Data/transcripts/1CxJVdeyltw_20241225194614.txt

welcome to the huberman Lab podcast
where we discuss science and
science-based tools for everyday
[Music]
life I'm Andrew huberman and I'm a
professor of neurobiology and
Opthalmology at Stanford school of
medicine today we are discussing skin
Health our skin is an incredibly
important organ not just for our
appearance or because it serves as a
barrier to the other organ systems of
the body but because it actually
reflects the health status of all the
other organs and systems in our body
including our brain as well you'll learn
today about the direct and reciprocal
relationship between the immune system
and our skin and if you think about it
you've seen this relationship in action
before when any of us is feeling
fatigued or sick the color the tone of
our skin tends to be a bit quote unquote
off at least for us relative to what it
normally is conversely when we are
feeling particularly well rested and
vibrant and healthy our skin reflects
that so today we will discuss the skin
as an organ we'll talk a little bit
about the biology of skin so that
everybody is on board the nomenclature
of the different cell types in the skin
and how they're affected by various
things and then we will discuss those
things such as sunlight and sun exposure
as it relates to skin cancers we'll talk
about sunscreens of course something
that I know Garners a lot of interest
these days and even some controversy we
will talk about common conditions of
skin that concern people such as acne
rosacea psoriasis eczema and of course
we will talk about so-called anti-aging
treatments for skin that is the things
that can be done to help reduce the
degradation of the protein components in
skin things like collagen things that
you can do to improve collagen turnover
as well as elastin these are other
proteins within skin that give skin its
youthful or in some cases where it's
degenerative non- youthful appearance
things like wrinkles and sagging skin so
we'll talk about all of that we'll also
talk about the various products that
have been developed in order to treat
wrinkles treat sagging skin reverse acne
Etc we'll talk about which ones are safe
which ones are not safe and which ones
for which there still is no clear answer
I want to make very clear here at the
outset that while I'll discuss various
skin products during today's episode I
nor the podcast has any Financial
relationship to those products I will
provide examples of certain products and
provide a few links in the show note
captions but I want to point out that
those serve merely as examples that I
found during researching this episode
which by the way included speaking to
several board-certified dermatologists
including a dermatologist expert in
oncology cancers of the Skin So by the
end of today's episode you will have a
much clearer understanding about skin
and what it is at the level of biology
and function its relationship to other
systems in the body including the immune
system and gut microbiome and you will
be armed with the knowledge to make the
best possible decisions for you in terms
of skin health and Skin Care depending
on your age your goals and any current
conditions you may have before we begin
I'd like to emphasize that this podcast
is separate from my teaching and
research roles at Stanford it is however
part of my desire and effort to bring
zero cost to Consumer information about
science and science related tools to the
general public in keeping with that
theme I'd like to thank the sponsors of
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to get 20% off okay so let's talk about
skin health and by extension skin care
what should we all be doing to take care
of this organ that we call our skin our
skin is a very interesting organ as I
mentioned earlier not just because it
protects all the other organs of our
body and I should mention it protects
them not just by a physical barrier but
there's also chemical things a chemical
composition a skin microbiome to the
skin that also provides additional
layers of support such as neutralizing
different bacteria that land on your
skin there's a lot more to skin than you
might realize but to start off let's
just talk about what skin is at the
level of its structure some of the cell
types because in understanding that
you'll be best equipped to understand
some of the recommendations for skin
health and Skin Care the skin like many
other organs in the body is a layered
structure so the very outermost layer is
called the epidermis the epidermis has
cells in it below that there are other
cells that comprise What's called the
dermis or sometimes referred to as the
dermal layer and then beneath that you
have subcutaneous fat now of course in
different areas of the body the skin and
as a consequence these different layers
of the epidermis and dermis and the fat
layer below it are of different
composition and different thicknesses
think for instance about the thickness
of the skin on your forearm versus the
thickness of the skin on your belly
versus the thickness of your skin on
your eyelid okay and as soon as you
think about your eyelid you realize okay
this thing that we call skin varies
tremendously in thickness depending on
whether or not we're with the scalp the
eyelid the face the chin even you know
neck versus chin body Etc so what we
think of as skin while it may have a
designated set of layers that have
particular names can vary tremendously
in terms of its overall thickness and
therefore its vulnerability to things
like sunlight which indeed can mutate
the cells within the skin cause them to
you know have disregulation of the
expression of DNA and the production of
other cells we'll get into that so I
just want you to think about skin as
having these critical components of
layers epidermis and dermis below it and
by the way within the dermis is where
you're going to find the blood supply
the vessels and capillaries that
innervate the skin innervate simply
means that Supply or go-to the skin you
of course have hair follicles and hair
growing out of those follicles in many
cases and then of course you have skin
that does not have hair the so-call
glabrous skin like on the palms of your
hands the bottoms of your feet Etc so I
don't want to give the impression that
skin is the same everywhere it varies in
thickness it varies in terms of the
presence of hair or lack of hair it
varies according to a lot of different
parameters including how much oil is
produced in one region or another but if
you just know that the skin has an
epidermis an outermost layer a dermis or
sometimes referred to as the dermal
layer which is below it and then it has
fat below that and that the vasculature
right the vessels and capillaries are at
the level of the dermis they come up
through the subcutaneous fat and into
that dermal layer but they don't reach
into the epidermal layer that outermost
layer and if you understand also that
that nerve endings okay the little
terminals as we call them of neurons
nerve cells also go up into that dermal
layer you've got temperature sensors in
the skin all of this becomes very
important for our discussions of skin
conditions things like rosacea things
like acne which sometimes can be painful
or can be exacerbated by things like
heat they can be suppressed in some
cases or even activated by things like
cold okay so if you just understand that
there three layers epidermis on the
outside dermis below it subcutaneous fat
and that skin varies in thickness and
that nerves that is nerve endings and
blood vessels and capillaries are within
the dermal layers of the skin well
you're going to be very well equipped
for the rest of today's discussion I'll
throw in some additional information
about oil production within the hair
follicle and a few other things like
extracellular Matrix which as the name
suggests is extracell it's outside where
the cells reside but gives it its
composition as either plump and moist
appearing on the outside or it can be
kind of sag and wrinkled and dry
appearing all of that relates to the
different components of proteins and
other things within those skin layers
but if you understand what I just told
you even at a crude level if you can
just imagine it just a little bit those
three layers you're going to be very
well equipped for the rest of today's
discussion I should also mention that
there are glands within the skin this
won't be surprising to most of you those
glands will produce oil either more or
less depending on certain conditions and
there are things that live on the skin
on that epidermal layer and within it
that we call microbiota you've no doubt
heard of the gut microbiome right the
existence of trillions of little
microbacteria that live within your gut
that provided they are varied in their
composition and of the right sort really
support your immune system and other
aspects of Health including brain
function and health well you also have a
skin microbiome that is the existence of
microbiota on the outside of your skin
that serve as a barrier to infections
but that also provide things that are
nourishing to the skin and give it that
vibrant look that most people want and
by cleansing your skin in particular
ways that is washing it with certain
substances and avoiding other substances
you can support as opposed to diminish
that skin microbiome okay so to start
today's discussion I want to jump right
into the deep end meaning into one of
the more controversial issues related to
skin health and Skin Care out there
right now which is sun exposure and
sunscreen now it makes sense why this
would be such a heated issue no pun
intended because most everyone is
exposed to the Sun or has the
opportunity to be exposed to the Sun to
some degree or another every single day
even on cloudy overcast days it's also
the case that we've learned a lot in the
last 10 years or so about how different
sunscreens and their components may be
good for us may be less good for us and
today we're going to talk about what is
known and what is still unknown but
before we do that we need to take a step
back and look at the context in which
all this controversy is happening my
read of the online community as a whole
as it relates to sunscreen and sun
exposure in particular is the following
I think most everybody I didn't say
everybody but most everybody out there
seems to accept the idea that excessive
sun exposure can cause certain cancers
of the skin that's the general belief
out there and there is good reason for
that belief because indeed the Sun as
full spectrum light includes long wave
lengths it's probably easier to think
about those long wavelengths as the Reds
and oranges and yellows and so forth
that are present in
well they're always present from
sunlight but they're most obvious to us
when the sun is low in the sky so-called
low solar angle sunlight at sunsets and
also at Sunrise but of course as full
spectrum light sunlight also includes UV
ultraviolet light of different types
we'll talk about those types today as
well as blue light and green light and
in midday sun when the sun is overhead
we just see the Sun as white light right
because containing all those different
wavelengths so while this is not a
discussion about wavelengths and optics
for sake of today's discussion just
understand that long wavelength light
tends to be more of the red orange
yellow variety okay Loosely speaking and
down at the other end of the spectrum
the short wavelength light is more of
the blue and green and so-called
ultraviolet light so it's well accepted
light of different wavelengths such as
UV Blue Light Green Light all the way
out to Red Light even near infrared
light can penetrate into cells it can
actually pass through surfaces it turns
out that long wavelength light can
actually go deeper in into the surface
of our skin right it literally can
penetrate just by shining a red light on
your skin it can actually penetrate the
skin to a deeper layer then can short
wavelength light like UV light and it's
well accepted that UV light when it
penetrates mostly that epidermal layer
of the skin that outermost layer it can
cause changes in the way that DNA
functions it can cause mutations such
that DNA which as many of you probably
remember from high school biology DNA is
transcribed into RNA and RNA is
translated into proteins the proteins
are the things that the cells produce
they're actually made up of proteins
well UV like can disrupt which DNA are
expressed and how they are expressed in
some cases leading to overproduction of
too many cells or disruptions in the
functions of cells and that's why people
link UV light to skin cancer that's the
whole idea there and that's the whole
notion behind using sunscreens and
notice I'm saying Sun screen so ways to
screen out UV light or maybe all
sunlight in some cases in order to
prevent that penetration of the UV light
into cells which can cause mutations
which in some cases can lead to skin
cancer now I realize as I'm saying this
there's probably a group of you out
there saying what's the evidence that
sunlight can actually cause skin cancer
well there is clear evidence that
sunlight can cause skin cancer so which
skin Cancers and how deadly those skin
cancers are we'll get to in a few
moments that turns out to be a very
interesting twist in the whole story but
I want to highlight the fact that
there's very little controversy as to
whether or not UV light can cause
mutations in cells right but what you
should be asking yourself is well why
would long wavelength light like red
light perhaps be good for skin we'll
talk about that later there are
therapies phototherapies that use that
exploit red light which can penetrate
deep into skin that actually can enhance
the health of skin if done correctly
whereas short wavelength light which
only hits that epidermal layer on the
outside of the skin may be bad for our
skin and I say maybe because it's really
a function of dose and timing and
genetic background okay if all this is
seeming rather complicated I'm going to
make it very simple and before I do that
I do want you to ask yourself a question
I want you to ask yourself where you
reside on the Continuum of beliefs about
sunscreen UV light and skin cancers so
here it goes my read of the landscape
out there is that there are some people
it's a small minority but there are some
people who feel that sunscreen in any
form is bad for them they think okay sun
is great for them and sunscreens of any
kind chemical or physical barriers bad
for them okay some people believe this
I'm not saying I believe this in fact I
don't believe that I'm a big believer in
sunlight and the power of sunlight for
health but I am not what is called a
sunscreen truther okay I'm not somebody
who thinks that sunscreen has no value
in fact quite the opposite under certain
conditions and certain sunscreens I want
to say that for the record other people
out there believe that certain
sunscreens can be valuable but only the
sunscreens that lack certain chemicals
because they are concerned about
chemicals in certain sunscreens being
so-called endocrine disruptors or maybe
even causing cancer on their own okay
other people are so afraid of sunlight
and believe that it causes so many
issues as it relates to skin cancer that
they basically create beekeeper uniforms
for themselves so that anytime they're
out in sunlight they want to have
sunglasses on they want to have a hat
they want to cover their neck every part
of their body okay they sit at the
opposite extreme of the people who don't
believe in using any sun protection
whatsoever and now of course there's the
backdrop of how much natural melanin
production we each make that is how dark
our skin happens to be according to our
genetics and of course there's the issue
of where we live on the planet and how
much sun we have available to us in
order to potentially expose ourselves to
and perhaps also ask yourself if you are
in what I believe is the largest
category of people out there which is
the category of people who probably
don't wear sunscreen every day maybe
they put it on occasionally but only if
it's very bright out very hot out
because they don't want to get a soall
sunburn and I believe most people fit
into that General category of a not
wanting to be burned B not wanting to
age any faster than they would were they
to not wear sunscreen at least that's
their belief and C they've just been
told that sunscreen's good for them and
they'll reach for whatever sunscreen is
on the shelf or that was recommended to
them either by their dermatologist or
that they they happen to find in the
pharmacy or when they're out skiing and
they you know they notice it's a bright
day and so they buy some sunscreen and
slather it on so before I go any further
just ask yourself those questions you
know where do you reside are you afraid
of sunscreen do you love sunscreen are
you in The Beekeeper category like you
think all sun is bad it's going to give
you skin cancer it's going to age you
faster we'll get to the Aging component
in a few minutes but just ask yourself
that question as we wade into the
material I'm about to cover so what's
the story with sun exposure sunburn
sunscreen skin cancer and aging I spoke
to several different dermatologists
about this including one expert in skin
cancers specifically and what I was told
is the following first of all sun
exposure will disrupt the collagen and
elastin but mostly the collagen
composition of your skin in a way that
makes it appear as if you're aging
faster okay so sun exposure yes ages the
skin now that does not mean however that
you want to avoid all sun exposure
because the same dermatologist said that
some sun exposure is healthy for us why
because our skin is also an endocrine
organ it's involved in making various
hormones it's part of the vitamin D
production pathway although a little bit
later we'll talk about the fact that
most people get their Vitamin D from
their diet and in some cases also from
supplementation but it is a good idea to
get some sunlight for sake of vitamin D
production but also the production of
other hormones like testosterone and
estrogen okay so every single dermat
ologist that I spoke to said that some
sun exposure is good for us but that too
much sun exposure will accelerate the
appearance of Aging in our skin so let's
pin that up on the wall as fact okay
this again is not saying you should
avoid Sun completely it's also not
saying you should get excessive sunlight
exposure it's saying sunlight exposure
