How to Improve Skin Health & Appearance

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.240 | where we discuss science

00:00:03.660 | and science-based tools for everyday life.

00:00:05.880 | I'm Andrew Huberman,

00:00:10.040 | and I'm a professor of neurobiology and ophthalmology

00:00:13.200 | at Stanford School of Medicine.

00:00:15.000 | Today, we are discussing skin health.

00:00:17.280 | Our skin is an incredibly important organ,

00:00:19.640 | not just for our appearance

00:00:20.880 | or because it serves as a barrier

00:00:22.720 | to the other organ systems of the body,

00:00:25.140 | but because it actually reflects the health status

00:00:27.760 | of all the other organs and systems in our body,

00:00:30.760 | including our brain.

00:00:32.560 | As well, you'll learn today

00:00:33.840 | about the direct and reciprocal relationship

00:00:35.680 | between the immune system and our skin.

00:00:38.360 | And if you think about it,

00:00:39.280 | you've seen this relationship in action before.

00:00:42.260 | When any of us is feeling fatigued or sick,

00:00:44.800 | the color, the tone of our skin,

00:00:46.800 | tends to be a bit, quote-unquote, "off,"

00:00:48.720 | at least for us, relative to what it normally is.

00:00:51.960 | Conversely, when we are feeling particularly well-rested

00:00:54.780 | and vibrant and healthy,

00:00:56.800 | our skin reflects that.

00:00:58.660 | So today, we will discuss the skin as an organ.

00:01:00.600 | We'll talk a little bit about the biology of skin

00:01:02.740 | so that everybody's on board the nomenclature

00:01:05.120 | of the different cell types in the skin

00:01:06.600 | and how they're affected by various things.

00:01:08.520 | And then we will discuss those things,

00:01:10.300 | such as sunlight and sun exposure

00:01:12.820 | as it relates to skin cancers.

00:01:14.840 | We'll talk about sunscreens, of course,

00:01:16.980 | something that I know garners a lot of interest these days

00:01:19.880 | and even some controversy.

00:01:21.440 | We will talk about common conditions of skin

00:01:23.480 | that concern people, such as acne, rosacea,

00:01:26.760 | psoriasis, eczema.

00:01:29.120 | And of course, we will talk about

00:01:30.200 | so-called anti-aging treatments for skin.

00:01:32.880 | That is, the things that can be done

00:01:34.780 | to help reduce the degradation

00:01:36.560 | of the protein components in skin,

00:01:38.200 | things like collagen,

00:01:39.920 | things that you can do to improve collagen turnover,

00:01:42.880 | as well as elastin.

00:01:44.040 | These are other proteins within skin

00:01:46.160 | that give skin its youthful,

00:01:47.920 | or in some cases, where it's degenerative,

00:01:50.700 | non-youthful appearance,

00:01:51.880 | things like wrinkles and sagging skin.

00:01:53.720 | So we'll talk about all of that.

00:01:54.960 | We'll also talk about the various products

00:01:56.680 | that have been developed in order to treat wrinkles,

00:01:59.820 | treat sagging skin, reverse acne, et cetera.

00:02:02.840 | We'll talk about which ones are safe,

00:02:04.600 | which ones are not safe,

00:02:05.820 | and which ones for which there still is no clear answer.

00:02:09.720 | I want to make very clear here at the outset

00:02:12.120 | that while I'll discuss various skin products

00:02:14.240 | during today's episode,

00:02:15.840 | I nor the podcast has any financial relationship

00:02:18.840 | to those products.

00:02:19.840 | I will provide examples of certain products

00:02:21.720 | and provide a few links in the show note captions,

00:02:24.080 | but I want to point out that those serve merely

00:02:25.880 | as examples that I found during researching this episode,

00:02:29.280 | which by the way,

00:02:30.120 | included speaking to several board certified dermatologists,

00:02:33.160 | including a dermatologist expert in oncology,

00:02:35.880 | cancers of the skin.

00:02:37.440 | So by the end of today's episode,

00:02:38.800 | you will have a much clearer understanding

00:02:40.640 | about skin and what it is at the level of biology

00:02:43.240 | and function,

00:02:44.160 | its relationship to other systems in the body,

00:02:46.560 | including the immune system and gut microbiome,

00:02:49.080 | and you will be armed with the knowledge

00:02:50.520 | to make the best possible decisions for you

00:02:52.920 | in terms of skin health and skin care,

00:02:55.360 | depending on your age, your goals,

00:02:57.560 | and any current conditions you may have.

00:02:59.840 | Before we begin,

00:03:00.840 | I'd like to emphasize that this podcast

00:03:02.640 | is separate from my teaching and research roles at Stanford.

00:03:05.240 | It is however, part of my desire and effort

00:03:07.360 | to bring zero cost to consumer information about science

00:03:10.040 | and science related tools to the general public.

00:03:12.640 | In keeping with that theme,

00:03:13.680 | I'd like to thank the sponsors of today's podcast.

00:03:16.400 | Our first sponsor is Juve.

00:03:18.360 | Juve makes medical grade red light therapy devices.

00:03:21.520 | Now, if there's one thing I've consistently emphasized

00:03:23.560 | on this podcast is the incredible impact

00:03:26.360 | that light can have on our biology.

00:03:28.280 | Now, in addition to sunlight,

00:03:29.640 | red light and near infrared light

00:03:31.400 | have been shown to have positive effects

00:03:33.040 | on improving numerous aspects of cellar and organ health,

00:03:36.040 | including faster muscle recovery,

00:03:37.640 | improved skin health and wound healing,

00:03:39.600 | even improvements in acne, reducing pain and inflammation,

00:03:42.720 | improving mitochondrial function,

00:03:44.280 | and even improving vision itself.

00:03:46.340 | What sets Juve lights apart

00:03:47.800 | and why they're my preferred red light therapy devices

00:03:50.540 | is that they use clinically proven wavelengths,

00:03:52.680 | meaning it uses specific wavelengths of red light

00:03:54.960 | and near infrared light in combination

00:03:57.020 | to trigger the optimal cellar adaptations.

00:03:59.540 | Personally, I use the Juve handheld light,

00:04:01.680 | both at home and when I travel.

00:04:03.160 | It's only about the size of a sandwich,

00:04:04.640 | so it's super portable and convenient to use.

00:04:06.880 | I also have a Juve whole body panel

00:04:08.580 | and I use that about three or four times per week.

00:04:11.280 | If you'd like to try Juve,

00:04:12.500 | you can go to juve, spelled J-O-O-V-V.com/huberman.

00:04:17.480 | Juve is offering an exclusive discount

00:04:19.280 | to all Huberman Loud listeners

00:04:20.880 | with up to $400 off select Juve products.

00:04:23.800 | Again, that's Juve, J-O-O-V-V.com/huberman

00:04:27.720 | to get $400 off select Juve products.

00:04:30.480 | Today's episode is also brought to us by BetterHelp.

00:04:33.640 | BetterHelp offers professional therapy

00:04:35.460 | with a licensed therapist carried out entirely online.

00:04:39.120 | I've been doing weekly therapy for over three decades.

00:04:42.080 | Initially, I didn't have a choice.

00:04:43.400 | It was a condition of being allowed to stay in school,

00:04:45.800 | but pretty soon I realized that therapy is critical

00:04:48.000 | to overall health.

00:04:48.880 | In fact, I consider doing regular therapy

00:04:50.680 | just as important as getting regular physical exercise,

00:04:53.760 | which of course I also do every week.

00:04:55.960 | Research tells us that excellent therapy

00:04:58.220 | includes three critical ingredients.

00:05:00.360 | The first ingredient is a strong rapport

00:05:02.760 | between you and the therapist,

00:05:04.040 | somebody that you can really trust and talk to

00:05:06.080 | about the issues that are concerning you.

00:05:08.080 | Second, great therapy should provide support

00:05:10.520 | in the form of emotional support

00:05:12.120 | or directed guidance towards the issues you're facing.

00:05:14.840 | And third, excellent therapy should provide insights

00:05:17.880 | either directly from the therapist or that you arrive at

00:05:20.680 | that you would have otherwise not been able to arrive at

00:05:23.600 | had you not had that emotional support and strong rapport.

00:05:26.840 | With BetterHelp, they make it easy

00:05:28.440 | for you to find an expert therapist

00:05:29.960 | with whom you can have those three critical components.

00:05:32.560 | And because BetterHelp is carried out entirely online,

00:05:35.300 | it can mesh well with your schedule.

00:05:36.760 | You don't have to commute anywhere.

00:05:38.060 | You don't have to find parking.

00:05:39.620 | You can fit it into essentially any schedule.

00:05:42.340 | If you'd like to try BetterHelp,

00:05:43.600 | go to betterhelp.com/huberman

00:05:46.240 | to get 10% off your first month.

00:05:47.960 | Again, that's betterhelp.com/huberman.

00:05:51.120 | Today's episode is also brought to us by Roka.

00:05:54.100 | Roka makes eyeglasses and sunglasses

00:05:56.200 | that are of the absolute highest quality.

00:05:58.600 | I've spent a lifetime working on the biology

00:06:00.320 | of the visual system,

00:06:01.280 | and I can tell you that your visual system

00:06:02.720 | has to contend with an enormous number

00:06:04.440 | of different challenges in order for you

00:06:06.200 | to be able to see clearly from moment to moment.

00:06:08.800 | Roka understands all of that

00:06:10.560 | and has designed all of their eyeglasses and sunglasses

00:06:13.080 | with the biology of the visual system in mind.

00:06:15.720 | Roka eyeglasses and sunglasses

00:06:17.200 | were first designed for use in sport,

00:06:18.880 | in particular for things like running and cycling.

00:06:21.120 | And as a consequence,

00:06:22.240 | Roka frames are extremely lightweight,

00:06:24.220 | so much so that most of the time

00:06:25.320 | you don't even remember that you're wearing them.

00:06:27.040 | And they're also designed so that they don't slip off,

00:06:29.240 | even if you get sweaty.

00:06:30.760 | Now, even though Roka eyeglasses and sunglasses

00:06:32.740 | were initially designed for sport,

00:06:34.480 | they now have many different frames and styles,

00:06:36.420 | all of which can be used not just for sport,

00:06:38.480 | but also for wearing out to dinner, to work,

00:06:40.520 | essentially any time and any setting.

00:06:42.920 | I wear Roka readers at night or Roka eyeglasses

00:06:45.360 | if I'm driving at night,

00:06:46.920 | and I wear Roka sunglasses in the middle of the day,

00:06:49.200 | anytime it's too bright for me to see clearly.

00:06:51.020 | My eyes are somewhat sensitive, so I need that.

00:06:53.360 | I do not wear sunglasses in the morning

00:06:55.240 | when I'm getting my morning sunlight viewing

00:06:56.920 | for sake of setting my circadian rhythm,

00:06:58.860 | but I do wear Roka sunglasses often at other times

00:07:01.520 | throughout the day when it's very bright out.

00:07:03.640 | I particularly like the Hunter 2.0 frames,

00:07:06.460 | which I have as eyeglasses and now as sunglasses too.

00:07:09.920 | If you'd like to try Roka,

00:07:11.120 | you can go to roka.com/huberman

00:07:13.820 | to get 20% off your purchase.

00:07:15.440 | Again, that's roka.com/huberman to get 20% off.

00:07:19.560 | Okay, so let's talk about skin health

00:07:21.640 | and by extension, skin care.

00:07:23.680 | What should we all be doing to take care of this organ

00:07:25.760 | that we call our skin?

00:07:27.640 | Now, our skin is a very interesting organ,

00:07:29.660 | as I mentioned earlier,

00:07:30.500 | not just because it protects all the other organs

00:07:33.160 | of our body,

00:07:34.000 | and I should mention it protects them

00:07:35.040 | not just by a physical barrier,

00:07:36.840 | but there's also chemical things,

00:07:39.300 | a chemical composition, a skin microbiome to the skin

00:07:42.680 | that also provides additional layers of support,

00:07:45.080 | such as neutralizing different bacteria

00:07:47.160 | that land on your skin.

00:07:48.440 | There's a lot more to skin than you might realize,

00:07:51.000 | but to start off,

00:07:51.840 | let's just talk about what skin is

00:07:53.620 | at the level of its structure,

00:07:54.920 | some of the cell types,

00:07:56.160 | because in understanding that you'll be best equipped

00:07:58.540 | to understand some of the recommendations

00:08:00.260 | for skin health and skin care.

00:08:02.640 | The skin, like many other organs in the body,

00:08:05.920 | is a layered structure.

00:08:07.640 | So the very outermost layer is called the epidermis.

00:08:10.360 | The epidermis has cells in it,

00:08:12.420 | below that, there are other cells

00:08:14.700 | that comprise what's called the dermis,

00:08:16.920 | or sometimes referred to as the dermal layer.

00:08:19.040 | And then beneath that, you have subcutaneous fat.

00:08:22.360 | Now, of course, in different areas of the body,

00:08:24.040 | the skin, and as a consequence,

00:08:26.040 | these different layers of the epidermis and dermis

00:08:29.040 | and the fat layer below it

00:08:31.280 | are of different composition and different thicknesses.

00:08:33.920 | Think, for instance,

00:08:34.760 | about the thickness of the skin on your forearm

00:08:37.280 | versus the thickness of the skin on your belly

00:08:39.800 | versus the thickness of your skin on your eyelid.

00:08:42.820 | Okay, and as soon as you think about your eyelid,

00:08:45.040 | you realize, okay, this thing that we call skin

00:08:47.700 | varies tremendously in thickness,

00:08:49.980 | depending on whether or not we're at the scalp,

00:08:51.620 | the eyelid, the face, the chin,

00:08:53.940 | even neck versus chin, body, et cetera.

00:08:57.080 | So what we think of as skin,

00:08:59.180 | while it may have a designated set of layers

00:09:02.380 | that have particular names,

00:09:04.740 | can vary tremendously in terms of its overall thickness,

00:09:07.760 | and therefore its vulnerability to things like sunlight,

00:09:11.360 | which indeed can mutate the cells within the skin,

00:09:14.220 | cause them to have dysregulation of the expression of DNA

00:09:17.860 | and the production of other cells.

00:09:19.420 | We'll get into that.

00:09:20.500 | So I just want you to think about skin

00:09:22.220 | as having these critical components of layers,

00:09:25.020 | epidermis and dermis below it.

00:09:26.700 | And by the way, within the dermis

00:09:29.100 | is where you're going to find the blood supply,

00:09:31.780 | the vessels and capillaries that innervate the skin.

00:09:34.660 | Innervate simply means that supply or go to the skin.

00:09:38.540 | You of course have hair follicles

00:09:40.320 | and hair growing out of those follicles in many cases.

00:09:42.800 | And then of course you have skin that does not have hair,

00:09:45.600 | the so-called glabrous skin,

00:09:46.800 | like on the palms of your hands,

00:09:48.120 | the bottoms of your feet, et cetera.

00:09:50.140 | So I don't want to give the impression

00:09:51.800 | that skin is the same everywhere.

00:09:53.520 | It varies in thickness.

00:09:54.960 | It varies in terms of the presence of hair or lack of hair.

00:09:58.680 | It varies according to a lot of different parameters,

00:10:01.120 | including how much oil is produced in one region or another.

00:10:04.160 | But if you just know that the skin has an epidermis,

00:10:07.420 | an outermost layer, a dermis,

00:10:10.180 | or sometimes referred to as the dermal layer,

00:10:11.940 | which is below it.

00:10:12.780 | And then it has fat below that.

00:10:15.620 | And that the vasculature, right?

00:10:17.580 | The vessels and capillaries are at the level of the dermis.

00:10:19.980 | They come up through the subcutaneous fat

00:10:22.780 | and into that dermal layer,

00:10:24.220 | but they don't reach into the epidermal layer,

00:10:25.960 | that outermost layer.

00:10:27.380 | And if you understand also that nerve endings, okay?

00:10:30.940 | The little terminals, as we call them, of neurons,

00:10:33.980 | nerve cells, also go up into that dermal layer.

00:10:36.960 | You've got temperature sensors in the skin.

00:10:38.840 | All of this becomes very important for our discussions

00:10:40.960 | of skin conditions.

00:10:42.440 | Things like rosacea, things like acne,

00:10:44.800 | which sometimes can be painful

00:10:46.100 | or can be exacerbated by things like heat.

00:10:49.040 | They can be suppressed in some cases

00:10:50.880 | or even activated by things like cold, okay?

00:10:53.160 | So if you just understand that there are three layers,

00:10:55.400 | epidermis on the outside, dermis below it,

00:10:57.640 | subcutaneous fat, and that skin varies in thickness,

00:11:00.520 | and that nerves, that is nerve endings and blood vessels

00:11:04.260 | and capillaries are within the dermal layers of the skin,

00:11:06.960 | well, you're going to be very well equipped

00:11:09.140 | for the rest of today's discussion.

00:11:10.420 | I'll throw in some additional information

00:11:12.420 | about oil production within the hair follicle

00:11:14.980 | and a few other things like extracellular matrix,

00:11:18.140 | which as the name suggests is extracellular.

00:11:20.500 | It's outside where the cells reside,

00:11:23.060 | but gives it its composition as either plump

00:11:25.940 | and moist appearing on the outside,

00:11:28.160 | or it can be kind of sagging and wrinkled

00:11:29.980 | and dry appearing.

00:11:31.060 | All of that relates to the different components of proteins

00:11:34.140 | and other things within those skin layers.

00:11:36.500 | But if you understand what I just told you,

00:11:38.100 | even at a crude level,

00:11:40.340 | if you can just imagine it just a little bit,

00:11:42.300 | those three layers,

00:11:44.160 | you're going to be very well equipped

00:11:45.340 | for the rest of today's discussion.

00:11:46.860 | I should also mention that there are glands within the skin.

00:11:49.300 | This won't be surprising to most of you.

00:11:50.900 | Those glands will produce oil either more or less,

00:11:53.380 | depending on certain conditions.

00:11:55.100 | And there are things that live on the skin,

00:11:57.260 | on that epidermal layer and within it

00:11:59.940 | that we call microbiota.

00:12:02.060 | You've no doubt heard of the gut microbiome, right?

00:12:04.300 | The existence of trillions of little micro bacteria

00:12:06.600 | that live within your gut,

00:12:08.180 | that provided they are varied in their composition

00:12:11.080 | and of the right sort,

00:12:12.460 | really support your immune system

00:12:14.100 | and other aspects of health,

00:12:15.180 | including brain function and health.

00:12:16.980 | Well, you also have a skin microbiome.

00:12:19.200 | That is the existence of microbiota

00:12:21.180 | on the outside of your skin

00:12:22.460 | that serve as a barrier to infections,

00:12:24.700 | but that also provide things that are nourishing to the skin

00:12:27.420 | and give it that vibrant look that most people want.

00:12:31.140 | And by cleansing your skin in particular ways,

00:12:33.580 | that is washing it with certain substances

00:12:35.780 | and avoiding other substances,

00:12:37.500 | you can support as opposed to diminish

00:12:39.980 | that skin microbiome.

00:12:41.680 | Okay, so to start today's discussion,

00:12:43.480 | I want to jump right into the deep end,

00:12:45.000 | meaning into one of the more controversial issues

00:12:47.300 | related to skin health and skincare out there right now,

00:12:50.220 | which is sun exposure and sunscreen.

00:12:53.460 | Now, it makes sense why this would be such a heated issue,

00:12:55.880 | no pun intended,

00:12:57.060 | because most everyone is exposed to the sun

00:12:59.720 | or has the opportunity to be exposed to the sun

00:13:02.000 | to some degree or another every single day,

00:13:04.340 | even on cloudy overcast days.

00:13:06.500 | It's also the case that we've learned a lot

00:13:08.180 | in the last 10 years or so

00:13:09.880 | about how different sunscreens and their components

00:13:13.160 | may be good for us, may be less good for us.

00:13:15.700 | And today we're going to talk about what is known

00:13:18.220 | and what is still unknown.

00:13:20.520 | But before we do that, we need to take a step back

00:13:22.800 | and look at the context

00:13:23.920 | in which all this controversy is happening.

00:13:26.180 | My read of the online community as a whole,

00:13:29.420 | as it relates to sunscreen and sun exposure in particular,

00:13:32.900 | is the following.

00:13:34.320 | I think most everybody, I didn't say everybody,

00:13:36.660 | but most everybody out there seems to accept the idea

00:13:40.340 | that excessive sun exposure

00:13:42.620 | can cause certain cancers of the skin.

00:13:45.540 | That's the general belief out there.

00:13:47.260 | And there is good reason for that belief,

00:13:48.780 | because indeed the sun as full spectrum light

00:13:52.080 | includes long wavelengths.

00:13:53.620 | It's probably easier to think about those long wavelengths

00:13:55.640 | as the reds and oranges and yellows and so forth

00:13:58.380 | that are present.

00:13:59.220 | And well, they're always present from sunlight,

00:14:01.140 | but they're most obvious to us

00:14:02.660 | when the sun is low in the sky,

00:14:04.060 | so-called low solar angle sunlight at sunsets

00:14:06.880 | and also at sunrise.

00:14:08.460 | But of course, as full spectrum light,

00:14:10.880 | sunlight also includes UV, ultraviolet light

00:14:14.620 | of different types.

00:14:15.460 | We'll talk about those types today,

00:14:16.540 | as well as blue light and green light.

00:14:18.740 | And in midday sun, when the sun is overhead,

00:14:20.700 | we just see the sun as white light, right?

00:14:22.860 | Because it's containing all those different wavelengths.

00:14:25.040 | So while this is not a discussion

00:14:26.300 | about wavelengths and optics,

00:14:27.380 | for sake of today's discussion,

00:14:28.540 | just understand that long wavelength light

00:14:30.540 | tends to be more of the red, orange, yellow variety,

00:14:33.900 | okay, loosely speaking.

00:14:35.140 | And down at the other end of the spectrum,

00:14:37.540 | the short wavelength light is more of the blue and green

00:14:42.140 | and so-called ultraviolet light.

00:14:44.400 | So it's well accepted light of different wavelengths,

00:14:46.540 | such as UV, blue light, green light,

00:14:50.180 | all the way out to red light,

00:14:51.500 | even near infrared light can penetrate into cells.

00:14:53.900 | It can actually pass through surfaces.

00:14:56.140 | It turns out that long wavelength light

00:14:57.540 | can actually go deeper into the surface of our skin, right?

00:15:01.080 | It literally can penetrate

00:15:02.660 | just by shining a red light on your skin.

00:15:04.340 | It can actually penetrate the skin to a deeper layer

00:15:07.160 | than can short wavelength light like UV light.

00:15:09.940 | And it's well accepted that UV light,

00:15:12.080 | when it penetrates mostly that epidermal layer of the skin,

00:15:16.340 | that outermost layer,

00:15:17.740 | it can cause changes in the way that DNA functions.

00:15:21.280 | It can cause mutations such that DNA,

00:15:24.200 | which as many of you probably remember

00:15:26.440 | from high school biology,

00:15:27.640 | DNA is transcribed into RNA

00:15:30.840 | and RNA is translated into proteins.

00:15:33.400 | The proteins are the things that the cells produce.

00:15:35.320 | They're actually made up of proteins.

00:15:36.900 | Well, UV light can disrupt which DNA are expressed

00:15:41.000 | and how they are expressed,

00:15:42.760 | in some cases leading to overproduction of too many cells

00:15:45.720 | or disruptions in the functions of cells.

00:15:47.840 | And that's why people link UV light to skin cancer.

00:15:52.320 | That's the whole idea there.

00:15:53.880 | And that's the whole notion behind using sunscreens.

00:15:57.800 | And notice I'm saying sunscreen.

00:15:59.320 | So ways to screen out UV light

00:16:01.820 | or maybe all sunlight in some cases,

00:16:04.280 | in order to prevent that penetration

00:16:07.200 | of the UV light into cells, which can cause mutations,

00:16:10.080 | which in some cases can lead to skin cancer.

00:16:12.120 | Now I realize as I'm saying this,

00:16:13.580 | there's probably a group of you out there saying,

00:16:15.960 | what's the evidence that sunlight

00:16:17.240 | can actually cause skin cancer?

00:16:18.480 | Well, there is clear evidence

00:16:20.680 | that sunlight can cause skin cancers.

00:16:22.640 | Which skin cancers and how deadly those skin cancers are,

00:16:25.480 | we'll get to in a few moments.

00:16:26.800 | That turns out to be a very interesting twist

00:16:29.000 | in the whole story.

00:16:30.100 | But I want to highlight the fact

00:16:31.080 | that there's very little controversy

00:16:32.520 | as to whether or not UV light

00:16:34.420 | can cause mutations in cells, right?

00:16:36.500 | But what you should be asking yourself is,

00:16:38.080 | well, why would long wavelength light like red light

00:16:40.880 | perhaps be good for skin?

00:16:42.600 | We'll talk about that later.

00:16:43.580 | There are therapies, phototherapies that use,

00:16:46.240 | that exploit red light,

00:16:47.460 | which can penetrate deep into skin

00:16:49.360 | that actually can enhance the health of skin

00:16:51.360 | if done correctly.

00:16:52.920 | Whereas short wavelength light,

00:16:54.440 | which only hits that epidermal layer

00:16:55.900 | on the outside of the skin,

00:16:57.500 | may be bad for our skin.

00:16:59.180 | And I say maybe because it's really a function

00:17:01.080 | of dose and timing and genetic background, okay?

00:17:05.040 | If all this is seeming rather complicated,

00:17:06.880 | I'm going to make it very simple.

00:17:09.040 | And before I do that,

00:17:10.680 | I do want you to ask yourself a question.

00:17:12.840 | I want you to ask yourself where you reside

00:17:14.860 | on the continuum of beliefs about sunscreen,

00:17:19.060 | UV light, and skin cancers.

00:17:21.340 | So here it goes.

00:17:22.340 | My read of the landscape out there

00:17:24.500 | is that there are some people,

00:17:25.800 | it's a small minority,

00:17:26.820 | but there are some people who feel that sunscreen

00:17:29.780 | in any form is bad for them.

00:17:32.100 | They think, okay, sun is great for them

00:17:33.620 | and sunscreens of any kind,

00:17:35.100 | chemical or physical barriers, bad for them, okay?

00:17:38.060 | Some people believe this.

00:17:39.140 | I'm not saying I believe this.

00:17:40.140 | In fact, I don't believe that.

00:17:41.820 | I'm a big believer in sunlight

00:17:43.000 | and the power of sunlight for health,

00:17:44.680 | but I am not what is called a sunscreen truther, okay?

00:17:47.760 | I'm not somebody who thinks that sunscreen has no value.

00:17:50.640 | In fact, quite the opposite under certain conditions

00:17:53.040 | and certain sunscreens.

00:17:54.400 | I want to say that for the record.

00:17:56.080 | Other people out there believe

00:17:57.640 | that certain sunscreens can be valuable,

00:18:00.280 | but only the sunscreens that lack certain chemicals

00:18:03.080 | because they are concerned about chemicals

00:18:05.280 | in certain sunscreens being so-called endocrine disruptors

00:18:09.240 | or maybe even causing cancer on their own, okay?

