Dhru Purohit Show - Expert Dermatologist Reveals the Truth About Sunscreen, Skin Cancer, and How to Maintain Youthful Skin At Any Age with Dr. Teo Soleymani (Rebroadcast)

Episode Date: June 24, 2026

This episode is brought to you by Bon Charge, Our Place, Cozy Earth, and Fatty15. We're constantly told to avoid the sun, wear sunscreen every day, and invest in expensive skincare products if we want healthy, youthful-looking skin. But what does the science actually say? Can some sun exposure be beneficial? Are mineral sunscreens really safer than chemical ones? And with so many devices, creams, and treatments promising younger skin, which ones are actually worth your time and money? Today on The Dhru Purohit Show, Dhru sits down with double board-certified dermatologist, skin cancer expert, and reconstructive surgeon Dr. Teo Soleymani to separate fact from fiction when it comes to skin health and aging. Dr. Soleymani breaks down the latest research on sun exposure, skin cancer risk, and sunscreen safety, while revealing the most effective strategies for preventing premature aging. He also shares the top treatments for wrinkles, acne scars, and sun damage, along with the devices and skincare interventions that deliver the biggest results without wasting your money. If you've ever wondered what actually works for healthier, younger-looking skin, this conversation is packed with practical, science-backed answers. Dr. Teo Soleymani is a nationally recognized, double board-certified dermatologist and fellowship-trained Mohs Micrographic and Facial Plastic & Reconstructive Surgeon. A Stanford-trained physician and former clinical professor at UCLA, he specializes in the treatment of complex, high-risk skin cancers and sun-damaged, aging skin. He now leads California Dermatology and Mohs Surgery Specialists in Pasadena, CA, and continues to contribute to academic research and innovation in dermatologic surgery. In this episode, Dhru and Dr. Soleymani dive into: (00:00) Changing What You Think About Skin Health (1:08) The Truth About Sun Exposure (4:37) Why Dermatologists Tell You to Avoid the Sun (9:36) Is Too Little Sun Hurting Your Health? (11:24) What You're Not Being Told About Sunscreen (17:52) The Best Way to Protect Your Skin  (23:24) How Your Skin Type Changes Everything (26:48) The Biggest Drivers of Premature Aging (35:14) Do Seed Oils Age Your Skin Faster? (43:24) Hidden Factors That Raise Skin Cancer Risk (46:58) Tanning Beds, Spray Sunscreens & Risk Rankings (1:00:21) Eat This to Protect Your Skin From Within (1:10:07) The Screening Tests That Could Save Your Life (1:17:33) Alcohol's Surprising Impact on Your Skin (1:22:02) Red Light, Microneedling & RF: What's Actually Worth It? (1:29:09) The #1 Device for Healthier, Younger-Looking Skin (1:37:08) The Cheapest Ways to Improve Your Skin Today (1:48:10) How to Catch Skin Cancer Before It's Too Late Also mentioned in this episode: Sun Powder  For more on Dr. Soleymani, follow him on Instagram, LinkedIn, and his Website. This episode is brought to you by Bon Charge, Our Place, Cozy Earth, and Fatty15. Right now, Bon Charge is offering my community 15% off their Red Light mask. Just go to boncharge.com/dhru and use code DHRU to save 15%. Reduce your toxic load by upgrading your cookware! Go to fromourplace.com today and use promo code DHRU at checkout to receive 10% off any order. Right now, get 20% off your Cozy Earth sheets and sleepwear. Just head over to cozyearth.com/dhru and use code DHRUP. Fatty15 is offering an additional 15% off its 90-day subscription Starter Kit. Go to fatty15.com/dhru and use code DHRU to replenish your C15 levels for long-term health. Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Teo Soleimani, welcome to the podcast. You're one of the world's foremost experts on all things skin, including helping people catch skin cancer early. Knock on wood, nobody here today listening is dealing with that. How to preserve your youthful skin into a later age and the top things that are worth it and not worth it when it comes to our time and investment. So it's a pleasure to have you here. I'm excited to jump into today's conversation.