by virtue of the UV wavelengths ability
to cause mutations in the epidermal
layers of the skin and to impact the
collagen composition of the dermal
layers below it as well as some of the
other proteins present in the cartinos
sites okay one of the major skin cell
types and other cell types of the skin
does lead to the appearance of aged skin
which is one rationale for wearing
sunscreen now when I say sunscreen
everyone including myself thinks about
lotions or in some cases sprays but
let's pay attention to the one fact that
I do think everybody regardless of what
category they are in the general
population or what background training a
dermatologist has
believes which is a physical barrier a
shirt a hat a jacket a physical barrier
can provide in some cases very good
protection from the Sun and I don't
think there's any controversy whatsoever
as to whether or not the composition of
the physical barrier is having negative
effects on the skin okay you will find
those Niche communities out there that
are saying okay certain chemicals
present in certain materials that
clothing are made with can be problems
for the endocrine system but we're not
talking about that here okay what I'm
saying is that all dermatologists I
spoke to and I think most every rational
human being on Earth would say that a
physical barrier can help to a great
degree in order to protect our skin from
the Sun as it relates to sunburn but
also acceleration of the appearance of
Aging in our skin okay so I don't think
there's any dispute about physical
barriers for protecting the skin how
much you want to protect your skin from
the Sun well that will depend on what
category you decided you were in from
the earlier discussion we'll get back to
that
what else did all the dermatologists and
skincare experts that I spoke to also
agree upon well they all said that
indeed excessive sun exposure can
increase the propensity for certain skin
cancers I want to go on record by saying
I believe that why well because of this
ability of UV light and some other
wavelengths of light potentially to
cause mutations in skin cells that can
lead to certain skin cancers okay I
don't think that's a debated topic out
there there might be a few people out
there who are going to hang their hat on
a study that I'll go into a little bit
later which is that the relationship
between sun exposure and all-cause
mortality is a tricky one it's one that
will parse okay meaning I'll just give
it a little you know hint into what I'm
saying people who avoid the sun entirely
don't tend to live as long as people
that get some sun exposure but there are
a bunch of confounding variables that
have to be understood in order to really
interpret that statement and the study
that we'll parse a little bit later for
now let's just accept the reality that
the vast vast Ma majority of
dermatologists out there and skincare
experts really understand that sun
exposure can accelerate aging of the
skin but most will also tell you that
some sun exposure is good for you not
just for skin Health but for overall
brain and body Health now as it relates
to skin cancer the dermatologist
oncologist that I spoke to all right who
did his training at Stanford and I'll
provide a link in the show note captions
to his clinic and you can learn more
about some of his work he's published
some really nice
papers said following and this was
surprising to me he said it turns out
that the skin cancers that sun exposure
causes while they can be serious and
should be taken seriously they should be
treated those generally are not the most
deadly of the skin cancers now why would
he say something like that okay he said
it because it turns out that there are
lots of different kinds of skin cancer
some of them arise or can arise through
sun exposure others and indeed some of
the most deadly of skin cancers are
independent of sun exposure and this is
where things can get a little bit tricky
you'll hear out there oh you know Sun
can cause skin cancer but not the skin
cancers that kill you I don't think
that's really a fair statement you'll
also hear however that all the skin
cancers that are out there are the
consequence of sun exposure and that
also is not true and if anything this
provides motivation not just on the part
of the dermatologist but it should be
motivation from within all of us to make
sure that we understand our background
genetics not just how much pigmentation
We Carry in our skin by virtue of our
genetics but we should know by asking if
you're not going to get genetically
sequenced which you can do nowadays of
course but you should know whether or
not your family your genetics tends to
carry certain mutations that make you
more prone to skin cancers in general
not just the type that can be
exacerbated by sun exposure what I'm
basically saying is that if you have
particular genetics in your family even
if you avoid all sun exposure you know
nobody should do that of course you need
some sunlight I mean like all other or
most all other uh creatures on Earth
sunlight is important for us it's
important for setting our circadian
rhythms that's why I'm always telling
people to get sunlight in their eyes
early in the day which by the way when
the sun is low in the Sky low solar
angle sunlight the UV index tends to be
very low okay so you are at the lowest
possible risk of getting burned of
getting any kind of mutations to your
skin that doesn't mean you should overdo
it it doesn't mean you should stare at
the Sun and damage your eyes I've talked
about this a lot on other podcasts how
to get morning sunlight exposure
properly but when the sun is low in the
sky that's generally a safe time to get
sun exposure it's that midday Sun
typically between the hours of you know
11:00 a.m. or even 10: a.m. Depending on
time of year and where you're at and 2
or 3 or 4 p.m. that the sun is overhead
and at its greatest intensity and where
the UV index can be very high it's very
easy to look up the UV index and when
the UV index is very high right I was
down in Australia earlier this year and
the UV index down there is so high you
can almost feel it you actually can feel
it you step outside and you immediately
feel like wow my skin is really being
bombarded with the sunlight and I'm
somebody who tolerates sunlight pretty
well because my dad's fairly um you know
dark pigmentation just Naturally by
virtue of being South American normally
I can tolerate the skin pretty well but
you should not rely on just that
subjective feel you should look up the
UV index and we'll provide a few Links
of good UV index sites that you can look
up the UV index and where you might want
to be extra cautious about providing a
physical barrier or a chemical barrier
to protect your skin now a lot of people
out there also believe that if you avoid
sunburn you're avoiding skin cancer
perhaps you're very pale or it's the
early phase of the summer season or you
have a susceptibility to sunlight such
that you know you step outside and you
get too much sunlight on a given day and
you get a sunburn that reflects an
immune reaction an inflammatory reaction
within the dermal layers of the skin so
that means the vasculature right those
vessels and capillaries they're going to
dilate you often times will get
infiltration of things like cyto coses
which are of the immune system you get
an inflammatory respon that's why it's
red that's why it's tender to the touch
the nerve endings there can be overly
activated so the reason why your skin
actually feels warm right when you touch
your sunburn is because in fact you have
an activation of some of the nerve
endings at that site as well as the
activation of the local immune system
properties that give rise to again
vessel and capillary dilation it's a
wound of sorts induced by excessive sun
exposure now does sunburn cause skin
cancer there's no direct relationship
between Sunburn and skin cancer except
the fact that sunburn reflects excessive
sunlight exposure and yes as I mentioned
before it's conclusive that excessive UV
sun exposure to the skin can cause
certain mutations in skin cells that
give rise to certain skin cancers why
are we parsing things at this level of
detail right is this all just semantics
no it's not just semantics many people
believe that if they didn't get a
sunburn they are not at additional risk
for inducing skin cancer or other issues
with skin right we're not just talking
about skin cancer we're talking about
accelerated aging of the skin according
to sun exposure so let's make this very
simple you don't need a sunburn for the
sun to accelerate the Aging appearance
of your skin you don't need a sunburn to
induce the kind of mutation that may
again I want to highlight may give rise
to a skin cancer it's also not the case
that if you got a sunburn or even
multiple sunburns that you'll
necessarily develop skin cancer although
by virtue of the fact that sunburn
reflects UV exposure
multiple sunburns would reflect
increased UV exposure and therefore
increased risk for certain skin cancers
so all this to say avoid sunburn however
you can and if you're somebody who just
loes sunscreen that doesn't want to even
hear the discussion we're about to have
next about which sunscreens are safe and
which ones appear to be less safe if
you're just one of these people that
does not want to put sunscreen on
because you're very concerned about
whatever chemical might be in sunscreen
well then consider that the physical
barrier of an article of clothing or a
hat or a bandana of sorts can indeed
Shield you from the Sun to some degree
often to a great degree and again I
don't think there's any controversy as
to whether or not those are safe as many
of you know I've been taking ag1 for
more than 10 years now so I'm delighted
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they're a sponsor rather they are a
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take ag1 once and often twice every
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starting way back in 2012 there is so
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vegan I think it's generally agreed that
you should get most of your food from
unprocessed or minimally processed
sources which allows you to eat enough
but not overeat get plenty of vitamins
and minerals probiotics and
micronutrients that we all need for
physical and mental health now I
personally am an omin and I strive to
get most of my food from unprocessed or
minimally processed sources but the
reason I still take ag1 once and often
twice every day is that it ensures I get
all of those vitamins minerals
probiotics Etc but it also has
adaptogens to help me cope with stress
it's basically a nutritional insurance
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ag1 in the morning and again in the
afternoon or evening I cover all of my
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huberman okay so before we dive into our
discussion about sunscreens and the
chemicals in
sunscreens let's just take a moment and
talk about vitamin D vitamin D is
important for a great number of bodily
and brain functions as I mentioned
earlier most people get their Vitamin D
from the foods they eat if you eat dairy
in most countries the dairy is fortified
with vitamin D many people nowadays
supplement with vitamin D anywhere from
a th000 IUS to 5,000 IUS that folks out
there who perhaps even take 10,000 IUS
seems a bit high for most people but
it's going to depend on how much sun
exposure you get the pigmentation of
your skin but there are a number of
people especially in countries where
they don't get a lot of sun exposure in
particular times of year and maybe
they're not eating enough Dairy
fortified with vitamin D who would
benefit from vitamin D supplementation
and many people find they feel better
when they supplement with vitamin D but
I encourage you that if you're going to
supplement with vitamin D to probably
start at the lower end of
supplementation like a th000 to 3,000 IU
maybe 5,000 IU best would be to measure
your vitamin D levels many people are
surprised to find that even if they live
in a part of the world where they get a
fair amount of sun exposure and they eat
some Dairy that's fortified with vitamin
D that for whatever reason their vitamin
D levels are still too low and benefit
from supplementation with vitamin D the
dermatologist that I spoke to told me
that yes even if you wear sunscreen or a
physical barrier okay this is
interesting even if you wear sunscreen
or a physical barrier when you get
outside into the
sun it can still have a positive effect
on your vitamin D levels this was
surprising to me but then of course it
makes sense sunlight is full spectrum
light it's not just UV and short
wavelength light the ability for longer
wavelength light to penetrate the skin
is clear and those longer wavelengths
can also impart a positive influence on
the vitamin D pathway okay so if you're
concerned about wearing sunscreen
because you're worried that it's going
to impair your vitamin D synthesis or
metabolism in any way probably no reason
to be concerned now if you're somebody
who is in The Beekeeper category who's
completely avoiding sun exposure for
whatever reason well then you probably
want to get your vitamin D levels
checked and you may want to rely on
supplementation or something of that
sort at the same time because of
variation in genetic background there
will even be some of you out there who
are super anti-s sunscreen who are
peeling your shirts off all the time who
getting lots of sun exposure who may
surprisingly have vitamin D levels that
are still low that's rare okay for all
the obvious reasons but it could still
be the case and indeed some of the
dermatologists that I spoke to said they
occasionally have a patient like that
vitamin D as you may recall is involved
in a bunch of different things it acts
as a hormone it's involved in calcium
absorption it's involved in some of the
other hormone Pathways and I should
mention that there's a study I'll link
to this in the show note captions that
shows that some amount of sunlight
exposure to the skin this is an Israeli
study where they had people you know get
several tens of minutes of sunlight
exposure in the afternoon during
particular times of year uh they didn't
have them going naked outside okay this
was sort of like context and culturally
appropriate um skin exposure to the
upper body and to the legs could induce
increases in hormones such as
testosterone and estrogen which were
correlated with it wasn't causal but it
was correlated with improvements in mood
well-being libido Etc well some of that
probably relates to testost Stone and
estrogen synthesis directly again the
skin as an endocrine organ okay there
are certain elements within the cortinos
sites skin cells that can literally
communicate with some of the organs of
the body that produce testosterone and
estrogen even some of the glands
pituitary Etc this is through a number
of different stations it's not
necessarily direct but also through the
sun's ability to impact the vitamin D
pathway that then impinges on those
testosterone estrogen and things like
luteinizing hormone Pathways we don't
have time to go into into all this now I
covered this in an episode about
testosterone and estrogen you have
hormones such as lutenizing hormone
which then stimulate the gonads the
testes to the ovaries to make
testosterone Endor estrogen the skin is
a not so obvious player in this whole
thing whereby external environmental
stimuli such as the availability of
sunlight which in most places in the
world varies across the year can
stimulate more or less vitamin D
production luteinizing hormone
production that can hinge on
testosterone and estrogen
production these pathways are one of the
reasons why when we get the right amount
of sunlight not too little not too much
we feel better we feel better because
certain hormones are being produced at
certain levels when we're getting that
sun exposure and when we don't get that
sun exposure we have lower levels of
those hormones this is well established
and the study that I linked to in the
show note captions which I've covered in
previous episodes is but one example of
that phenomenon okay let's talk about
sunscreens now the reason I changed my
tone of voice voice with this is that if
you look on the internet you will see
claims that I don't use or believe in
sunscreen that is just false I've worn
sunscreen my entire life I don't
necessarily wear every day I don't tend
to burn easily okay I have some natural
level of pigmentation in my skin based
on my genetics as I mentioned earlier
but as we talked about earlier just
avoiding sunburn is not going to protect
me or anyone else against certain
sun-induced mutations in skin cells and
the aging effects that sun can have so I
do believe in certain sunscreens meaning
I will put sunscreen on on certain days
on certain parts of my
body however I do believe now having
spoken to multiple
dermatologists and looked into the
literature very deeply that there are
certain chemicals in certain sunscreens
that are of concern I don't mean that if
you put these on once or even twice that
you are going to suffer negative
consequences I mean they are of concern
meaning we should pay attention to them
and when given the option we should opt
for the healthier choices and in fact
there are known healthier choices to
make all of this very clear I'm going to
tell you what is very clear to the
Dermatology community at this point in
time okay in June of 2024 here's what we
know there are two major types of
sunscreens out there well really three
we talked about physical barrier before
no one argues about a physical barrier
no one's worried about the chemical
compos I of physical barriers okay when
we talk about sunscreen so lotions
creams sprays Etc there are two major
types the first are organic types which
is essentially chemical sunscreens okay
so when you hear organic sunscreens that
means chemical type sunscreens and then
there are inorganic types which are
sometimes referred to as mineral-based
sunscreens here's what most everybody
seems to accept that mineral-based
sunscreens meaning sunscreen that tend
to include either zinc oxide or titanium
dioxide or both in some cases are
generally thought to be safe up to
concentrations of 25% 25% is a pretty
high concentration you can find
sunscreens out there that have 25% zinc
oxide or 25% titanium dioxide they're
rare to find however more often you'll
find sunscreens that have 15% 10% 18%