00:18:12.260 | Other people are so afraid of sunlight

00:18:15.940 | and believe that it causes so many issues

00:18:17.860 | as it relates to skin cancer

00:18:19.600 | that they basically create beekeeper uniforms for themselves

00:18:24.600 | so that anytime they're out in sunlight,

00:18:27.620 | they want to have sunglasses on, they want to have a hat,

00:18:29.860 | they want to cover their neck, every part of their body,

00:18:31.820 | okay?

00:18:32.660 | They sit at the opposite extreme of the people

00:18:34.180 | who don't believe in using any sun protection whatsoever.

00:18:36.820 | And now, of course, there's the backdrop

00:18:38.740 | of how much natural melanin production we each make,

00:18:42.000 | that is how dark our skin happens to be

00:18:43.560 | according to our genetics.

00:18:44.760 | And of course, there's the issue

00:18:45.840 | of where we live on the planet

00:18:47.160 | and how much sun we have available to us

00:18:49.520 | in order to potentially expose ourselves to.

00:18:52.320 | And perhaps also ask yourself,

00:18:53.760 | if you are in what I believe

00:18:55.440 | is the largest category of people out there,

00:18:58.200 | which is the category of people

00:18:59.480 | who probably don't wear sunscreen every day,

00:19:02.200 | maybe they put it on occasionally,

00:19:03.480 | but only if it's very bright out, very hot out,

00:19:05.760 | because they don't want to get a so-called sunburn.

00:19:08.200 | And I believe most people fit into that general category

00:19:11.040 | of A, not wanting to be burned,

00:19:12.880 | B, not wanting to age any faster than they would

00:19:15.800 | were they to not wear sunscreen,

00:19:17.320 | at least that's their belief,

00:19:18.680 | and C, they've just been told

00:19:21.400 | that sunscreen is good for them

00:19:22.720 | and they'll reach for whatever sunscreen is on the shelf

00:19:25.880 | or that was recommended to them

00:19:27.040 | either by their dermatologist

00:19:28.420 | or that they happen to find in the pharmacy

00:19:30.260 | or when they're out skiing

00:19:31.360 | and they notice it's a bright day

00:19:33.000 | and so they buy some sunscreen and slather it on.

00:19:35.160 | So before I go any further,

00:19:36.240 | just ask yourself those questions.

00:19:37.560 | You know, where do you reside?

00:19:38.480 | Are you afraid of sunscreen?

00:19:39.920 | Do you love sunscreen?

00:19:41.080 | Are you in the beekeeper category?

00:19:42.480 | Like you think all sun is bad,

00:19:43.860 | it's going to give you skin cancer,

00:19:44.880 | it's going to age you faster.

00:19:46.240 | We'll get to the aging component in a few minutes,

00:19:47.840 | but just ask yourself that question

00:19:49.480 | as we wade into the material I'm about to cover.

00:19:52.600 | So what's the story with sun exposure, sunburn, sunscreen,

00:19:57.520 | skin cancer, and aging?

00:20:01.280 | I spoke to several different dermatologists about this,

00:20:03.840 | including one expert in skin cancers specifically.

00:20:08.040 | And what I was told is the following.

00:20:10.320 | First of all, sun exposure will disrupt the collagen

00:20:15.320 | and elastin, but mostly the collagen composition

00:20:18.000 | of your skin in a way that makes it appear

00:20:20.560 | as if you're aging faster.

00:20:23.160 | Okay, so sun exposure, yes, ages the skin.

00:20:26.840 | Now that does not mean, however,

00:20:28.440 | that you want to avoid all sun exposure

00:20:30.260 | because the same dermatologist said

00:20:31.900 | that some sun exposure is healthy for us.

00:20:34.160 | Why?

00:20:35.000 | Because our skin is also an endocrine organ.

00:20:37.160 | It's involved in making various hormones.

00:20:39.080 | It's part of the vitamin D production pathway.

00:20:41.120 | Although a little bit later,

00:20:42.200 | we'll talk about the fact that most people

00:20:44.160 | get their vitamin D from their diet,

00:20:46.440 | and in some cases also from supplementation.

00:20:49.040 | But it is a good idea to get some sunlight

00:20:51.560 | for sake of vitamin D production,

00:20:52.880 | but also the production of other hormones

00:20:55.020 | like testosterone and estrogen.

00:20:57.000 | Okay, so every single dermatologist that I spoke to

00:21:00.240 | said that some sun exposure is good for us,

00:21:02.700 | but that too much sun exposure will accelerate

00:21:05.060 | the appearance of aging in our skin.

00:21:07.500 | So let's pin that up on the wall as fact, okay?

00:21:10.060 | This again is not saying you should avoid sun completely.

00:21:12.980 | It's also not saying you should get

00:21:14.260 | excessive sunlight exposure.

00:21:15.860 | It's saying sunlight exposure by virtue

00:21:18.420 | of the UV wavelength's ability to cause mutations

00:21:22.580 | in the epidermal layers of the skin

00:21:25.140 | and to impact the collagen composition

00:21:27.700 | of the dermal layers below it,

00:21:29.260 | as well as some of the other proteins

00:21:30.580 | present in the keratinocytes, okay?

00:21:32.940 | One of the major skin cell types

00:21:35.360 | and other cell types of the skin

00:21:37.400 | does lead to the appearance of aged skin,

00:21:41.480 | which is one rationale for wearing sunscreen.

00:21:44.280 | Now, when I say sunscreen,

00:21:45.560 | everyone, including myself,

00:21:47.160 | thinks about lotions or in some cases, sprays.

00:21:49.520 | But let's pay attention to the one fact

00:21:51.320 | that I do think everybody,

00:21:53.180 | regardless of what category they are

00:21:54.680 | in the general population,

00:21:56.200 | or what background training a dermatologist has,

00:21:59.800 | believes, which is a physical barrier,

00:22:02.560 | a shirt, a hat, a jacket,

00:22:05.600 | a physical barrier can provide, in some cases,

00:22:08.640 | very good protection from the sun.

00:22:11.360 | And I don't think there's any controversy whatsoever

00:22:14.280 | as to whether or not the composition

00:22:16.000 | of the physical barrier

00:22:17.040 | is having negative effects on the skin, okay?

00:22:19.560 | You will find those niche communities out there

00:22:21.480 | that are saying, okay, certain chemicals

00:22:22.840 | present in certain materials that clothing are made with

00:22:25.400 | can be problems for the endocrine system,

00:22:27.060 | but we're not talking about that here, okay?

00:22:29.140 | What I'm saying is that all dermatologists I spoke to,

00:22:31.740 | and I think most every rational human being on earth,

00:22:34.380 | would say that a physical barrier

00:22:36.180 | can help to a great degree

00:22:37.900 | in order to protect our skin from the sun

00:22:40.700 | as it relates to sunburn,

00:22:42.660 | but also acceleration of the appearance of aging

00:22:45.820 | in our skin.

00:22:46.900 | Okay, so I don't think there's any dispute

00:22:48.580 | about physical barriers for protecting the skin.

00:22:50.860 | How much you want to protect your skin from the sun,

00:22:52.860 | well, that will depend on what category

00:22:54.980 | you decided you were in from the earlier discussion.

00:22:57.360 | We'll get back to that.

00:22:58.520 | What else did all the dermatologists and skincare experts

00:23:02.080 | that I spoke to also agree upon?

00:23:04.100 | Well, they all said that indeed,

00:23:06.560 | excessive sun exposure can increase the propensity

00:23:10.160 | for certain skin cancers.

00:23:11.260 | I want to go on record by saying, I believe that.

00:23:13.920 | Why?

00:23:14.760 | Well, because of this ability of UV light

00:23:16.480 | and some other wavelengths of light potentially

00:23:18.920 | to cause mutations in skin cells

00:23:21.740 | that can lead to certain skin cancers, okay?

00:23:24.520 | I don't think that's a debated topic out there.

00:23:26.700 | There might be a few people out there

00:23:28.020 | who are going to hang their hat on a study

00:23:29.740 | that I'll go into in a little bit later,

00:23:31.180 | which is that the relationship between sun exposure

00:23:34.460 | and all-cause mortality is a tricky one.

00:23:36.660 | It's one that we'll parse, okay?

00:23:38.580 | Meaning, I'll just give it a little hint

00:23:40.460 | into what I'm saying.

00:23:41.680 | People who avoid the sun entirely

00:23:44.320 | don't tend to live as long as people

00:23:46.600 | that get some sun exposure,

00:23:48.120 | but there are a bunch of confounding variables

00:23:50.300 | that have to be understood

00:23:51.420 | in order to really interpret that statement

00:23:53.120 | and the study that we'll parse a little bit later.

00:23:55.180 | For now, let's just accept the reality

00:23:57.200 | that the vast, vast majority of dermatologists out there

00:23:59.840 | and skincare experts really understand

00:24:02.520 | that sun exposure can accelerate aging of the skin,

00:24:05.440 | but most will also tell you that some sun exposure

00:24:08.320 | is good for you, not just for skin health,

00:24:10.800 | but for overall brain and body health.

00:24:13.840 | Now, as it relates to skin cancer,

00:24:16.180 | the dermatologist oncologist that I spoke to, all right,

00:24:19.440 | who did his training at Stanford,

00:24:20.760 | and I'll provide a link in the show note captions

00:24:22.520 | to his clinic, and you can learn more

00:24:24.280 | about some of his work.

00:24:25.160 | He's published some really nice papers,

00:24:27.120 | said the following, and this was surprising to me.

00:24:30.320 | He said, "It turns out that the skin cancers

00:24:34.360 | that sun exposure causes, while they can be serious

00:24:37.400 | and should be taken seriously, they should be treated,

00:24:40.520 | those generally are not the most deadly

00:24:42.840 | of the skin cancers."

00:24:44.000 | Now, why would he say something like that, okay?

00:24:46.080 | He said it because it turns out

00:24:48.440 | that there are lots of different kinds of skin cancer.

00:24:51.160 | Some of them arise or can arise through sun exposure.

00:24:55.440 | Others, and indeed, some of the most deadly of skin cancers

00:24:59.480 | are independent of sun exposure.

00:25:01.520 | And this is where things can get a little bit tricky.

00:25:03.480 | You'll hear out there, oh, you know,

00:25:05.120 | sun can cause skin cancer,

00:25:06.800 | but not the skin cancers that kill you.

00:25:08.280 | I don't think that's really a fair statement.

00:25:10.440 | You'll also hear, however, that all the skin cancers

00:25:13.640 | that are out there are the consequence of sun exposure,

00:25:16.400 | and that also is not true.

00:25:18.000 | And if anything, this provides motivation,

00:25:19.840 | not just on the part of the dermatologist,

00:25:21.360 | but it should be motivation from within all of us

00:25:24.900 | to make sure that we understand our background genetics,

00:25:28.360 | not just how much pigmentation we carry in our skin

00:25:30.880 | by virtue of our genetics, but we should know by asking,

00:25:34.780 | if you're not going to get genetically sequenced,

00:25:36.440 | which you can do nowadays, of course,

00:25:37.800 | but you should know whether or not your family,

00:25:40.640 | your genetics tends to carry certain mutations

00:25:43.400 | that make you more prone to skin cancers in general,

00:25:46.400 | not just the type that can be exacerbated by sun exposure.

00:25:50.540 | What I'm basically saying

00:25:51.380 | is that if you have particular genetics in your family,

00:25:54.400 | even if you avoid all sun exposure,

00:25:56.720 | you know, nobody should do that, of course.

00:25:58.160 | You need some sunlight.

00:25:59.080 | I mean, like all other,

00:26:00.800 | or most all other creatures on earth,

00:26:02.800 | sunlight is important for us.

00:26:04.320 | It's important for setting our circadian rhythms.

00:26:06.320 | That's why I'm always telling people

00:26:07.240 | to get sunlight in their eyes early in the day,

00:26:09.020 | which by the way, when the sun is low in the sky,

00:26:11.420 | low solar angle sunlight,

00:26:13.160 | the UV index tends to be very low, okay?

00:26:15.780 | So you are at the lowest possible risk of getting burned,

00:26:20.640 | of getting any kind of mutations to your skin.

00:26:22.720 | That doesn't mean you should overdo it.

00:26:24.200 | It doesn't mean you should stare at the sun

00:26:25.440 | and damage your eyes.

00:26:26.280 | I've talked about this a lot on other podcasts,

00:26:27.840 | how to get morning sunlight exposure properly.

00:26:30.080 | But when the sun is low in the sky,

00:26:31.860 | that's generally a safe time to get sun exposure.

00:26:34.260 | It's that midday sun, typically between the hours of,

00:26:37.480 | you know, 11 AM or even 10 AM,

00:26:39.440 | depending on time of year and where you're at,

00:26:41.340 | and two or three or 4 PM that the sun is overhead

00:26:45.940 | and at its greatest intensity

00:26:47.380 | and where the UV index can be very high.

00:26:49.340 | It's very easy to look up the UV index.

00:26:50.820 | And when the UV index is very high, right?

00:26:53.140 | I was down in Australia earlier this year

00:26:55.060 | and the UV index down there is so high.

00:26:57.540 | You can almost feel it.

00:26:58.420 | You actually can feel it.

00:26:59.260 | You step outside and you immediately feel like,

00:27:00.740 | wow, my skin is really being bombarded with the sunlight.

00:27:03.620 | And I'm somebody who tolerates sunlight pretty well

00:27:05.620 | because my dad's fairly, you know,

00:27:07.140 | dark pigmentation just naturally

00:27:08.860 | by virtue of being South American.

00:27:10.820 | Normally I can tolerate the skin pretty well,

00:27:12.640 | but you should not rely on just that subjective feel.

00:27:15.240 | You should look up the UV index

00:27:16.580 | and we'll provide a few links of good UV index sites

00:27:18.760 | that you can look up the UV index

00:27:20.000 | and where you might want to be extra cautious

00:27:21.760 | about providing a physical barrier

00:27:23.240 | or a chemical barrier to protect your skin.

00:27:25.680 | Now, a lot of people out there also believe

00:27:27.500 | that if you avoid sunburn, you're avoiding skin cancer.

00:27:31.800 | Perhaps you're very pale

00:27:32.880 | or it's the early phase of the summer season,

00:27:34.760 | or you have a susceptibility to sunlight

00:27:36.600 | such that, you know, you step outside

00:27:38.160 | and you get too much sunlight on a given day

00:27:40.400 | and you get a sunburn, that reflects an immune reaction,

00:27:43.300 | an inflammatory reaction

00:27:45.140 | within the dermal layers of the skin.

00:27:47.180 | So that means the vasculature, right?

00:27:48.900 | Those vessels and capillaries, they're going to dilate.

00:27:52.540 | You oftentimes will get infiltration

00:27:54.380 | of things like cytokines, which are of the immune system.

00:27:56.740 | You get an inflammatory response.

00:27:58.380 | That's why it's red.

00:27:59.220 | That's why it's tender to the touch.

00:28:00.900 | The nerve endings there can be overly activated.

00:28:03.120 | So the reason why your skin actually feels warm, right?

00:28:05.780 | When you touch your sunburn is because in fact,

00:28:08.780 | you have an activation of some of the nerve endings

00:28:10.680 | at that site, as well as the activation

00:28:12.520 | of the local immune system properties that give rise to,

00:28:16.280 | again, vessel and capillary dilation.

00:28:18.360 | It's a wound of sorts induced by excessive sun exposure.

00:28:21.560 | Now, does sunburn cause skin cancer?

00:28:24.640 | There's no direct relationship

00:28:26.520 | between sunburn and skin cancer,

00:28:28.480 | except the fact that sunburn reflects

00:28:30.520 | excessive sunlight exposure.

00:28:31.840 | And yes, as I mentioned before,

00:28:34.140 | it's conclusive that excessive UV sun exposure

00:28:37.680 | to the skin can cause certain mutations in skin cells

00:28:41.360 | that give rise to certain skin cancers.

00:28:44.080 | Why are we parsing things at this level of detail, right?

00:28:46.360 | Is this all just semantics?

00:28:47.520 | No, it's not just semantics.

00:28:48.920 | Many people believe that if they didn't get a sunburn,

00:28:52.600 | they are not at additional risk for inducing skin cancer

00:28:56.640 | or other issues with skin, right?

00:28:58.080 | We're not just talking about skin cancer.

00:28:59.760 | We're talking about accelerated aging of the skin,

00:29:02.280 | according to sun exposure.

00:29:03.800 | So let's make this very simple.

00:29:05.260 | You don't need a sunburn for the sun to accelerate

00:29:09.400 | the aging appearance of your skin.

00:29:11.840 | You don't need a sunburn to induce the kind of mutation

00:29:15.180 | that may, again, I want to highlight may,

00:29:17.140 | give rise to a skin cancer.

00:29:18.660 | It's also not the case that if you've got a sunburn

00:29:20.640 | or even multiple sunburns,

00:29:21.820 | that you'll necessarily develop skin cancer.

00:29:23.900 | Although by virtue of the fact

00:29:25.260 | that sunburn reflects UV exposure,

00:29:27.620 | multiple sunburns would reflect increased UV exposure

00:29:32.140 | and therefore increase risk for certain skin cancers.

00:29:36.060 | So all of this to say, avoid sunburn however you can.

00:29:40.260 | And if you're somebody who just loathes sunscreen,

00:29:42.540 | that doesn't want to even hear the discussion

00:29:44.180 | we're about to have next about which sunscreens are safe

00:29:46.780 | and which ones appear to be less safe,

00:29:49.060 | if you're just one of these people

00:29:50.020 | that does not want to put sunscreen on

00:29:51.900 | because you're very concerned

00:29:53.060 | about whatever chemical might be in sunscreen,

00:29:56.460 | well then consider that the physical barrier

00:29:58.900 | of an article of clothing or a hat or a bandana of sorts

00:30:02.100 | can indeed shield you from the sun to some degree,

00:30:05.820 | often to a great degree.

00:30:07.340 | And again, I don't think there's any controversy

00:30:09.500 | as to whether or not those are safe.

00:30:11.540 | As many of you know,

00:30:12.420 | I've been taking AG-1 for more than 10 years now.

00:30:15.320 | So I'm delighted that they're sponsoring this podcast.

00:30:17.780 | To be clear, I don't take AG-1 because they're a sponsor,

00:30:20.540 | rather they are a sponsor because I take AG-1.

00:30:23.660 | In fact, I take AG-1 once and often twice every single day.

00:30:27.060 | And I've done that since starting way back in 2012.

00:30:30.540 | There is so much conflicting information out there nowadays

00:30:33.140 | about what proper nutrition is.

00:30:35.300 | But here's what there seems to be a general consensus on.

00:30:38.280 | Whether you're an omnivore, a carnivore,

00:30:40.620 | a vegetarian or a vegan,

00:30:42.340 | I think it's generally agreed

00:30:43.500 | that you should get most of your food

00:30:45.040 | from unprocessed or minimally processed sources,

00:30:48.060 | which allows you to eat enough, but not overeat,

00:30:50.540 | get plenty of vitamins and minerals,

00:30:52.140 | probiotics and micronutrients

00:30:54.140 | that we all need for physical and mental health.

00:30:56.580 | Now, I personally am an omnivore

00:30:58.380 | and I strive to get most of my food

00:30:59.920 | from unprocessed or minimally processed sources.

00:31:02.700 | But the reason I still take AG-1 once

00:31:04.680 | and often twice every day is that it ensures

00:31:07.300 | I get all of those vitamins, minerals, probiotics, et cetera,

00:31:11.040 | but it also has adaptogens to help me cope with stress.

00:31:13.860 | It's basically a nutritional insurance policy

00:31:16.140 | meant to augment, not replace quality food.

00:31:18.840 | So by drinking a serving of AG-1 in the morning

00:31:21.060 | and again in the afternoon or evening,

00:31:23.100 | I cover all of my foundational nutritional needs.

00:31:25.740 | And I, like so many other people that take AG-1,

00:31:28.440 | report feeling much better in a number of important ways,

00:31:31.460 | such as energy levels, digestion, sleep, and more.

00:31:34.620 | So while many supplements out there

00:31:36.020 | are really directed towards obtaining one specific outcome,

00:31:39.180 | AG-1 is foundational nutrition

00:31:40.940 | designed to support all aspects of wellbeing

00:31:43.100 | related to mental health and physical health.

00:31:45.620 | If you'd like to try AG-1,

00:31:47.020 | you can go to drinkag1.com/huberman

00:31:50.480 | to claim a special offer.

00:31:51.900 | They'll give you five free travel packs with your order,

00:31:54.020 | plus a year supply of vitamin D3K2.

00:31:56.620 | Again, that's drinkag1.com/huberman.

00:32:00.580 | Okay, so before we dive into our discussion

00:32:02.340 | about sunscreens and the chemicals in sunscreens,

00:32:05.420 | let's just take a moment and talk about vitamin D.

00:32:08.580 | Vitamin D is important for a great number

00:32:11.120 | of bodily and brain functions.

00:32:13.460 | As I mentioned earlier,

00:32:14.700 | most people get their vitamin D from the foods they eat.

00:32:17.660 | If you eat dairy, in most countries,

00:32:20.380 | the dairy is fortified with vitamin D.

00:32:22.860 | Many people nowadays supplement with vitamin D

00:32:25.180 | anywhere from 1,000 IUs to 5,000 IUs.

00:32:27.820 | There are folks out there who perhaps even take 10,000 IUs,

00:32:31.620 | seems a bit high for most people,

00:32:33.660 | but it's going to depend on how much sun exposure you get,

00:32:36.740 | the pigmentation of your skin.

00:32:38.300 | But there are a number of people,

00:32:39.980 | especially in countries where they don't get

00:32:42.380 | a lot of sun exposure in particular times of year,

00:32:44.380 | and maybe they're not eating enough dairy

00:32:45.860 | fortified with vitamin D,

00:32:47.220 | who would benefit from vitamin D supplementation.

00:32:49.980 | And many people find they feel better

00:32:52.200 | when they supplement with vitamin D,

00:32:53.780 | but I encourage you that if you're going to supplement

00:32:55.660 | with vitamin D to probably start at the lower end

00:32:58.380 | of supplementation, like 1,000 to 3,000 IU, maybe 5,000 IU,

00:33:02.700 | best would be to measure your vitamin D levels.

00:33:05.060 | Many people are surprised to find that even

00:33:07.180 | if they live in a part of the world

00:33:08.860 | where they get a fair amount of sun exposure

00:33:11.020 | and they eat some dairy that's fortified with vitamin D,

00:33:13.380 | that for whatever reason,

00:33:14.580 | their vitamin D levels are still too low

00:33:16.620 | and benefit from supplementation with vitamin D.

00:33:19.020 | The dermatologist that I spoke to told me

00:33:21.420 | that yes, even if you wear sunscreen or a physical barrier,

00:33:25.780 | okay, this is interesting.

00:33:26.940 | Even if you wear sunscreen or a physical barrier

00:33:29.440 | when you get outside into the sun,

00:33:31.300 | it can still have a positive effect on your vitamin D levels.

00:33:35.700 | This was surprising to me,

00:33:36.660 | but then of course it makes sense.

00:33:38.260 | Sunlight is full spectrum light.

00:33:39.980 | It's not just UV and short wavelength light.

00:33:42.780 | The ability for longer wavelength light

00:33:44.440 | to penetrate the skin is clear.

00:33:47.180 | And those longer wavelengths can also impart

00:33:50.660 | a positive influence on the vitamin D pathway.

00:33:53.220 | Okay, so if you're concerned about wearing sunscreen

00:33:55.860 | because you're worried that it's going to impair

00:33:57.800 | your vitamin D synthesis or metabolism in any way,

00:34:01.200 | probably no reason to be concerned.

00:34:04.000 | Now, if you're somebody who is in the beekeeper category,

00:34:06.380 | who's completely avoiding sun exposure for whatever reason,

00:34:09.660 | well, then you probably want to get

00:34:11.420 | your vitamin D levels checked

00:34:12.740 | and you may want to rely on supplementation

00:34:14.820 | or something of that sort.

00:34:16.760 | At the same time, because of variation in genetic background,

00:34:20.540 | there will even be some of you out there

00:34:22.460 | who are super anti-sunscreen,

00:34:24.020 | who are peeling your shirts off all the time,

00:34:26.380 | who are getting lots of sun exposure,

00:34:28.020 | who may surprisingly have vitamin D levels

00:34:31.420 | that are still low.

00:34:32.260 | That's rare, okay, for all the obvious reasons,

00:34:35.300 | but it could still be the case.

00:34:36.420 | And indeed, some of the dermatologists that I spoke to

00:34:38.860 | said they occasionally have a patient like that.

00:34:41.620 | Vitamin D, as you may recall,

00:34:42.980 | is involved in a bunch of different things.

00:34:44.740 | It acts as a hormone.

00:34:46.140 | It's involved in calcium absorption.

00:34:47.900 | It's involved in some of the other hormone pathways.

00:34:50.420 | And I should mention that there's a study,

00:34:51.880 | I'll link to this in the show note captions,

00:34:53.860 | that shows that some amount of sunlight exposure to the skin,

00:34:57.640 | this is an Israeli study where they had people, you know,

00:34:59.900 | get several tens of minutes of sunlight exposure

00:35:02.260 | in the afternoon during particular times of year.

00:35:05.940 | They didn't have them going naked outside, okay?

00:35:07.900 | This was sort of like context and culturally appropriate.

00:35:11.260 | Skin exposure to the upper body and to the legs

00:35:14.060 | could induce increases in hormones

00:35:16.120 | such as testosterone and estrogen,

00:35:17.780 | which were correlated with, it wasn't causal,

00:35:19.740 | but it was correlated with improvements in mood,

00:35:22.940 | well-being, libido, et cetera.

00:35:25.100 | Well, some of that probably relates

00:35:27.100 | to testosterone and estrogen synthesis directly.

00:35:30.020 | Again, the skin as an endocrine organ, okay?

00:35:33.340 | There are certain elements

00:35:34.860 | within the keratinocyte skin cells

00:35:36.980 | that can literally communicate

00:35:38.980 | with some of the organs of the body

00:35:41.100 | that produce testosterone and estrogen,

00:35:42.740 | even some of the glands, pituitary, et cetera.

00:35:44.820 | This is through a number of different stations.

00:35:46.340 | It's not necessarily direct,

00:35:47.780 | but also through the sun's ability

00:35:49.140 | to impact the vitamin D pathway

00:35:51.740 | that then impinges on those testosterone, estrogen,

00:35:54.700 | and things like luteinizing hormone pathways.

00:35:56.820 | We don't have time to go into all this now.

00:35:58.300 | I covered this in an episode about testosterone and estrogen.

00:36:02.360 | You have hormones such as luteinizing hormone,

00:36:04.500 | which then stimulate the gonads,

00:36:06.060 | the testes to the ovaries,

00:36:07.500 | to make testosterone and/or estrogen.

00:36:10.600 | The skin is a not so obvious player in this whole thing,

00:36:13.700 | whereby external environmental stimuli,

00:36:16.100 | such as the availability of sunlight,

00:36:17.820 | which in most places in the world varies across the year,

00:36:21.500 | can stimulate more or less vitamin D production,

00:36:25.900 | luteinizing hormone production

00:36:27.160 | that can impinge on testosterone and estrogen production.