Drew, thanks for having me. I don't know if I feel that I'm worthy of those words, but I appreciate. I love what I do and I've dedicated my career to that. So thank you for having me. It's going to be a lot of fun, a lot of things to talk about. I know skin's always hot and that's why I chose that as a career, but thank you. One of the things we're going to do on today's conversation is we are going to tier rank some of the top things that people are concerned about when it comes to their skin health or are wondering, is this thing real or is it bunk? We're going to bust some myths. that are out there. So for those of you that are listening on audio, you can watch the video on YouTube, but you'll still be able to follow along if you're listening on audio. So we're gonna jump right in. One of the first things we're gonna go into is the sun.

Help us understand the sun and give it some context, because the thing is on social media today, depending on which dermatologists you follow, and most of them would say, we have to be aware of the sun. We have to watch out for the sun. The sun is out to kill us. And if you're not careful, you're going to end up with skin cancer super early.

Talk to us about the sun and then give us a ranking on our system from S to F. Okay. This is if you couldn't hit a bigger category than the sun. So I love the sun. I'm a skin cancer surgeon. I'm a dermatologist. I see a lot of patients with sun-related conditions. It's essentially more than 80% of my practice.

Do I think we need to be afraid of the sun? Absolutely not. And my colleagues on the East Coast will probably want to kill me for saying this stuff. But I'm just not one to want to dress like a beekeeper and go outside. Now, just like with anything in life, too much of a good thing can be a bad thing. You know, if you are outside and you are getting sunburns constantly, that's your body's way of telling you, hey, you're killing something. You're killing the top layer of your skin.

That's what a blistering sunburn is. But we know for many different reasons that the sun actually provides a lot of benefits both physically and mentally, and sometimes improvements in well-being, that I can't quantify in a lab test. I can't necessarily measure the improvement in your health, but the sun provides it. I myself did two fellowships on the East Coast, and I knew in the gray I didn't feel good, I wasn't happy, it would affect my quality of life. And that's not something my primary care doctor, for example, could mention. but as soon as the sun came out, my feelings changed.

And as a dermatologist, there is a component of the sun that you can get every single day that's safe. The problem with getting a blanket statement is that every person's body is different. Your skin type is very different than my skin type is very different than my patient's skin type. So what I can tolerate in the sun is not the same as perhaps somebody else.

And figuring that out is the key for personalized medicine, right? For example, if you are somebody who's had a strong family history of skin cancer, or you have certain conditions in which you cannot tolerate the sun, let's say you have melasma, which is a condition we see in pregnancy and women a lot. Or if you have lupus, some of these sun-sensitive conditions, then maybe you can only tolerate five minutes of sunlight before your skin tells you something. If you have more ethnic melanin, you can tolerate the sun a little bit more. If you have no strong family or personal history of skin cancer, you can tolerate it more.

So I think sun avoidance is a problem. I think we've turned into this society, which is, in my opinion, not the right direction that we're going, where we say, avoid the sun, avoid these foods, but take this pill to replace this mineral, take this pill to replace this vitamin. And somewhere along the line, we've kind of derailed ourselves. Should you be in Panama getting a sunburn all the time, laying on the beach, eight hours a day, five days a week? Probably not. is getting 20 minutes of morning sun, 20 minutes of afternoon sun, okay? I think it's totally fine. It makes you feel better, you look better.