zinc oxide sometimes alone or in
combination with titanium dioxide you'll
find some pure titanium dioxide
sunscreens out there alth those are a
bit more rare right a little bit harder
to find here's the story zinc oxide and
titanium dioxide reflect back UV light
those short wavelengths of light that
would otherwise potentially cause
mutations in your skin cells at the
level of the epidermis okay in the
outermost layers of skin remember short
wavelength light doesn't pass very
deeply into the skin sunscreens
containing zinc oxide Andor titanium
dioxide were engineered for that
specific purpose to reflect back UV
light this is very different than
organic or chemical sunscreens which
contain certain compounds these Go by
different names
oxybenzone avobenzone there are a bunch
of these different chemicals that are
contained in so-called organic or
chemical sunscreens those chemicals in
general don't serve to reflect back UV
light but rather absorb UV light okay so
when they're applied to the skin they're
designed to absorb the UV light so that
the UV light can't negatively impact the
skin those chemical again chemical AKA
organic components within organic
sunscreens again sometimes called
chemical sunscreens are designed to
absorb UV light mineral-based sunscreens
so-called inorganic sunscreens
containing things like zinc oxide or
titanium dioxide are designed to reflect
back UV light why am I telling you this
well I'm telling you this because it's
generally believed that the zinc oxide
and titanium dioxide containing
sunscreens are safe up to concentrations
of 25% whereas there is some again some
concern about the chemicals within
chemical AKA organic sunscreens as
potential endocrine disruptors so
disrupting things like testosterone
synthesis estrogen synthesis and other
hormones it's not all just about
testosterone and estrogen folks other
hormone Pathways that many people
including some governing bodies and
agencies that assess the safety of
different cosmetic and sunscreen
products are concerned about now how
concerned they are depends on where you
are in the world okay so in Europe they
have different stringencies for what is
considered safe versus unsafe or just of
concern as opposed to in the US here's
what every dermatologist in the US
because those are the ones I spoke to
told me which is that it is advised that
on children younger than 6 months of age
you do not use chemical based B
sunscreens why well young skin even the
skin on the external part of the body in
children 6 months or younger acts more
like mucosal skin in that it can very
easily absorb things transdermally
through the skin however even as we age
so into puberty our young adult years
and even into our elderly years there is
still a capacity for things to pass
transdermally through the skin although
because of some of the additional
barriers formed within the dermal and
epidermal layers of the skin like
extracellular Matrix the changes in
collagen Etc there is less tendency for
compounds to pass transdermally through
the skin now that just simply highlights
the fact that if you are a very young
person or if you're applying sunscreen
to a very young person maybe six months
or younger but also perhaps older
depending on how careful you want to be
to avoid these chemical-based
sunscreens there is very little if any
evidence that the mineral-based
sunscreens are of concern for
transdermal pass into the skin at
concentrations of 25% or less meaning
sunscreens containing zinc oxide and
titanium dioxide are probably safe or at
least have been deemed safe enough that
they are freely available on the market
and we are told that they are safe for
people of all ages so if you are
somebody who is concerned about the
chemicals in sunscreen most every
dermatologist or chemist who works on
sunscreens will tell you well
mineral-based inorganic sunscreens are
going to be your safer option if you're
concerned but get this the
chemical-based sunscreens while some of
the chemicals in them indeed can be
quite scary when you read the literature
you look at some of these things like
oxybenzone um avobenzone and some
similar chemicals even at low
concentrations have been shown to be
endocrine disruptors people talk about
how the fact when they apply these
sunscreens they can taste them in their
mouth there's a lot of fear around these
and some of that fear is substantiated
when one goes and looks at the studies
that have been done on these
chemical-based sunscreens you may find
it interesting to note that the way
these studies were done often involves
having people apply a ton of these
chemical based sunscreens like two full
bottles of these sunscreens over the
course of a very short period of time
and then have their blood drawn and then
it's revealed that some of these
chemical components are within the blood
so a big issue that's not often
discussed because it's very difficult to
control for in a natural setting but is
straightforward to control for in a
laboratory setting is how much sunscreen
one is applying and how often and across
how many years of time so there's no
real prescriptive that can tell you hey
if you put chemical sunscreens on once
that's problematic although certainly
pay attention to that six months and
younger what is essentially a rule that
I mentioned earlier and do not put
chemical based sunscreens on really
young kids you might want to avoid them
entirely depending on how stringent you
are about this stuff but when it comes
to chemical based sunscreens personally
I avoid them but then it becomes a
question of if you could only use a
chemical based sunscreen you simply look
at the label some of these have by the
way zinc oxide titanium oxide and
chemical based components okay keep that
in mind some are purely mineral based
some are purely chemical based but if
you look at a sunscreen label you know
okay well this is the only thing
available on this very hot day with a
very high UV index and otherwise I'm
going to get a burn well if you're
really concerned then I would resort to
a physical barrier if you are less
concerned then you could perhaps tell
yourself okay you get to put it on that
day but you might not want to use it
every day and you might want to use a
small volume of it right or maybe just
on parts of your face or your ears or
your neck that are particularly
sensitive to Sun okay these are the
things that need to be taken into
consideration but when we step back from
all of this all of the literature
including by the way some of the
literature that assessed and I'll put a
link to this review a review on the
potential neurotoxicity of titanium
dioxide nanoparticles I'll get into this
in a moment it has been explored whether
or not titanium dioxide is more risky
than zinc oxide talk about that in a
moment but when you step back from all
of this here's what you get physical
barrier no one argues About That No One
Believes that clothing is dangerous per
se when it comes to avoiding excessive
sun exposure again excessive relates to
your skin tone your background genetics
your activities and where you are in the
world and what time of year okay very
specific to your needs very few folks
are concerned about mineral-based
inorganic sunscreen so if you want to
use sunscreen as many people do and you
want to make sure that it's not an
endocrine disruptor and it's not a
neurotoxin or something else that's been
raised for some of these chemical-based
sunscreens well then find a sunscreen
that has 25% less zinc oxide and or
titanium dioxide if you were a bit more
concerned about say titanium dioxide and
some of the suggestive evidence only
suggestive evidence that maybe titanium
dioxide is more risky than zinc oxide
especially when it's in its Nano form
the very small form that may indeed
allow it for more easy Passage through
the layers of the skin that transdermal
passage will then find a sunscreen that
is purely zinc oxide sunscreen and again
they always have other things in them
but what I mean is the only active
ingredient in a zinc oxide only
containing sunscreen is zinc oxide and
then there are a bunch of other things
that allow it to be a lotion for
instance again up to 25% concentration
why would somebody not want to use zinc
oxide containing sunscreen up to 25% and
opt for anything else you might ask
right if that's considered safe the
reason is the consistency of the zinc
oxide is it's pretty sticky and thick
and it's kind of pasty right back in the
80s and 90s some of you may recall that
had um zinc oxide um sunscreens that
would actually you know color the nose
white so you could really see it was
really prominent on the face they tried
to turn that into a fashion statement
didn't go over so well over time but in
any case the addition of titanium
dioxide to those zinc oxide containing
sunscreens allow it to be a bit silkier
so that it would spread on more evenly
and then you may say well why even put
chemicals in sunscreen at all if there's
risk the reason why chemical-based
organic sunscreens even exist is that
they can come up with compositions of
those sunscreens that are very silky and
that could spread on clear over makeup
and things of that sort but there are
these concerns about some of those
chemical components as endocrine
disruptors and potentially as mutagens
that could cause other issues or you
know any number of different things you
you know you can find all sorts of
concerns out there on the internet most
of those concerns are not substantiated
but these chemicals can be problematic
at high concentrations and that takes us
back to the point made earlier which is
that in the studies of those chemicals
and the reasons in some cases being
banned in certain countries and other
countries carrying uh warning
recommendations the amount of those
chemical-based sunscreens that were
applied was exceedingly high so if
you're wearing sunscreen very often
you're wearing a lot of it probably best
of year towards a mineral-based
sunscreen if you are concerned at all
about the chemicals in chemical based
sunscreen wear a mineral based sunscreen
and or use physical barrier and if
you're somebody who just doesn't believe
that sunscreens are safe whatsoever well
you know as far as I know it's a free
world you don't have to wear sunscreen
but then I would say you need to be very
aware of the fact that sun can induce
the appearance of accelerated aging in
the skin right that's an actual process
that takes place there's really no
debating that frankly and sun exposure
can potentially accelerate or even give
rise to certain skin Cancers and nobody
wants that okay before we move on to a
discussion about what can be done to to
increase the youthfulness of our skin or
the appearance of youthfulness in our
skin we need to have a bit more
discussion about skin cancers notice I
said skin cancers plural because there
are many different forms of skin cancer
some of them relate to sun exposure as
we discussed earlier others do not and
in fact some of the more deadly skin
cancers are independent of sun exposure
they can relate to genetics and to other
factors so the most straightforward
story about all of this is that
approximately 80 to 90 % of melanomas
which are skin Cancers and they are very
serious skin cancers that can indeed be
very deadly arise in what's called
denovo skin denovo skin is non mole skin
now does that mean that you should not
pay attention to the shape and any
changes in your moles no you absolutely
should but for people who have naturally
darker pigmentation everywhere or who
have very few
moles then you aren't going to be able
to use the monitoring of your moles as
the only readout of potential
development of skin cancer and frankly
everybody should be thinking about these
more serious skin cancers independent of
moles or changes in moles here are a
couple things that everyone should pay
attention to if you have a pimple like
lesion or you have any kind of spot on
your skin that seems like it's an acne
that's lasted more than a month or you
have an area that's seeping something
that might look like plasma or pus or
blood and it persists over a long period
of time like a month or more
absolutely get that checked out by a
dermatologist okay don't wait any longer
than a month get it checked out in
addition it's highly recommended that
you go in and you get your moles checked
by a dermatologist and frankly that you
get all of your skin checked by a
dermatologist at least once per year
this is going to really protect you
against both the sun-induced skin
Cancers and other forms of skin cancer
the most common form of sun exposure
induced cancers are basil cell
carcinomas and indeed those are less
deadly many of the melanomas but they
still can be exceedingly problematic and
they can be deadly so it's very
important to get these checked out now
there are websites and I'll provide a
link to one of them in the show note
captions for which you can look at a
bunch of different examples of different
moles and how they change over time and
if you happen to have a mole that
resembles the appearance of any of the
moles in that image gallery then you
would be wise to go to a dermatologist
right away because it could be again
could be cancer of some sort you do not
want to let these things linger for too
long at the same time many people get
concerned about one mole that didn't
have an irregular border and then
suddenly has an irregular border there
are a lot of different features as
you'll learn from the website or if you
talk to your dermatologist that relate
to whether or not something is
predicting skin cancer or has become
skin cancer it's not just irregular
border it's changes in size certainly
changes in pigmentation vascularization
bleeding any kind of seeping there are a
lot of different things there so don't
be alarmed at first appearance of one of
these things but do take it seriously
and keep in mind that there are things
that your dermatologist can do to help
prevent certain skin cancers so for
instance there's a growing Trend now
among dermatologists to suggest laser
resurfacing of skin that is a laser used
to essentially disrupt that epidermal
outermost layer turn it over so that it
regenerates because it can indeed
regenerate to create new cells there
keep in mind that UV light and other
factors in the environment can cause
mutations within that skin layer
sometimes they're caused by genetic
factors but often environmental factors
like sun and chemicals and other things
and by encouraging turnover of that skin
layer through laser resurfacing which by
the way may also increase the sort of
youthfulness appearance of your skin so
many people are motivated to do it for
that reason can dramatically reduce the
incidence of certain kinds of skin
cancer in fact the dermatologist I spoke
to who's an expert in Derm oncology okay
cancers of the skin said that laser
resurfacing can cause a 30% reduction in
skin cancers because of this ability to
rejuvenate that epidermal layer and
that's especially true for areas of the
body like the face ears neck tops of the
hands etc for which the sun often
induces the most damage because those
are the most exposed parts of the body
on a regular basis and by the way this
whole thing about skin cancer is not a
trivially small number it's a big number
in the us alone there are up to four
million cases per year of what's called
Squam cell carcinoma one of these forms
of skin cancer so getting checked out by
a highly qualified dermatologist on a
yearly basis maybe even more if you're
really concerned about this because you
have a lot of familiar
genetically inherited skin cancers
things of that sort is really highly
advised I'd like to take a brief break
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sample pack now with respect to
everything we've talked about about sun
exposure sunscreen and skin cancer I'd
be remiss if I didn't discuss a study
that's often used kind of as a wedge or
a weapon in the online debates about sun
exposure skin cancer and mortality and
the title of this study is quote
avoidance of sun exposure as a risk
factor that's right sun exposure as a
risk factor for major causes of death a
competing risk analysis of the melanoma
in southern Sweden cohort so the basic
design of the study was to evaluate
people's self-reported amount of sun
exposure across many years and then to
correlate that with all cause mortality
and then to relate it to different
causes of disease in particular
cardiovascular death compare this to
smokers keep in mind that some of the
people who were reporting their sun
exposure were smokers some weren't
and the conclusion of this study that
Drew a lot of attention and continues to
draw a lot of attention is the following
quote and here I quote from the abstract
non-smokers who avoided sun exposure had
a life expectancy similar to smokers in
the highest sun exposure group okay I'm
going to repeat that non-smokers who
avoided sun exposure had a life
expectancy similar to smokers in the
highest sun exposure group so what many
people take this to con clude is that
avoiding sun exposure is as dangerous as
smoking okay that's not the conclusion
that I'd like you to take away because
what this study basically shows is and
here I continue quote compared to the
highest sun exposure group life
expectancy of avoiders of sun exposure
was reduced by 0.6 to 2.1 years so way a
second can this really be true that
people that are avoiding sun exposure
have a low life expectancy than people
who get sun exposure and indeed in this
particular study that does seem to be
the case but the interpretation of this
is not completely straightforward here's
what we know getting some degree of sun
exposure appears to be good for life
expectancy that is true but is it
directly related to sun exposure that's
a critical question and is the increased
sun exposure that one gets if you do get
sun exposure linked to other issues in
particular the development of melanoma
as you recall melanoma was even in the
title of the study so here's how I think
we should think about this study it does
appear that getting sun exposure is
correlated with longer life expectancy
but there could be any number of
different reasons for that for instance
people that are getting regular sun
exposure presumably are also enhancing
activation of the vitamin D Pathways
which is related to any number of
different things they no doubt are
experiencing increased feelings of
well-being I talked about papers that
have substantiated that earlier and