00:36:30.140 | These pathways are one of the reasons why

00:36:32.740 | when we get the right amount of sunlight,

00:36:34.500 | not too little, not too much, we feel better.

00:36:37.460 | We feel better because certain hormones

00:36:39.140 | are being produced at certain levels

00:36:40.700 | when we're getting that sun exposure.

00:36:42.140 | And when we don't get that sun exposure,

00:36:44.280 | we have lower levels of those hormones.

00:36:45.840 | This is well-established.

00:36:46.940 | And the study that I linked to in the "Show Note" captions,

00:36:48.740 | which I've covered in previous episodes,

00:36:50.260 | is but one example of that phenomenon.

00:36:52.780 | Okay, let's talk about sunscreens.

00:36:55.700 | Now, the reason I changed my tone of voice with this

00:36:58.180 | is that if you look on the internet,

00:37:00.900 | you will see claims that I don't use

00:37:04.420 | or believe in sunscreen, and that is just false.

00:37:07.780 | I've worn sunscreen my entire life.

00:37:09.940 | I don't necessarily wear it every day.

00:37:12.140 | I don't tend to burn easily, okay?

00:37:14.220 | I have some natural level of pigmentation in my skin

00:37:16.160 | based on my genetics, as I mentioned earlier.

00:37:18.460 | But as we talked about earlier,

00:37:19.600 | just avoiding sunburn is not going to protect me

00:37:22.880 | or anyone else against certain sun-induced mutations

00:37:25.600 | in skin cells and the aging effects that sun can have.

00:37:30.120 | So I do believe in certain sunscreens,

00:37:32.940 | meaning I will put sunscreen on on certain days,

00:37:35.320 | on certain parts of my body.

00:37:37.480 | However, I do believe,

00:37:39.880 | now having spoken to multiple dermatologists

00:37:43.000 | and looked into the literature very deeply,

00:37:45.660 | that there are certain chemicals in certain sunscreens

00:37:49.280 | that are of concern.

00:37:51.020 | I don't mean that if you put these on once or even twice,

00:37:54.580 | that you are going to suffer negative consequences.

00:37:57.600 | I mean, they are of concern,

00:37:58.900 | meaning we should pay attention to them.

00:38:00.940 | And when given the option,

00:38:02.800 | we should opt for the healthier choices.

00:38:04.920 | And in fact, there are known healthier choices.

00:38:08.740 | To make all of this very clear,

00:38:09.800 | I'm going to tell you what is very clear

00:38:12.680 | to the dermatology community at this point in time, okay?

00:38:16.240 | In June of 2024, here's what we know.

00:38:19.980 | There are two major types of sunscreens out there.

00:38:22.280 | Well, really three.

00:38:23.120 | We talked about physical barrier before.

00:38:24.600 | No one argues about a physical barrier.

00:38:26.160 | No one's worried about the chemical composition

00:38:27.760 | of physical barriers, okay?

00:38:29.640 | When we talk about sunscreen,

00:38:31.120 | so lotions, creams, sprays, et cetera,

00:38:34.780 | there are two major types.

00:38:36.200 | The first are organic types,

00:38:38.520 | which is essentially chemical sunscreens, okay?

00:38:42.480 | So when you hear organic sunscreens,

00:38:44.160 | that means chemical type sunscreens.

00:38:46.240 | And then there are inorganic types,

00:38:48.700 | which are sometimes referred to as mineral-based sunscreens.

00:38:51.720 | Here's what most everybody seems to accept,

00:38:55.140 | that mineral-based sunscreens,

00:38:56.840 | meaning sunscreens that tend to include

00:38:59.120 | either zinc oxide or titanium dioxide,

00:39:03.480 | or both in some cases,

00:39:05.960 | are generally thought to be safe

00:39:08.200 | up to concentrations of 25%.

00:39:10.960 | 25% is a pretty high concentration.

00:39:13.200 | You can find sunscreens out there

00:39:15.320 | that have 25% zinc oxide or 25% titanium dioxide.

00:39:20.320 | They're rare to find, however.

00:39:22.040 | More often, you'll find sunscreens that have 15%, 10%,

00:39:27.040 | 18% zinc oxide, sometimes alone,

00:39:30.520 | or in combination with titanium dioxide.

00:39:33.280 | You'll find some pure titanium dioxide sunscreens out there,

00:39:36.360 | although those are a bit more rare, right?

00:39:38.600 | A little bit harder to find.

00:39:40.320 | Here's the story.

00:39:41.160 | Zinc oxide and titanium dioxide reflect back UV light,

00:39:45.440 | the short wavelengths of light,

00:39:47.020 | that would otherwise potentially cause mutations

00:39:50.980 | in your skin cells at the level of the epidermis, okay?

00:39:53.920 | In the outermost layers of skin.

00:39:55.280 | Remember, short wavelength light

00:39:56.360 | doesn't pass very deeply into the skin.

00:39:58.320 | Sunscreens containing zinc oxide and/or titanium dioxide

00:40:01.920 | were engineered for that specific purpose,

00:40:03.820 | to reflect back UV light.

00:40:05.680 | This is very different than organic or chemical sunscreens,

00:40:09.060 | which contain certain compounds.

00:40:11.120 | These go by different names, oxybenzone, avobenzone.

00:40:14.680 | There are a bunch of these different chemicals

00:40:16.160 | that are contained in so-called organic

00:40:18.360 | or chemical sunscreens.

00:40:19.960 | Those chemicals, in general,

00:40:21.040 | don't serve to reflect back UV light,

00:40:23.520 | but rather absorb UV light, okay?

00:40:26.160 | So when they're applied to the skin,

00:40:27.600 | they're designed to absorb the UV light

00:40:30.520 | so that the UV light can't negatively impact the skin.

00:40:33.160 | Those chemical, again, chemical,

00:40:34.960 | aka organic components within organic sunscreens,

00:40:38.480 | again, sometimes called chemical sunscreens,

00:40:40.760 | are designed to absorb UV light.

00:40:43.000 | Mineral-based sunscreens,

00:40:44.120 | so-called inorganic sunscreens

00:40:45.960 | containing things like zinc oxide or titanium dioxide,

00:40:50.380 | are designed to reflect back UV light.

00:40:53.060 | Why am I telling you this?

00:40:54.040 | Well, I'm telling you this

00:40:55.500 | because it's generally believed

00:40:57.280 | that the zinc oxide and titanium dioxide

00:40:59.480 | containing sunscreens are safe up to concentrations of 25%,

00:41:02.940 | whereas there is some, again,

00:41:05.160 | some concern about the chemicals within chemical,

00:41:09.920 | aka organic sunscreens, as potential endocrine disruptors,

00:41:13.640 | so disrupting things like testosterone synthesis,

00:41:16.440 | estrogen synthesis, and other hormones.

00:41:18.640 | It's not all just about testosterone and estrogen, folks.

00:41:21.160 | Other hormone pathways that many people,

00:41:23.560 | including some governing bodies

00:41:25.220 | and agencies that assess the safety

00:41:28.080 | of different cosmetic and sunscreen products

00:41:30.240 | are concerned about.

00:41:31.640 | Now, how concerned they are

00:41:34.200 | depends on where you are in the world, okay?

00:41:36.420 | So in Europe, they have different stringencies

00:41:38.320 | for what is considered safe versus unsafe

00:41:40.840 | or just of concern, as opposed to in the US.

00:41:43.520 | Here's what every dermatologist in the US,

00:41:46.240 | 'cause those are the ones I spoke to, told me,

00:41:48.980 | which is that it is advised

00:41:51.600 | that on children younger than six months of age,

00:41:54.880 | you do not use chemical-based sunscreens.

00:41:58.540 | Why?

00:41:59.380 | Well, young skin,

00:42:00.520 | even the skin on the external part of the body,

00:42:03.640 | in children six months or younger,

00:42:05.520 | acts more like mucosal skin

00:42:07.120 | in that it can very easily absorb things transdermally

00:42:10.200 | through the skin.

00:42:11.680 | However, even as we age,

00:42:14.160 | so into puberty, our young adult years,

00:42:16.400 | and even into our elderly years,

00:42:18.360 | there is still a capacity for things

00:42:20.120 | to pass transdermally through the skin,

00:42:22.120 | although because of some of the additional barriers

00:42:24.760 | formed within the dermal and epidermal layers of the skin,

00:42:27.120 | things like extracellular matrix,

00:42:28.440 | the changes in collagen, et cetera,

00:42:31.000 | there is less tendency for compounds

00:42:33.400 | to pass transdermally through the skin.

00:42:35.400 | Now, that just simply highlights the fact

00:42:38.040 | that if you are a very young person

00:42:39.800 | or if you're applying sunscreen to a very young person,

00:42:42.440 | maybe six months or younger,

00:42:43.880 | but also perhaps older,

00:42:45.680 | depending on how careful you want to be,

00:42:47.880 | to avoid these chemical-based sunscreens.

00:42:51.000 | There is very little, if any, evidence

00:42:53.440 | that the mineral-based sunscreens

00:42:55.360 | are of concern for transdermal passage into the skin

00:42:57.880 | at concentrations of 25% or less,

00:43:00.200 | meaning sunscreens containing zinc oxide

00:43:02.960 | and titanium dioxide are probably safe,

00:43:05.280 | or at least have been deemed safe enough

00:43:08.320 | that they are freely available on the market,

00:43:10.080 | and we are told that they are safe for people of all ages.

00:43:14.400 | So if you are somebody who is concerned

00:43:16.320 | about the chemicals in sunscreen,

00:43:18.080 | most every dermatologist or chemist

00:43:19.720 | who works on sunscreens will tell you,

00:43:22.320 | well, mineral-based inorganic sunscreens

00:43:24.400 | are going to be your safer option if you're concerned.

00:43:27.400 | But get this, the chemical-based sunscreens,

00:43:30.640 | while some of the chemicals in them,

00:43:32.560 | indeed, can be quite scary when you read the literature,

00:43:34.920 | you look at some of these things like oxybenzone,

00:43:38.040 | avobenzone, and some similar chemicals,

00:43:41.600 | even at low concentrations,

00:43:42.920 | have been shown to be endocrine disruptors.

00:43:44.760 | People talk about how the fact

00:43:45.920 | when they apply these sunscreens,

00:43:47.200 | they can taste them in their mouth.

00:43:48.360 | There's a lot of fear around these,

00:43:49.840 | and some of that fear is substantiated.

00:43:52.400 | When one goes and looks at the studies

00:43:54.240 | that have been done on these chemical-based sunscreens,

00:43:56.880 | you may find it interesting to note

00:43:58.980 | that the way these studies were done

00:44:00.880 | often involves having people apply a ton

00:44:04.040 | of these chemical-based sunscreens,

00:44:05.680 | like two full bottles of these sunscreens

00:44:07.800 | over the course of a very short period of time,

00:44:09.920 | and then have their blood drawn,

00:44:11.800 | and then it's revealed

00:44:13.000 | that some of these chemical components are within the blood.

00:44:15.520 | So a big issue that's not often discussed

00:44:17.880 | because it's very difficult to control for

00:44:20.040 | in a natural setting,

00:44:21.040 | but is straightforward to control for in a laboratory setting

00:44:24.480 | is how much sunscreen one is applying and how often,

00:44:28.620 | and across how many years of time.

00:44:31.960 | So there's no real prescriptive that can tell you,

00:44:34.560 | hey, if you put chemical sunscreens on once,

00:44:37.620 | that's problematic,

00:44:38.480 | although certainly pay attention

00:44:39.480 | to that six months and younger,

00:44:41.160 | what is essentially a rule that I mentioned earlier,

00:44:44.400 | and do not put chemical-based sunscreens

00:44:46.320 | on really young kids.

00:44:47.680 | You might want to avoid them entirely,

00:44:49.200 | depending on how stringent you are about this stuff.

00:44:51.720 | But when it comes to chemical-based sunscreens,

00:44:54.280 | personally, I avoid them,

00:44:56.040 | but then it becomes a question

00:44:57.200 | of if you could only use a chemical-based sunscreen,

00:44:59.360 | you simply look at the label.

00:45:01.000 | Some of these have, by the way,

00:45:02.520 | zinc oxide, titanium oxide, and chemical-based components.

00:45:06.520 | Okay, keep that in mind.

00:45:07.640 | Some are purely mineral-based,

00:45:09.720 | some are purely chemical-based,

00:45:11.260 | but if you look at a sunscreen label,

00:45:13.100 | you know, okay, well, this is the only thing available

00:45:14.840 | on this very hot day with a very high UV index,

00:45:17.020 | and otherwise I'm going to get a burn.

00:45:18.720 | Well, if you're really concerned,

00:45:19.600 | then I would resort to a physical barrier.

00:45:21.800 | If you are less concerned,

00:45:23.320 | then you could perhaps tell yourself,

00:45:24.600 | okay, you get to put it on that day,

00:45:26.300 | but you might not want to use it every day,

00:45:28.040 | and you might want to use a small volume of it, right?

00:45:30.240 | Or maybe just on parts of your face or your ears

00:45:32.960 | or your neck that are particularly sensitive to sun.

00:45:35.640 | Okay, these are the things

00:45:36.480 | that need to be taken into consideration.

00:45:38.560 | But when we step back from all of this,

00:45:40.800 | all of the literature, including, by the way,

00:45:42.640 | some of the literature that assessed,

00:45:44.340 | and I'll put a link to this review,

00:45:45.780 | a review on the potential neurotoxicity

00:45:47.980 | of titanium dioxide nanoparticles.

00:45:50.260 | I'll get into this in a moment.

00:45:51.660 | It has been explored whether or not titanium dioxide

00:45:54.980 | is more risky than zinc oxide.

00:45:57.140 | We'll talk about that in a moment.

00:45:58.440 | But when you step back from all of this,

00:46:00.220 | here's what you get.

00:46:01.060 | Physical barrier, no one argues about that.

00:46:02.900 | No one believes that clothing is dangerous per se

00:46:05.700 | when it comes to avoiding excessive sun exposure.

00:46:08.300 | Again, excessive relates to your skin tone,

00:46:11.060 | your background genetics, your activities,

00:46:13.180 | and where you are in the world and what time of year, okay?

00:46:15.500 | Very specific to your needs.

00:46:18.280 | Very few folks are concerned

00:46:19.740 | about mineral-based inorganic sunscreen.

00:46:22.300 | So if you want to use sunscreen, as many people do,

00:46:24.360 | and you want to make sure

00:46:25.200 | that it's not an endocrine disruptor

00:46:26.860 | and it's not a neurotoxin or something else

00:46:29.180 | that's been raised

00:46:30.020 | for some of these chemical-based sunscreens,

00:46:31.580 | well, then find a sunscreen that has 25% less zinc oxide

00:46:35.620 | and/or titanium dioxide.

00:46:37.860 | If you were a bit more concerned about, say,

00:46:40.820 | titanium dioxide and some of the suggestive evidence,

00:46:45.020 | only suggestive evidence

00:46:46.140 | that maybe titanium dioxide is more risky than zinc oxide,

00:46:50.380 | especially when it's in its nano form,

00:46:52.260 | the very small form that may indeed allow it

00:46:54.420 | for more easy passage through the layers of the skin,

00:46:57.180 | that transdermal passage,

00:46:58.700 | well, then find a sunscreen

00:46:59.660 | that is purely zinc oxide sunscreen.

00:47:01.940 | And again, they always have other things in them,

00:47:03.420 | but what I mean is the only active ingredient

00:47:05.460 | in a zinc oxide-only containing sunscreen is zinc oxide,

00:47:08.540 | and then there are a bunch of other things

00:47:10.020 | that allow it to be a lotion, for instance.

00:47:13.140 | Again, up to 25% concentration.

00:47:15.380 | Why would somebody not want to use zinc oxide

00:47:17.380 | containing sunscreen up to 25%

00:47:19.300 | and opt for anything else, you might ask, right,

00:47:21.500 | if that's considered safe?

00:47:22.740 | The reason is the consistency of the zinc oxide

00:47:26.260 | is it's pretty sticky and thick and it's kind of pasty, right?

00:47:30.420 | Back in the '80s and '90s,

00:47:31.580 | some of you may recall that zinc oxide sunscreens

00:47:35.980 | that would actually color the nose white,

00:47:37.900 | so you could really see it,

00:47:38.740 | it was really prominent on the face.

00:47:40.100 | They tried to turn that into a fashion statement

00:47:42.140 | and didn't go over so well over time.

00:47:44.020 | But in any case, the addition of titanium dioxide

00:47:47.220 | to those zinc oxide-containing sunscreens

00:47:48.900 | allow it to be a bit silkier

00:47:50.620 | so that it would spread on more evenly.

00:47:52.220 | And then you may say,

00:47:53.060 | well, why even put chemicals in sunscreen at all

00:47:55.980 | if there's risk?

00:47:57.020 | The reason why chemical-based organic sunscreens even exist

00:47:59.820 | is that they can come up with compositions

00:48:02.620 | of those sunscreens that are very silky

00:48:04.300 | then that could spread on clear over makeup

00:48:06.300 | and things of that sort.

00:48:07.700 | But there are these concerns

00:48:09.020 | about some of those chemical components

00:48:10.600 | as endocrine disruptors and potentially as mutagens

00:48:14.540 | that could cause other issues

00:48:15.820 | or any number of different things.

00:48:17.860 | You can find all sorts of concerns out there on the internet.

00:48:20.340 | Most of those concerns are not substantiated,

00:48:22.240 | but these chemicals can be problematic

00:48:24.260 | at high concentrations.

00:48:25.240 | And that takes us back to the point made earlier,

00:48:27.180 | which is that in the studies of those chemicals

00:48:30.060 | and the reasons, in some cases,

00:48:31.900 | being banned in certain countries

00:48:33.220 | and other countries carrying warning recommendations,

00:48:36.580 | the amount of those chemical-based sunscreens

00:48:39.500 | that were applied was exceedingly high.

00:48:42.400 | So if you're wearing sunscreen very often,

00:48:44.100 | you're wearing a lot of it,

00:48:45.380 | probably best if you're towards a mineral-based sunscreen.

00:48:48.180 | If you are concerned at all

00:48:49.980 | about the chemicals in chemical-based sunscreen,

00:48:52.080 | wear a mineral-based sunscreen and/or use physical barrier.

00:48:56.180 | And if you're somebody who just doesn't believe

00:48:58.100 | that sunscreens are safe whatsoever,

00:49:00.300 | well, you know, as far as I know, it's a free world.

00:49:03.500 | You don't have to wear sunscreen,

00:49:04.660 | but then I would say you need to be very aware

00:49:06.860 | of the fact that sun can induce the appearance

00:49:09.460 | of accelerated aging in the skin, right?

00:49:11.940 | That's an actual process that takes place.

00:49:14.140 | There's really no debating that, frankly.

00:49:16.380 | And sun exposure can potentially accelerate

00:49:20.440 | or even give rise to certain skin cancers,

00:49:22.260 | and nobody wants that.

00:49:23.940 | Okay, before we move on to a discussion

00:49:25.540 | about what can be done to increase the youthfulness

00:49:28.100 | of our skin or the appearance of youthfulness in our skin,

00:49:31.380 | we need to have a bit more discussion about skin cancers.

00:49:34.540 | Notice I said skin cancers, plural,

00:49:37.460 | because there are many different forms of skin cancer.

00:49:39.940 | Some of them relate to sun exposure,

00:49:41.620 | as we discussed earlier, others do not.

00:49:44.060 | And in fact, some of the more deadly skin cancers

00:49:46.340 | are independent of sun exposure.

00:49:48.380 | They can relate to genetics and to other factors.

00:49:51.180 | So the most straightforward story about all of this

00:49:53.980 | is that approximately 80 to 90% of melanomas,

00:49:58.480 | which are skin cancers,

00:49:59.540 | and they are very serious skin cancers

00:50:01.140 | that can indeed be very deadly,

00:50:03.420 | arise in what's called de novo skin.

00:50:05.500 | De novo skin is non-mole skin.

00:50:08.820 | Now, does that mean that you should not pay attention

00:50:11.340 | to the shape and any changes in your moles?

00:50:13.580 | No, you absolutely should.

00:50:15.480 | But for people who have naturally darker pigmentation

00:50:18.100 | everywhere or who have very few moles,

00:50:21.660 | then you aren't going to be able to use

00:50:23.380 | the monitoring of your moles as the only readout

00:50:26.100 | of potential development of skin cancer.

00:50:27.860 | And frankly, everybody should be thinking about

00:50:30.120 | these more serious skin cancers

00:50:31.460 | independent of moles or changes in moles.

00:50:34.180 | Here are a couple of things

00:50:35.080 | that everyone should pay attention to.

00:50:37.200 | If you have a pimple-like lesion,

00:50:41.040 | or you have any kind of spot on your skin

00:50:44.460 | that seems like it's an acne

00:50:46.700 | that's lasted more than a month,

00:50:48.880 | or you have an area that's seeping something

00:50:50.820 | that might look like plasma or pus or blood,

00:50:53.760 | and it persists over a long period of time,

00:50:55.820 | like a month or more,

00:50:57.100 | absolutely get that checked out by a dermatologist, okay?

00:51:00.780 | Don't wait any longer than a month, get it checked out.

00:51:03.280 | In addition, it's highly recommended that you go in

00:51:06.440 | and you get your moles checked by a dermatologist.

00:51:09.500 | And frankly, that you get all of your skin checked

00:51:12.060 | by a dermatologist at least once per year.

00:51:14.860 | This is going to really protect you

00:51:17.020 | against both the sun-induced skin cancers

00:51:19.060 | and other forms of skin cancer,

00:51:20.600 | the most common form of sun exposure-induced cancers

00:51:23.660 | are basal cell carcinomas.

00:51:25.020 | And indeed, those are less deadly

00:51:26.520 | than many of the melanomas,

00:51:28.120 | but they still can be exceedingly problematic

00:51:30.180 | and they can be deadly.

00:51:31.540 | So it's very important to get these checked out.

00:51:33.320 | Now there are websites,

00:51:34.260 | and I'll provide a link to one of them

00:51:35.640 | in the show note captions,

00:51:37.180 | for which you can look at a bunch of different examples

00:51:39.360 | of different moles and how they change over time.

00:51:41.420 | And if you happen to have a mole

00:51:42.540 | that resembles the appearance

00:51:43.700 | of any of the moles in that image gallery,

00:51:46.360 | then you would be wise to go to a dermatologist right away

00:51:48.900 | because it could be, again, could be cancer of some sort.

00:51:52.400 | You do not want to let these things linger for too long.

00:51:55.240 | At the same time,

00:51:56.080 | many people get concerned about one mole

00:51:58.460 | that didn't have an irregular border

00:51:59.900 | and then suddenly has an irregular border.

00:52:01.500 | There are a lot of different features

00:52:02.880 | that you'll learn from the website,

00:52:04.460 | or if you talk to your dermatologist

00:52:06.000 | that relate to whether or not something

00:52:07.420 | is predicting skin cancer or has become skin cancer.

00:52:10.160 | It's not just irregular border, it's changes in size,

00:52:13.160 | certainly changes in pigmentation, vascularization,

00:52:16.100 | bleeding, any kind of seeping.

00:52:17.560 | There are a lot of different things there.

00:52:18.960 | So don't be alarmed at first appearance

00:52:20.880 | of one of these things, but do take it seriously.

00:52:23.680 | And keep in mind that there are things

00:52:25.000 | that your dermatologist can do

00:52:26.680 | to help prevent certain skin cancer.

00:52:28.400 | So for instance, there's a growing trend now

00:52:30.920 | among dermatologists to suggest laser resurfacing of skin.

00:52:35.360 | That is a laser used to essentially disrupt

00:52:39.400 | that epidermal outermost layer,

00:52:41.240 | turn it over so that it regenerates

00:52:43.540 | 'cause it can indeed regenerate to create new cells there.

00:52:46.480 | Keep in mind that UV light and other factors

00:52:48.240 | in the environment can cause mutations

00:52:49.760 | within that skin layer.

00:52:51.080 | Sometimes they're caused by genetic factors,

00:52:53.040 | but often environmental factors like sun

00:52:54.800 | and chemicals and other things.

00:52:56.480 | And by encouraging turnover of that skin layer

00:52:58.780 | through laser resurfacing, which by the way,

00:53:01.100 | may also increase the sort of youthfulness appearance

00:53:03.760 | of your skin, so many people are motivated

00:53:05.280 | to do it for that reason, can dramatically reduce

00:53:08.460 | the incidence of certain kinds of skin cancer.

00:53:10.960 | In fact, the dermatologist that I spoke to

00:53:13.320 | who's an expert in derm oncology, okay, cancers of the skin,

00:53:16.820 | said that laser resurfacing can cause a 30% reduction

00:53:20.400 | in skin cancers because of this ability

00:53:22.360 | to rejuvenate that epidermal layer.

00:53:24.220 | And that's especially true for areas of the body

00:53:26.360 | like the face, ears, neck, tops of the hands, et cetera,

00:53:30.520 | for which the sun often induces the most damage

00:53:33.460 | because those are the most exposed parts of the body

00:53:35.520 | on a regular basis.

00:53:36.840 | And by the way, this whole thing about skin cancer

00:53:38.760 | is not a trivially small number, it's a big number.

00:53:42.360 | In the US alone, there are up to 4 million cases per year

00:53:46.040 | of what's called squamous cell carcinoma,

00:53:47.960 | one of these forms of skin cancer.

00:53:49.600 | So getting checked out by a highly qualified dermatologist

00:53:52.240 | on a yearly basis, maybe even more,

00:53:53.940 | if you're really concerned about this,

00:53:55.240 | 'cause you have a lot of familial,

00:53:56.900 | genetically inherited skin cancers,

00:53:59.400 | things of that sort is really highly advised.

00:54:02.940 | I'd like to take a brief break

00:54:04.080 | and acknowledge one of our sponsors, Element.

00:54:06.600 | Element is an electrolyte drink

00:54:07.920 | that has everything you need.

00:54:09.280 | That means the electrolytes, sodium, magnesium,

00:54:11.480 | and potassium in the correct amounts and ratios

00:54:14.240 | and nothing you don't, which means no sugar.

00:54:16.560 | Now, I and others on this podcast

00:54:18.280 | have talked about the critical importance of hydration

00:54:20.560 | for proper brain and body functioning.

00:54:22.160 | Even a slight degree of dehydration

00:54:24.080 | can diminish cognitive and physical performance.

00:54:26.560 | It's also important that you get adequate electrolytes.

00:54:28.880 | The electrolytes, sodium, magnesium, and potassium

00:54:31.860 | are critical for the functioning

00:54:33.040 | of all the cells in your body,

00:54:34.560 | especially your neurons, your nerve cells.

00:54:36.640 | Drinking Element dissolved in water

00:54:38.080 | makes it very easy to ensure

00:54:39.440 | that you're getting adequate hydration

00:54:41.200 | and adequate electrolytes.