In fact, we use the sun and the sun's equivalent race to treat skin disease. So to say the sun is terrible, I think is a bad idea. Now, why do dermatologists make a big stink about the sun? Yeah, if you had a traditional dermatologist here, they would put the sun on F in the F category. And I would probably put the sun maybe in a B. I think it's good for you, man. I think too much is a problem, but I think it's good for you. And the reason we make a big stink, and a lot of people won't talk to you about this,

but there is no evidence, not a single shred of evidence, that sun avoidance will protect you from our most lethal forms of skin cancer. In fact, there is no evidence that avoiding the sun results in a decrease in skin cancer-specific deaths. The reason dermatologists and doctors make a big deal about it, that is I can't control your genetic predisposition. I can't control your family history, your personal history, things that your genes are going to do. So what I can control is environmental insults.

And that's why we make such a big stink about the sun because I can say, okay, I don't know what's going to happen to your skin, but at least I can control an outside insult that's coming in. That's too much UV. So I wouldn't put it as an F though. Most of my colleagues would. I probably put it as a Mewa B, you know. It's crazy to hear you say that there's no evidence that's out there. I say crazy in a way that's shocking to a lot of people that are listening, that the sun in itself is connected, well, it is connected to skin cancer.

You wouldn't deny that. No, no, definitely. That a healthy usage of sun is going to increase your risk of skin cancer. Is that how you'd say it? So I'm going to phrase it in a couple different ways. There's many forms of skin cancer. The three most common that we see in the world are basal cell carcinoma, squamous cell carcinoma, and melanoma. It's what I've dedicated my career to treating as well as some of the rarer types.

There's no evidence that sun protection, strict sun protection, decreases your likelihood from dying from metastatic melanoma or metastatic squamous cell carcinoma. In fact, the most lethal forms of these cancers arise in sun-protected skin. The most lethal forms of squamous cell carcinomas don't even have the UV mutation signatures that we see in kind of more garden variety sun damage skin. skin cancers. Now, it's not to say that sun doesn't cause them, but there's so many other factors that don't go into that, into that category that I think saying sun avoidance means you will not get this is absolutely not true. In fact, most of my patients that succumb to these diseases,

and I have a very unique practice, and I see the worst of the worst probably in Los Angeles, most of my patients, including my young patients that have very bad outcomes, they're not sun-related tumors. So I don't want people to show up typically in the body. I've heard you share in the podcast, they show up in the body that may not be getting a lot of signs. 100%. Melanoma. No one would be examples. Yeah, melanomas are historically been our most lethal form of skin cancer.

You know, Bob Marley died of it. Jimmy Carter famously survived. It was in his brain. The most commonplace that they show up is the back of men and the lower legs of women. Why do you think that is? There's genetic factors and genetic mutations that occur that partly are hereditary, partly sporadic, meaning they just, they happen. Unfortunately, luck of the draw.

That's why a majority of these melancholy. melanomas occur. Now, we say, okay, don't go outside and get added mutations to your skin, which is too much UV. But we know, in fact, that these bad sun naive areas, the tumors are not, they don't have a sun signature. So I don't want people to feel guilty that they went out in 1992, went to a beach vacation, Virginia Beach or something, and that's the cause of their skin cancer. In fact, there was a very large study in 1999, publishing one of our most incredible journals that looked at sunscreen versus no sunscreen use. Diligent sun protection versus none.

And the incidence, meaning the number of these cancers, of basal cell carcinoma, which is our most common cancer in the world, one in four Americans will get this. There was no difference between the groups. So it scratched our heads saying, hey, we've been saying, like, avoid the sun like the plague, you know, dress like a beekeeper, don't go out in the sun,

don't do this stuff. But we couldn't solve for this difference. So there's a lot of factors that go into it. Now, I'm not saying burn. I'm not saying do the stuff you see online where people are tanning their perineum in their but whole. That's like not the thing to do. But if you enjoy the sun and you can do it without burning, I think that's fine. I think you feel good. I think you said so many important things that are there. The first one is that it's not that the sun doesn't play a role. 100%. It's that having all this sun protection in the traditional sense and we're going to

break some these down because there's a lot of different classifications. some that are better than others. But in the traditional sense of traditional sunscreen, there's no evidence that's out there that that is going to protect you from the most common skin cancers that are there. Yeah, particularly the life-threatening ones. And is there a secondary factor that if you don't have enough high