frankly we didn't even need a scientific
study to substantiate that although it's
always great to have it we know that
being out in sunshine for some period of
time each day as long as we don't get
burned in the sun feels good why does it
feel good it leads to the production of
testosterone estrogen some of the
endorphins that generally make us feel
good it is directly related to the
pathways associated with dopamine
release there's a whole story there
about seasonality both in humans and
other animals about dopamine synthesis
when we get sunlight there's elevated
dopamine and serotonin and testosterone
and estrogen and feelings of well-being
and libido this is all well
substantiated in animal models and
humans so getting sun exposure makes
people feel good when people feel good
they tend to be lower stress when people
are feeling good and they have energy
because there indeed is a direct
relationship between sun exposure
especially to the eyes early in the day
and our feelings of elevated mood and
alertness and energy they tend to
exercise more walk more and of course if
you're outside exercising more walking
more cycling swimming you're also going
to get more sun exposure and we know
that exercise is strongly related to
improved or extended life expectancy
okay so the study basically says getting
sunlight as opposed to very little
sunlight is good for life expectancy but
it doesn't say get too much sunlight
right because and this is interesting it
is very clear that the people who lived
longer because they were getting more
sunlight also tended to have more
cancers including melanoma but this is a
very important point it's also the case
that the longer one lives the more
likely you are to develop a cancer okay
so as you can see these studies that
many people just draw one
straightforward conclusion from such as
people who get less sun exposure don't
live as long as people to get more sun
exposure well that's true but when you
get more sun exposure very likely you're
doing other things like exercise and
feeling better that relate to living
longer so it's very difficult if not
impossible to isolate one single
variable in this case sun exposure as
the key variable however I'm happy to go
on record saying that we know from so
many studies of animal models and humans
that sun exposure especially early day
sun exposure when the sun is low in the
sky to set your circadian rhythm and
late day sun exposure okay I'm not
talking about middle of the day getting
baked in the Sun and you know sunburned
or things of that sort but around the
time of sunset especially sun exposure
to the eyes is powerfully modulating
your circadian rhythm to elevate daytime
mood focus and alertness and improv
sleep both of which are strongly
correlated with improvements in mental
health immune system function feelings
of well-being enhanced cognition I mean
there's this whole story about people
with Alzheimer's and disruptions in
circadian rhythms and sleep so sun
exposure to the eyes in terms of setting
circadian rhythm
powerful powerful Improvement of life
expectancy and immediate health sun
exposure to the skin no doubt very
powerful positive modulators of certain
hormone and neuromodulator Pathways such
as dopamine testosterone estrogen and so
forth that make people feel good and do
things generally that are good for them
okay generally not all the things people
do with elevated dopamine testosterone
and estrogen are good for them we know
that for sure but getting some sunlight
that is some appropriate dosage of
sunlight especially to the eyes ear in
the day don't stare at the sun don't
damage your eyes but getting some of
that sun exposure to your eyes early in
the day and some to the skin especially
in the early and later part of the day
clearly is positively correlated with
various Health metrics in terms of
mental health and physical health and
not surprisingly with lifespan so I
mentioned the study because I do think
it's very interesting right I think it's
really interesting that people who
completely avoid sunlight are not living
as long as people who get some sun
exposure and some of this actually is on
par with what's experienced with
cigarette smoking I think something that
everyone agrees is negative in terms of
life
expectancy and certainly is not good for
a great number of different systems
within the brain and body but I think
the study sometimes is used to highlight
the wrong conclusion which is that
sunlight itself is extending lifespan I
think that that very simple conclusion
can be taken too far and can start to
negate some of the equally important
messages about excessive sunlight
exposure causing certain problems as it
relates to skin cancers which we talked
about earlier as it relates to things
that you can do in order to offset some
of that risk with if I were to suggest a
physical barrier if you need it a
chemical based sunscreen if you choose
to use sunscreen and of course that's an
independent choice that each of us have
to make for ourselves okay let's talk
about youthfulness of skin or the
appearance of youthfulness in skin
before I did this episode I put the call
out on social media for questions about
skin and skin health and I must say that
the vast majority of questions related
to this topic and it's a very
interesting one because it relates to a
lot of decisions that people are making
about what to do what to buy or not BU
as the case may be and it is an
enormous probably hundreds of billions
of dollars industry if not trillion
dollar industry over time this business
of devices products and procedures to
try and reverse aging or the appearance
of Aging in skin or even create denovo
new synthesis of collagen and skin and
other things to make skin look more
youthful okay so if we step back from
this whole area we have to ask ourselves
what do we know for sure about what
makes skin look youthful and what can be
done to make skin look more youthful and
to understand the answers to those
questions we simply have to go back to
the beginning of today's discussion for
just a moment remember that we have the
EP dermal layer of skin we have the
dermal layer of skin where you have the
vascul the blood vessels and capillaries
you have the nerve inputs there and you
have a bunch of different cell types in
there the cartinos sites you have
different proteins within those cells
like collagen elastin that over time can
yes be mutated by things like UV rays
from the Sun but that over time tend to
lose their elasticity which leads to
wrinkles and sagging skin you also have
this issue of hydration of the skin
right the skin has a lot of watery
components within it actual water within
it and those watery components are what
give it its kind of plump moist look
smooth look as opposed to desiccated you
know sagging wrinkled look to speak in
extremes and there are hundreds if not
thousands of different chemicals out
there that dermatologists as well as
cosmetic surgeons as well as just you
know frankly manufacturers of products
assert are going to be good for skin so
let's talk about where there is a lot of
evidence for certain things that you can
do if your goal is to increase the
youthfulness or the appearance of
youthfulness in your skin and one of the
main ones is collagen itself now I have
to admit I was very surprised when I
looked at this literature but I was
positively surprised here's why as you
know there are various macronutrients
present in foods you can have proteins
fats and carbohydrates when we ingest
proteins such as beef chicken fish eggs
as well as some vegan sources of
proteins like beans or lentils or tofu
things of that sort they contain
different amounts of different essential
amino acids and those essential amino
acids and other amino acids are used as
the building blocks for proteins in our
muscles in our tendons in essentially
all the organ systems of our body the
lipids are also used for cell membranes
Etc okay this has been discussed various
times on this podcast before people like
Dr Lane Norton Dr Gabrielle lion and
others it's well established that when
these proteins are broken down in the
gut some of those amino acids go and
serve for the purpose of tissue repair
others are for the purpose of other
things what most people in the field of
nutrition agree upon and what certainly
I believe is that if you were to say eat
a little bit of liver right you might
have a little bit of cooked liver or a
little bit of skeletal muscle in the
form of like a steak that there's no
selective trafficking of the amino acids
that are broken down from the liver that
you eat to your liver right so when you
hear that eating liver supports your
liver it may do that by the broad
process of certain amino acids and
vitamins and lipids Etc serving your
liver and other organ and tissue systems
of the body but not selectively your
liver however when we talk about
collagen this protein that forms one of
the most essential aspects of what makes
our skin what it is which is elastic and
you know and and to have some tensile
strength where we can push on it it
returns to its uh original position
especially if if it's well hydrated and
makes our skin very youthful in
appearance when we're young and then as
it degrades when we get old makes it
look less youthful wrinkles and sagging
and so forth well then why would eating
collagen protein which can come from any
number of different sources it can come
from fish sources it can come from
Believe It or Not animal hoof sources
can come from any number of different
sources tendon Etc why would ingesting
collagen be selectively trafficked to
the collagen in our skin right that
doesn't square with everything we know
and yet when you look at studies
including metaanalyses of studies where
people supplement with collagen powders
and these powders typically come from
fish or Tender any number of different
sources when people do this and then
measures are taken as to skin appearance
skin elasticity there are a bunch of
measures that could be done in humans in
the laboratory to do this you often will
find studies that show statistically
significant improvements in collagen
composition and skin appearance and even
the appearance of reduction in wrinkles
and so forth
so this is an interesting exception
where the ingestion of a particular
protein that naturally exists in
abundance in certain tissues such as
Skin but also other tissues like tendon
ligaments Etc seems to be assisting in
either the repair and Rejuvenation of
collagen or perhaps some other aspect of
collagen synthesis that leads to
improvements in collagen composition and
the appearance of skin in humans that's
very interesting and the stud study that
I find particularly interesting is one
that I'll link to in the show note
captions it's entitled quote exploring
the impact of hydrolized collagen oral
supplementation on skin Rejuvenation a
systematic review and metaanalysis and
the basic takeaway of this and other
metaanalyses and the studies with in
this metaanalyses is that when people
supplement with anywhere from 5 to 15
grams okay grams of hydrolized collagen
per day in particular in combination
with vitamin C it doesn't have to be a
of vitamin C that one can observe okay
not always but can observe some visible
improvements in skin composition meaning
less wrinkles even some reversal of
wrinkles less skin sagging more youthful
appearance more kind of um let's just
call it rebound elasticity of the skin I
realize that's not the appropriate
technical term but uh the ability of the
skin to bounce back from an indentation
when you push down on it as opposed to
saying down or or sagging so some pretty
impressive results when one considers
that what people are basically doing
here is just mixing up some hydrolyzed
collagen protein and then uh drinking
that down once per day or so now that is
not to say that you have to supplement
with hydrolyzed collagen why well
collagen is also present in various
Foods so for instance drinking bone
broth beef bone broth chicken bone broth
is a rich source of collagen you can go
online and simply look up just by web
search you can just say you know what
foods contain high levels of collagen
and you'll get a list of things back
there hopefully a few of those are not
just palatable to you but you actually
like and you can start to include those
in your daily diet or you could
supplement with hydrolyzed collagen
protein there any number of different
sources for these it's interesting that
while indeed I don't believe and there
is frankly zero evidence for Selective
trafficking of amino acids arising from
a particular organ source to that
particular organ when you ingest it it
is interesting that consuming hydrolized
collagen in the form of a supplement or
deriving it from foods like bone broth
Etc does seem to be able to improve
collagen synthesis or the appearance of
skin making it more youthful for those
of you that are interested in ingesting
collagen peptides as a way to improve
the youthfulness of your skin should
mention that the dosages there uh come
in a Range depending on the studies that
you've looked at and the dermatologist
that I spoke to said if one decides to
go down this route of supplementing or
getting collagen from food sources you
want to aim for anywhere from 15 gam to
30 gam of collagen peptide per day okay
that's a bit higher than what was used
in a number of uh studies but you'll
find studies that use 30 grams and that
that whole process can be augmented can
be
improved through ingestion of 500 to
1,000 milligrams of Vitamin C as well
but check the label on those collagen
peptides that you might be supplementing
with because often times they already
include that 500 to 1,000 milligrams of
Vitamin C I should also mention that the
dermatologists I spoke to said that they
like collagen protein supplement ation
not just for the reasons discussed up
until now but that they like them for a
number of other reasons such as the
potential anti-inflammatory effects of
collagen proteins to be honest I don't
know what the exact mechanism of that is
maybe if you get a certain protein
threshold the inflammation is down but
anyway that's still cryptic to me but in
any case they did describe some of the
potential mechanisms by which collagen
ingestion can do its thing in terms of
improving youthfulness it's broken down
in the blood into dipeptides and
tripeptides which then are used within
the collagen itself of the skin this is
the hypothesis and that it can increase
the chemotaxis the mobility of
fiberblast which make up some of the
skin tissue and give rise to the
appearance of more youthful skin there's
also evidence that ingestion of
hydrolized collagen peptides can improve
the elasticity of the Skin Barrier on
the outside right make it look nice and
taut if I guess we say nice we're sort
of passing subjective readout on this uh
make it appear taut um through the
increase of certain proteins unrelated
to collagen such as filigran elastins
Etc what about other peptides okay so
this is a big topic nowadays especially
in the online communities I did an
entire episode of this podcast about
peptides keep in mind that insulin is a
peptide OIC what is essentially an
Agonist for glucagonlike peptide one
this is a very popular prescription drug
now for the treatment of obesity and for
the treatment of diabetes there there
are lots of things that qualify as
peptides a peptide is simply a small
chain of amino acids a polypeptide is a
bit longer chain of amino acids and then
proteins are made up of amino acids okay
so when we say peptides that means many
many things but these days when you hear
about quote unquote peptides especially
in online communities generally people
are referring to exogenously given okay
so pills ointments or more typically
injections of peptides that are designed
to achieve some specific biological or
physiological outcome and one of the
more common of these peptides being used
nowadays is one that I've talked about
before called bpc157 body protection
compound 157 which is essentially a
synthetic version of something found in
gastric juice in all of us it's known
that certain peptides within the gut
that bpc 157 is known to mimic or
actually is a synthetic version of that
exact sequence or a portion of that
sequence can assist in tissue and wound
repair of different kinds tendon
anything involving fiber blast all of
that has been well demonstrated in vitro
in a dish okay so not in Vivo as well as
inv Vivo in certain cases but only in
animal models to my knowledge there's
only one study and frankly it's not a
very good study at all on bpc157 in
humans and yet a lot of people are
taking bpc157 either orally in the form
of a capsule or pill or more typically
injecting it what does it do or what
does it likely do in humans we know from
animal models that pc-1 157 increases
angiogenesis the growth of capillaries
in blood vessels we know this it can
accelerate wound healing by virtue of
increasing fibr blast motility for this
reason it's used post injury in sports
it's used by people who want to build
more muscle it's used by endurance
athletes it's used for cosmetic purposes
anytime people are using bpc157 for any
of those purposes it's likely that
they're using it in part to increase the
blood flow that's available to a given
tissue and the repair of that tissue now
again I do want to caution people that
there is very little basically no
evidence in humans besides the anecdotal
evidence that people say they healed
faster what I do know is that anytime
you get vascularization of tissue you're
going to get improved blood flow so it
all makes sense mechanistically I also
know that vascularization due to bpc157
even if it's injected locally into a
given tissue is likely to occur globally
throughout the body this is why some
people taking oral bpc157 or injecting
it you know just subcutaneously at the
level of you know their stomach a little
bit you know Under the Skin at the level
of their stomach report faster wound
healing even in a distal limb or like a
hand or a nerve injury in their foot or
something like that that also tells us
that there's going to be increased
vascularization of other tissues such as
Skin such as tumors if tumors exist so
you need to be very careful I need to
say that upfront as a cautionary note
because it is very clear that many many
people are starting to either inject
bpc157 or apply in the form of a topical
cream in effort to get more
vascularization of skin in order to make
that skin appear more youthful and more