00:54:42.800 | To make sure I'm getting proper amounts

00:54:44.280 | of hydration and electrolytes,

00:54:46.020 | I dissolve one packet of Element

00:54:47.840 | in about 16 to 32 ounces of water

00:54:49.840 | when I wake up in the morning,

00:54:51.080 | and I drink that basically first thing in the morning.

00:54:53.600 | I'll also drink Element dissolved in water

00:54:55.720 | during any kind of physical exercise I'm doing,

00:54:57.600 | especially in hot days when I'm sweating a lot,

00:54:59.980 | losing water and electrolytes.

00:55:02.040 | They have a bunch of different

00:55:02.960 | great tasting flavors of Element.

00:55:04.620 | My favorite is the watermelon,

00:55:06.200 | although I confess I also like the raspberry

00:55:08.080 | and the citrus.

00:55:08.920 | Basically, I like all the flavors.

00:55:10.760 | And Element has also just released a new line

00:55:12.800 | of canned sparkling Element.

00:55:14.320 | So these aren't the packets you dissolve in water.

00:55:16.060 | These are cans of Element that you crack open

00:55:18.440 | like any other canned drink, like a soda,

00:55:20.760 | but you're getting your hydration

00:55:22.080 | and your electrolytes with no sugar.

00:55:23.960 | If you'd like to try Element,

00:55:25.120 | you can go to drinkelement, spelled L-M-N-T.com/huberman,

00:55:29.980 | to claim a free Element sample pack

00:55:31.620 | with the purchase of any Element drink mix.

00:55:33.480 | Again, that's drinkelement.com/huberman

00:55:36.520 | to claim a free sample pack.

00:55:38.200 | Now, with respect to everything we've talked about

00:55:39.800 | about sun exposure, sunscreen, and skin cancer,

00:55:43.480 | I'd be remiss if I didn't discuss a study

00:55:45.300 | that's often used kind of as a wedge or a weapon

00:55:50.200 | in the online debates about sun exposure,

00:55:52.960 | skin cancer, and mortality.

00:55:54.520 | And the title of this study is quote,

00:55:56.760 | "Avoidance of sun exposure as a risk factor."

00:55:59.100 | That's right, sun exposure as a risk factor

00:56:01.240 | "for major causes of death, a competing risk analysis

00:56:04.240 | "of the melanoma in Southern Sweden cohort."

00:56:07.400 | So the basic design of this study

00:56:08.700 | was to evaluate people's self-reported amount

00:56:11.400 | of sun exposure across many years,

00:56:14.200 | and then to correlate that with all-cause mortality,

00:56:17.520 | and then to relate it to different causes of disease,

00:56:19.400 | in particular, cardiovascular death,

00:56:20.880 | compare this to smokers.

00:56:22.280 | Keep in mind that some of the people

00:56:23.720 | who were reporting their sun exposure were smokers,

00:56:25.760 | some weren't.

00:56:26.860 | And the conclusion of this study

00:56:29.100 | that drew a lot of attention

00:56:30.480 | and continues to draw a lot of attention is the following.

00:56:33.440 | Quote, and here I quote from the abstract,

00:56:35.280 | "Non-smokers who avoided sun exposure

00:56:38.680 | "had a life expectancy similar to smokers

00:56:41.920 | "in the highest sun exposure group."

00:56:44.200 | Okay, I'm going to repeat that.

00:56:45.600 | "Non-smokers who avoided sun exposure

00:56:48.280 | "had a life expectancy similar to smokers

00:56:50.820 | "in the highest sun exposure group."

00:56:53.560 | So what many people take this to conclude

00:56:56.960 | is that avoiding sun exposure is as dangerous

00:57:00.160 | as smoking, okay?

00:57:01.600 | That's not the conclusion that I'd like you to take away,

00:57:05.520 | because what this study basically shows is,

00:57:07.860 | and here I continue, quote,

00:57:09.160 | "Compared to the highest sun exposure group,

00:57:11.780 | "life expectancy of avoiders of sun exposure

00:57:14.700 | "was reduced by 0.6 to 2.1 years."

00:57:19.700 | So you go, wait a second.

00:57:20.960 | Can this really be true,

00:57:21.960 | that people that are avoiding sun exposure

00:57:25.080 | have a lower life expectancy

00:57:27.720 | than people who get sun exposure?

00:57:29.680 | And indeed, in this particular study,

00:57:31.600 | that does seem to be the case,

00:57:33.440 | but the interpretation of this

00:57:35.160 | is not completely straightforward.

00:57:36.840 | Here's what we know.

00:57:38.400 | Getting some degree of sun exposure

00:57:40.200 | appears to be good for life expectancy.

00:57:43.120 | That is true.

00:57:44.480 | But is it directly related to sun exposure?

00:57:47.940 | That's a critical question.

00:57:49.520 | And is the increased sun exposure that one gets,

00:57:52.260 | if you do get sun exposure,

00:57:53.900 | linked to other issues,

00:57:55.120 | in particular, the development of melanoma?

00:57:58.580 | As you recall, melanoma was even in the title of the study.

00:58:02.740 | So here's how I think we should think about this study.

00:58:05.840 | It does appear that getting sun exposure

00:58:07.980 | is correlated with longer life expectancy,

00:58:10.820 | but there could be any number of different reasons for that.

00:58:13.080 | For instance, people that are getting regular sun exposure,

00:58:16.300 | presumably, are also enhancing activation

00:58:19.080 | of the vitamin D pathways,

00:58:20.440 | which is related to any number of different things.

00:58:22.640 | They, no doubt, are experiencing

00:58:24.720 | increased feelings of well-being.

00:58:26.400 | I talked about papers that have substantiated that earlier.

00:58:29.100 | And frankly, we didn't even need a scientific study

00:58:32.040 | to substantiate that,

00:58:32.980 | although it's always great to have it.

00:58:34.880 | We know that being out in sunshine

00:58:36.460 | for some period of time each day,

00:58:37.700 | as long as we don't get burned in the sun, feels good.

00:58:40.500 | Why does it feel good?

00:58:41.340 | It leads to the production of testosterone, estrogen,

00:58:45.000 | some of the endorphins that generally make us feel good.

00:58:47.500 | It is directly related to the pathways

00:58:49.720 | associated with dopamine release.

00:58:51.580 | There's a whole story there about seasonality,

00:58:53.940 | both in humans and other animals,

00:58:55.420 | about dopamine synthesis.

00:58:57.840 | When we get sunlight, there's elevated dopamine

00:59:00.200 | and serotonin and testosterone and estrogen

00:59:02.540 | and feelings of well-being and libido.

00:59:04.460 | This is all well-substantiated in animal models and humans.

00:59:08.440 | So getting sun exposure makes people feel good.

00:59:10.720 | When people feel good, they tend to be lower stress.

00:59:13.060 | When people are feeling good and they have energy,

00:59:16.300 | because there indeed is a direct relationship

00:59:18.460 | between sun exposure,

00:59:19.400 | especially to the eyes early in the day,

00:59:21.340 | and our feelings of elevated mood and alertness and energy,

00:59:25.820 | they tend to exercise more, walk more.

00:59:27.580 | And of course, if you're outside exercising more,

00:59:30.140 | walking more, cycling, swimming,

00:59:32.160 | you're also going to get more sun exposure.

00:59:34.800 | And we know that exercise is strongly related

00:59:38.340 | to improved or extended life expectancy.

00:59:42.220 | Okay, so the study basically says getting sunlight

00:59:46.240 | as opposed to very little sunlight

00:59:47.780 | is good for life expectancy,

00:59:49.140 | but it doesn't say get too much sunlight, right?

00:59:52.140 | Because, and this is interesting,

00:59:54.520 | it is very clear that the people who lived longer

00:59:57.140 | because they were getting more sunlight

00:59:59.140 | also tended to have more cancers, including melanoma.

01:00:02.980 | But this is a very important point.

01:00:05.420 | It's also the case that the longer one lives,

01:00:08.620 | the more likely you are to develop a cancer, okay?

01:00:11.260 | So as you can see,

01:00:12.580 | these studies that many people

01:00:15.000 | just draw one straightforward conclusion from,

01:00:17.280 | such as people who get less sun exposure

01:00:19.540 | don't live as long as people to get more sun exposure.

01:00:21.620 | Well, that's true.

01:00:22.600 | But when you get more sun exposure,

01:00:24.440 | very likely you're doing other things like exercise

01:00:26.780 | and feeling better that relate to living longer.

01:00:28.780 | So it's very difficult,

01:00:29.660 | if not impossible to isolate one single variable,

01:00:32.480 | in this case, sun exposure as the key variable.

01:00:35.340 | However, I'm happy to go on record saying that

01:00:38.660 | we know from so many studies of animal models and humans

01:00:42.920 | that sun exposure, especially early day sun exposure,

01:00:45.860 | when the sun is low in the sky to set your circadian rhythm

01:00:48.760 | and late day sun exposure, okay?

01:00:50.720 | I'm not talking about middle of the day,

01:00:52.480 | getting baked in the sun and sunburned

01:00:55.240 | or things of that sort.

01:00:56.080 | But around the time of sunset,

01:00:57.580 | especially sun exposure to the eyes,

01:00:59.580 | is powerfully modulating your circadian rhythm

01:01:02.300 | to elevate daytime mood focus and alertness

01:01:04.480 | and improve sleep.

01:01:05.820 | Both of which are strongly correlated

01:01:07.940 | with improvements in mental health,

01:01:09.480 | immune system function,

01:01:10.680 | feelings of wellbeing, enhanced cognition.

01:01:13.720 | I mean, there's this whole story

01:01:14.800 | about people with Alzheimer's

01:01:16.060 | and disruptions in circadian rhythms and sleep.

01:01:18.560 | So sun exposure to the eyes

01:01:20.660 | in terms of setting circadian rhythm, powerful.

01:01:24.040 | Powerful improvement of life expectancy

01:01:26.820 | and immediate health.

01:01:29.200 | Sun exposure to the skin, no doubt,

01:01:31.720 | very powerful positive modulators

01:01:33.980 | of certain hormone and neuromodulator pathways

01:01:36.760 | such as dopamine, testosterone, estrogen, and so forth

01:01:39.980 | that make people feel good

01:01:41.280 | and do things generally that are good for them.

01:01:43.480 | Okay, generally, not all the things people do

01:01:45.480 | with elevated dopamine, testosterone, and estrogen

01:01:47.440 | are good for them.

01:01:48.280 | We know that for sure.

01:01:49.500 | But getting some sunlight,

01:01:51.720 | that is some appropriate dosage of sunlight,

01:01:54.880 | especially to the eyes early in the day.

01:01:56.660 | Don't stare at the sun, don't damage your eyes,

01:01:58.560 | but getting some of that sun exposure

01:02:00.280 | to your eyes early in the day

01:02:01.240 | and some to the skin,

01:02:02.600 | especially in the early and later part of the day,

01:02:05.040 | clearly is positively correlated

01:02:06.960 | with various health metrics

01:02:08.880 | in terms of mental health and physical health

01:02:10.800 | and not surprisingly with lifespan.

01:02:13.120 | So I mentioned the study

01:02:13.960 | 'cause I do think it's very interesting, right?

01:02:15.880 | I think it's really interesting

01:02:16.920 | that people who completely avoid sunlight

01:02:19.280 | are not living as long as people who get some sun exposure.

01:02:23.240 | And some of this actually is on par

01:02:24.800 | with what's experienced with cigarette smoking.

01:02:27.620 | I think something that everyone agrees

01:02:29.040 | is negative in terms of life expectancy

01:02:32.520 | and certainly is not good

01:02:34.340 | for a great number of different systems

01:02:37.180 | within the brain and body.

01:02:38.640 | But I think the study sometimes is used

01:02:41.320 | to highlight the wrong conclusion,

01:02:43.460 | which is that sunlight itself is extending lifespan.

01:02:47.440 | I think that that very simple conclusion

01:02:49.940 | can be taken too far

01:02:51.680 | and can start to negate

01:02:53.920 | some of the equally important messages

01:02:55.880 | about excessive sunlight exposure

01:02:58.040 | causing certain problems as it relates to skin cancers,

01:03:00.700 | which we talked about earlier,

01:03:02.160 | as it relates to things that you can do

01:03:03.960 | in order to offset some of that risk

01:03:05.900 | with, if I were to suggest,

01:03:07.840 | a physical barrier if you need it,

01:03:09.700 | a chemical-based sunscreen

01:03:11.020 | if you choose to use sunscreen.

01:03:12.840 | And of course, that's an independent choice

01:03:15.080 | that each of us have to make for ourselves.

01:03:17.560 | Okay, let's talk about youthfulness of skin

01:03:20.160 | or the appearance of youthfulness in skin.

01:03:23.480 | Before I did this episode,

01:03:24.600 | I put the call out on social media

01:03:26.360 | for questions about skin and skin health.

01:03:29.040 | And I must say that the vast majority of questions

01:03:32.120 | related to this topic.

01:03:33.880 | And it's a very interesting one

01:03:35.280 | because it relates to a lot of decisions

01:03:37.520 | that people are making about what to do,

01:03:40.500 | what to buy or not buy as the case may be.

01:03:43.240 | And it is an enormous,

01:03:46.080 | probably hundreds of billions of dollars industry,

01:03:48.920 | if not trillion dollar industry over time,

01:03:51.320 | this business of devices, products and procedures

01:03:55.220 | to try and reverse aging

01:03:57.620 | or the appearance of aging in skin,

01:03:59.880 | or even create de novo,

01:04:02.040 | new synthesis of collagen in skin

01:04:05.000 | and other things to make skin look more youthful.

01:04:07.720 | Okay, so if we step back from this whole area,

01:04:10.540 | we have to ask ourselves,

01:04:11.500 | what do we know for sure about what makes skin look youthful

01:04:16.220 | and what can be done to make skin look more youthful?

01:04:18.960 | And to understand the answers to those questions,

01:04:20.980 | we simply have to go back

01:04:22.020 | to the beginning of today's discussion for just a moment.

01:04:24.460 | Remember that we have the epidermal layer of skin,

01:04:26.700 | we have the dermal layer of skin,

01:04:28.100 | we have the vasculature, the blood vessels and capillaries,

01:04:30.420 | you have the nerve inputs there,

01:04:32.620 | and you have a bunch of different cell types in there,

01:04:35.180 | the keratinocytes.

01:04:36.700 | You have different proteins within those cells

01:04:39.820 | like collagen, elastin that over time can, yes,

01:04:43.420 | be mutated by things like UV rays from the sun,

01:04:46.300 | but that over time tend to lose their elasticity,

01:04:48.980 | which leads to wrinkles and sagging skin.

01:04:50.900 | You also have this issue of hydration of the skin, right?

01:04:54.740 | Skin has a lot of watery components within it,

01:04:57.300 | actual water within it.

01:04:59.020 | And those watery components are what give it

01:05:01.580 | its kind of plump, moist look, smooth look,

01:05:04.960 | as opposed to desiccated, sagging, wrinkled look,

01:05:08.720 | to speak in extremes.

01:05:09.940 | And there are hundreds,

01:05:10.900 | if not thousands of different chemicals out there

01:05:13.820 | that dermatologists, as well as cosmetic surgeons,

01:05:16.820 | as well as just, frankly, manufacturers of products,

01:05:20.480 | assert are going to be good for skin.

01:05:22.060 | So let's talk about where there is a lot of evidence

01:05:24.780 | for certain things that you can do

01:05:26.580 | if your goal is to increase the youthfulness

01:05:29.300 | or the appearance of youthfulness in your skin.

01:05:31.140 | And one of the main ones is collagen itself.

01:05:34.180 | And now I have to admit,

01:05:35.520 | I was very surprised when I looked at this literature,

01:05:37.700 | but I was positively surprised.

01:05:39.940 | Here's why.

01:05:41.220 | As you know, there are various macronutrients

01:05:43.260 | present in foods.

01:05:44.100 | You can have proteins, fats, and carbohydrates.

01:05:46.500 | When we ingest proteins, such as beef, chicken, fish, eggs,

01:05:50.860 | as well as some vegan sources of proteins,

01:05:52.700 | like beans, or lentils, or tofu, or things of that sort,

01:05:57.100 | they contain different amounts

01:05:59.180 | of different essential amino acids.

01:06:01.380 | And those essential amino acids and other amino acids

01:06:04.460 | are used as the building blocks for proteins in our muscles,

01:06:08.020 | in our tendons,

01:06:09.340 | in essentially all the organ systems of our body.

01:06:12.220 | The lipids are also used for cell membranes, et cetera, okay?

01:06:15.740 | This has been discussed various times on this podcast before,

01:06:18.400 | people like Dr. Lane Norton, Dr. Gabrielle Lyon, and others.

01:06:22.860 | It's well-established

01:06:24.420 | that when these proteins are broken down in the gut,

01:06:27.260 | some of those amino acids go

01:06:28.940 | and serve for the purpose of tissue repair.

01:06:31.940 | Others are for the purpose of other things.

01:06:34.060 | What most people in the field of nutrition agree upon,

01:06:36.140 | and what certainly I believe,

01:06:37.340 | is that if you were to, say, eat a little bit of liver,

01:06:41.360 | right, you might have a little bit of cooked liver,

01:06:43.500 | or a little bit of skeletal muscle

01:06:45.120 | in the form of like a steak,

01:06:47.180 | that there's no selective trafficking of the amino acids

01:06:50.260 | that are broken down from the liver that you eat

01:06:53.060 | to your liver, right?

01:06:54.540 | So when you hear that eating liver supports your liver,

01:06:57.340 | it may do that by the broad process of certain amino acids

01:07:02.140 | and vitamins and lipids, et cetera,

01:07:04.140 | serving your liver and other organ

01:07:06.660 | and tissue systems of the body,

01:07:08.020 | but not selectively your liver.

01:07:10.420 | However, when we talk about collagen,

01:07:12.300 | this protein that forms one of the most essential aspects

01:07:15.580 | of what makes our skin what it is, which is elastic,

01:07:19.020 | and to have some tensile strength where you can push on it,

01:07:22.500 | it returns to its original position,

01:07:25.160 | especially if it's well-hydrated.

01:07:27.000 | And makes our skin very youthful in appearance

01:07:29.360 | when we're young, and then as it degrades when we get old,

01:07:31.840 | makes it look less youthful,

01:07:33.100 | wrinkles and sagging and so forth.

01:07:35.240 | Well, then why would eating collagen protein,

01:07:37.700 | which can come from any number of different sources,

01:07:39.580 | it can come from fish sources,

01:07:40.920 | it can come from, believe it or not, animal health sources,

01:07:43.700 | can come from any number of different sources,

01:07:45.260 | tendon, et cetera,

01:07:46.460 | why would ingesting collagen be selectively trafficked

01:07:51.180 | to the collagen in our skin, right?

01:07:54.180 | That doesn't square with everything we know,

01:07:56.060 | and yet, when you look at studies,

01:07:57.940 | including meta-analyses of studies

01:07:59.760 | where people supplement with collagen powders,

01:08:02.360 | and these powders typically come from fish or tendon,

01:08:05.000 | any number of different sources,

01:08:06.600 | when people do this,

01:08:09.280 | and then measures are taken as to skin appearance,

01:08:11.840 | skin elasticity, there are a bunch of measures

01:08:13.680 | that can be done in humans in the laboratory to do this,

01:08:16.120 | you often will find studies

01:08:17.320 | that show statistically significant improvements

01:08:20.140 | in collagen composition and skin appearance,

01:08:22.800 | and even the appearance of reduction in wrinkles

01:08:24.940 | and so forth.

01:08:26.000 | So this is an interesting exception

01:08:27.860 | where the ingestion of a particular protein

01:08:30.180 | that naturally exists in abundance in certain tissues,

01:08:33.460 | such as skin, but also other tissues,

01:08:35.440 | like tendon, ligaments, et cetera,

01:08:38.080 | seems to be assisting in either the repair

01:08:42.200 | and rejuvenation of collagen,

01:08:44.600 | or perhaps some other aspect of collagen synthesis

01:08:48.280 | that leads to improvements in collagen composition

01:08:51.600 | and the appearance of skin in humans.

01:08:53.880 | That's very interesting,

01:08:54.880 | and the study that I find particularly interesting

01:08:56.960 | is one that I'll link to in the show note captions,

01:08:58.900 | it's entitled, quote,

01:09:00.160 | "Exploring the Impact of Hydrolyzed Collagen

01:09:02.800 | "Oral Supplementation on Skin Rejuvenation,

01:09:05.000 | "A Systematic Review and Meta-Analysis."

01:09:07.520 | And the basic takeaway of this and other meta-analyses,

01:09:10.420 | and the studies within this meta-analyses,

01:09:13.240 | is that when people supplement

01:09:14.560 | with anywhere from five to 15 grams, okay, grams,

01:09:19.280 | of hydrolyzed collagen per day,

01:09:22.360 | in particular in combination with vitamin C,

01:09:24.640 | it doesn't have to be a lot of vitamin C,

01:09:26.640 | that one can observe, okay, not always,

01:09:29.080 | but can observe some visible improvements

01:09:31.960 | in skin composition, meaning less wrinkles,

01:09:34.840 | even some reversal of wrinkles,

01:09:37.080 | less skin sagging, more youthful appearance,

01:09:39.880 | more kind of, let's just call it rebound elasticity

01:09:44.800 | of the skin.

01:09:45.640 | I realize that's not the appropriate technical term,

01:09:47.400 | but the ability of a skin to bounce back

01:09:49.520 | from an indentation when you push down on it,

01:09:52.360 | as opposed to saying down or sagging.

01:09:55.120 | So some pretty impressive results when one considers

01:09:57.440 | that what people are basically doing here

01:09:58.660 | is just mixing up some hydrolyzed collagen protein,

01:10:00.880 | and then drinking that down once per day or so.

01:10:03.960 | Now, that is not to say that you have to supplement

01:10:06.600 | with hydrolyzed collagen, why?

01:10:08.160 | Well, collagen is also present in various foods.

01:10:11.520 | So for instance, drinking bone broth, beef bone broth,

01:10:15.840 | chicken bone broth is a rich source of collagen.

01:10:17.960 | You can go online and simply look up, just by web search,

01:10:20.960 | you can just say what foods contain high levels of collagen,

01:10:23.880 | and you'll get a list of things back there.

01:10:25.320 | Hopefully a few of those are not just palatable to you,

01:10:27.920 | but you actually like,

01:10:28.800 | and you can start to include those in your daily diet,

01:10:30.920 | or you could supplement with hydrolyzed collagen protein.

01:10:34.300 | There are any number of different sources for these.

01:10:36.480 | It's interesting that while indeed I don't believe,

01:10:39.740 | and there is frankly zero evidence

01:10:41.320 | for selective trafficking of amino acids

01:10:43.840 | arising from a particular organ source

01:10:46.240 | to that particular organ when you ingest it,

01:10:48.520 | it is interesting that consuming hydrolyzed collagen

01:10:51.960 | in the form of a supplement

01:10:52.960 | or deriving it from foods like bone broth, et cetera,

01:10:56.940 | does seem to be able to improve collagen synthesis

01:10:59.860 | or the appearance of skin, making it more youthful.

01:11:02.720 | For those of you that are interested

01:11:04.040 | in ingesting collagen peptides

01:11:05.840 | as a way to improve the youthfulness of your skin,

01:11:09.380 | should mention that the dosages there come in a range,

01:11:12.580 | depending on the studies that you've looked at.

01:11:14.000 | And the dermatologist that I spoke to said,

01:11:15.940 | if one decides to go down this route of supplementing

01:11:19.020 | or getting collagen from food sources,

01:11:21.000 | you want to aim for anywhere from 15 grams to 30 grams

01:11:24.420 | of collagen peptides per day, okay?

01:11:26.600 | That's a bit higher than what was used

01:11:28.540 | in a number of studies,

01:11:30.100 | but you'll find studies that use 30 grams.

01:11:32.580 | And that that whole process can be augmented,

01:11:35.420 | can be improved through ingestion of 500

01:11:39.700 | to a thousand milligrams of vitamin C as well.

01:11:42.380 | But check the label on those collagen peptides

01:11:44.680 | that you might be supplementing with,

01:11:45.860 | 'cause oftentimes they already include

01:11:47.720 | that 500 to a thousand milligrams of vitamin C.

01:11:50.500 | I should also mention that the dermatologist I spoke to

01:11:53.180 | said that they like collagen protein supplementation,

01:11:55.660 | not just for the reasons discussed up until now,

01:11:58.100 | but that they liked them for a number of other reasons,

01:11:59.920 | such as the potential anti-inflammatory effects

01:12:02.540 | of collagen proteins.

01:12:03.860 | To be honest, I don't know what the exact mechanism

01:12:05.820 | of that is.

01:12:06.800 | Maybe if you get a certain protein threshold,

01:12:08.780 | the inflammation is down.

01:12:09.860 | But anyway, that's still cryptic to me.

01:12:11.780 | But in any case, they did describe

01:12:13.580 | some of the potential mechanisms

01:12:14.940 | by which collagen ingestion can do its thing

01:12:18.020 | in terms of improving youthfulness.

01:12:19.820 | It's broken down in the blood into dipeptides

01:12:22.300 | and tripeptides, which then are used

01:12:25.440 | within the collagen itself of the skin.

01:12:27.300 | This is the hypothesis.

01:12:29.020 | And that it can increase the chemotaxis,

01:12:32.500 | the mobility of fibroblasts,

01:12:33.940 | which make up some of the skin tissue

01:12:36.620 | and give rise to the appearance of more youthful skin.

01:12:40.260 | There's also evidence that ingestion

01:12:41.840 | of hydrolyzed collagen peptides can improve the elasticity

01:12:46.360 | of the skin barrier on the outside, right?

01:12:48.400 | Make it look nice and taut.

01:12:49.960 | If I guess we say nice,

01:12:51.120 | we're sort of passing subjective readout on this.

01:12:53.520 | Make it appear taut through the increase

01:12:56.040 | of certain proteins unrelated to collagen,

01:12:58.040 | such as filigrenes, elastins, et cetera.

01:13:00.320 | What about other peptides?

01:13:02.240 | Okay, so this is a big topic nowadays,

01:13:04.640 | especially in the online communities.

01:13:06.240 | I did an entire episode of this podcast about peptides.

01:13:09.440 | Keep in mind that insulin is a peptide.

01:13:12.080 | Ozempic, what is essentially an agonist

01:13:15.160 | for glucagon-like peptide one.

01:13:17.480 | This is a very popular prescription drug now

01:13:20.720 | for the treatment of obesity

01:13:22.360 | and for the treatment of diabetes.

01:13:25.040 | There are lots of things that qualify as peptides.

01:13:27.720 | A peptide is simply a small chain of amino acids.

01:13:30.400 | A polypeptide is a bit longer chain of amino acids.

01:13:33.000 | And then proteins are made up of amino acids.

01:13:35.600 | Okay, so when we say peptides,

01:13:37.600 | that means many, many things.

01:13:38.820 | But these days, when you hear about quote-unquote peptides,

01:13:41.840 | especially in online communities,

01:13:43.800 | generally people are referring to exogenously given, okay?

