, that other people are also feeling that way and thinking this way. And then us speaking about it, we actually have stories that are coming in and letting us know like, “Hey, this is actually how I'm feeling”, and also getting your point of view. I think that would be even calming for them at the same time.
Dr. Amy Shah: Yeah, I agree.
Amanda: Any final thoughts you would like to share on your experience with hyperhidrosis patients or your journey in wellness?
Dr. Amy Shah: Biggest thing is don't be afraid to share. I think the biggest wellness journey that I've had is that you don't have to keep your struggles inside. In fact, the more I talked about my personal struggles with health, the more I was able to find that there were so many other people who were suffering like me, and the more we were able to share solutions with each other. And so someone who's suffering with hyperhidrosis and any other medical problem, make sure that you go ahead and share. And I understand not everybody feels comfortable sharing on social media. You don't have to do it that way. You can find a group that you feel comfortable with online, offline, a person you feel comfortable talking to, a provider. But I think that talking about your issues is in a wonderful way, not only to find solutions, but to also feel fulfilled and happy inside.
Amanda: Yes. And that's actually one of the programs that we were also trying to incorporate. We had programs such as Voices of Hyperhidrosis, where people are actually able to speak openly or even they could, we could hide their name and help them tell their story. So letting other people know. We did a school scholarship for them to actually video video record their experience or how they live their day-to-day life with hyperhidrosis. And we got amazing feedback and it's really amazing and astonishing to see the stories that they have and for us to actually share those with the community or even, like you said, like little community groups, I feel like that's really important for them to have. A safe space for them to actually say their story and say, “Hey, this is what I have. Do you feel the same?” So I think that's a really important aspect to have.
Dr. Amy Shah: Yeah. That's great. Very wonderful work that you're doing.
Amanda: Thank you very much for having us today. It was a pleasure speaking with you and we're very excited to get to the next Dermadry Segments. Have a good one.
Dr. Amy Shah: Thank you!