and more products are out there that
contain bpc157 I can't in good conscious
recommend those products I can only
offer to you the likely mechanism by
which they work if they work and also
offer you the caveat that it is unclear
that bpc 157 can go transdermally if
it's applied topically so if you put on
a say wrinkly portion of your face so
like I've got crow's feet crow's feet
come from either aging smiling or both
um you know crow's feet are the kind
wrinkles that extend out the corners of
your eyes when you smile or for me
because I'm you know 48 you know
probably do that even when I don't smile
the the logic would be that if you take
a cream containing bpc157 and you put it
on there that you'll get increased
vascularization of that area delivery of
more growth factors in nutrients and
those wrinkles will either be halted in
their aging progression or that they
will reverse that's the logic to my
knowledge there are no clinical studies
and I'd love to know from you if you've
tried these products please put your
experience of those in the comments on
YouTube so we can get a sense of whether
or not people are having good um results
with this that of course is not a
controlled study but I'm very curious as
to know many of the products that
contain bpc157 by the way also contain
copper copper is a trace mineral it's
found in your diet there is some
evidence that copper is important for
some of the collagen and other elements
of skin synthesis Pathways and so the
mechanistic logic and the biochemical
logic is there on paper however it's
also clear that ingesting too much
copper can induce an inflammatory
response and would lead to the exact
opposite desired effect that people who
are using copper and usually copper bpc
containing products are taking them for
which is to Halt or reverse the
appearance of Aging in their skin why am
I going through this whole gymnastics of
you know bpc157 and copper well because
nowadays many many products are starting
to include quote unquote peptides for
skin Rejuvenation and most often those
peptides are of the copper variety of
the bpc 157 variety and often times also
with things related to collagen
synthesis sometimes collagen directly so
you'll find oral products that one takes
by pill form that are bpc157
copper and or things that promote
synthesis of collagen you'll find
ointments that are pure bpc157 still
unclear if those go transdermal okay so
this is still a very very young science
and most of this is not being explored
in randomized control trials however I
know some of you out there are pretty
experimental you like experimenting with
this kind of stuff you like hearing
what's working for other people here's
what I suggest if a sunscreen or a
lotion or a pill or an injection is
asserted to contain peptides to help
with skin Rejuvenation make sure you
look and see which specific peptides are
included know the risks associated with
bpc-157 it's uncertain risk about
acceleration of tumor growth but the
mechanistic logic is just as strong for
that with bpc-157 as it is for bpc157
encouraging vascularization of any other
tissue muscle tendon ligament or skin
for that matter so I'm not telling you
what to do just know what you're doing
and understand the likely mechanisms
behind it um in the absence of any of
these randomized controls trials I will
say in service to making sure that your
diet and/or supplementation includes
enough Trace mineral copper copper has
been shown to play a key role in DNA
repair which is a critical component of
the turnover of collagen and other
proteins in skin it has been shown to
reduce so-called reactive oxygen species
so it serves as a so-called antioxidant
and and this relates to what I just said
reduced inflammation but too much copper
is a problem so I wouldn't run out and
start supplementing with excessive
amounts of copper please don't do that
but you want to make sure that you're
getting sufficient amounts of copper
from your diet and you can simply look
up online what sufficient amounts of
copper are given it's a trace mineral
and it's very likely that if you ingest
any kind of supplement that is a
multivitamin mineral supplement or a
foundational nutrition supplement that
includes at least some copper so it's
likely that you're sort of quote unquote
topped off in terms of the amount of
copper that you need but very unlikely
to be excessive amounts of copper but if
you start supplementing with copper
beyond that again you can induce an infl
inflammatory response so it's a dosage
uh kind of Middle Ground issue there you
don't want your copper too low you don't
want your copper too high you want it
right there in the middle okay as I
mentioned before we will talk about
other components of food that are great
for skin health and we'll also talk
about components of certain foods like
Advanced glycation end products I don't
know if you've heard of those before but
very interesting not good stuff that you
want to avoid if you can especially if
you're concern is youthful looking skin
and healthy skin and frankly Health
overall but before we do that I think
it's worth paying attention to a few
things that you can potentially take
that can really improve the youthfulness
of your skin for which there is
excellent science to support it okay so
when I spoke to board certified
dermatologists who trained at excellent
institutions what people can do to
improve the youthfulness or the
appearance of youthfulness In Their Skin
and that there specifically be
peer-reviewed studies to support their
statements they mentioned hydrolyzed
collagen protein in combination with
vitamin C we talked about that earlier
they mentioned a bunch of dos and don'ts
as it relates to sun exposure and
nutrition Etc some of which we've
covered some of which we are yet to
cover but will soon and they mentioned
supplementing with
niacinamide niacinamide is a form of
vitamin B3 it is also sometimes referred
to as nicotinamide and I was told that
when taken at twice per day at a dosage
of 500 milligrams per dose for a total
of 1 gram or 1,000 milligrams per day
that niacinamide supplementation can
increase the production of ceramides
which relate to the lipids in skin that
improve the moisture in skin and by the
way moisture in skin is a key component
of the youthfulness or plump appearance
of that skin and when I say plump I
don't necessarily mean outwardly rounded
plump I mean the fact that the skin
looks like the outermost layer of the
skin which you now know as the epidermis
is kind of taut and the skin looks
hydrated and smooth at the level of its
outer appearance all of that
is improved by niacinamide
supplementation but that the
supplementation has to be carried out
for 3 to six months or more before that
effect is noticed now the origin of the
niacinamide effect on the youthfulness
of skin could also be related to the
fact that there's evidence that
niacinamide supplementation can reduce
inflammation of skin overall we haven't
talked so much about the immune skin
relationship although as I alluded to at
the beginning of the episode this is a
key relationship but for those of you
suffering from rosacea from acne so
rosacea being a rening of the skin we're
going to talk more about it later and
specific things that can be done for it
acne almost always involves some rening
often painful rening of specific pox on
the skin sometimes even the appearance
of you know pus-filled bumps this sort
of thing that nicomide supplementation
may also assist there because of the
reduction in inflammation and we'll talk
all about the relationship between
inflammation and acne regardless of
whether or not you suffer from rosacea
acne or not at all that ninite
supplementation May benefit you also
because nicomide supplementation appears
to balance the level of oil production
in the skin you need oil in the skin you
need oil down in those pores but not too
much and that it can definitely help
reduce the appearance of clogged pores
and if you're concerned about pores that
appear too large this typically happens
in the face around the nose on the upper
cheeks although other regions of the
body as well nicomide supplementation
May assist with that as well there's
also a number of people out there that
are concerned with specific spot spots
that they see as hyperpigmented spots so
regardless of whether or not overall
your skin is very light or very heavily
pigmented supplementation with nicomide
can reduce the appearance of
accumulation and maybe even the actual
accumulation of melan in at particular
spot so-called dark pigmented spots that
some people decide that they don't want
for whatever reason usually just
cosmetic reasons although there may be
reasons why hyperpigmentation in a given
area could relate to skin cancers we
talked about that earlier another reason
to go get not just your moles but all of
your skin checked at least once per year
now if you decide to supplement with
niacinamide you have the option of
either taking that th000 migs and 2 500
Mig dosages per day you also have the
option of using any number of different
topical niacinamide ointments or serums
that exist out there keep in mind that
many skincare products already contain
niacinamide so check the label and there
the dermatologists tell me that to be
effective the nicomide needs to be
present at at least a two and as high as
10% concentration within those ointments
or serums keep in mind that many serums
and ointments also contain what's called
hyaluronic acid hyaluronic acid is a
natural component of the skin that
provides a physical substrate for
holding in water so moisture within the
skin it does a bunch of other important
things too within the extracell Matrix
and elsewhere the regions between the
cells that is and supplementation with
hyaluronic acid or ointments or serums
that contain hyaluronic acid and
niacinamide are pretty common out there
because of the already stated effects of
niacinamide and the fact that hyaluronic
acid can serve as what's called a
humectant something that serves to S
barrier in moisture at the level of the
skin okay so it gives that kind of um
Plumping uh moist look of skin that's
characteristic of youthful skin as
opposed to aged skin the dermatologists
and the cosmetic surgeons that work on
faces that I spoke to I told you I
consulted with a fairly large and
Diversified Group of folks um in
preparation for this episode all agreed
that supplementation with collag vitamin
C niacinamide and hyaluronic acid was
something that they suggest to their
patients the other supplement well
actually it's a prescription treatment
most often that dermatologists recommend
if the goal is youthful appearing skin
are things within the so-called retinoid
pathway such as retinol okay many of you
have perhaps heard of this and it's a
whole story related to the relationship
between vitamin A and skin okay so
Trenton Noah is the common name for it
although some of you may know it as
retina and prescription drugs that are
similar to that are basically
derivatives of vitamin A why why are
these used for skin care why are they
used to increase the youthfulness of
skin well vitamin A gets into skin cells
and is converted into something called
retin aldhy then into something called
retinoic acid now very important to know
that retinoic acid is involved in a lot
of different cellular processes
especially during neural development
this is why and please pay careful
attention to this this is why women who
are pregnant or breastfeeding should
avoid taking these products because it
can seriously disrupt the development of
the fetus okay and keep in mind that
many times people don't realize they're
pregnant for some period of time so this
is of Paramount concern okay we could
have a whole discussion as to the role
of retinoic acid in fetal development
but you don't want to tamper with that
pathway okay very serious consequences
can occur okay so when retinoic acid
gets into cells it can activate what's
called transcription factors
transcription factors bind to DNA okay
your genetic code and can induce the
transcription and translation of DNA
into RNA and RNA into proteins of
particular types so think of
transcription factors is sort of setting
a menu of different proteins that
ultimately will be formed okay by
binding to DNA and then you get DNA to
RNA rnate a protein and you're getting a
set of proteins related to a particular
process that's generally how
transcription factors work and retina
Treno and things similar to that are
going to induce the formation of
collagen protein within skin as well as
other proteins that relate to the
formation of denovo skin new skin and
can replace old degenerated skin so the
dermatologists that I spoke to were
really bullish about the fact that
believe it or not they felt that people
starting in their 20s could very well as
long as they're not pregnant or
lactating or planning to get pregnant
could take a or things similar to it in
order to stimulate the production of
more skin and look more youthful now for
people already in their 20s you know by
my RAID they're already youthful but
that they could initiate the use of
these compounds at least in one's 20s
and continuing on really as long as they
wanted through life and they told me
about quote remarkable results so I said
well why isn't everyone aware of this
why isn't everyone taking them well it
turns out that these different compounds
can also increase sensitivity to life
make you more prone to sunburn to some
of the other effects of light on skin
even from screens or from artificial
lights so one has to be careful about
inducing too much skin sensitivity to
light of all kinds not just sunlight
that they can also induce some redness
or dryness so one has to get the dosage
right the frequency of use right they
can be a little bit tricky to work with
but that if one can home in on the right
dosages the right frequency Etc the
dermatologist felt like this was one of
the best things that one could do to
improve the youthfulness or the
appearance of youthfulness in one's skin
now I find this interesting for a number
of reasons first of all I've heard of
retina right I've heard of these
compounds before um but I hadn't heard
about all these you know reportedly
spectacular things like improved
angiogenesis vascularization of the skin
this is why people are taking the rather
um experimental untested bpc157 that I
talked about before um the improved
elasticity of skin which somehow seems
related to the ability of these
compounds to remove degenerated elastin
within the skin to clear that out as
well as to induce denovo synthesis and
even the number of different fiber
blasts that are present in skin so more
new skin clearing away of old skin
improved vascularization and while all
of this sounds a little bit too good to
be true the mechanisms by which it's
asserted to work all hold up so that's
always reassuring right mechanism isn't
everything but it's really nice to see
there for instance these compounds are
known to get into the nucleus of cells
right to impact gene expression and we
talked about that before you have
receptors on the surface of cells okay
so cell surface receptors you also have
nuclear receptors and the ability of
certain things we call them ligans but
these are chemicals right in this case
you know in the vitamin A pathway to get
into the nucleus of cells and impact
gene expression this is actually how
hormones like testosterone and estrogen
change the way that people look so
dramatically during puberty they
actually you know they operate by
binding the cell surface receptors they
also get into the nuclear compartment of
the cell they bind to nuclear receptors
and they turn on entire genetic program
prams that cause for instance deepening
of The Voice or the growth of hair or
breast tissue Etc so these are powerful
compounds now I talked to a cosmetic
surgeon expert in face specifically uh
remember cosmetic surgery is done for a
number of different areas of the of the
body but for face specifically who also
specializes in these sorts of treatments
for skin and they've started using and
are frankly quite confident in the use
of retinoid Esters that can be applied
to the surface of the skin these things
are available not by prescription
there's far less research on these sorts
of compounds but these compounds get
enough positive support from the people
that have tried them reporting improved
youthfulness of skin Etc that some of
them are becoming quite sought-after and
um people let's just say are very
enthusiastic about them and I will say
that in discussing the various
mechanisms of this with these cosmetic
surgeons and some dermatologists the
logic holds up so you're starting to see
more and more of these now as I
mentioned at the beginning of today's
episode there is zero
business relationship between me the
podcast or any of these um people that
have marketed serums or creams or
prescription drugs for that matter
related to skin health and skincare
however I have provided a couple links
in the show note captions of some of the
different sources of these obviously if
you need a prescription for something
like Trent noan or something similar
because you're interested in this whole
retinol retina um vitamin A pathway
story you need to talk to a board
certified dermatologist who could
potentially prescribe that for you if
they decide it's right for you but in
terms of these topical ointments and
serums and creams and things like that I
do provide a link to at least one source
of those that uses the retinoid Esther
just keep in mind that these various
ointments and serums do not yet have the
randomized control trials to support
them that some of the other compounds
that we were discussing do have now I'd
like to talk about things that one can
do to improve the health and appearance
of one's skin that don't involve taking
anything or putting on any kind of
ointment or serum or anything like that
and what I'm referring to is
phototherapy now at the earlier part of
the episode I talked about how different
wavelengths of light like UV light and
long wavelength light can penetrate skin
to different depths and some of the
negative but also positive things that
that can do so for instance we talked
about UV light mutating DNA in cells and
potentially causing cancers accelerating
the aging process and so forth but as
you also recall long wavelength light
so-called red light and near infrared
light which is even longer wavelengths
of light can penetrate deep into the