01:13:47.720 | So pills, ointments, or more typically injections

01:13:52.040 | of peptides that are designed to achieve

01:13:54.520 | some specific biological or physiological outcome.

01:13:58.000 | And one of the more common of these peptides

01:13:59.600 | being used nowadays is one that I've talked about before

01:14:01.560 | called BPC-157, Body Protection Compound 157,

01:14:05.700 | which is essentially a synthetic version

01:14:08.080 | of something found in gastric juice in all of us.

01:14:11.260 | It's known that certain peptides within the gut

01:14:14.540 | that BPC-157 is known to mimic,

01:14:16.740 | or it actually is a synthetic version

01:14:18.280 | of that exact sequence or a portion of that sequence,

01:14:20.980 | can assist in tissue and wound repair of different kinds.

01:14:24.040 | Tendon, anything involving fibroblasts,

01:14:26.900 | all of that has been well-demonstrated in vitro in a dish,

01:14:31.180 | okay, so not in vivo,

01:14:32.740 | as well as in vivo in certain cases,

01:14:35.460 | but only in animal models.

01:14:37.040 | To my knowledge, there's only one study,

01:14:38.860 | and frankly, it's not a very good study at all,

01:14:42.020 | on BPC-157 in humans,

01:14:43.820 | and yet a lot of people are taking BPC-157

01:14:46.420 | either orally in the form of a capsule or pill,

01:14:49.540 | or more typically injecting it.

01:14:51.440 | What does it do, or what does it likely do in humans?

01:14:53.700 | We know from animal models that BPC-157

01:14:56.500 | increases angiogenesis,

01:14:58.020 | the growth of capillaries and blood vessels.

01:14:59.900 | We know this.

01:15:00.940 | It can accelerate wound healing

01:15:02.340 | by virtue of increasing fibroblast motility.

01:15:05.940 | For this reason, it's used post-injury in sports.

01:15:10.200 | It's used by people who want to build more muscle.

01:15:13.240 | It's used by endurance athletes.

01:15:14.740 | It's used for cosmetic purposes.

01:15:16.880 | Anytime people are using BPC-157,

01:15:19.800 | for any of those purposes,

01:15:21.580 | it's likely that they're using it in part

01:15:24.000 | to increase the blood flow that's available

01:15:26.400 | to a given tissue and the repair of that tissue.

01:15:29.600 | Now, again, I do want to caution people

01:15:31.640 | that there is very little,

01:15:33.640 | basically no evidence in humans

01:15:35.280 | besides the anecdotal evidence

01:15:37.460 | that people say they healed faster.

01:15:39.280 | What I do know is that

01:15:40.160 | anytime you get vascularization of tissue,

01:15:42.320 | you're going to get improved blood flow,

01:15:44.960 | so it all makes sense mechanistically.

01:15:46.980 | I also know that vascularization due to BPC-157,

01:15:50.400 | even if it's injected locally into a given tissue,

01:15:53.520 | is likely to occur globally throughout the body.

01:15:55.800 | This is why some people taking oral BPC-157

01:15:58.240 | or injecting it just subcutaneously

01:16:00.280 | at the level of their stomach,

01:16:02.200 | a little bit under the skin at the level of their stomach,

01:16:04.400 | report faster wound healing even in a distal limb

01:16:07.020 | or like a hand or a nerve injury in their foot

01:16:09.280 | or something like that.

01:16:11.000 | That also tells us that there's going to be

01:16:12.880 | increased vascularization of other tissues,

01:16:15.560 | such as skin, such as tumors, if tumors exist.

01:16:19.720 | So you need to be very careful.

01:16:20.960 | I need to say that upfront as a cautionary note

01:16:22.880 | because it is very clear that many people

01:16:25.240 | are starting to either inject BPC-157

01:16:28.080 | or apply it in the form of a topical cream

01:16:30.480 | in effort to get more vascularization of skin

01:16:33.640 | in order to make that skin appear more youthful.

01:16:36.080 | And more and more products are out there

01:16:37.480 | that contain BPC-157.

01:16:39.240 | I can't in good conscious recommend those products.

01:16:42.200 | I can only offer to you the likely mechanism

01:16:44.720 | by which they work if they work,

01:16:47.160 | and also offer you the caveat that it is unclear

01:16:50.160 | that BPC-157 can go transdermally if it's applied topically.

01:16:54.200 | So if you put it on a, say, wrinkly portion of your face,

01:16:57.320 | so like I've got crow's feet.

01:16:58.440 | Crow's feet come from either aging, smiling, or both.

01:17:01.760 | You know, the crow's feet are the kind of wrinkles

01:17:03.360 | that extend out the corners of your eyes when you smile,

01:17:05.260 | or for me, 'cause I'm, you know, 48,

01:17:06.960 | you know, and probably do that even when I don't smile.

01:17:09.560 | The logic would be that if you take a cream containing

01:17:12.040 | BPC-157 and you put it on there,

01:17:14.340 | that you'll get increased vascularization of that area,

01:17:17.000 | delivery of more growth factors and nutrients,

01:17:19.580 | and those wrinkles will either be halted

01:17:21.800 | in their aging progression or that they will reverse.

01:17:25.480 | That's the logic.

01:17:26.480 | To my knowledge, there are no clinical studies,

01:17:28.640 | and I'd love to know from you,

01:17:29.840 | if you've tried these products,

01:17:32.060 | please put your experience of those

01:17:33.720 | in the comments on YouTube,

01:17:35.720 | so we can get a sense of whether or not

01:17:37.160 | people are having good results with this.

01:17:39.480 | That, of course, is not a controlled study,

01:17:40.880 | but I'm very curious as to know.

01:17:42.440 | Many of the products that contain BPC-157, by the way,

01:17:45.360 | also contain copper.

01:17:47.120 | Copper is a trace mineral.

01:17:48.200 | It's found in your diet.

01:17:49.960 | There is some evidence that copper is important

01:17:52.040 | for some of the collagen and other elements

01:17:54.780 | of skin synthesis pathways.

01:17:57.080 | And so the mechanistic logic and the biochemical logic

01:18:00.320 | is there on paper.

01:18:01.320 | However, it's also clear that ingesting too much copper

01:18:05.600 | can induce an inflammatory response

01:18:07.580 | and would lead to the exact opposite desired effect

01:18:10.460 | that people who are using copper

01:18:13.920 | and usually copper BPC-containing products

01:18:17.200 | are taking them for,

01:18:18.040 | which is to halt or reverse the appearance

01:18:21.100 | of aging in their skin.

01:18:22.320 | Why am I going through this whole gymnastics

01:18:24.560 | of, you know, BPC-157 and copper?

01:18:26.680 | Well, because nowadays many, many products

01:18:29.760 | are starting to include "peptides" for skin rejuvenation.

01:18:33.280 | And most often those peptides are of the copper variety,

01:18:37.640 | of the BPC-157 variety,

01:18:40.300 | and oftentimes also with things

01:18:43.280 | related to collagen synthesis, sometimes collagen directly.

01:18:46.240 | So you'll find oral products that one takes by pill form

01:18:49.960 | that are BPC-157, copper, and collagen,

01:18:54.960 | or things that promote synthesis of collagen.

01:18:57.560 | You'll find ointments that are pure BPC-157,

01:18:59.760 | still unclear if those go transdermal.

01:19:01.680 | Okay, so this is still a very, very young science.

01:19:05.280 | And most of this is not being explored

01:19:07.920 | in randomized control trials.

01:19:09.480 | However, I know some of you out there

01:19:10.960 | are pretty experimental.

01:19:12.360 | You like experimenting with this kind of stuff.

01:19:14.920 | You like hearing what's working for other people.

01:19:16.800 | Here's what I suggest.

01:19:18.300 | If a sunscreen or a lotion or a pill or an injection

01:19:23.300 | is asserted to contain peptides

01:19:26.700 | to help with skin rejuvenation,

01:19:28.120 | make sure you look and see

01:19:29.000 | which specific peptides are included.

01:19:31.220 | Know the risks associated with BPC-157.

01:19:33.520 | It's uncertain risk about acceleration of tumor growth,

01:19:36.340 | but the mechanistic logic is just as strong for that

01:19:38.880 | with BPC-157 as it is for BPC-157,

01:19:41.980 | encouraging vascularization of any other tissue,

01:19:44.280 | muscle, tendon, ligament, or skin for that matter.

01:19:47.320 | So I'm not telling you what to do,

01:19:48.360 | just know what you're doing

01:19:49.600 | and understand the likely mechanisms behind it

01:19:52.720 | in the absence of any of these randomized control trials.

01:19:55.400 | I will say in service to making sure that your diet

01:19:58.240 | and or supplementation includes enough trace mineral copper.

01:20:01.880 | Copper has been shown to play a key role in DNA repair,

01:20:05.000 | which is a critical component of the turnover of collagen

01:20:07.960 | and other proteins in skin.

01:20:09.800 | It has been shown to reduce

01:20:11.520 | so-called reactive oxygen species.

01:20:13.280 | So it serves as a so-called antioxidant

01:20:15.760 | and this relates to what I just said, reduced inflammation,

01:20:19.020 | but too much copper is a problem.

01:20:20.940 | So I wouldn't run out and start supplementing

01:20:22.640 | with excessive amounts of copper.

01:20:23.900 | Please don't do that.

01:20:25.080 | But you want to make sure

01:20:25.920 | that you're getting sufficient amounts of copper

01:20:28.160 | from your diet and you can simply look up online

01:20:30.060 | what sufficient amounts of copper are

01:20:32.400 | given it's a trace mineral.

01:20:33.640 | And it's very likely that if you ingest any kind

01:20:36.320 | of supplement that is a multivitamin mineral supplement

01:20:40.080 | or a foundational nutrition supplement,

01:20:41.720 | that includes at least some copper.

01:20:43.480 | So it's likely that you're sort of quote unquote topped off

01:20:45.880 | in terms of the amount of copper that you need,

01:20:47.800 | but very unlikely to be excessive amounts of copper.

01:20:50.400 | But if you start supplementing with copper beyond that,

01:20:53.040 | again, you can induce an inflammatory response.

01:20:55.520 | So it's a dosage kind of middle ground issue there.

01:20:59.160 | You don't want your copper too low.

01:21:00.580 | You don't want your copper too high.

01:21:01.720 | You want it right there in the middle.

01:21:03.320 | Okay, as I mentioned before,

01:21:04.320 | we will talk about other components of food

01:21:06.300 | that are great for skin health.

01:21:08.100 | And we will also talk about components of certain foods

01:21:10.760 | like advanced glycation end products.

01:21:13.680 | I don't know if you've heard of those before,

01:21:14.760 | but very interesting, not good stuff

01:21:16.880 | that you want to avoid if you can,

01:21:18.240 | especially if your concern is youthful looking skin

01:21:20.320 | and healthy skin and frankly health overall.

01:21:23.500 | But before we do that,

01:21:24.720 | I think it's worth paying attention to a few things

01:21:26.520 | that you can potentially take

01:21:28.400 | that can really improve the youthfulness of your skin

01:21:30.760 | for which there is excellent science to support it.

01:21:33.580 | Okay, so when I spoke to board certified dermatologists

01:21:37.160 | who trained at excellent institutions,

01:21:39.520 | what people can do to improve the youthfulness

01:21:43.000 | or the appearance of youthfulness in their skin

01:21:45.640 | and that there specifically be peer reviewed studies

01:21:48.720 | to support their statements.

01:21:50.420 | They mentioned hydrolyzed collagen protein

01:21:53.120 | in combination with vitamin C.

01:21:54.320 | We talked about that earlier.

01:21:55.960 | They mentioned a bunch of do's and don'ts

01:21:57.440 | as it relates to sun exposure and nutrition, et cetera,

01:22:00.160 | some of which we've covered,

01:22:01.060 | some of which we are yet to cover, but will soon.

01:22:03.960 | And they mentioned supplementing with niacinamide.

01:22:08.200 | Niacinamide is a form of vitamin B3.

01:22:11.240 | It is also sometimes referred to as nicotinamide.

01:22:14.120 | And I was told that when taken at twice per day

01:22:17.080 | at a dosage of 500 milligrams per dose

01:22:19.200 | for a total of one gram or 1000 milligrams per day,

01:22:22.960 | that niacinamide supplementation

01:22:25.720 | can increase the production of ceramides,

01:22:28.360 | which relate to the lipids in skin

01:22:32.180 | that improve the moisture in skin.

01:22:34.400 | And by the way, moisture in skin is a key component

01:22:37.560 | of the youthfulness or plump appearance of that skin.

01:22:39.900 | And when I say plump,

01:22:40.740 | I don't necessarily mean outwardly rounded plump.

01:22:43.440 | I mean, the fact that the skin looks

01:22:45.480 | like the outermost layer of the skin,

01:22:47.400 | which you now know as the epidermis,

01:22:48.920 | is kind of taut and the skin looks hydrated

01:22:51.440 | and smooth at the level of its outer appearance,

01:22:53.840 | all of that is improved by niacinamide supplementation,

01:22:58.160 | but that the supplementation has to be carried out

01:22:59.940 | for three to six months or more

01:23:02.060 | before that effect is noticed.

01:23:04.240 | Now, the origin of the niacinamide effect

01:23:06.360 | on the youthfulness of skin

01:23:07.960 | could also be related to the fact that there's evidence

01:23:09.920 | that niacinamide supplementation

01:23:11.280 | can reduce inflammation of skin overall.

01:23:13.720 | We haven't talked so much

01:23:14.560 | about the immune skin relationship,

01:23:16.380 | although as I alluded to at the beginning of the episode,

01:23:18.600 | this is a key relationship.

01:23:20.400 | But for those of you suffering from rosacea, from acne,

01:23:25.020 | so rosacea being a reddening of the skin,

01:23:27.320 | we're going to talk more about it later

01:23:28.660 | and specific things that can be done for it.

01:23:30.240 | Acne almost always involves some reddening,

01:23:33.120 | often painful reddening of specific pox on the skin,

01:23:36.080 | sometimes even the appearance of, you know,

01:23:38.140 | pus-filled bumps, this sort of thing,

01:23:40.800 | that niacinamide supplementation may also assist there

01:23:43.740 | because of the reduction in inflammation.

01:23:45.560 | And we'll talk all about the relationship

01:23:47.280 | between inflammation and acne.

01:23:49.320 | Regardless of whether or not you suffer from rosacea or acne

01:23:51.640 | or not at all,

01:23:53.500 | that niacinamide supplementation may benefit you.

01:23:56.660 | Also because niacinamide supplementation

01:23:58.640 | appears to balance the level of oil production in the skin,

01:24:01.360 | you need oil in the skin,

01:24:02.600 | you need oil down in those pores, but not too much.

01:24:05.560 | And that it can definitely help reduce

01:24:07.080 | the appearance of clogged pores.

01:24:08.720 | And if you're concerned about pores that appear too large,

01:24:11.960 | this typically happens in the face, around the nose,

01:24:15.120 | on the upper cheeks,

01:24:16.000 | although other regions of the body as well,

01:24:17.760 | niacinamide supplementation may assist with that as well.

01:24:20.840 | There's also a number of people out there

01:24:22.080 | that are concerned with specific spots

01:24:24.680 | that they see as hyperpigmented spots.

01:24:26.860 | So regardless of whether or not overall your skin

01:24:28.980 | is very light or very heavily pigmented,

01:24:31.440 | supplementation with niacinamide

01:24:34.880 | can reduce the appearance of accumulation

01:24:37.800 | and maybe even the actual accumulation

01:24:40.060 | of melanin in a particular spot,

01:24:41.400 | so-called dark pigmented spots,

01:24:43.080 | that some people decide that they don't want

01:24:44.640 | for whatever reason, usually just cosmetic reasons.

01:24:46.760 | Although there may be reasons why hyperpigmentation

01:24:49.180 | in a given area could relate to skin cancers.

01:24:51.360 | We talked about that earlier.

01:24:52.800 | Another reason to go get not just your moles,

01:24:54.700 | but all of your skin checked at least once per year.

01:24:56.960 | Now, if you decide to supplement with niacinamide,

01:24:58.960 | you have the option of either taking that 1,000 milligrams

01:25:01.240 | and two 500 milligram dosages per day.

01:25:03.900 | You also have the option of using any number

01:25:06.280 | of different topical niacinamide ointments

01:25:09.440 | or serums that exist out there.

01:25:11.440 | Keep in mind that many skincare products

01:25:13.080 | already contain niacinamide, so check the label.

01:25:15.800 | And there, the dermatologists tell me that to be effective,

01:25:19.640 | the niacinamide needs to be present at at least a two

01:25:22.480 | and as high as 10% concentration

01:25:24.440 | within those ointments or serums.

01:25:26.660 | Keep in mind that many serums and ointments

01:25:28.520 | also contain what's called hyaluronic acid.

01:25:30.920 | Hyaluronic acid is a natural component of the skin

01:25:34.640 | that provides a physical substrate for holding in water,

01:25:37.120 | so moisture within the skin.

01:25:38.400 | It does a bunch of other important things too

01:25:39.880 | within the extracellular matrix and elsewhere,

01:25:42.460 | the regions between the cells that is.

01:25:44.480 | And supplementation with hyaluronic acid

01:25:47.240 | or ointments or serums that contain hyaluronic acid

01:25:49.440 | and niacinamide are pretty common out there

01:25:51.520 | because of the already stated effects of niacinamide

01:25:54.600 | and the fact that hyaluronic acid can serve

01:25:56.440 | as what's called a humectant,

01:25:57.600 | something that serves to sort of barrier in moisture

01:26:01.280 | at the level of the skin, okay?

01:26:02.800 | So it gives that kind of plumping moist look of skin

01:26:06.520 | that's characteristic of youthful skin

01:26:08.720 | as opposed to aged skin.

01:26:10.600 | The dermatologists and the cosmetic surgeons

01:26:13.360 | that work on faces that I spoke to,

01:26:16.480 | I told you I consulted with a fairly large

01:26:18.840 | and diversified group of folks

01:26:20.840 | in preparation for this episode,

01:26:22.320 | all agreed that supplementation with collagen, vitamin C,

01:26:25.680 | niacinamide and hyaluronic acid

01:26:28.600 | was something that they suggest to their patients.

01:26:31.040 | The other supplement,

01:26:31.880 | well, actually it's a prescription treatment most often

01:26:35.720 | that dermatologists recommend

01:26:37.480 | if the goal is youthful appearing skin,

01:26:40.120 | are things within the so-called retinoid pathway

01:26:43.160 | such as retinol, okay?

01:26:44.640 | Many of you have perhaps heard of this

01:26:46.560 | and it's a whole story related to the relationship

01:26:50.080 | between vitamin A and skin.

01:26:53.200 | Okay, so tretinoin is the common name for it,

01:26:55.620 | although some of you may know it as retin-A

01:26:58.400 | and prescription drugs that are similar to that

01:27:01.760 | are basically derivatives of vitamin A, why?

01:27:05.360 | Why are these used for skincare?

01:27:07.400 | Why are they used to increase the youthfulness of skin?

01:27:09.360 | Well, vitamin A gets into skin cells

01:27:11.760 | and is converted into something called retinaldehyde,

01:27:14.440 | then into something called retinoic acid.

01:27:16.720 | Now, very important to know that retinoic acid

01:27:19.440 | is involved in a lot of different cellular processes,

01:27:22.080 | especially during neural development.

01:27:24.360 | This is why, and please pay careful attention to this,

01:27:26.920 | this is why women who are pregnant or breastfeeding

01:27:30.260 | should avoid taking these products

01:27:32.760 | because it can seriously disrupt the development

01:27:36.140 | of the fetus, okay?

01:27:37.520 | And keep in mind that many times people don't realize

01:27:39.800 | they're pregnant for some period of time,

01:27:42.120 | so this is of paramount concern, okay?

01:27:44.840 | We could have a whole discussion as to the role

01:27:46.680 | of retinoic acid in fetal development,

01:27:49.040 | but you don't want to tamper with that pathway, okay?

01:27:51.760 | Very serious consequences can occur.

01:27:53.840 | Okay, so when retinoic acid gets into cells,

01:27:55.720 | it can activate what's called transcription factors.

01:27:58.180 | Transcription factors bind to DNA, okay, your genetic code,

01:28:02.560 | and can induce the transcription and translation of DNA

01:28:06.120 | into RNA and RNA into proteins of particular types.

01:28:09.200 | So think of transcription factors as sort of setting a menu

01:28:12.400 | of different proteins that ultimately will be formed, okay?

01:28:15.320 | By binding to DNA, and then you get DNA to RNA,

01:28:18.040 | RNA to protein, and you're getting a set of proteins

01:28:20.720 | related to a particular process.

01:28:22.160 | That's generally how transcription factors work.

01:28:25.200 | And retin-A, tretinoin, and things similar to that

01:28:27.520 | are going to induce the formation of collagen protein

01:28:30.420 | within skin, as well as other proteins that relate

01:28:33.280 | to the formation of de novo skin, new skin,

01:28:36.000 | and can replace old degenerated skin.

01:28:38.920 | So the dermatologists that I spoke to were really bullish

01:28:42.640 | about the fact that, believe it or not,

01:28:45.000 | they felt that people starting in their 20s

01:28:48.040 | could very well, as long as they're not pregnant

01:28:49.880 | or lactating or planning to get pregnant,

01:28:52.580 | could take retin-A or things similar to it

01:28:56.000 | in order to stimulate the production of more skin

01:28:59.360 | and look more youthful.

01:29:00.680 | Now, for people already in their 20s, you know,

01:29:02.760 | by my read, they're already youthful,

01:29:04.660 | but that they could initiate the use of these compounds,

01:29:08.040 | at least in one's 20s and continuing on,

01:29:10.360 | really, as long as they wanted through life.

01:29:13.320 | And they told me about, quote, "remarkable results."

01:29:15.640 | So I said, well, why isn't everyone aware of this?

01:29:17.440 | Why isn't everyone taking them?

01:29:19.040 | Well, it turns out that these different compounds

01:29:21.440 | can also increase sensitivity to light,

01:29:24.440 | make you more prone to sunburn,

01:29:26.520 | to some of the other effects of light on skin,

01:29:28.280 | even from screens or from artificial lights.

01:29:31.040 | So one has to be careful about inducing

01:29:32.760 | too much skin sensitivity to light of all kinds,

01:29:34.920 | not just sunlight,

01:29:36.360 | that they can also induce some redness or dryness.

01:29:38.400 | So one has to get the dosage right,

01:29:40.120 | the frequency of use right,

01:29:41.600 | and they can be a little bit tricky to work with,

01:29:43.080 | but that if one can home in on the right dosages,

01:29:45.960 | the right frequency, et cetera,

01:29:48.040 | the dermatologists felt like this was one of the best things

01:29:50.240 | that one could do to improve the youthfulness

01:29:52.520 | or the appearance of youthfulness in one's skin.

01:29:54.880 | Now, I find this interesting for a number of reasons.

01:29:56.760 | First of all, I've heard of Retin-A, right?

01:29:58.640 | I've heard of these compounds before,

01:30:01.280 | but I hadn't heard about all these, you know,

01:30:03.720 | reportedly spectacular things like improved angiogenesis,

01:30:07.320 | vascularization of the skin.

01:30:08.480 | This is why people are taking the rather experimental,

01:30:12.360 | untested BPC-157 that I talked about before,

01:30:15.920 | the improved elasticity of skin,

01:30:18.060 | which somehow seems related to the ability

01:30:19.960 | of these compounds to remove degenerated elastin

01:30:23.260 | within the skin, to clear that out,

01:30:25.080 | as well as to induce de novo synthesis,

01:30:27.800 | and even the number of different fibroblasts

01:30:30.640 | that are present in skin.

01:30:31.780 | So more new skin, clearing away of old skin,

01:30:35.480 | improved vascularization.

01:30:37.480 | And while all of this sounds a little bit too good

01:30:39.080 | to be true, the mechanisms by which it's asserted to work

01:30:43.800 | all hold up.

01:30:44.640 | So that's always reassuring, right?

01:30:46.040 | Mechanism isn't everything,

01:30:47.160 | but it's really nice to see there.

01:30:48.920 | For instance, these compounds are known to get

01:30:50.720 | into the nucleus of cells, right?

01:30:52.880 | To impact gene expression.

01:30:54.060 | We talked about that before.

01:30:55.000 | You have receptors on the surface of cells.

01:30:56.960 | Okay, so cell surface receptors.

01:30:58.780 | You also have nuclear receptors.

01:31:00.920 | And the ability of certain things, we call them ligands,

01:31:02.800 | but these are chemicals, right?

01:31:04.280 | In this case, you know, in the vitamin A pathway

01:31:06.560 | to get into the nucleus of cells and impact gene expression.

01:31:09.520 | This is actually how hormones like testosterone

01:31:11.740 | and estrogen change the way that people look

01:31:14.060 | so dramatically during puberty.

01:31:15.440 | They actually, you know,

01:31:16.400 | they operate by binding to cell surface receptors.

01:31:18.360 | They also get into the nuclear compartment of the cell.

01:31:20.900 | They bind to nuclear receptors

01:31:22.240 | and they turn on entire genetic programs that cause,

01:31:24.760 | for instance, deepening of the voice

01:31:26.040 | or the growth of hair or breast tissue, et cetera.

01:31:28.000 | So these are powerful compounds.

01:31:29.880 | Now I talked to a cosmetic surgeon expert

01:31:33.040 | in face specifically.

01:31:35.280 | Remember, cosmetic surgery is done

01:31:36.440 | for a number of different areas of the body,

01:31:38.120 | but for face specifically,

01:31:39.920 | who also specializes in these sorts of treatments for skin.

01:31:43.600 | And they've started using,

01:31:45.480 | and are frankly quite confident in,

01:31:47.960 | the use of retinoid esters

01:31:50.320 | that can be applied to the surface of the skin.

01:31:53.080 | These things are available not by prescription.

01:31:55.140 | There's far less research on these sorts of compounds,

01:31:58.000 | but these compounds get enough positive support

01:32:00.880 | from the people that have tried them,

01:32:02.200 | reporting improved youthfulness of skin, et cetera,

01:32:05.040 | that some of them are becoming quite sought after

01:32:07.880 | and people, let's just say,

01:32:09.280 | are very enthusiastic about them.

01:32:10.880 | And I will say that in discussing

01:32:12.080 | the various mechanisms of this

01:32:13.880 | with these cosmetic surgeons and some dermatologists,

01:32:16.920 | the logic holds up.

01:32:18.240 | So you're starting to see more and more of these.

01:32:20.280 | Now, as I mentioned at the beginning of today's episode,

01:32:22.680 | there is zero business relationship between me,

01:32:26.440 | the podcast, or any of these people

01:32:28.960 | that have marketed serums or creams

01:32:31.680 | or prescription drugs for that matter,

01:32:33.440 | related to skin health and skincare.

01:32:35.280 | However, I have provided a couple of links

01:32:37.200 | in the show note captions

01:32:38.600 | of some of the different sources of these.

01:32:40.240 | Obviously, if you need a prescription

01:32:42.000 | for something like tretinoin or something similar,

01:32:43.980 | because you're interested in this whole retinol,

01:32:46.600 | retin-A, vitamin A pathway story,

01:32:49.560 | you need to talk to a board-certified dermatologist

01:32:52.280 | who could potentially prescribe that for you

01:32:53.840 | if they decide it's right for you.