skin tissue so pass that outer epidermal
layer into the dermal layers of the skin
and can access the vasculature the
neurons some of the glands located
deeper in the skin and of course the
cells there like cells in the epidermis
I should point out contain things like
mitochondria for which red light has
been shown to be beneficial why red
light and near infrared light
phototherapy has been shown to reduce
reactive oxygen speed species and
thereby to improve mitochondrial
function in cells and that in turn has
been shown to be beneficial for all the
different processes within cells that
involve mitochondria which of course
include energy production but a bunch of
other things too so when I say that
photo therapy has been shown to be
beneficial for cells of the body it's
not just cells of the skin in fact a
Nobel Prize was granted in the early
1900s for the use of phototherapy for
the treatment of Lupus so this is not a
new technology at the same time
while there are many studies exploring
the use of phototherapy for improvement
of skin health and appearance most of
those Studies have fairly low sample
sizes but there are a lot of those
studies and fortunately by now there are
a few metaanalyses and reviews that take
into account lots of different studies
using slightly different wavelengths of
light appli to different portions of the
face for different purposes treatment of
acne U maybe even um putting red light
near infrared light on one half of the
face to have a so-called within person
control to compare you know the changes
in skin or lack of changes in skin as
the case may be between one side of the
face and the other um I'll put links to
some of these studies and some of the
metaanalyses and reviews of these
studies one that I like in particular
was published in 2018 entitled light
emitting diodes in dermatology a
systematic review of randomized control
Trials of course randomized control
trials being one very powerful way to
analyze the utility of a practice or a
compound it's not the only way to assess
the utility of something I know some
people argue that they are very use ful
but keep in mind in the field of
medicine we often have entire fields or
even entire chapters of medical books
that are based on case studies for
instance we implicate the so-called
hippocampus of the brain for its
function in human memory which it
absolutely has and that fact largely
Grew From one major case study that then
exploded into a number of different
animal model and then human studies
later on so we all love randomized
control trials reviews of randomized
control trials and the uses of the
phototherapy for treatment of skin
conditions and improving the quality of
skin are wonderful and point to the fact
that phototherapy can indeed improve the
appearance of skin in conditions like
acne can accelerate wound healing can
improve the youthfulness appearance of
skin but these effects tend to be
somewhat mild to moderate when they
occur and certainly there are many
studies that show no significant effect
no statistically significant effect that
said I'm of the belief based on my read
of the literature and this is a
literature I've spent a lot of time with
frankly because I did an episode all
about light and health I've also been
very interested in the use of
phototherapy for the treatment of eye
diseases and offsetting age related
decline in visual function there's some
interesting evidence there again mild to
moderate effects but that can be
meaningful in the real world and when I
step back from all of the literature
here's what I see and this is what I ran
by a dermatologist to make sure that
they they thought that this protocol
would be useful or not useful right I
asked them I didn't tell them do you
think this will be useful tell me yes I
asked them and what we basically
converged on was that if somebody
decides to do phototherapy the use of
phototherapy that involves long
wavelengths of light so red light Plus
near infrared light typically at a
distance of about a foot to 2 feet from
the light source depending on the
intensity of the light source although
that doesn't seem to be so critical but
one can't be across the room from the
red light source nor should one get
right up next to the red light source so
that there's a lot of heat generated
from the red light source that one can
feel but at a distance of about a foot
to 2 feet away at fairly High
intensities done for anywhere from 10 to
15 minutes 5 to 7even days per week on a
consistent basis does seem on average to
lead to improvements in the youthfulness
appearance of skin why this would be the
case isn't exactly clear but there are
number of different logical
interpretations such as reduced
inflammation improved mitochondrial
function all Downstream of reduced
reactive oxygen species improved blood
flow to that particular area because of
the effect that long wavelength light
can have on vasod dilation of expansion
as opposed to contraction of blood
vessels and capillaries all of this
makes mechanistic logical sense and the
effects that one sees in these various
peer-reviewed papers randomized control
trials seem pretty good meaning there
are mild to moderate none of them are
sort of jaw-dropping like wow complete
reversal of severe acne or you know
massively accelerated wound healing and
we also of course have to take into
account that many people who are doing
phototherapy often are combining it with
other things sometimes in today's era
like injections of bpc-157 or the use of
hyaluronic acid or niacinamide Etc so
these things aren't always being
examined in isolation but when we look
at this literature I think it's fair to
say that there is now substantial
evidence for the use of phototherapy y
for improving the quality of skin and in
some cases for reducing the symptoms of
acne reducing the symptoms of psoriasis
basically any condition where improved
blood flow lowered inflammation fewer or
reduced oxygen species improved
mitochondrial function delivery of
nutrients anytime some or all of those
things are going to be involved
phototherapy makes logical sense and so
it's no surprise that we're seeing
increased evidence for phototherapy in
these conditions now I've provided a
link to the review of the random control
trials that I mentioned a bit ago I also
provided a few links to some specific
studies that show pictures of before and
after some cases on two sides of the
very same
face I did an entire episode about light
and health I'll also provide a link to
that episode and if you don't want to
listen to or watch that entire episode
you can go to specific um timestamps in
that episode to learn about the uses of
phototherapy for the treatment of skin
eye and other conditions related to
mental health and physical health now
keep in mind that when people hear
phototherapy they almost immediately
think about a device and that makes
sense right red light near infrared
light however if you recall there's this
thing called the Sun that emits full
spectrum light which of course
includes red light and longer
wavelengths of light okay so just
because you can't see those longer
wavelengths of light that doesn't mean
they're not there just like UV light you
can't sense UV light with your eyes by
the way ground squirrels and some other
animals can it's thought to be the case
that they have photo receptors to detect
UV because they actually this is sort of
strange but interesting you'll never
forget this that they'll take their
urine and they'll spread it on their
stomach with their little paws and
they'll stand up and they'll like signal
flash one another from across the
Prairie or whatever it is across the
lawn to signal to one another so they're
sending uvp signals across the lawn I'm
not making this up I actually studied a
little bit of this when I was an
undergraduate but not at the level of
the urine and the signaling at the level
of the retina any discussion about skin
has to include a discussion about
nutrition why remember the fact that I
mentioned at the beginning of today's
episode that your skin and your immune
system have a very intimate relationship
it's bidirectional your skin reflects
the status of your immune system in many
ways and this is why many people with
autoimmune conditions things like lyen
planis you can look it up or if you you
know mind uh particularly you know
striking photographs please don't look
it up but people that have autoimmune
conditions that often manifests in skin
conditions we'll talk more about this in
the context of psoriasis in a little bit
but anytime we're talking about the
immune system or skin we need to take
into account the gut microbiome and
nutrition so many people asked what are
the things that they should eat to have
healthy appearing youthful
skin they also asked what are the things
that one eats that could exacerbate
things like acne and what can one eat in
order to reduce their acne so let's just
start off with the basics and here I'm
going to be fairly brief because I think
we all know the big take-home message
about nutrition nowadays we hear over
and over again and we should pay
attention to the fact that the vast
majority of our food well I should say
if one desires to be healthy mentally
healthy physically healthy and a high
performing individual in any number of
different things cognitive physical or
otherwise we want to consume the vast
majority of our foods from nonprocessed
or minimally processed sources so-called
Whole Foods so fruits vegetables if
that's within your diet some people
include grains some people don't I'm not
here to discuss that meat eggs fish
chicken and so forth if that's within
your diet plan or your nutrition or if
you're a vegetarian or vegan you make
the associated adjustment so that you
can make sure you're getting enough
protein and amino acids but it's in
keeping with your ethical and maybe your
health goals okay so we're not here to
discuss vegan vegetarian omnivore of
which I am or carnivore okay that's not
the discussion I think all of those
groups agree that getting the majority
of your nutrition from nonprocessed or
minimally processed foods is going to be
best and that of course if you're human
sometimes you'll ingest processed foods
but really trying to avoid highly
processed foods is critical now with
respect to the specific foods that can
improve skin appearance and skin Health
it's very clear that diets that are of
the so-called lowi inflammatory type
that don't spark inflammation so these
would be things that sometimes are
referred to as the Mediterranean diet or
a Paleo like Diet you hear these terms
but what what are we really talking
about mostly Whole Foods minimally
processed foods okay and then there's
variation depending on whether or not
you emphasize or deemphasize meat and
fish or emphasize or deemphasize
vegetables this kind of thing again I'm
an omnivore I love fruit I love
vegetables I do like rice oatmeal and
some pastas I like a great sourdough
bread I like butter I like olive oil I
like meat I like fish I think I am
representative of most people out there
because I eat most all those things but
I also eat the occasional croissant I
also eat the occasional slice of pizza I
don't eat a lot of that stuff but I eat
it now and again and then of course you
have people that are super strict what
do we know about the relationship
between specific foods and skin health
and skin appearance well
anti-inflammatory diet we've more or
less spelled out what that represents
without getting into too many specifics
and then there are the specific
components within Foods so vitamins
minerals and
micronutrients as well as things like
collagen present in bone broth that can
be really useful to include so one one
of the I think best accounts on
dermatologic health and skin health and
appearance on the Internet is Dr Andrea
Suarez she's a medical doctor board
certified dermatologist and she has a
wonderful video that describes the
various foods that one can eat to
promote skin health and skin appearance
and rather than repeat that entire video
because a that wouldn't be right and B
um it already exists out there in
excellent form I'll just give a brief
synopsis of some of the things that she
suggests because I entirely agree and
again there's no need to be repetive
and she does an excellent job so she
certainly mentions collagen and bone
broth she also mentions various sources
of omega fatty acids that are often
lacking in people's diets that they
should pay extra careful attention to
get so things like walnuts flax fatty
fish I personally am a big believer in
supplementing with liquid form fish oil
that's what I do why am I a big believer
in that well I don't tend to cook much
fatty fish I love the taste of it if
it's prepared right but I don't tend to
do that very often so I use a liquid
form fish oil or capsules but the liquid
form is generally more affordable this
was discussed in episode that I did with
Dr Ronda Patrick so we can put a link to
that particular segment in the show note
captions it's also suggested that we eat
a lot of leafy greens so dark leafy
greens you're probably noticing a lot of
these recommendations are kind of
typical for what people describe anytime
they're talking about nutrition for
health she highly recommends people get
enough folic acid for the role that
folic acid plays in DNA synthesis is and
repair of skin cells as among other
cells and cell proliferation and of
course we should get our colored fruits
and veggies so our oranges our
strawberries the Reds and oranges are
critical out there and she also
highlights something very important that
I want to reiterate which is that we
have a critical need for Vitamin A for
our skin health and this was covered
albeit through the lens of exploring the
pharmacology of trentino and those retin
A compounds but vitamin A is crucial for
a number of different processes with in
the cell types that make up skin she
appropriately cautions against
supplementing with vitamin A because
it's a fat soluble vitamin it's very
easy to overdose vitamin A if one is
supplementing with too much of it she
recommends rather getting enough vitamin
A from things like oranges carrot sweet
potatoes she recommends as much Berry
intake as is appropriate for someone and
one can afford the berries are so
delicious but they tend to be expensive
Depending on time of year ingesting
things like garlic because garlic has
sulfur which is key for collagen
synthesis and repair and she talks about
the critical role of torine anyway she
does such a terrific job of describing
the nutrition for skin health and skin
appearance those are just a few of the
highlights I do encourage you to check
out that video and her other content is
spectacular as well again she has an
Instagram account YouTube channel that
are really wonderful so again without
doing a deep dive into nutrition decide
whether or not you're going to be vegan
vegetarian omnivore or carnivore and
then make sure that you're getting
enough of the vitamins and minerals and
micronutrients from your Foods or
supplement if necessary but note that
caution about vitamin A supplementation
in excess and also make sure you're
avoiding excessive amounts of Highly
processed foods you know I mentioned
earlier these Advanced glycation end
products these are things that are
present in a lot of processed foods like
crackers and chips and things like that
that make those Foods inflammatory so
you're getting the theme now
inflammation is bad not just for the
skin but for all organ systems of the
body it's not just about the high
density of calories
and the high density of taste present in
highly processed foods those are
problematic but a lot of the issue with
these highly processed foods is the high
heat conditions used to make those Foods
stable on shelves or stable in packaging
over time okay so there's a whole
discussion to be had here that frankly I
don't think iy had enough but that is
outside the scope of today's episode the
point is that when these highly
processed foods are basically made right
they're constructed um they involve the
interactions between sugars and proteins
and fats at high heat that make them
stable on the shelf or in packaging and
those can be very inflammatory and that
can show up in the form of reactive skin
it can make your psoriasis worse yes it
can make your acne worse it can make
your skin more tender and painful it can
make your skin basically more reactive
to some of the underlying
predispositions you might have either
because of genetics or other things
you're doing or not doing maybe you're
going through a particularly stressful
time maybe you're getting a little a
little bit of extra sun and you're
eating more highly processed foods and
those things are combining and making
your skin break out or flush more than
it would ordinarily again there's so
many reasons to eat most of your foods
from non-processed or minimally
processed sources and of course and now
I sound like a broken record because you
can hear this all over the Internet
ingesting foods that are excessively
high in sugar excessively high in sugars
combined with fats just not good to do
pro-inflammatory it's going to cause all
sorts of issues and we're going to get
into this more as it relates to acne in
particular because as you probably know
when you ingest foods that are high in
sugars or even just carbohydrates
generally that also contain a lot of
fats and in particular when those foods
are highly processed well then you
initiate an inflammatory response and
you often can initiate additional things
happening in the pores of cells that can
start to really aggravate acne and cause
more acne this has to do with the whole
insulin pathway so when we talk about
acne I'll talk about diets that create a
high glycemic load we're not necessarily
talking about the glycemic index of food
you may know that when people measure
the glycemic index of food they're
looking at the blood sugar response
after eating that food typically in
isolation and not in combination with
other Foods what I'm talking about is
eating combinations of foods that induce
high levels of insulin high levels of
blood glucose that then lead to all
sorts of things in the hormone Pathways
and cell growth Pathways that exacerbate
acne so we'll get there in a moment but
I think the Takeo message around
nutrition is pretty clear so much so
that I don't want to to spend any more
time on it we all know what the best
nutrition really is for us regardless of
whether or not you're vegan vegetarian
omnivore or carnivore it's nonprocessed
or minimally processed foods
representing probably anywhere from
let's say 75 to 100% of your food intake
depending on how strict you want to be
and then sure make some room if you want
for some processed foods but just know
that those Advanced glycation end
products and the high glycemic load that
comes from those processed foods can
really exacerbate inflammatory responses
in skin and set for it a whole domino
set of issues related to hormone
Pathways and cell growth Pathways that
make everything acne psoriasis and
overall appearance worse yes your skin
will appear to age faster and on the
positive side most of the foods that we
think of as healthy and
anti-inflammatory are actually quite
delicious so enjoy ah and I forgot to
say what's absolutely clear you know
that myth that they told us when we were
teenagers they eat a lot of fried food
would make you break out would make your
skin worse guess what it's true that
high heat preparation required for
creating things as delicious as the
doughnut or french fries right there's a
reason people love these Foods they're
so delicious they do cause problems
they're pro-inflammatory does that mean
you can never have a french fry no you
decide what's best for you but know what
you're doing as a segue to talking about
acne we need to talk about the gut
microbiome and this is a direct
outgrowth of our discussion about
nutrition here's the simple takeaway
that I believe everyone should follow
not just for sake of healthy appearing
skin but also for sake of every organ
and tissue system in your body which is
the data clearly show that ingestion of
sufficient amounts of fiber so Prebiotic
and probiotic fiber so fruits vegetables
sometimes this can also come from grains
some people will supplement with
additional fiber if they feel they need
it as well as ingestion of low sugar
fermented foods talked about this before
so regular listeners of this podcast may
have heard this things like kimchi
sauerkraut the sort of sauerkraut that
has to stay in the fridge so not the
stuff that's stable on the Shelf at room
temperature anything containing a brine
that salty brine so pickles but not the
pickles that are stable at room
temperature the ones that have to be
kept in the refrigerated section of the
grocery store these low sugar fermented
foods are powerful enhancers of the gut
microbiome and when the gut microbiome
is healthy you have reduced overall
inflammation in the body this is often
reflected at the level of the skin and
basically skin health and the
youthfulness appearance of skin is
enhanced okay this can also help with
conditions like acne or psoriasis
especially in conditions where there's a
direct immune system skin relationship
that we'll talk about more in a little
bit okay so I highly recommend people
have anywhere from 1 to four servings of
low sugar fermented foods per day or try
and enhance the health of their gut
microb biome generally maybe you take a
pill probiotic although those can be
very expensive there's a little bit of
data suggesting that if you chronically
take pill probiotics that yield very
high levels of bacteria well then maybe
there's some Associated brain fog that's
a little unclear pun intended but you
know they are very expensive they have
to be kept refrigerated and let's face
it low sugar fermented foods if you find
the ones that you like are really great
to ingest cuz they're tasty and they're
good for you now why am I talking about
this in part because we keep coming back
to inflammation as a general issue for
skin health and that points us also
towards some specific dos and don'ts as
it relates to
Lifestyle let's face it pun intended if
you sleep well so maybe you need six
hours maybe you need seven maybe you
need eight maybe you need nine but if
you sleep well on a consistent basis
your skin is going to look so much
better so much healthier more vibrant
than if you are not getting enough sleep
if you drink alcohol and you wake up the
next morning you know your Skin's going
to look puffy it's not going to look
good but many of you can ingest alcohol
without issues I've an entire episode
about alcohol yes it's a poison up to
two drinks per week for adults who are
non-alcoholics is probably safe zero is
better than any but let's face it
alcohol is going to exacerbate most skin
issues this is just clear from the
literature doesn't mean you never have a
glass of wine doesn't mean you never
have a beer or a cocktail if that's your
thing but alcohol consumed in excess and
it doesn't take much to get there is
going to cause sleep issues microbiome
issues so indirectly and negatively
impact the skin appearance and health
and indirectly and negatively impact the
health of other tissues in your body but
it's clear some of that is reduced to
increase inflammation some is related to
decreased Sleep Quality or duration so
get great sleep avoid alcohol in excess
maybe avoid it allog together drink
plenty of water this sounds like such
basic advice but proper hydration is key
get enough water in electrolytes it
absolutely will impact your inflammation
Levels by reducing them it absolutely
will impact your skin health and
appearance in a positive way so these
are just basic things that I'd be remiss
if I didn't mention the other one is
smoking and nicotine from non-smoked
sources so it's very clear that smoking
vaping dipping or snuffing is bad for
skin appearance and health bad bad bad
every dermatologist said this why well
with smoking you can imagine why okay a
lot of carcinog and toxic end products
generated from smoking even from vaping
yes even from vaping it will make your
skin age faster that's clear but it's
also the substance itself why all of
those things in addition to increasing
inflammation nicotine itself is a
vasoconstrictor so you're doing the
exact opposite of what you want when it
comes to skin health and appearance and
that's why people take things like bpc
157 that's why people take nicotinamide
that's why people are trying to improve
the hydration status of their skin so if
you're somebody that's vaping nicotine
or even taking nicotine in some other
form pouch or smoking nicotine and
you're interested in having youthful
appearing skin you are really shooting
yourself in the I know face and as we
all know our emotions impact the
appearance of our skin and yes it can
exacerbate so-called breakouts and we'll
get to that in a moment as to what the
exact pathway is but I've done entire
episodes about controlling your stress
we have a master stress episode that
talks about real time tools that you can
use like the physiological sigh provide
a link to a clip about the physiological
sigh it's the fastest way that I'm aware
of to reduce one's levels of stress this
is something my laboratory has studied
in detail at Stanford there are also
things you can do and we're all aware of
what they are proper sleep meditation
non-sleep deep rest we'll provide a link
for that all things that we can do that
are zero cost very minimal time
investment physiological side takes
about 10 to 15 seconds uh non-sleep deep
breast AK Yoga Nidra sometimes called
takes anywhere from 10 to 20 minutes per
day and that reduced stress can
dramatically improve not just the health
but the appearance of your skin and it
makes perfect sense as to why that is
the stress hormones such as cortisol but
other hormones too such as adrenaline
when they are chronically elevated
because of the fact that adrenaline
impacts Vaso constriction in the skin
it's going to reduce blood flow to the
periphery to the skin it can cause all
sorts of issues at the level of nerve
endings that can lead to believe it or
not enhanced Flushing when we're under
stress this is why we measure the
galvanic skin response so not just
sweating but also blood flow and other
things to the skin when we are studying
stress okay so direct relationship
between stress and skin appearance learn
to control your stress stress is part of
life but learn to control your stress in
real time and through tools like
non-sleep deep rest that are zero cost
that can help you reduce your overall
levels of stress get great sleep don't
use nicotine if you do use nicotine know
what you're doing maybe use it sparingly
and please don't smoke or vape it dip it
or snuff it there are other form forms
and I don't recommend those forms
because they're very very addictive and
keep in mind that things that improve
blood flow reduce inflammation give you
lower stress better sleep all of that is
going to make you look more youthful
it's not an imagined effect it is real
let's talk about acne acne is very
common it impacts anywhere from 80 to
90% of young people at some point some
people get very bad cystic acne you know
deep acne in the cheeks on the back of
the neck the back it can be very
uncomfortable very painful some people
only get the oal pimple but they get
them very deeply they're very painful
and look nobody likes acne nobody likes
the appearance of acne on themselves it
can be very distressing for people it
can cause additional stress that then
feeds back in terms of inflammation and
you know I guess my first uh you know
request I suppose I I can't tell people
what to do and never do but you know for
people that have acne you know be
compassionate okay young people be
compassionate I remember when I was
younger some of the kids with bad acne
got teased and it it really upset me as
is really frustrating especially when
going through puberty because there's
this hormonal component to acne now
fortunately there are things that we can
do for acne I'll provide a link to one
of the major sources I used for
researching this episode I also of
course spoke to dermatologists one of
whom really knows an exceptional amount
about acne and its relationship to the
immune
system the paper that I'm referring to
now is a systematic review and network
metaanalysis of topical pharmacological
oral pharmacological physical and
combined treatments for acne GIS which
is the technical name for acne there are
a lot of things that impact acne let's
just briefly talk about what acne is
anytime you talk about acne you're
usually thinking about pus or oil that's
called sebum the sebum accumulates in
essentially the follicle around the hair
this also occurs on non-hairy skin or
where they're just tiny little hairs
that often aren't uh visible that's why
it's very unusual to get acne on say the
glabrous skin of the Palms I suppose it
could happen but it's very rare at any
given moment 10% of people worldwide
will have acne as I mentioned up to 90%
of young people have acne so very common
very distressing the accumulation of
that sebum in the follicle can be due to
a number of different things some of it
can be related to androgens things like
testosterone increasing the amount of
sebum that's produced okay this is why
you often see acne during puberty in
addition the anabolic the progrowth
effects of androgens such as
testosterone and by the way these occur
in both males and females because both
males and females have testosterone and
estrogen the androgenic effects of
testosterone can also cause hypertrophy
growth of the hair follicle right so an
increase in the number of catinos sites
the cells in and around the follicle
which can compress that and hold some of
that additional sebum beneath the
surface and that's why you're getting a
swelling of what looks like a pimple or
a cyst so there's the potential for a
hormonal influence on increasing acne
now if someone going through puberty you
just have to deal with that increase now
if there's a sudden increase in acne
when one is post puberty you may want to
look at levels of androgens that are
being produced and nowadays with
increasing numbers apparently of things
like polycystic ovarian syndrome which
in part relates to increases in
androgens this is becoming an additional
concern so getting a quality blood test
looking at Androgen levels over time can
be very beneficial for both males and
females now in addition insulin that is
related to our diet so insulin and
glucose generally go up together or down
together depending on whether or not
we're ingesting Foods or amounts of
foods that greatly increase our insulin
and blood glucose so insulin is part of
an anabolic pathway as well a cell
growth pathway progrowth pathway we
should call it that involves mtor
mamalian Target of
rapamycin that is a general growth
signal for cells so this occurs in the
eye this occurs in the liver you know
mtor is involved involved in growth of
cells of all kinds including cells
within the skin when our
diet increases the amount of insulin and
glucose to a degree that is in excess of
some threshold that's going to be
different for everybody depending on
your activity levels your metabolism the
way you manage insulin when that happens
you get increases in mtor that then can
feed back on those Androgen receptors
increase the levels of things like
testosterone further that then feed back
on the production of increased SE
okay that oily stuff increased kosy
proliferation and you get more acne in
other words having a diet that has a
high glycemic load or evokes a large
insulin response can be problematic so
what to do well we talked about it
before you want to eat mostly
nonprocessed minimally processed foods
you definitely want to exert portion
control right you don't want to eat much
sugar or sugar in excess you don't want
big spikes in insulin and blood glucose
you want to avoid inflammatory diet so
again fewer if any highly processed
foods because of those glycation n
products that we talked about before and
on the positive side if one exercises
something like say intermittent fasting
and here I don't necessarily think young
people especially people going through
puberty should do this because they're
growing they need nutrients so you have
to strike that balance between getting
enough nutrients and not overloading the
system with insulin glucose and calories
but things like intermittent fasting
could be useful or making sure that if
you ingest complex carbohydrates as I
mentioned I do okay I'm an omnivore that
you don't do it in excess to the point
where you're getting big spikes in
insulin and blood glucose all of this
the dermatologist tell me can help serve
to reduce acne and while it might seem
indirect you know this relationship
between testosterone and sebum
accumulation the relationship between
insulin and mtor and increased
testosterone and SE sebum accumulation
and growth of the carattino sites these
are real Pathways that have been
established and some of those are
discussed in detail in the review
so much so that there has been the
exploration of specific Foods in
particular Dairy and Whey you know we
hear a lot about ingestion of whey
protein it's a very high quality protein
High bioavailability high in the amino
acid Lucine which for those of you that
are interested in muscle building and
repair there's a lot of discussion about
Lucine being a critical component there
you want Lucine but it does appear that
people that overc consume whey people
that over consume Dairy can run into
issues now does that mean you shouldn't
consume whey protein no I take whey
protein do I suffer from acne no if I
did would I reduce my whey protein
intake well I might decide to run a bit
of an experiment where I reduce the
amount of whey protein that I eat for a
little bit and see how that goes should
I reduce the amount of dairy I ingest ah
well here's where things get interesting
so in discussing this with a
dermatologist who also happens to know a
lot about nutrition they told me
something very interesting a lot of
people think that high-fat Dairy will
exacerbate their acne
but here's the
situation nonfat and low-fat Dairy has
emulsifiers this actually based on work
I believe some of which was done at
Stanford that can Spike insulin more
than full fat Dairy so some people in an
attempt to reduce the amount of acne
they're getting will move from high fat
dairy or full fat I should say to
non-fat milk or non-fat dairy or low fat
Dairy and their acne will actually get
worse and that could be because of the
insulin Spike associated with some of
the Ulsa fires in that non-fat and
low-fat Dairy so what this means is that
you don't have to avoid Dairy altogether
but you might be better off ingesting
full fat Dairy you might be best off not
ingesting any dairy at all maybe you
want to run that experiment on yourself
and just see what works and what doesn't
work or if there's no change at all in
addition if you're consuming a lot of
fried foods so those french fries you're
ingesting cheeseburgers and things of
that sort it may not be so much the fat
content of those meals but rather the
big insulin response that occurs when we
ingest high fat meals in common with
things like sugary milkshakes or fried
foods like french fries and things of
that sort that's leading to the acne by
way of increased inflammation right so
there are a lot of different Pathways
inflammation androgens like testosterone
insulin leading to increases in
testosterone and inflammation a lot of
Pathways converge to exacerbate acne and
often times it's just the removal or
even just the reduction of some of this
food intake or types of food intake that
can really lead to Big improvements in
one's acne so all of these things
combined to support lower inflammation
appropriate amounts of sebum production
because you do need sebum production you
do need cartinos sites in and around the
hair follicle but you don't want too
many of them and so on but what can be
done to directly address acne well there
are a number of different prescription
treatments that your dermatologist can
suggest but one thing that all the
dermatologists agree upon is first of
all getting adequate sleep reducing
stress taking care of your gut
microbiome the nutrition recommendations
that we've been talking about up until
now but also get this this is
interesting not over cleansing a lot of
people with acne will start to wash
their face constantly and we'll often
use harsh cleansers that can exacerbate
that acne either by virtue of removing
some important skin microbiome
components that then lead to even other
infections like fungal infections or
additional inflammation because you're
removing that microbiome barrier but
they all recommend regular cleansing of
the skin usually two or three times per
day but not in excess of that using a
gentle unscented unfragranced
cleanser okay so they're number of