01:32:55.560 | But in terms of these topical ointments and serums

01:32:58.360 | and creams and things like that,

01:33:00.080 | I do provide a link to at least one source of those

01:33:02.640 | that uses the retinoid ester.

01:33:04.320 | Just keep in mind that these various ointments and serums

01:33:06.680 | do not yet have the randomized control trials

01:33:08.840 | to support them that some of the other compounds

01:33:11.240 | that we were discussing do have.

01:33:13.180 | Now, I'd like to talk about things that one can do

01:33:15.040 | to improve the health and appearance of one's skin

01:33:18.200 | that don't involve taking anything

01:33:20.220 | or putting on any kind of ointment or serum

01:33:22.760 | or anything like that.

01:33:24.440 | And what I'm referring to is phototherapy.

01:33:27.520 | Now, at the earlier part of the episode,

01:33:29.640 | I talked about how different wavelengths of light,

01:33:31.760 | like UV light and long wavelength light

01:33:33.680 | can penetrate skin to different depths

01:33:36.240 | and some of the negative,

01:33:37.960 | but also positive things that that can do.

01:33:39.960 | So for instance, we talked about UV light

01:33:41.600 | mutating DNA in cells and potentially causing cancers,

01:33:45.320 | accelerating the aging process and so forth.

01:33:48.520 | But as you also recall, long wavelength light,

01:33:51.100 | so-called red light and near infrared light,

01:33:53.420 | which is even longer wavelengths of light

01:33:55.940 | can penetrate deep into the skin tissue.

01:33:57.760 | So pass that outer epidermal layer

01:34:00.000 | into the dermal layers of the skin

01:34:02.320 | and can access the vasculature, the neurons,

01:34:05.960 | some of the glands located deeper in the skin.

01:34:08.720 | And of course, the cells there,

01:34:10.400 | like cells in the epidermis, I should point out,

01:34:13.720 | contain things like mitochondria

01:34:15.160 | for which red light has been shown to be beneficial.

01:34:17.640 | Why?

01:34:18.600 | Red light and near infrared light phototherapy

01:34:21.400 | has been shown to reduce reactive oxygen species

01:34:24.140 | and thereby to improve mitochondrial function in cells.

01:34:27.440 | And that in turn has been shown to be beneficial

01:34:29.400 | for all the different processes within cells

01:34:32.040 | that involve mitochondria,

01:34:33.100 | which of course include energy production,

01:34:35.320 | but a bunch of other things too.

01:34:37.640 | So when I say that phototherapy has been shown

01:34:40.640 | to be beneficial for cells of the body,

01:34:42.280 | it's not just cells of the skin.

01:34:44.000 | In fact, a Nobel prize was granted in the early 1900s

01:34:47.120 | for the use of phototherapy for the treatment of lupus.

01:34:50.440 | So this is not a new technology.

01:34:52.420 | At the same time, while there are many studies

01:34:55.920 | exploring the use of phototherapy

01:34:57.400 | for improvement of skin health and appearance,

01:34:59.920 | most of those studies have fairly low sample sizes,

01:35:02.460 | but there are a lot of those studies.

01:35:04.400 | And fortunately by now, there are a few meta-analyses

01:35:07.480 | and reviews that take into account

01:35:10.120 | lots of different studies

01:35:11.160 | using slightly different wavelengths of light

01:35:13.080 | applied to different portions of the face

01:35:14.720 | for different purposes, treatment of acne,

01:35:17.060 | maybe even putting red light near infrared light

01:35:19.640 | on one half of the face

01:35:20.900 | to have a so-called within person control

01:35:23.660 | to compare the changes in skin

01:35:25.820 | or lack of changes in skin as the case may be

01:35:27.640 | between one side of the face and the other.

01:35:29.760 | I'll put links to some of these studies

01:35:31.540 | and some of the meta-analyses and reviews of these studies.

01:35:34.600 | One that I like in particular was published in 2018

01:35:37.380 | entitled "Light Emitting Diodes in Dermatology,

01:35:39.600 | A Systematic Review of Randomized Controlled Trials."

01:35:42.560 | Of course, randomized controlled trials

01:35:44.360 | being one very powerful way to analyze

01:35:46.600 | the utility of a practice or a compound.

01:35:49.160 | It's not the only way to assess the utility of something.

01:35:51.960 | I know some people argue that they are very useful,

01:35:53.840 | but keep in mind in the field of medicine,

01:35:56.960 | we often have entire fields

01:35:58.760 | or even entire chapters of medical books

01:36:00.660 | that are based on case studies.

01:36:01.960 | For instance, we implicate the so-called hippocampus

01:36:05.140 | of the brain for its function in human memory,

01:36:09.240 | which it absolutely has.

01:36:10.960 | And that fact largely grew from one major case study

01:36:14.140 | that then exploded into a number of different animal model

01:36:17.760 | and then human studies later on.

01:36:19.840 | So we all love randomized controlled trials,

01:36:22.360 | reviews of randomized controlled trials

01:36:23.740 | and the uses of their phototherapy

01:36:25.280 | for treatment of skin conditions

01:36:27.440 | and improving the quality of skin are wonderful

01:36:31.200 | and point to the fact that phototherapy

01:36:34.560 | can indeed improve the appearance of skin

01:36:37.220 | in conditions like acne, can accelerate wound healing,

01:36:40.280 | can improve the youthfulness appearance of skin,

01:36:43.500 | but these effects tend to be somewhat mild

01:36:46.440 | to moderate when they occur.

01:36:47.740 | And certainly there are many studies

01:36:49.440 | that show no significant effect,

01:36:51.360 | no statistically significant effect.

01:36:53.720 | That said, I'm of the belief

01:36:55.360 | based on my read of the literature,

01:36:56.900 | and this is a literature I've spent a lot of time with,

01:36:58.900 | frankly, because I did an episode all about light and health.

01:37:01.980 | I've also been very interested in the use of phototherapy

01:37:04.120 | for the treatment of eye diseases

01:37:06.820 | and offsetting age-related decline in visual function.

01:37:10.000 | There's some interesting evidence there.

01:37:11.380 | Again, mild to moderate effects,

01:37:13.380 | but that can be meaningful in the real world.

01:37:15.200 | And when I step back from all of the literature,

01:37:17.680 | here's what I see.

01:37:18.680 | And this is what I ran by a dermatologist

01:37:21.680 | to make sure that they thought that this protocol

01:37:25.120 | would be useful or not useful, right?

01:37:27.560 | I asked them, I didn't tell them,

01:37:29.600 | do you think this will be useful?

01:37:30.880 | Tell me yes, I asked them.

01:37:32.600 | And what we basically converged on was

01:37:34.920 | that if somebody decides to do phototherapy,

01:37:37.100 | the use of phototherapy

01:37:38.200 | that involves long wavelengths of light,

01:37:39.920 | so red light plus near infrared light, typically,

01:37:43.800 | at a distance of about a foot to two feet

01:37:48.060 | from the light source,

01:37:48.960 | depending on the intensity of the light source,

01:37:50.920 | although that doesn't seem to be so critical,

01:37:53.200 | but one can't be across the room from the red light source,

01:37:56.040 | nor should one get right up next to the red light source

01:37:58.680 | so that there's a lot of heat

01:38:00.000 | generated from the red light source that one can feel.

01:38:02.560 | But at a distance of about a foot to two feet away

01:38:05.880 | at fairly high intensities,

01:38:07.400 | done for anywhere from 10 to 15 minutes,

01:38:10.300 | five to seven days per week on a consistent basis,

01:38:14.080 | does seem on average to lead to improvements

01:38:17.200 | in the youthfulness appearance of skin.

01:38:19.900 | Why this would be the case isn't exactly clear,

01:38:22.640 | but there are a number of different logical interpretations

01:38:24.880 | such as reduced inflammation,

01:38:26.280 | improved mitochondrial function,

01:38:28.220 | all downstream of reduced reactive oxygen species,

01:38:31.460 | improved blood flow to that particular area

01:38:34.200 | because of the effect that long wavelength light

01:38:36.120 | can have on vasodilation,

01:38:38.240 | sort of expansion as opposed to contraction

01:38:40.120 | of blood vessels and capillaries.

01:38:41.760 | All of this makes mechanistic logical sense,

01:38:44.140 | and the effects that one sees

01:38:45.880 | in these various peer-reviewed papers,

01:38:47.800 | randomized controlled trials, seem pretty good,

01:38:50.640 | meaning they are mild to moderate.

01:38:53.160 | None of them are sort of jaw-dropping,

01:38:55.040 | like, wow, complete reversal of severe acne

01:38:57.680 | or massively accelerated wound healing.

01:39:00.520 | And we also, of course, have to take into account

01:39:02.500 | that many people who are doing phototherapy

01:39:04.240 | often are combining it with other things,

01:39:06.500 | sometimes in today's era, like injections of BPC-157

01:39:09.860 | or the use of hyaluronic acid or niacinamide, et cetera.

01:39:13.100 | So these things aren't always being examined in isolation,

01:39:16.660 | but when we look at this literature,

01:39:19.380 | I think it's fair to say that there is now

01:39:21.420 | substantial evidence for the use of phototherapy

01:39:24.000 | for improving the quality of skin,

01:39:26.320 | and in some cases for reducing the symptoms of acne,

01:39:30.460 | reducing the symptoms of psoriasis,

01:39:32.120 | basically any condition where improved blood flow,

01:39:34.640 | lowered inflammation, fewer or reduced oxygen species,

01:39:38.540 | improved mitochondrial function, delivery of nutrients,

01:39:41.400 | anytime some or all of those things are gonna be involved,

01:39:44.040 | phototherapy makes logical sense,

01:39:46.200 | and so it's no surprise that we're seeing

01:39:47.960 | increased evidence for phototherapy in these conditions.

01:39:51.440 | Now, I've provided a link to the review

01:39:52.960 | of the randomized controlled trials

01:39:54.180 | that I mentioned a bit ago.

01:39:55.780 | I also provided a few links to some specific studies

01:39:58.640 | that show pictures of before and after,

01:40:01.180 | in some cases on two sides of the very same face.

01:40:03.640 | I did an entire episode about light and health.

01:40:07.900 | I'll also provide a link to that episode,

01:40:09.640 | and if you don't wanna listen to

01:40:10.560 | or watch that entire episode,

01:40:11.760 | you can go to specific timestamps in that episode

01:40:14.960 | to learn about the uses of phototherapy

01:40:17.000 | for the treatment of skin, eye, and other conditions

01:40:19.760 | related to mental health and physical health.

01:40:22.040 | Now, keep in mind that when people hear phototherapy,

01:40:25.160 | they almost immediately think about a device,

01:40:27.720 | and that makes sense, right?

01:40:28.760 | Red light, near-infrared light.

01:40:30.460 | However, if you recall, there's this thing called the sun

01:40:34.000 | that emits a full-spectrum light,

01:40:35.920 | which of course includes red light

01:40:38.880 | and longer wavelengths of light, okay?

01:40:40.960 | So just 'cause you can't see

01:40:41.980 | those longer wavelengths of light,

01:40:43.080 | that doesn't mean they're not there, just like UV light.

01:40:45.200 | You can't sense UV light with your eyes.

01:40:46.600 | By the way, ground squirrels and some other animals can.

01:40:49.080 | It's thought to be the case that they have photoreceptors

01:40:51.700 | to detect UV because they actually,

01:40:54.640 | this is sort of strange but interesting,

01:40:56.160 | you'll never forget this, that they'll take their urine

01:40:58.160 | and they'll spread it on their stomach

01:40:59.740 | with their little paws and they'll stand up

01:41:01.200 | and they'll like signal flash one another

01:41:02.880 | from across the prairie or whatever it is

01:41:05.000 | or across the lawn to signal to one another.

01:41:06.580 | So they're sending UVP signals across the lawn.

01:41:09.520 | I'm not making this up.

01:41:10.560 | I actually studied a little bit of this

01:41:11.800 | when I was an undergraduate,

01:41:13.160 | but not at the level of the urine and the signaling,

01:41:15.000 | at the level of the retina.

01:41:17.040 | Any discussion about skin

01:41:19.380 | has to include a discussion about nutrition.

01:41:21.800 | Why?

01:41:22.760 | Well, remember the fact that I mentioned

01:41:23.960 | at the beginning of today's episode

01:41:25.480 | that your skin and your immune system

01:41:27.720 | have a very intimate relationship.

01:41:30.140 | It's bi-directional.

01:41:31.040 | Your skin reflects the status of your immune system

01:41:33.680 | in many ways.

01:41:34.720 | And this is why many people with autoimmune conditions,

01:41:37.960 | things like lichen planus, you can look it up,

01:41:40.120 | or if you mind particularly striking photographs,

01:41:44.740 | please don't look it up.

01:41:45.840 | But people that have autoimmune conditions

01:41:48.320 | that often manifest in skin conditions.

01:41:50.800 | We'll talk more about this in the context of psoriasis

01:41:53.280 | in a little bit.

01:41:54.360 | But anytime we're talking about the immune system or skin,

01:41:58.240 | we need to take into account

01:41:59.560 | the gut microbiome and nutrition.

01:42:02.160 | So many people asked,

01:42:03.840 | what are the things that they should eat

01:42:05.520 | to have healthy appearing youthful skin?

01:42:07.880 | They also asked,

01:42:09.780 | what are the things that one eats

01:42:12.040 | that could exacerbate things like acne?

01:42:15.300 | And what can one eat in order to reduce their acne?

01:42:18.260 | So let's just start off with the basics.

01:42:20.260 | And here I'm going to be fairly brief

01:42:21.880 | because I think we all know the big take-home message

01:42:25.480 | about nutrition nowadays.

01:42:27.560 | We hear over and over again,

01:42:28.840 | and we should pay attention to the fact

01:42:30.280 | that the vast majority of our food,

01:42:32.940 | well, I should say,

01:42:33.780 | if one desires to be healthy, mentally healthy,

01:42:36.080 | physically healthy,

01:42:37.160 | and a high-performing individual

01:42:38.560 | in any number of different things,

01:42:39.720 | cognitive, physical, or otherwise,

01:42:41.920 | we want to consume the vast majority of our foods

01:42:44.840 | from non-processed or minimally processed sources,

01:42:48.240 | so-called whole foods.

01:42:49.120 | So fruits, vegetables, if that's within your diet,

01:42:51.800 | some people include grains, some people don't.

01:42:54.040 | I'm not here to discuss that.

01:42:56.140 | Meat, eggs, fish, chicken, and so forth,

01:42:59.360 | if that's within your diet plan or your nutrition,

01:43:02.800 | or if you're a vegetarian or vegan,

01:43:04.300 | you make the associated adjustments

01:43:06.840 | so that you can make sure you're getting enough protein

01:43:08.520 | and amino acids,

01:43:09.360 | but it's in keeping with your ethical

01:43:11.320 | and maybe your health goals, okay?

01:43:12.640 | So we're not here to discuss vegan, vegetarian,

01:43:15.200 | omnivore, of which I am, or carnivore, okay?

01:43:18.680 | That's not the discussion.

01:43:20.140 | I think all of those groups agree

01:43:22.240 | that getting the majority of your nutrition

01:43:23.840 | from non-processed or minimally processed foods

01:43:26.400 | is going to be best,

01:43:28.120 | and that, of course, if you're human,

01:43:29.960 | sometimes you'll ingest processed foods,

01:43:31.880 | but really trying to avoid highly processed foods

01:43:34.400 | is critical.

01:43:35.400 | Now, with respect to the specific foods

01:43:38.000 | that can improve skin appearance and skin health,

01:43:41.600 | it's very clear that diets

01:43:43.800 | that are of the so-called low-inflammatory type,

01:43:46.760 | that don't spark inflammation,

01:43:48.240 | so these would be things that sometimes are referred to

01:43:49.960 | as the Mediterranean diet or a paleo-like diet.

01:43:52.300 | You hear these terms,

01:43:53.300 | but what are we really talking about?

01:43:55.320 | Mostly whole foods, minimally processed foods, okay?

01:43:58.220 | And then there's variation depending on whether or not

01:44:00.780 | you emphasize or de-emphasize meat and fish

01:44:03.520 | or emphasize or de-emphasize vegetables,

01:44:05.460 | this kind of thing.

01:44:06.320 | Again, I'm an omnivore.

01:44:07.380 | I love fruit.

01:44:08.220 | I love vegetables.

01:44:09.460 | I do like rice, oatmeal, and some pastas.

01:44:11.420 | I like a great sourdough bread.

01:44:12.720 | I like butter.

01:44:13.560 | I like olive oil.

01:44:14.380 | I like meat.

01:44:15.220 | I like fish.

01:44:16.060 | I think I am representative of most people out there

01:44:18.260 | because I eat most all those things,

01:44:20.120 | but I also eat the occasional croissant.

01:44:22.720 | I also eat the occasional slice of pizza.

01:44:24.320 | I don't eat a lot of that stuff,

01:44:25.340 | but I eat it now and again.

01:44:26.520 | And then of course you have people that are super strict.

01:44:28.800 | What do we know about the relationship

01:44:30.880 | between specific foods and skin health and skin appearance?

01:44:34.080 | Well, anti-inflammatory diet,

01:44:36.280 | we've more or less spelled out what that represents

01:44:38.560 | without getting into too many specifics.

01:44:40.320 | And then there are the specific components within foods.

01:44:43.040 | So vitamins, minerals, and micronutrients,

01:44:46.400 | as well as things like collagen present in bone broth

01:44:49.700 | that can be really useful to include.

01:44:52.340 | So one of the, I think,

01:44:54.020 | best accounts on dermatologic health

01:44:56.780 | and skin health and appearance on the internet

01:44:59.420 | is Dr. Andrea Suarez.

01:45:00.780 | She's a medical doctor, board-certified dermatologist,

01:45:03.380 | and she has a wonderful video

01:45:05.020 | that describes the various foods

01:45:06.980 | that one can eat to promote skin health and skin appearance.

01:45:09.380 | And rather than repeat that entire video,

01:45:11.480 | because A, that wouldn't be right,

01:45:13.380 | and B, it already exists out there in excellent form.

01:45:16.760 | I'll just give a brief synopsis

01:45:18.520 | of some of the things that she suggests

01:45:20.120 | because I entirely agree.

01:45:21.680 | And again, there's no need to be repetitive.

01:45:24.080 | And she does an excellent job.

01:45:26.160 | So she certainly mentions collagen and bone broth.

01:45:29.360 | She also mentions various sources of omega fatty acids

01:45:33.720 | that are often lacking in people's diets

01:45:36.000 | that they should pay extra careful attention to get.

01:45:38.740 | So things like walnuts, flax, fatty fish.

01:45:42.100 | I personally am a big believer

01:45:43.480 | in supplementing with liquid form fish oil.

01:45:46.040 | That's what I do.

01:45:46.880 | Why am I a big believer in that?

01:45:48.140 | Well, I don't tend to cook much fatty fish.

01:45:50.200 | I love the taste of it if it's prepared right,

01:45:52.240 | but I don't tend to do that very often.

01:45:53.720 | So I use a liquid form fish oil or capsules,

01:45:56.760 | but the liquid form is generally more affordable.

01:46:00.100 | This was discussed in an episode

01:46:01.400 | that I did with Dr. Rhonda Patrick.

01:46:03.240 | So we can put a link to that particular segment

01:46:05.000 | in the show note captions.

01:46:06.680 | It's also suggested that we eat a lot of leafy greens,

01:46:09.480 | so dark leafy greens.

01:46:11.160 | You're probably noticing a lot of these recommendations

01:46:12.980 | are kind of typical for what people describe any time

01:46:15.420 | they're talking about nutrition for health.

01:46:17.820 | She highly recommends people get enough folic acid

01:46:20.100 | for the role that folic acid plays in DNA synthesis

01:46:23.180 | and repair of skin cells as among other cells

01:46:26.520 | and cell proliferation.

01:46:29.220 | And of course we should get our colored fruits and veggies.

01:46:32.080 | So our oranges, our strawberries,

01:46:34.220 | the reds and oranges are critical out there.

01:46:37.000 | And she also highlights something very important

01:46:38.700 | that I want to reiterate,

01:46:40.080 | which is that we have a critical need for vitamin A

01:46:42.300 | for our skin health.

01:46:43.380 | And this was covered,

01:46:44.260 | albeit through the lens of exploring the pharmacology

01:46:46.660 | of tretinoin and those retin-A compounds.

01:46:49.180 | But vitamin A is crucial

01:46:51.100 | for a number of different processes

01:46:52.660 | within the cell types that make up skin.

01:46:55.900 | She appropriately cautions

01:46:57.260 | against supplementing with vitamin A

01:46:59.040 | because as a fat soluble vitamin,

01:47:00.680 | it's very easy to overdose vitamin A.

01:47:02.900 | If one is supplementing with too much of it,

01:47:05.380 | she recommends rather getting enough vitamin A

01:47:07.540 | from things like oranges, carrots, sweet potatoes.

01:47:10.380 | She recommends as much berry intake

01:47:12.960 | as is appropriate for someone and one can afford.

01:47:14.780 | The berries are so delicious,

01:47:15.860 | but they tend to be expensive depending on time of year.

01:47:19.100 | Ingesting things like garlic because garlic has sulfur,

01:47:24.100 | which is key for collagen synthesis and repair.

01:47:27.300 | And she talks about the critical role of taurine.

01:47:29.580 | Anyway, she does such a terrific job

01:47:31.220 | of describing the nutrition

01:47:32.660 | for skin health and skin appearance.

01:47:34.620 | Those are just a few of the highlights.

01:47:36.060 | I do encourage you to check out that video

01:47:38.020 | and her other content is spectacular as well.

01:47:41.020 | Again, she has an Instagram account,

01:47:42.380 | YouTube channel that are really wonderful.

01:47:44.600 | So again, without doing a deep dive into nutrition,

01:47:47.420 | decide whether or not you're going to be vegan,

01:47:49.100 | vegetarian, omnivore or carnivore,

01:47:51.660 | and then make sure that you're getting enough

01:47:53.100 | of the vitamins and minerals and micronutrients

01:47:55.380 | from your foods or supplement if necessary.

01:47:57.980 | But note that caution

01:47:59.040 | about vitamin A supplementation in excess.

01:48:00.940 | And also make sure you're avoiding excessive amounts

01:48:03.340 | of highly processed foods.

01:48:05.100 | You know, I mentioned earlier

01:48:06.220 | these advanced glycation end products.

01:48:08.660 | These are things that are present

01:48:09.780 | in a lot of processed foods,

01:48:11.100 | like crackers and chips and things like that,

01:48:13.180 | that make those foods inflammatory.

01:48:15.180 | So you're getting the theme now.

01:48:16.420 | Inflammation is bad, not just for the skin,

01:48:18.440 | but for all organ systems of the body.

01:48:20.180 | It's not just about the high density of calories

01:48:23.380 | and the high density of taste

01:48:25.540 | present in highly processed foods.

01:48:27.260 | Those are problematic,

01:48:28.460 | but a lot of the issue with these highly processed foods

01:48:30.840 | is the high heat conditions used

01:48:32.980 | to make those foods stable on shelves

01:48:35.660 | or stable in packaging over time.

01:48:37.620 | Okay, so there's a whole discussion to be had here

01:48:39.780 | that frankly, I don't think Amy had enough,

01:48:43.020 | but that is outside the scope of today's episode.

01:48:46.340 | The point is that when these highly processed foods

01:48:48.340 | are basically made, right, they're constructed,

01:48:51.340 | they involve the interactions

01:48:53.340 | between sugars and proteins and fats at high heat

01:48:56.460 | that make them stable on the shelf or in packaging.

01:48:59.000 | And those can be very inflammatory.

01:49:02.020 | And that can show up in the form of reactive skin.

01:49:05.380 | It can make your psoriasis worse.

01:49:06.960 | Yes, it can make your acne worse.

01:49:08.380 | It can make your skin more tender and painful.

01:49:10.660 | It can make your skin basically more reactive

01:49:13.260 | to some of the underlying predispositions you might have,

01:49:16.160 | either because of genetics

01:49:17.320 | or other things you're doing or not doing.

01:49:19.540 | Maybe you're going through a particularly stressful time.

01:49:22.020 | Maybe you're getting a little bit of extra sun

01:49:23.940 | and you're eating more highly processed foods

01:49:25.940 | and those things are combining

01:49:26.940 | and making your skin break out

01:49:29.060 | or flush more than it would ordinarily.

01:49:31.660 | Again, there's so many reasons to eat most of your foods

01:49:34.460 | from non-processed or minimally processed sources.

01:49:37.220 | And of course, and now I sound like a broken record

01:49:39.140 | 'cause you can hear this all over the internet,

01:49:41.820 | ingesting foods that are excessively high in sugar,

01:49:44.380 | excessively high in sugars combined with fats,

01:49:47.040 | just not good to do.

01:49:48.720 | Pro-inflammatory, it's going to cause all sorts of issues.

01:49:51.620 | And we're going to get into this more

01:49:52.860 | as it relates to acne in particular,

01:49:55.140 | because as you probably know,

01:49:57.220 | when you ingest foods that are high in sugars

01:49:59.580 | or even just carbohydrates generally,

01:50:01.340 | that also contain a lot of fats,

01:50:03.100 | and in particular when those foods are highly processed,

01:50:05.660 | well, then you initiate an inflammatory response

01:50:07.900 | and you often can initiate additional things

01:50:10.940 | happening in the pores of cells

01:50:12.900 | that can start to really aggravate acne

01:50:15.340 | and cause more acne.

01:50:17.260 | This has to do with the whole insulin pathway.

01:50:19.940 | So when we talk about acne,

01:50:20.980 | I'll talk about diets that create a high glycemic load.

01:50:23.660 | We're not necessarily talking

01:50:24.500 | about the glycemic index of food.

01:50:26.700 | You may know that when people measure

01:50:28.580 | the glycemic index of food,

01:50:29.700 | they're looking at the blood sugar response

01:50:31.260 | after eating that food typically in isolation

01:50:33.300 | and not in combination with other foods.

01:50:34.620 | What I'm talking about is eating combinations of foods

01:50:37.500 | that induce high levels of insulin,

01:50:39.580 | high levels of blood glucose,

01:50:41.120 | that then leads all sorts of things

01:50:42.740 | in the hormone pathways and cell growth pathways

01:50:45.260 | that exacerbate acne.

01:50:46.540 | So we'll get there in a moment,

01:50:47.620 | but I think the take-home message

01:50:49.380 | around nutrition is pretty clear.

01:50:50.780 | So much so that I don't want to spend any more time on it.

01:50:54.420 | We all know what the best nutrition really is for us,

01:50:58.220 | regardless of whether or not you're vegan, vegetarian,

01:50:59.940 | omnivore or carnivore.

01:51:01.860 | It's non-processed or minimally processed foods

01:51:05.280 | representing probably anywhere from,

01:51:07.780 | let's say 75 to 100% of your food intake,

01:51:10.180 | depending on how strict you want to be.

01:51:12.260 | And then sure, make some room if you want

01:51:14.860 | for some processed foods,

01:51:15.940 | but just know that those advanced glycation end products

01:51:19.740 | and the high glycemic load

01:51:21.900 | that comes from those processed foods

01:51:23.980 | can really exacerbate inflammatory responses in skin

01:51:26.900 | and set forward a whole domino set of issues

01:51:30.060 | related to hormone pathways and cell growth pathways

01:51:32.900 | that make everything, acne, psoriasis,

01:51:35.260 | and overall appearance worse.

01:51:36.900 | Yes, your skin will appear to age faster.

01:51:38.740 | And on the positive side,

01:51:40.340 | most of the foods that we think of as healthy

01:51:42.320 | and anti-inflammatory are actually quite delicious.

01:51:45.060 | So enjoy.

01:51:46.540 | Ah, and I forgot to say what's absolutely clear.

01:51:49.520 | You know that myth that they told us when we were teenagers,

01:51:52.220 | that eating a lot of fried food would make you break out,

01:51:54.420 | would make your skin worse?

01:51:55.380 | Guess what? It's true.

01:51:57.200 | That high heat preparation required

01:51:59.140 | for creating things as delicious

01:52:01.340 | as the donut or French fries, right?

01:52:03.700 | There's a reason people love these foods.

01:52:05.100 | They're so delicious.

01:52:06.340 | They do cause problems.

01:52:07.460 | They're pro-inflammatory.

01:52:09.280 | Does that mean you can never have a French fry?

01:52:11.460 | No. You decide what's best for you,

01:52:13.900 | but know what you're doing.

01:52:15.500 | As a segue to talking about acne,

01:52:17.220 | we need to talk about the gut microbiome.

01:52:19.660 | And this is a direct outgrowth

01:52:21.180 | of our discussion about nutrition.

01:52:22.780 | Here's the simple takeaway

01:52:24.060 | that I believe everyone should follow,

01:52:25.960 | not just for sake of healthy appearing skin,

01:52:28.660 | but also for sake of every organ

01:52:32.120 | and tissue system in your body,

01:52:33.240 | which is the data clearly show

01:52:35.460 | that ingestion of sufficient amounts of fiber,

01:52:38.780 | so prebiotic and probiotic fiber, so fruits, vegetables,

01:52:42.220 | sometimes this can also come from grains.

01:52:44.180 | Some people will supplement with additional fiber

01:52:46.820 | if they feel they need it,

01:52:48.660 | as well as ingestion of low sugar fermented foods.

01:52:52.420 | I've talked about this before.

01:52:53.560 | So regular listeners of this podcast may have heard this.

01:52:56.260 | Things like kimchi, sauerkraut,

01:52:59.060 | the sort of sauerkraut that has to stay in the fridge.

01:53:01.500 | So not the stuff that's stable

01:53:03.020 | on the shelf at room temperature.

01:53:04.780 | Anything containing a brine, that salty brine.

01:53:07.460 | So pickles, but not the pickles

01:53:09.260 | that are stable at room temperature,

01:53:10.740 | the ones that have to be kept

01:53:12.240 | in the refrigerated section of the grocery store.

01:53:14.340 | These low sugar fermented foods

01:53:16.260 | are powerful enhancers of the gut microbiome.

01:53:19.500 | And when the gut microbiome is healthy,

01:53:21.060 | you have reduced overall inflammation in the body.

01:53:24.840 | This is often reflected at the level of the skin.

01:53:27.540 | And basically skin health

01:53:29.760 | and the youthfulness appearance of skin is enhanced, okay?

01:53:33.360 | This can also help with conditions like acne or psoriasis,

01:53:37.460 | especially in conditions

01:53:38.960 | where there's a direct immune system skin relationship

01:53:42.080 | that we'll talk about more in a little bit, okay?

01:53:43.960 | So I highly recommend people have anywhere

01:53:45.960 | from one to four servings

01:53:46.960 | of low sugar fermented foods per day,

01:53:49.480 | or try and enhance the health

01:53:51.820 | of their gut microbiome generally.

01:53:53.940 | Maybe you take a pill probiotic,

01:53:55.580 | although those can be very expensive.

01:53:57.180 | There's a little bit of data suggesting

01:53:58.840 | that if you chronically take pill probiotics

01:54:02.060 | that yield very high levels of bacteria,

01:54:04.780 | well then maybe there's some associated brain fog.

01:54:06.980 | That's a little unclear, pun intended,

01:54:09.300 | but they are very expensive.

01:54:11.940 | They have to be kept refrigerated

01:54:13.180 | and let's face it, low sugar fermented foods,

01:54:15.380 | if you find the ones that you like,

01:54:16.820 | are really great to ingest 'cause they're tasty

01:54:19.140 | and they're good for you.

01:54:20.440 | Now, why am I talking about this?

01:54:22.240 | In part, because we keep coming back to inflammation

01:54:25.080 | as a general issue for skin health.

01:54:26.760 | And that points us also towards some specific do's and don'ts

01:54:29.800 | as it relates to lifestyle.

01:54:31.280 | Let's face it, pun intended, if you sleep well,

01:54:36.280 | so maybe you need six hours, maybe you need seven,

01:54:38.080 | maybe you need eight, maybe you need nine,

01:54:39.540 | but if you sleep well on a consistent basis,

01:54:41.460 | your skin is going to look so much better,

01:54:43.860 | so much healthier, more vibrant

01:54:46.160 | than if you are not getting enough sleep.

01:54:49.280 | If you drink alcohol and you wake up the next morning,

01:54:52.720 | you know your skin's going to look puffy,

01:54:54.280 | it's not going to look good.

01:54:55.920 | But many of you can ingest alcohol without issues.

01:54:58.720 | I've done an entire episode about alcohol.

01:55:01.120 | Yes, it's a poison, up to two drinks per week.

01:55:03.460 | For adults who are non-alcoholics, it's probably safe.

01:55:06.100 | Zero is better than any, but let's face it,

01:55:08.580 | alcohol is going to exacerbate most skin issues.

01:55:11.920 | This is just clear from the literature.

01:55:14.120 | Doesn't mean you never have a glass of wine,

01:55:15.800 | doesn't mean you never have a beer or a cocktail

01:55:17.760 | if that's your thing, but alcohol consumed in excess,

01:55:21.520 | and it doesn't take much to get there,

01:55:23.320 | is going to cause sleep issues, microbiome issues,

01:55:25.960 | so indirectly and negatively impact

01:55:28.880 | the skin appearance and health,

01:55:31.040 | and indirectly and negatively impact

01:55:34.120 | the health of other tissues in your body.

01:55:36.020 | But it's clear, some of that is reduced

01:55:37.560 | to increase inflammation, some is related

01:55:39.480 | to decreased sleep quality or duration.

01:55:42.800 | So get great sleep, avoid alcohol in excess,

01:55:46.220 | maybe avoid it altogether, drink plenty of water.

01:55:48.880 | This sounds like such basic advice,

01:55:50.800 | but proper hydration is key.

01:55:52.200 | Get enough water and electrolytes.

01:55:54.200 | It absolutely will impact your inflammation levels

01:55:57.560 | by reducing them, it absolutely will impact

01:56:00.600 | your skin health and appearance in a positive way.

01:56:03.400 | So these are just basic things that I'd be remiss

01:56:05.420 | if I didn't mention.

01:56:06.560 | The other one is smoking and nicotine

01:56:08.360 | from non-smoked sources.

01:56:10.460 | So it's very clear that smoking, vaping,

01:56:12.560 | dipping or snuffing is bad for skin appearance and health.

01:56:15.680 | Bad, bad, bad, every dermatologist said this, why?

01:56:19.360 | Well, with smoking, you can imagine why, okay?

01:56:21.600 | A lot of carcinogens and toxic end products

01:56:24.440 | generated from smoking, even from vaping.

01:56:27.260 | Yes, even from vaping, it will make your skin age faster,

01:56:30.200 | that's clear, but it's also the substance itself.

01:56:33.960 | Why?

01:56:34.800 | All of those things, in addition to increasing inflammation,

01:56:37.480 | nicotine itself is a vasoconstrictor,

01:56:39.400 | so you're doing the exact opposite of what you want

01:56:42.000 | when it comes to skin health and appearance.

01:56:43.760 | And that's why people take things like BPC-157,

01:56:46.040 | that's why people take nicotinamide,

01:56:48.560 | that's why people are trying to improve

01:56:49.880 | the hydration status of their skin.

01:56:51.400 | So if you're somebody that's vaping nicotine

01:56:54.060 | or even taking nicotine in some other form,

01:56:56.520 | pouch or smoking nicotine,

01:56:57.800 | and you're interested in having youthful appearing skin,

01:57:00.480 | you are really shooting yourself in the, I don't know, face.

01:57:03.960 | And as we all know, our emotions impact the appearance

01:57:06.520 | of our skin, and yes, it can exacerbate so-called breakouts.

01:57:09.960 | And we'll get to that in a moment

01:57:11.420 | as to what the exact pathway is.

01:57:13.240 | But I've done entire episodes about controlling your stress.

01:57:16.140 | We have a master stress episode

01:57:18.400 | that talks about real-time tools that you can use,

01:57:20.720 | like the physiological psi.

01:57:22.480 | Provide a link to a clip about the physiological psi,

01:57:24.820 | it's the fastest way that I'm aware of

01:57:26.840 | to reduce one's levels of stress.

01:57:28.560 | This is something my laboratory has studied

01:57:30.240 | in detail at Stanford.

01:57:32.980 | There are also things you can do,

01:57:34.000 | and we're all aware of what they are,

01:57:35.740 | proper sleep, meditation, non-sleep deep rest.

01:57:38.800 | We'll provide a link for that.

01:57:39.800 | All things that we can do that are zero cost,

01:57:42.360 | very minimal time investment.

01:57:44.140 | Physiological psi takes about 10 to 15 seconds.

01:57:46.700 | Non-sleep deep rest, aka yoga nidra, sometimes called,

01:57:51.760 | takes anywhere from 10 to 20 minutes per day.

01:57:53.880 | And that reduced stress can dramatically improve

01:57:57.400 | not just the health, but the appearance of your skin.

01:58:00.160 | And it makes perfect sense as to why that is.

01:58:01.960 | The stress hormones such as cortisol,

01:58:04.120 | but other hormones too, such as adrenaline,

01:58:07.120 | when they are chronically elevated,

01:58:09.560 | because of the fact that adrenaline impacts

01:58:12.040 | vasoconstriction in the skin,

01:58:13.920 | it's gonna reduce blood flow to the periphery, to the skin.

01:58:17.240 | It can cause all sorts of issues

01:58:18.520 | at the level of nerve endings that can lead to,

01:58:20.760 | believe it or not, enhanced flushing

01:58:22.120 | when we're under stress.

01:58:23.360 | This is why we measure the galvanic skin response.

01:58:26.320 | So not just sweating, but also blood flow

01:58:28.740 | and other things to the skin when we are studying stress.

01:58:31.160 | Okay, so direct relationship

01:58:32.540 | between stress and skin appearance.

01:58:34.200 | Learn to control your stress.

01:58:35.400 | Stress is part of life,

01:58:36.240 | but learn to control your stress in real time

01:58:38.520 | and through tools like non-sleep deep rest

01:58:40.620 | that are zero cost that can help you

01:58:42.080 | reduce your overall levels of stress, get great sleep.

01:58:45.360 | Don't use nicotine.

01:58:46.200 | If you do use nicotine, know what you're doing.

01:58:48.240 | Maybe use it sparingly and please don't smoke or vape it,

01:58:50.320 | dip it or snuff it.

01:58:51.480 | There are other forms and I don't recommend those forms

01:58:53.680 | because they're very addictive.

01:58:55.480 | And keep in mind that things that improve blood flow,

01:58:57.880 | reduce inflammation, give you lower stress, better sleep,

01:59:01.080 | all of that is going to make you look more youthful.

01:59:03.240 | It's not an imagined effect, it is real.

01:59:05.980 | Let's talk about acne.

01:59:07.400 | Acne is very common.

01:59:08.920 | It impacts anywhere from 80 to 90%

01:59:11.120 | of young people at some point.

01:59:12.920 | Some people get very bad cystic acne,

01:59:16.280 | you know, deep acne in the cheeks,

01:59:17.720 | on the back of the neck, the back,

01:59:19.120 | it can be very uncomfortable, very painful.

01:59:21.000 | Some people only get the occasional pimple,

01:59:24.160 | but they get them very deeply, they're very painful.

01:59:26.400 | And look, nobody likes acne.

01:59:28.640 | Nobody likes the appearance of acne on themselves.

01:59:31.660 | It can be very distressing for people,

01:59:33.360 | can cause additional stress that then feeds back

01:59:36.120 | in terms of inflammation.

01:59:37.560 | And, you know, I guess my first, you know, request,

01:59:40.960 | I suppose, I can't tell people what to do and never do,

01:59:43.420 | but, you know, for people that have acne, you know,

01:59:45.300 | be compassionate, okay?

01:59:46.640 | Young people, be compassionate.

01:59:47.720 | I remember when I was younger,

01:59:48.680 | some of the kids with bad acne got teased

01:59:50.400 | and it really upset me.

01:59:51.920 | It was really frustrating,

01:59:53.320 | especially when going through puberty

01:59:54.520 | because there's this hormonal component to acne.

01:59:56.760 | Now, fortunately, there are things

01:59:57.880 | that we can do for acne.

01:59:58.760 | I'll provide a link to one of the major sources I used

02:00:01.480 | for researching this episode.

02:00:03.600 | I also, of course, spoke to dermatologists,

02:00:05.400 | one of whom really knows an exceptional amount about acne

02:00:08.920 | and its relationship to the immune system.

02:00:11.980 | The paper that I'm referring to now

02:00:14.560 | is a systematic review and network meta-analysis

02:00:16.920 | of topical, pharmacological, oral pharmacological,

02:00:19.400 | physical, and combined treatments for acne vulgaris,

02:00:22.720 | which is the technical name for acne.

02:00:25.160 | There are a lot of things that impact acne.

02:00:27.440 | Let's just briefly talk about what acne is.

02:00:30.240 | Anytime you talk about acne,

02:00:31.280 | you're usually thinking about pus or oil.

02:00:33.520 | That's called sebum.

02:00:34.560 | The sebum accumulates in, essentially,

02:00:36.800 | the follicle around the hair.

02:00:38.640 | This also occurs on non-hairy skin

02:00:40.800 | or where there's just tiny little hairs

02:00:42.180 | that often aren't visible.

02:00:44.720 | That's why it's very unusual to get acne

02:00:47.560 | on, say, the glabrous skin of the palms.

02:00:49.540 | I suppose it could happen, but it's very rare.

02:00:51.640 | At any given moment, 10% of people worldwide

02:00:54.320 | will have acne.

02:00:55.280 | As I mentioned, up to 90% of young people have acne,

02:00:58.000 | so very common, very distressing.

02:01:00.160 | The accumulation of that sebum in the follicle

02:01:02.400 | can be due to a number of different things.

02:01:04.480 | Some of it can be related to androgens,

02:01:06.900 | things like testosterone,

02:01:08.600 | increasing the amount of sebum that's produced, okay?

02:01:12.040 | This is why you often see acne during puberty.

02:01:14.240 | In addition, the anabolic, the pro-growth effects

02:01:17.640 | of androgens, such as testosterone,

02:01:20.720 | and by the way, these occur in both males and females

02:01:23.780 | because both males and females have testosterone

02:01:26.200 | and estrogen.

02:01:27.040 | The androgenic effects of testosterone

02:01:30.200 | can also cause hypertrophy growth of the hair follicle,

02:01:33.880 | right, so an increase in the number of keratinocytes,

02:01:36.960 | the cells in and around the follicle,

02:01:39.580 | which can compress that and hold some of that

02:01:41.400 | additional sebum beneath the surface,

02:01:43.640 | and that's why you're getting a swelling

02:01:45.320 | of what looks like a pimple or a cyst.

02:01:47.280 | So there's the potential for a hormonal influence

02:01:50.080 | on increasing acne.

02:01:51.440 | Now, if someone's going through puberty,

02:01:53.200 | you just have to deal with that increase.

02:01:55.960 | If there's a sudden increase in acne

02:01:58.040 | when one is post-puberty,

02:01:59.880 | you may want to look at levels of androgens

02:02:01.940 | that are being produced.

02:02:02.780 | And nowadays, with increasing numbers, apparently,

02:02:05.820 | of things like polycystic ovarian syndrome,

02:02:08.040 | which in part relates to increases in androgens,

02:02:10.840 | this is becoming an additional concern.

02:02:12.620 | So getting a quality blood test,

02:02:14.480 | looking at androgen levels over time

02:02:16.520 | can be very beneficial for both males and females.

02:02:19.220 | Now, in addition, insulin that is related to our diet.

02:02:24.220 | So insulin and glucose generally go up together

02:02:27.260 | or down together, depending on whether or not

02:02:28.860 | we're ingesting foods or amounts of foods

02:02:31.460 | that greatly increase our insulin and blood glucose.

02:02:34.260 | So insulin is part of an anabolic pathway as well,

02:02:37.020 | a cell growth pathway, pro-growth pathway,

02:02:39.260 | we should call it, that involves mTOR,

02:02:41.700 | mammalian target of rapamycin,

02:02:44.300 | that is a general growth signal for cells.

02:02:47.700 | So this occurs in the eye, this occurs in the liver,

02:02:51.180 | mTOR is involved in growth of cells of all kinds,

02:02:53.500 | including cells within the skin.

02:02:55.820 | When our diet increases the amount of insulin and glucose

02:03:00.820 | to a degree that is in excess of some threshold,

02:03:04.340 | that's going to be different for everybody,

02:03:05.740 | depending on your activity levels, your metabolism,

02:03:07.920 | the way you manage insulin.

02:03:09.420 | When that happens, you get increases in mTOR

02:03:11.220 | that then can feed back on those androgen receptors,

02:03:13.780 | increase the levels of things like testosterone further,

02:03:17.160 | that then feed back on the production of increased sebum,

02:03:22.160 | okay, that oily stuff,

02:03:23.740 | increased keratinocyte proliferation,

02:03:26.780 | and you get more acne.

02:03:28.480 | In other words, having a diet that has a high glycemic load

02:03:32.260 | or evokes a large insulin response can be problematic.

02:03:37.060 | So what to do?

02:03:38.180 | Well, we talked about it before,

02:03:39.300 | you wanna eat mostly non-processed,

02:03:40.780 | minimally processed foods,

02:03:41.820 | you definitely wanna exert portion control, right?

02:03:44.100 | You don't wanna eat much sugar or sugar in excess,

02:03:47.360 | you don't want big spikes in insulin and blood glucose,

02:03:50.520 | you want to avoid an inflammatory diet.

02:03:52.860 | So again, fewer, if any, highly processed foods

02:03:56.260 | because of those glycation end products

02:03:58.320 | that we talked about before.

02:03:59.640 | And on the positive side,

02:04:01.920 | if one exercises something like say intermittent fasting,

02:04:05.020 | and here I don't necessarily think young people,

02:04:06.720 | especially people going through puberty should do this

02:04:09.040 | because they're growing, they need nutrients,

02:04:10.760 | so you have to strike that balance

02:04:11.840 | between getting enough nutrients

02:04:13.160 | and not overloading the system

02:04:14.500 | with insulin, glucose, and calories.

02:04:16.340 | But things like intermittent fasting could be useful,

02:04:19.080 | or making sure that if you ingest complex carbohydrates,

02:04:21.800 | as I mentioned, I do, okay, I'm an omnivore,

02:04:24.600 | that you don't do it in excess

02:04:26.080 | to the point where you're getting big spikes in insulin

02:04:28.120 | and blood glucose.

02:04:28.960 | All of this, the dermatologists tell me,

02:04:30.960 | can help serve to reduce acne.

02:04:33.480 | And while it might seem indirect,

02:04:35.580 | you know, this relationship between testosterone

02:04:37.440 | and sebum accumulation,

02:04:39.120 | the relationship between insulin and mTOR

02:04:41.960 | and increased testosterone and sebum accumulation

02:04:45.720 | and growth of the keratinocytes,

02:04:47.560 | these are real pathways that have been established.

02:04:49.440 | And some of those are discussed in detail in the review.

02:04:52.160 | So much so that there has been the exploration

02:04:55.320 | of specific foods, in particular dairy and whey.

02:04:58.680 | You know, we hear a lot about ingestion of whey protein.

02:05:00.960 | It's a very high quality protein, high bioavailability,

02:05:04.240 | high in the amino acid leucine,

02:05:06.480 | which for those of you that are interested

02:05:08.160 | in muscle building and repair,

02:05:10.160 | there's a lot of discussion about leucine

02:05:11.520 | being a critical component there.

02:05:12.680 | You want leucine.

02:05:13.740 | But it does appear that people that over-consume whey,

02:05:17.320 | people that over-consume dairy can run into issues.

02:05:21.080 | Now, does that mean you shouldn't consume whey protein?

02:05:23.080 | No, I take whey protein.

02:05:25.440 | Do I suffer from acne?

02:05:26.480 | No.

02:05:27.320 | If I did, would I reduce my whey protein intake?

02:05:29.540 | Well, I might decide to run a bit of an experiment

02:05:31.880 | where I reduce the amount of whey protein

02:05:33.380 | that I eat for a little bit and see how that goes.

02:05:36.040 | Should I reduce the amount of dairy I ingest?

02:05:38.120 | Ah, well, here's where things get interesting.

02:05:40.440 | So in discussing this with a dermatologist

02:05:43.000 | who also happens to know a lot about nutrition,

02:05:45.240 | they told me something very interesting.

02:05:47.120 | A lot of people think that high-fat dairy

02:05:50.020 | will exacerbate their acne, but here's the situation.

02:05:54.060 | Non-fat and low-fat dairy has emulsifiers,

02:05:59.200 | this is actually based on work I believe,

02:06:00.480 | some of which was done at Stanford,

02:06:02.120 | that can spike insulin more than full-fat dairy.

02:06:05.140 | So some people, in an attempt to reduce

02:06:07.360 | the amount of acne they're getting,

02:06:09.040 | will move from high-fat dairy, or full-fat I should say,

02:06:12.880 | to non-fat milk, or non-fat dairy, or low-fat dairy,

02:06:16.320 | and their acne will actually get worse,

02:06:18.040 | and that could be because of the insulin spike

02:06:20.400 | associated with some of the emulsifiers

02:06:21.960 | in that non-fat and low-fat dairy.

02:06:24.100 | So what this means is that you don't have

02:06:25.660 | to avoid dairy altogether, but you might be better off

02:06:28.040 | ingesting full-fat dairy.

02:06:30.000 | You might be best off not ingesting any dairy at all,

02:06:33.020 | maybe you want to run that experiment on yourself

02:06:34.960 | and just see what works and what doesn't work,

02:06:37.280 | or if there's no change at all.

02:06:38.640 | In addition, if you're consuming a lot of fried foods,

02:06:40.860 | so those French fries, you're ingesting cheeseburgers

02:06:43.240 | and things of that sort, it may not be so much

02:06:45.440 | the fat content of those meals,

02:06:47.000 | but rather the big insulin response that occurs

02:06:49.360 | when we ingest high-fat meals in combination

02:06:51.880 | with things like sugary milkshakes, or fried foods,

02:06:55.380 | like French fries and things of that sort,

02:06:57.040 | that's leading to the acne by way of increased inflammation.

02:07:01.040 | All right, so there are a lot of different pathways,

02:07:03.040 | inflammation, androgens like testosterone,

02:07:06.200 | insulin leading to increases in testosterone

02:07:08.440 | and inflammation, a lot of pathways converge

02:07:11.200 | to exacerbate acne, and oftentimes it's just the removal

02:07:14.600 | or even just the reduction of some of this food intake

02:07:17.760 | or types of food intake that can really lead

02:07:19.920 | to big improvements in one's acne.

02:07:22.760 | So all of these things combined to support

02:07:24.480 | lower inflammation, appropriate amounts of sebum production,

02:07:27.480 | because you do need sebum production,

02:07:29.240 | you do need keratinocytes in and around the hair follicle,

02:07:32.080 | but you don't want too many of them, and so on.

02:07:34.440 | But what can be done to directly address acne?

02:07:36.860 | Well, there are a number of different prescription

02:07:38.240 | treatments that your dermatologist can suggest,

02:07:40.500 | but one thing that all the dermatologists agree upon

02:07:43.520 | is, first of all, getting adequate sleep, reducing stress,

02:07:47.600 | taking care of your gut microbiome,

02:07:49.200 | the nutrition recommendations that we've been talking

02:07:51.800 | about up until now, but also, get this,

02:07:54.520 | this is interesting, not over-cleansing.

02:07:57.320 | A lot of people with acne will start

02:07:58.800 | to wash their face constantly and will often use

02:08:01.280 | harsh cleansers that can exacerbate that acne,

02:08:03.720 | either by virtue of removing some important skin microbiome

02:08:08.660 | components that then lead to even other infections

02:08:11.980 | like fungal infections or additional inflammation,

02:08:14.740 | 'cause you're removing that microbiome barrier,

02:08:17.340 | but they all recommend regular cleansing of the skin,

02:08:20.700 | usually two or three times per day,

02:08:22.580 | but not in excess of that, using a gentle, unscented,

02:08:26.340 | unfragranced cleanser, okay?

02:08:29.060 | So there are a number of different types of these.

02:08:30.660 | I personally, basically my entire life

02:08:33.060 | that I, at least as far as I can remember,

02:08:34.900 | I've always used unscented, unfragranced dove soap, okay?

02:08:38.380 | I have no relationship to dove soap.

02:08:39.840 | I'm sure people out there are going to say,

02:08:41.420 | "Oh my goodness, you know, it contains a bunch of things

02:08:43.260 | that are bad for you," but that's what's worked for me

02:08:45.380 | and not the liquid form, just bar soap,

02:08:48.020 | and there are things like Cetaphil,

02:08:49.820 | these are some brand names, and there are a bunch

02:08:51.380 | of other more sophisticated, gentle cleansers

02:08:53.760 | that one could use.

02:08:54.780 | There are also a lot of products out there

02:08:56.300 | that contain what's called salicylic acid, okay?

02:08:59.280 | This is often as, you know, a clear fluid

02:09:02.180 | that you put onto a cotton ball or a tissue

02:09:03.940 | and then you spread on the face.

02:09:05.580 | It's very important, very, very important

02:09:07.580 | that if you're going to use these products

02:09:09.740 | that you do it on clean skin,

02:09:11.500 | that is skin that's been cleaned

02:09:13.340 | with a combination of mild, zero-fragrance soap

02:09:18.340 | and lukewarm water, okay?

02:09:22.060 | Because of the relationship between inflammation and acne,

02:09:24.620 | that's what gives it its red appearance.

02:09:26.660 | You don't want to use extreme temperatures

02:09:29.060 | of especially hot water when washing your skin.

02:09:32.580 | So lukewarm water, mild soap, and then,

02:09:35.820 | and only if it's been recommended by your dermatologist,

02:09:38.180 | the salicylic acid.