different types of these I personally my
basically my entire life that I at least
as far as I can remember I've always
used unscented unfragranced Dove soap
okay I have no relationship to Dove soap
I'm sure people out there are going to
say oh my goodness you know it contains
a bunch of things that are bad for you
but that's what's worked for me and not
the liquid form just bar soap and there
are things like Cetaphil these are some
brand names and there are a bunch of
other more sophisticated gentle
cleansers that one could use there are
also a lot of products out there that
contain what's called salicylic acid
okay this as often as um you know clear
fluid that you put onto a cotton ball or
a tissue and then you you spread on on
the face it's very important very very
important that if you're going to use
these products that you do it on clean
skin that is skin that's been cleaned
with a combination of mild zero
fragrance soap and lukewarm water okay
because of the relationship between
inflammation and acne that's what gives
it its red appearance you don't want to
use extreme temperatures of especially
hot water when washing your skin so
lukewarm water mild soap and then and
only if it's been recommended by your
dermatologist the salicylic acid
salicylic acid comes from the same class
of drugs as aspirin so it tends to
reduce cattiny stickiness right the
extent to which um those cells stick
together why do I mention aspirin well
you may have heard that people will take
aspirin to reduce the stickiness between
their platelets and an attempt to
improve heart health we'll cover that on
another episode at some point but
salicylic acid reduces the stickiness of
the coratin oyes so it can lead to less
clogging of the pores by accumulation of
carattino sites or I should say by less
accumulation of the cortinos sites and
it can reduce swelling in and around the
area related to the acne sometimes if
people get an acne pimple especially if
they have an event or they don't want to
be seen with that pimple the use of a
little bit of corticosteroid cream put
on there can reduce the redness or
swelling the dermatologists tell me you
should absolutely not pop your pimples
part of the problem when you pop a
pimple I know there entire videos about
this online I know please don't go look
at them these uh the whole communi is
around this is super gross but I know
people find it very satisfying in some
cases to pop these pimples get the
infection out while there are certain
use cases for that where someone has an
infection it just absolutely needs to
get out then be cleaned then covered
with a bandage and maybe some topical
antibiotic that would be a use case for
that the dermatologist practically
begged me to tell you don't pop your
pimples because a they will go away in
not too much time if you leave them
alone and B you can always put a little
bit of corticosterone cream on top of
them to reduce the redness or swelling
but most importantly they tell me that
when you pop those pimples what ends up
happening is you get a mechanical a
physical disruption of that area which
to you might just seem like okay
whatever it turns a little bit red and
that's transient but you get the influx
of what are called Matrix
metalloproteases these are enzymes
remember anytime you hear an ace it's
usually an enzyme Matrix Metallo
proteases that then and go eat at The
extracellular Matrix and then you can
get an indentation scar that is
permanent okay so if you're concerned
about the appearance of your skin avoid
popping those pimples I know it can be
hard to do but really try and avoid
popping pimples it can lead to scarring
because of the Matrix metallic proteases
and the eating away of the exellar
Matrix keep the area clean cover it up
if you need to get some cortico stero
and cream on there if you want to reduce
the redness if it's really bad and you
have some big important event like
you're getting married tomorrow and it's
right on the tip of your nose or
something like that then you can
potentially go to the dermatologist and
get it injected with a corticosteroid to
reduce the redness um in a more potent
way but they did ask that I ask you to
please not pop your pimples and if
you're somebody that suffers from acne
I'd like you to know I provide a link to
a paper in the show note captions
entitled acne and diet a review of
pathogenic mechanisms and I also provide
a link to the review I mentioned before
that covers all of the other aspects of
treating acne topical pharmacological
oral pharmacological physical and
combined treatments for acne vulgaris
because again I do sympathize with the
fact that acne can be very distressing
very painful fortunately there are a
number of different avenues that you
without a dermatologist but ideally you
and a dermatologist can use use to
attack acne at the level of inflammation
through diet through lifestyle if needed
prescription medications and again
gentle cleansing and thinking about the
various things that indirectly will
impact that acne so much so that a few
of the derms told me that they have
patients young and old who will be
suffering from really bad acne that will
sometimes just make a few adjustments to
their diet the exclusion of certain
things mainly highly processed foods
maybe reducing Dairy a little bit or
weigh a little little bit or completely
and increasing the amount of things that
reduce inflammation so more fruits and
vegetables and meat fish eggs from
healthy sources and seeing dramatic
improvements in acne so that's always
reassuring to hear doesn't always
require prescription medication but if
you need it you should take it okay
let's talk about rosacea rosacea is
rening of the skin and some people
suffer from this pretty severely other
people mildly some people transiently
but it tends to be kind of distressing
for people and the reason it's stressing
is that it can look like blushing or
flushing of the face when in fact one
isn't emotionally embarrassed however
being embarrassed or having any flushing
of the skin can exacerbate existing
rosacea so it's thought to be caused by
a combination of genetics there can
perhaps be some again over inflammation
of the skin which probably reflects
inflammation more globally at the level
of the gut and body Etc we've been
talking a lot about that today and there
are things that can exacerbate rosacea
such as alcohol intake or anything that
acts as a vasod dilator that dilates the
vasculature innervating the skin so the
approach to treating rosacea is pretty
much similar to the other things that
we've talked about consuming a low
inflammation low glycemic low diet
trying to get enough sleep keeping
alcohol intake in particular to a
minimum or cutting out alcohol
completely the reason I say in
particular is that a lot of people that
suffer from rosacea who cut out alcohol
completely essentially eliminate the
rosacea or dramatically reduce it so
often times it's alcohol that's the
culprit either directly or indirectly we
don't know again alcohol is a poison but
could be the indirect manner in which
alcohol impacts sleep and the gut
microbiome negatively that's causing the
rosacea without knowing the direct or
indirect mechanism reduce or even
eliminate your alcohol for a bit and see
if your rosacea improves that will give
you a strong indication of what might be
going on and even better it could give
you a potential solution to the problem
now now for those that don't experience
a reduction or elimination of rosacea If
you eliminate alcohol get your sleep
right get your diet right there are some
additional things you can do first of
all you want to follow the same
recommendation we talked about for acne
which is also the general recommendation
for skin care use lukewarm water not
excessively hot or cold water a gentle
unfragranced cleanser you want to use
sunscreen regularly remember sun damage
to the skin is also inflammation so
that's going to exacerbate rosacea and
of course sunlight because of the
release of nitric oxide is also going to
act as a vasod dilator does that mean
you have to go full beekeeper mode no it
doesn't you can if you want to I suppose
but use a quality mineral-based
sunscreen which we talked about earlier
in the episode and you should use some
sort of moisturizer to help lock in the
moisture within your skin you could use
things like hyaluronic acid or use any
kind of gentle moisturizing cream that's
not going to cause inflammation or kind
of irritate the skin in any way and can
keep the moisture within the skin and
there are a lot of different versions of
these available out there and frankly a
lot of them are not terribly expensive
you can find super expensive varieties
of any and all these things but many of
the things that meet the criteria of
gentle unfragranced
cleanser SPF 30 mineral only sunscreen
as well as a quality moisturizer are not
necessarily the most expensive available
and you know what justifies the higher
expense in some cases could be I don't
know the silkiness or the um packaging
it could be any number of different
things I'm not going to say that the
cheapest varieties are necessarily as
good as the most expensive varieties but
I do think and the dermatologist that I
spoke to definitely confirmed that
there's a lot of price inflation out
there related to kind of the overall
milu of packaging and ex and purported
exclusivity of certain skincare products
look for the things that meet the
criteria you are trying to establish for
your skinc care but just like with acne
just like with General skincare if you
have rosacea you want to think about
mild treatments for the skin at the
level of cleaning at the level of sun
protection at the level of locking in
moisture and then there's some
additional things that if you can spare
the expense could also be beneficial
like nicotinamide niacinamide as it's
also called or there's also been some
evidence that things like licorice root
can be of benefit okay these things are
typically found as a topical ointment or
in a topical ointment but in the case of
niacinamide nicotinamide talked about
how this can be available in an ointment
form a topical form or it can be taken
as 2 500 milligram dosages per day I
gave you the long list of the various
mechanisms by which it can improve skin
Health reduced inflammation production
of collagen Etc all of that still holds
for the potential treatment of rosacea
be sure to avoid any kind of things that
are acting as strong astringents or that
increase heat so people who have rosacea
will often try to avoid hot peppers so
spicy foods of any kind I know that's
tough I'm somebody who really enjoys
spicy foods so if you have to avoid
spicy foods I sympathize with you um
that's rough um anything that acts as an
EST stringent or can you know really
irritate the skin from the inside or
from the outside so think not
excessively hot foods as it relates to
spicy or temperature things of that sort
now I should point out there are
different types of rosacea the
dermatologist I spoke to who is expert
in rosacea told me there are four major
types of rosacea many of them respond to
the sorts of guidelines that we've been
talking about up until now some of them
that also include acne need some
additional treatment we talked about
acne treatments that can be easily
folded into the treatment for
rosacea there are people who have very
stubborn rosacea this may be due to
excessive use of cleansers and again
we're talking about how over cleansing
can really be a problem so we're not
saying don't wash your face we're not
saying don't take a shower please do in
fact and I should have said this earlier
by the way for a lot of reasons related
to your comfort and appearance and other
people's
Comfort after you work out at a gym
regardless of whether or not you're
rolling around on the floor with a foam
roller or you're rolling Jiu-Jitsu or
you're lifting weights or you're doing
cardio it is a good idea to take a
shower and cleanse with a gentle
cleanser as soon as possible I know this
sounds like just basic advice but a lot
of people just throw on a clean shirt or
they don't rinse off or they don't wash
their face and they're wondering why
they're getting all sorts of skin issues
well there's a lot of bacteria gyms a
lot of sweating people um there are a
lot of bacteria on you a lot of bacteria
on the equipment and yeah you can spray
down the equipment and do these various
things but it's a good idea to shower as
soon as possible or to bathe rather as
soon as possible wash your face after
going to a gym for your sake and for the
sake of others now some rosacea is very
stubborn meaning it does not go away
even if somebody makes all the
appropriate LIF style adjustments tries
any number of different Medical
Treatments and by the way rosacea is a
medical condition and in some cases
people will get angomas um you know the
accumulation of blood vessels near the
surface of the skin that can be you know
for them something they don't want so we
could say unsightly but they just don't
want it or in some cases they'll treat
their rosacea and then they'll get an
accumulation of Broken Vessels near the
surface of the skin this is pretty
common for people that experience
rosacea and treat rosacea for these
people there is a treatment it has to be
done in a dermatologist office called
pulse die laser where they use a laser
of a particular wavelength that can
penetrate excuse me The Superficial
layers of the skin and now you know how
different wavelengths of light can
penetrate to different depths within
skin and destroy the blood vessels or
the broken blood vessels that then call
in immune system cells to clear out the
destroyed endothelial cells and other
stuff around it and take it away get rid
of those blood vessels that sit beneath
the surface let's talk about psoriasis
so when I was researching this episode I
asked the dermatologist is psoriasis
related to yeast or overproduction no
skin cells and what they told me was
really interesting they said for more
than 80 years within the dermatologic
community it was thought that psoriasis
was just an over production of skin
cells but it wasn't really known what
the source was and it turns out that now
almost all the derms at least the ones I
spoke to said that it has something to
do either directly or at least
powerfully and indirectly with the
immune system so what can be done to
treat psoriasis you can probably guess
things that reduce the overall level of
activation in the immune system not so
much that you become susceptible to
infections because that's not good but
you treat this like any other autoimmune
condition there are now drugs these are
prescription drugs that directly Target
the inter lucans the components of the
immune system that are directly involved
in psoriasis such as interlukin 17 and
interlukin 23 and I'm told that these
drugs are very effective in the
treatment of psoriasis so that's very
reassuring you know I know um especially
in communities online that are focused
more on behavioral tools and nutrition
based tools or supplementation based
tools of which I am right we focus on
those but as you probably noticed in
this and other episodes of The hubman
Lab podcast we also talk about
prescription drugs that have proven to
be very effective in certain conditions
so it's very reassuring to hear that
there are excellent prescription drugs
that can Target the specific inter
lucans that are
overactivated in psoriasis because
psoriasis is now known as an
overactivation of the immune system and
a kind of uh turning of the body on
itself if you will to create this itchy
scaly uncomfortable and in some cases
unsightly uh overproduction of skin
cells at the scalp and elsewhere Okay so
we've covered a lot of topics thus far
we've talked about skin biology we
talked about various skin conditions
that are very common such as acne
psoriasis and so forth we talked about
ways to increase the youthfulness or the
appearance of youthfulness in skin that
are based on data some that are a bit
more
experimental and we talked about even
some laser procedures and phototherapy
things of that sort and at the same time
I acknowledge that there are many topics
and conditions related to skin health
and skin care that we did not talk about
we didn't talk about Eczema we didn't
talk about Botox we didn't talk about an
enormous number of topics that I know
are of interest and relevant to many of
you so as a consequence the plan is to
host various expert guests both
dermatologist expert in particular areas
as well as yes a cosmetic surgeon who
believe it or not does not like to cut
but rather likes to use fairly
non-invasive procedures that touch on
some of these very same mechanisms yes
injections of certain things things that
operate at the surface level of the skin
and sometimes surgical procedures that
you know I know when people hear
cosmetic surgery they think oh people
just trying to improve the youthfulness
of their look or something of that sort
but you know that also relate to certain
serious skin conditions for which
surgery and non-surgical approaches can
assist in so the point is that any
discussion about skin health and Skin
Care is going to be an ongoing
discussion one that I do plan to
continue on this podcast in the form of
expert guest episodes maybe even another
solo episode we've occasionally done
so-called toolkit episodes where we
summarize some of the main points of
previous solo episodes and that arrive
with guest episodes and that reflect the
latest knowledge that gets published in
between episodes I do plan to cover this
topic in more detail going forward
meanwhile I like to think that what I've
covered today provides at at least an
introduction to the biology of skin and
an understanding about the various
things that we all can and should do for
our skin health and appearance as well
as ways to attack certain pain points
related to certain skin conditions that
come from expert sources from excellent
literature that has been established
over many many decades and I personally
find this organ that we call skin to be
infinitely fascinating not just by
virtue of what it does but by virtue of
all the different organ and tissue
systems that it interacts within our
body and by virtue of the fact that our
skin is this incredible living organ on
the outside of our body that tells us oh
so very much about how we and others are
doing in terms of our immediate and
potentially our long-term Health if
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