02:09:39.500 | Salicylic acid comes from the same class of drugs

02:09:41.940 | as aspirin, so it tends to reduce keratinocyte stickiness,

02:09:46.020 | right, the extent to which those cells stick together.

02:09:49.220 | Why do I mention aspirin?

02:09:50.260 | Well, you may have heard that some people

02:09:51.660 | will take aspirin to reduce the stickiness

02:09:53.440 | between their platelets in an attempt to improve heart health.

02:09:55.800 | We'll cover that on another episode at some point.

02:09:58.600 | But salicylic acid reduces the stickiness

02:10:01.720 | of the keratinocytes, so it can lead to less clogging

02:10:04.820 | of the pores by accumulation of keratinocytes,

02:10:07.060 | or I should say by less accumulation of the keratinocytes,

02:10:10.100 | and it can reduce swelling in and around the area

02:10:13.220 | related to the acne.

02:10:14.460 | Sometimes if people get an acne pimple,

02:10:16.560 | especially if they have an event

02:10:17.740 | or they don't want to be seen with that pimple,

02:10:20.420 | the use of a little bit of corticosterone cream

02:10:23.020 | put on there can reduce the redness or swelling.

02:10:25.780 | The dermatologists tell me you should

02:10:27.760 | absolutely not pop your pimples.

02:10:29.960 | Part of the problem when you pop a pimple,

02:10:32.240 | I know there are entire videos about this online.

02:10:35.240 | I know, please don't go look at them.

02:10:36.920 | The whole community is around this, it's super gross.

02:10:40.040 | But I know people find it very satisfying in some cases

02:10:42.720 | to pop these pimples, get the infection out.

02:10:45.020 | While there are certain use cases for that

02:10:46.920 | where someone has an infection,

02:10:48.100 | it just absolutely needs to get out,

02:10:49.440 | then be cleaned, then covered with a bandage

02:10:51.960 | and maybe some topical antibiotic,

02:10:53.640 | that would be a use case for that.

02:10:55.400 | The dermatologist practically begged me

02:10:57.580 | to tell you don't pop your pimples

02:10:59.700 | because A, they will go away in not too much time

02:11:03.780 | if you leave them alone,

02:11:04.740 | and B, you can always put a little bit

02:11:06.980 | of corticosterone cream on top of them

02:11:08.720 | to reduce the redness or swelling.

02:11:10.780 | But most importantly, they tell me

02:11:12.580 | that when you pop those pimples,

02:11:14.380 | what ends up happening is you get a mechanical,

02:11:17.260 | a physical disruption of that area,

02:11:19.340 | which to you might just seem like, okay, whatever,

02:11:20.900 | it turns a little bit red and that's transient,

02:11:22.460 | but you get the influx of what are called

02:11:24.520 | matrix metalloproteases.

02:11:26.220 | These are enzymes, and remember,

02:11:27.620 | anytime you hear an ace, it's usually an enzyme,

02:11:30.020 | matrix metalloproteases that then,

02:11:32.420 | and go eat at the extracellular matrix,

02:11:34.740 | and then you can get an indentation scar

02:11:37.820 | that is permanent, okay?

02:11:39.980 | So if you're concerned about the appearance of your skin,

02:11:42.680 | avoid popping those pimples.

02:11:44.100 | I know it can be hard to do,

02:11:45.300 | but really try and avoid popping pimples.

02:11:47.540 | It can lead to scarring

02:11:48.480 | because of the matrix metalloproteases

02:11:50.180 | and the eating away of the extracellular matrix.

02:11:52.660 | Keep the area clean, cover it up if you need to,

02:11:55.160 | get some corticosterone cream on there

02:11:57.640 | if you want to reduce the redness.

02:11:58.760 | If it's really bad and you have some big important event,

02:12:01.600 | like you're getting married tomorrow

02:12:02.960 | and it's right on the tip of your nose

02:12:04.200 | or something like that,

02:12:05.200 | then you can potentially go to the dermatologist

02:12:07.640 | and get it injected with a corticosteroid

02:12:09.360 | to reduce the redness in a more potent way.

02:12:12.880 | But they did ask that I ask you

02:12:15.440 | to please not pop your pimples.

02:12:17.960 | And if you're somebody that suffers from acne,

02:12:20.120 | I'd like you to know I provide a link to a paper

02:12:22.120 | in the show note captions entitled "Acne and Diet,

02:12:25.000 | A Review of Pathogenic Mechanisms."

02:12:27.640 | And I also provide a link to the review I mentioned before

02:12:30.280 | that covers all of the other aspects of treating acne,

02:12:33.840 | topical, pharmacological, oral, pharmacological,

02:12:36.520 | physical, and combined treatments for acne vulgaris.

02:12:39.160 | Because again, I do sympathize with the fact

02:12:41.800 | that acne can be very distressing, very painful.

02:12:44.520 | Fortunately, there are a number of different avenues

02:12:47.000 | that you, without a dermatologist,

02:12:49.160 | but ideally you and a dermatologist can use

02:12:51.780 | to attack acne at the level of inflammation,

02:12:54.480 | through diet, through lifestyle,

02:12:56.360 | if needed prescription medications.

02:12:58.560 | And again, gentle cleansing

02:13:00.880 | and thinking about the various things

02:13:03.040 | that indirectly will impact that acne.

02:13:04.800 | So much so that a few of the derms told me

02:13:07.640 | that they have patients young and old

02:13:09.640 | who will be suffering from really bad acne

02:13:12.400 | that will sometimes just make a few adjustments

02:13:14.400 | to their diet, the exclusion of certain things,

02:13:16.400 | mainly highly processed foods,

02:13:17.760 | maybe reducing dairy a little bit

02:13:20.000 | or weigh a little bit or completely

02:13:22.460 | and increasing the amount of things

02:13:24.380 | that reduce inflammation.

02:13:25.420 | So more fruits and vegetables

02:13:26.820 | and meat, fish, eggs from healthy sources

02:13:29.140 | and seeing dramatic improvements in acne.

02:13:31.660 | So that's always reassuring to hear.

02:13:33.540 | It doesn't always require a prescription medication,

02:13:35.700 | but if you need it, you should take it.

02:13:37.820 | Okay, let's talk about rosacea.

02:13:39.580 | Rosacea is reddening of the skin.

02:13:42.100 | And some people suffer from this pretty severely,

02:13:44.700 | other people mildly, some people transiently,

02:13:47.460 | but it tends to be kind of distressing for people.

02:13:49.980 | And the reason it's distressing is that

02:13:52.180 | it can look like blushing or flushing of the face

02:13:55.580 | when in fact one isn't emotionally embarrassed.

02:13:58.440 | However, being embarrassed or having any flushing

02:14:01.340 | of the skin can exacerbate existing rosacea.

02:14:04.640 | So it's thought to be caused by a combination of genetics.

02:14:08.160 | There can perhaps be some, again,

02:14:10.440 | over-inflammation of the skin,

02:14:12.740 | which probably reflects inflammation more globally

02:14:16.000 | at the level of the gut and body, et cetera.

02:14:18.220 | We've been talking a lot about that today.

02:14:20.180 | And there are things that can exacerbate rosacea

02:14:22.200 | such as alcohol intake or anything that acts

02:14:25.060 | as a vasodilator that dilates the vasculature

02:14:27.700 | innervating the skin.

02:14:29.260 | So the approach to treating rosacea is pretty much similar

02:14:33.160 | to the other things that we've talked about,

02:14:34.580 | consuming a low inflammation, low glycemic load diet,

02:14:37.580 | trying to get enough sleep,

02:14:38.940 | keeping alcohol intake in particular to a minimum

02:14:42.140 | or cutting out alcohol completely.

02:14:44.080 | The reason I say in particular is that a lot of people

02:14:46.480 | that suffer from rosacea who cut out alcohol completely

02:14:49.860 | essentially eliminate their rosacea

02:14:51.580 | or dramatically reduce it.

02:14:53.100 | So oftentimes it's alcohol that's the culprit

02:14:55.300 | either directly or indirectly, we don't know.

02:14:57.880 | Again, alcohol is a poison,

02:14:59.220 | but it could be the indirect manner

02:15:01.540 | in which alcohol impacts sleep

02:15:02.800 | and the gut microbiome negatively

02:15:04.480 | that's causing the rosacea.

02:15:06.020 | Without knowing the direct or indirect mechanism,

02:15:09.020 | reduce or even eliminate your alcohol for a bit

02:15:12.140 | and see if your rosacea improves.

02:15:14.220 | That will give you a strong indication

02:15:15.840 | of what might be going on and even better,

02:15:17.980 | it could give you a potential solution to the problem.

02:15:20.900 | Now, for those that don't experience a reduction

02:15:23.400 | or elimination of rosacea, if you eliminate alcohol,

02:15:26.220 | get your sleep right, get your diet right,

02:15:27.820 | there are some additional things you can do.

02:15:29.980 | First of all, you want to follow the same recommendation

02:15:32.000 | we talked about for acne,

02:15:33.040 | which is also the general recommendation for skincare.

02:15:35.980 | Use lukewarm water, not excessively hot or cold water,

02:15:39.700 | a gentle unfragrance cleanser.

02:15:42.340 | You want to use sunscreen regularly.

02:15:43.820 | Remember, sun damage to the skin is also inflammation,

02:15:46.920 | so that's going to exacerbate rosacea.

02:15:49.420 | And of course, sunlight,

02:15:50.940 | because of the release of nitric oxide,

02:15:52.940 | is also going to act as a vasodilator.

02:15:55.160 | Does that mean you have to go full beekeeper mode?

02:15:57.560 | No, it doesn't.

02:15:58.480 | You can if you want to, I suppose,

02:16:00.320 | but use a quality mineral-based sunscreen,

02:16:03.040 | which we talked about earlier in the episode.

02:16:05.320 | And you should use some sort of moisturizer

02:16:08.200 | to help lock in the moisture within your skin.

02:16:10.920 | You could use things like hyaluronic acid

02:16:12.960 | or use any kind of gentle moisturizing cream

02:16:15.960 | that's not going to cause inflammation

02:16:17.720 | or kind of irritate the skin in any way

02:16:20.200 | and can keep the moisture within the skin.

02:16:22.000 | And there are a lot of different versions

02:16:23.200 | of these available out there.

02:16:24.240 | And frankly, a lot of them are not terribly expensive.

02:16:26.640 | You can find super expensive varieties

02:16:28.600 | of any and all these things.

02:16:30.160 | But many of the things that meet the criteria

02:16:32.240 | of gentle unfragrance cleanser,

02:16:34.800 | SPF 30 mineral-only sunscreen,

02:16:38.000 | as well as a quality moisturizer

02:16:39.760 | are not necessarily the most expensive available.

02:16:42.460 | And what justifies the higher expense in some cases

02:16:45.800 | could be, I don't know, the silkiness or the packaging.

02:16:49.480 | It could be any number of different things.

02:16:50.760 | I'm not going to say that the cheapest varieties

02:16:53.360 | are necessarily as good as the most expensive varieties,

02:16:55.960 | but I do think, and the dermatologist that I spoke to

02:16:59.640 | definitely confirmed that there's a lot of price inflation

02:17:02.100 | out there related to kind of the overall milieu of packaging

02:17:05.800 | and purported exclusivity of certain skincare products.

02:17:09.320 | Look for the things that meet the criteria.

02:17:12.040 | You are trying to establish for your skincare.

02:17:14.900 | But just like with acne, just like with general skincare,

02:17:18.340 | if you have rosacea,

02:17:19.660 | you want to think about mild treatments for the skin

02:17:21.860 | at the level of cleaning, at the level of sun protection,

02:17:24.540 | at the level of locking in moisture.

02:17:26.660 | And then there's some additional things

02:17:28.020 | that if you can spare the expense could also be beneficial

02:17:32.420 | like nicotinamide, niacinamide, as it's also called.

02:17:36.300 | Or there's also been some evidence

02:17:38.140 | that things like licorice root can be a benefit, okay?

02:17:40.840 | These things are typically found as a topical ointment

02:17:43.380 | or in a topical ointment.

02:17:45.220 | But in the case of niacinamide, nicotinamide,

02:17:47.820 | we talked about how this can be available

02:17:49.220 | in an ointment form, a topical form,

02:17:51.420 | or it can be taken as two 500 milligram dosages per day.

02:17:55.300 | I gave you the long list of the various mechanisms

02:17:58.040 | by which it can improve skin health, reduced inflammation,

02:18:01.260 | production of collagen, et cetera.

02:18:03.380 | All of that still holds

02:18:04.660 | for the potential treatment of rosacea.

02:18:07.180 | Be sure to avoid any kind of things

02:18:09.020 | that are acting as strong astringents or that increase heat.

02:18:12.040 | So people who have rosacea

02:18:14.240 | will often try to avoid hot peppers.

02:18:16.920 | So spicy foods of any kind, I know that's tough.

02:18:19.600 | I'm somebody who really enjoys spicy foods.

02:18:21.440 | So if you have to avoid spicy foods, I sympathize with you.

02:18:25.240 | That's rough.

02:18:27.560 | Anything that acts as an astringent

02:18:29.400 | or can really irritate the skin

02:18:31.840 | from the inside or from the outside.

02:18:33.760 | So think not excessively hot foods

02:18:36.600 | as it relates to spicy or temperature.

02:18:38.880 | Things of that sort.

02:18:39.940 | Now, I should point out

02:18:40.900 | there are different types of rosacea.

02:18:43.420 | The dermatologist I spoke to who is expert in rosacea

02:18:46.700 | told me there are four major types of rosacea.

02:18:49.820 | Many of them respond to the sorts of guidelines

02:18:52.260 | that we've been talking about up until now.

02:18:54.620 | Some of them that also include acne

02:18:56.580 | need some additional treatment.

02:18:58.580 | Talked about acne treatments

02:18:59.700 | that can be easily folded into the treatment for rosacea.

02:19:04.000 | There are people who have very stubborn rosaceas.

02:19:06.700 | This may be due to excessive use of cleansers.

02:19:10.200 | And again, we're talking about how over cleansing

02:19:12.480 | can really be a problem.

02:19:13.440 | So we're not saying don't wash your face.

02:19:15.520 | We're not saying don't take a shower, please do.

02:19:17.320 | In fact, and I should have said this earlier, by the way,

02:19:19.680 | for a lot of reasons related to your comfort and appearance

02:19:22.960 | and other people's comfort.

02:19:24.320 | After you work out at a gym,

02:19:27.240 | regardless of whether or not you're rolling around

02:19:28.960 | on the floor with a foam roller,

02:19:30.960 | or you're rolling jujitsu, or you're lifting weights,

02:19:33.880 | you're doing cardio, it is a good idea to take a shower

02:19:37.740 | and cleanse with a gentle cleanser as soon as possible.

02:19:40.420 | I know this sounds like just basic advice,

02:19:42.140 | but a lot of people just throw on a clean shirt

02:19:44.180 | or they don't rinse off or they don't wash their face

02:19:46.140 | and they're wondering why they're getting

02:19:47.860 | all sorts of skin issues.

02:19:49.300 | Well, there's a lot of bacteria in gyms,

02:19:51.140 | a lot of sweating people.

02:19:53.020 | There are a lot of bacteria on you,

02:19:54.860 | a lot of bacteria on the equipment.

02:19:56.180 | And yeah, you can spray down the equipment

02:19:57.580 | and do these various things,

02:19:58.620 | but it's a good idea to shower as soon as possible,

02:20:01.300 | or to bathe rather as soon as possible,

02:20:03.120 | wash your face after going to a gym for your sake

02:20:06.240 | and for the sake of others.

02:20:08.100 | Now, some rosacea is very stubborn,

02:20:10.760 | meaning it does not go away

02:20:12.160 | even if somebody makes all the appropriate

02:20:14.520 | lifestyle adjustments,

02:20:15.640 | tries any number of different medical treatments.

02:20:17.500 | And by the way, rosacea is a medical condition.

02:20:19.920 | And in some cases, people will get angiomas,

02:20:22.880 | you know, the accumulation of blood vessels

02:20:25.280 | near the surface of the skin that can be, you know,

02:20:27.780 | for them something they don't want.

02:20:30.280 | So we could say unsightly, but they just don't want it.

02:20:33.000 | Or in some cases they'll treat their rosacea

02:20:35.160 | and then they'll get an accumulation of broken vessels

02:20:38.000 | near the surface of the skin.

02:20:39.120 | This is pretty common for people that experience rosacea

02:20:41.920 | and treat rosacea.

02:20:43.120 | For these people, there is a treatment,

02:20:45.000 | it has to be done in a dermatologist's office

02:20:46.760 | called pulse dye laser,

02:20:48.400 | where they use a laser of a particular wavelength

02:20:50.680 | that can penetrate, excuse me,

02:20:52.940 | the superficial layers of the skin.

02:20:55.240 | And now you know how different wavelengths of light

02:20:57.080 | can penetrate to different depths within skin

02:20:59.600 | and destroy the blood vessels or the broken blood vessels

02:21:03.840 | that then call in immune system cells

02:21:05.520 | to clear out the destroyed endothelial cells

02:21:08.040 | and other stuff around it and take it away,

02:21:09.920 | get rid of those blood vessels that sit beneath the surface.

02:21:12.840 | Let's talk about psoriasis.

02:21:14.600 | So when I was researching this episode,

02:21:16.340 | I asked the dermatologist, is psoriasis related to yeast

02:21:19.780 | or overproduction of skin cells?

02:21:21.920 | And what they told me was really interesting.

02:21:23.500 | They said for more than 80 years

02:21:25.760 | within the dermatologic community,

02:21:27.720 | it was thought that psoriasis was just an overproduction

02:21:30.840 | of skin cells,

02:21:32.220 | but it wasn't really known what the source was.

02:21:34.280 | And it turns out that now almost all the derms,

02:21:36.720 | at least the ones I spoke to,

02:21:38.040 | said that it has something to do either directly

02:21:40.320 | or at least powerfully and indirectly

02:21:42.580 | with the immune system.

02:21:44.180 | So what can be done to treat psoriasis?

02:21:47.520 | You can probably guess.

02:21:48.480 | Things that reduce the overall level of activation

02:21:51.820 | in the immune system.

02:21:52.660 | Not so much that you become susceptible to infections

02:21:55.360 | 'cause that's not good,

02:21:56.360 | but you treat this like any other autoimmune condition.

02:21:59.560 | There are now drugs, these are prescription drugs,

02:22:02.400 | that directly target the interleukins,

02:22:04.320 | the components of the immune system,

02:22:06.000 | that are directly involved in psoriasis,

02:22:09.080 | such as interleukin-17 and interleukin-23.

02:22:12.920 | And I'm told that these drugs are very effective

02:22:15.620 | in the treatment of psoriasis.

02:22:17.120 | So that's very reassuring.

02:22:18.520 | You know, I know, especially in communities online

02:22:22.000 | that are focused more on behavioral tools

02:22:23.800 | and nutrition-based tools or supplementation-based tools,

02:22:26.560 | of which I am, right, we focus on those.

02:22:28.520 | But as you probably noticed in this and other episodes

02:22:31.120 | of the "Huberman Lab" podcast,

02:22:32.040 | we also talk about prescription drugs

02:22:33.780 | that have proven to be very effective in certain conditions.

02:22:36.500 | So it's very reassuring to hear

02:22:37.840 | that there are excellent prescription drugs

02:22:39.880 | that can target the specific interleukins

02:22:42.140 | that are overactivated in psoriasis

02:22:45.680 | because psoriasis is now known

02:22:47.400 | as an overactivation of the immune system

02:22:50.040 | and a kind of turning of the body on itself, if you will,

02:22:53.520 | to create this itchy, scaly, uncomfortable,

02:22:56.700 | and in some cases, unsightly overproduction

02:22:59.600 | of skin cells at the scalp and elsewhere.

02:23:01.760 | Okay, so we've covered a lot of topics thus far.

02:23:04.740 | We've talked about skin biology.

02:23:06.680 | We talked about various skin conditions

02:23:08.180 | that are very common, such as acne, psoriasis, and so forth.

02:23:12.080 | We talked about ways to increase the youthfulness

02:23:14.560 | or the appearance of youthfulness in skin

02:23:16.180 | that are based on data,

02:23:17.200 | some that are a bit more experimental.

02:23:19.760 | And we talked about even some laser procedures

02:23:23.200 | and phototherapy, things of that sort.

02:23:25.680 | And at the same time, I acknowledge

02:23:27.120 | that there are many topics and conditions

02:23:29.320 | related to skin health and skincare

02:23:30.960 | that we did not talk about.

02:23:31.960 | We didn't talk about eczema.

02:23:33.700 | We didn't talk about Botox.

02:23:35.280 | We didn't talk about an enormous number of topics

02:23:37.040 | that I know are of interest and relevant to many of you.

02:23:40.160 | So as a consequence,

02:23:41.600 | the plan is to host various expert guests,

02:23:44.940 | both dermatologists, expert in particular areas,

02:23:47.760 | as well as, yes, a cosmetic surgeon

02:23:50.520 | who, believe it or not, does not like to cut,

02:23:52.480 | but rather likes to use fairly non-invasive procedures

02:23:55.400 | that touch on some of these very same mechanisms.

02:23:57.520 | Yes, injections of certain things,

02:23:59.360 | things that operate at the surface level of the skin,

02:24:01.720 | and sometimes surgical procedures that, you know,

02:24:05.040 | I know when people hear cosmetic surgery,

02:24:07.000 | they think, oh, people just trying to improve

02:24:09.180 | the youthfulness of their look or something of that sort.

02:24:11.280 | But, you know, that also relates

02:24:12.960 | to certain serious skin conditions

02:24:14.560 | for which surgery and non-surgical approaches can assist in.

02:24:18.960 | So the point is that any discussion about skin health

02:24:21.000 | and skincare is going to be an ongoing discussion,

02:24:24.160 | one that I do plan to continue on this podcast

02:24:27.320 | in the form of expert guest episodes,

02:24:29.060 | maybe even another solo episode.

02:24:31.400 | We've occasionally done so-called toolkit episodes

02:24:33.760 | where we summarize some of the main points

02:24:35.840 | of previous solo episodes

02:24:37.240 | and that arrive with guest episodes

02:24:39.080 | and that reflect the latest knowledge

02:24:41.040 | that gets published in between episodes.

02:24:43.160 | I do plan to cover this topic in more detail going forward.

02:24:46.720 | Meanwhile, I like to think that what I've covered today

02:24:49.520 | provides at least an introduction to the biology of skin

02:24:52.440 | and an understanding about the various things

02:24:54.380 | that we all can and should do

02:24:56.080 | for our skin health and appearance,

02:24:57.880 | as well as ways to attack certain pain points

02:25:00.880 | related to certain skin conditions

02:25:03.040 | that come from expert sources,

02:25:05.480 | from excellent literature

02:25:07.240 | that has been established over many, many decades.

02:25:09.640 | And I personally find this organ that we call skin

02:25:12.400 | to be infinitely fascinating,

02:25:14.440 | not just by virtue of what it does,

02:25:16.040 | but by virtue of all the different organ and tissue systems

02:25:18.920 | that it interacts within our body,

02:25:20.800 | and by virtue of the fact that our skin

02:25:22.460 | is this incredible living organ on the outside of our body

02:25:25.800 | that tells us oh so very much

02:25:27.620 | about how we and others are doing in terms of our immediate

02:25:30.920 | and potentially our long-term health.

02:25:33.580 | If you're learning from and/or enjoying this podcast,

02:25:35.880 | please subscribe to our YouTube channel.

02:25:37.920 | Please also subscribe to the podcast

02:25:39.780 | on both Spotify and Apple.

02:25:41.300 | That's a terrific zero-cost way to support us.

02:25:43.680 | And on both Spotify and Apple,

02:25:45.400 | you can leave us up to a five-star review.

02:25:47.600 | Please also check out the sponsors mentioned

02:25:49.600 | at the beginning and throughout today's episode.

02:25:51.760 | That's the best way to support this podcast.

02:25:53.960 | If you have questions for me or comments about the podcast

02:25:56.320 | or topics or guests you'd like me to consider

02:25:58.080 | for the "Huberman Lab" podcast,

02:25:59.600 | please put those in the comments section on YouTube.

02:26:01.740 | I do read all the comments.

02:26:03.360 | For those of you that haven't heard,

02:26:04.500 | I have a new book coming out.

02:26:05.700 | It's my very first book.

02:26:07.320 | It's entitled "Protocols,

02:26:08.720 | an Operating Manual for the Human Body."

02:26:10.880 | This is a book that I've been working on

02:26:12.040 | for more than five years,

02:26:13.200 | and that's based on more than 30 years

02:26:15.520 | of research and experience.

02:26:17.080 | And it covers protocols for everything from sleep,

02:26:20.140 | to exercise, to stress control,

02:26:22.640 | protocols related to focus and motivation.

02:26:25.080 | And of course, I provide the scientific substantiation

02:26:28.440 | for the protocols that are included.

02:26:30.520 | The book is now available by presale at protocolsbook.com.

02:26:34.420 | There you can find links to various vendors.

02:26:36.800 | You can pick the one that you like best.

02:26:38.560 | Again, the book is called "Protocols,

02:26:40.320 | an Operating Manual for the Human Body."

02:26:43.100 | If you're not already following me on social media,

02:26:45.280 | I am Huberman Lab on all social media platforms.

02:26:48.280 | So that means Instagram, X, formerly known as Twitter,

02:26:51.640 | Threads, Facebook, and LinkedIn.

02:26:53.660 | And on all those platforms,

02:26:54.980 | I cover science and science-related tools,

02:26:57.320 | some of which overlaps with the content

02:26:58.800 | of the Huberman Lab podcast,

02:27:00.280 | but much of which is distinct from the content I cover

02:27:02.680 | on the Huberman Lab podcast.

02:27:04.080 | So again, that's Huberman Lab on all social media platforms.

02:27:07.520 | If you haven't already subscribed

02:27:08.760 | to our Neural Network newsletter,

02:27:10.400 | our Neural Network newsletter

02:27:11.720 | is a zero-cost monthly newsletter

02:27:13.800 | that includes summaries of podcast episodes,

02:27:16.320 | as well as protocols in the form of brief

02:27:18.240 | one-to-three-page PDFs that explain protocols

02:27:21.480 | for things like deliberate heat or deliberate cold exposure,

02:27:24.520 | for optimizing dopamine, for improving your sleep,

02:27:26.960 | for neuroplasticity and learning.

02:27:28.400 | Again, all zero costs in the format

02:27:30.760 | of one-to-three-page PDFs.

02:27:32.280 | To access it, you simply go to hubermanlab.com,

02:27:34.880 | go to the menu tab,

02:27:36.080 | scroll down to newsletter, and enter your email.

02:27:38.400 | And we do not share your email with anybody.

02:27:40.840 | Thank you for joining me for today's discussion

02:27:43.020 | all about skin health and skincare.

02:27:45.960 | And last, but certainly not least,

02:27:48.240 | thank you for your interest in science.

02:27:50.200 | [MUSIC PLAYING]

02:27:53.560 | you

How to Improve Skin Health & Appearance

Chapters