vitamin D levels, which partly relates to the sun, can also be influenced by supplementation, that you are also at a higher risk for, certain cancers that are out there. So sun avoidance, is this true that sun avoidance could actually increase your risk if it leads to a situation where you have chronically low vitamin D levels? Is there any truth to that? So yes, with an asterisk, not skin specifically, because we know sun avoidance will decrease the likelihood of some garden variety skin cancers. But there was a great study that came out of Sweden back in 2000, maybe 16, 17, that looked at over 20,000 women that avoid the sun

for risk of melanoma. And they matched those women who had strict sun avoidance to those who smoked a pack a day. And those patients had the same cardiovascular disease risk. And the presumption was that the patients who avoided the sun had some biologic changes related to chronic low vitamin D and other factors they couldn't measure in a test tube that equated to higher cardiovascular disease similar to pack a day smokers. So there's a lot that the sun provides that I can't quantify, but I can tell you you'll feel better, you'll look better. So I think sun avoidance, complete son avoidance of problem. Now, if you know your family history, Drew, let's say you go outside and okay, mom had skin cancer, dad had skin cancer, uncles had skin cancer, then maybe your tolerance,

your body's ability to heal after getting a lot of UV is lower. genetically defined. So maybe you take a little bit more protection. But I think this blanket statement of you got to wear sunscreen every single day or you're going to die of skin cancer is total nonsense. So important. Yeah. Well, that goes right into our second item that we have here to tier rank. And that is sunscreen. And before we do it, if you guys are new to us doing this tier ranking system, we have it broken down into the following categories. S, which is at the top, which means supreme. And I'd probably even argue, and you probably agree, that healthy use of the sun is probably one of the best sources of medicine that we have in our life. Morning sunlight and other things.

So could we bump it up from a B as long as you're being smart with it and bump it up to an S if you're being smart with it and not overdoing it? Summer is amazing for getting outside. And it's also when your skin takes on a lot more stress. You got more sun exposure, more UV and more UV intensity, more travel, more late nights, more time and dry. airplanes and air-conditioned hotel rooms. And while we're often thinking about recovery for our muscles after a workout, we rarely ever think about supporting recovery of our skin. Your skin is constantly repairing itself.

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Plus, they offer a hundred-day risk-free trial, free shipping, and free returns. So you can try it for yourself with zero pressure. Upgrade your kitchen today with OurPlace. Visit from ourplace.com slash. Drew and use the code Drew for 10% off sitewide. That's from F-R-O-M, Ourplace, O-U-R-P-L-A-C-E dot com slash D-H-R-U and use the code Drew, D-H-R-U for 10% off site-wide. With a 100-day trial, you can try it completely risk-free. Check out our place today. I would put SunSmart as S for sure. Okay, let's recatigratize. SunSmart. If you're doing it

the right way with all the context that we have, throw in all the recommendations from your friend, Dr. Andrew. If you're in a morning sunlight, it's going to be one of the best things for you. If you're not burning, if you're getting it in the right way, S, zero question. And just so everybody knows, burning is killing your skin cells. So that's not what we want to do. Yeah, exactly right. We're going to be coming back to that. So S is supreme. We've bumped up the sun. Yeah, the sun is happy. It's shining down on us. A is really good. B is pretty good. C is kind of neutral. D is kind of bad. And F is obviously the worst that's there. So you talked to all about sunscreen,

traditional sunscreen. There's a lot of different sunscreens that are out there, something I'm a fan of. But traditional sunscreen, it seems like the word is getting out to some people that it's a layered conversation. It might be doing more bad than good. What's your thoughts on the standard sunscreen

that you see at every drugstore that's out there? C at best. At best. Okay, got it. See at best. So why did you put it as a C and not a D or an F? Well, we know that. when people use it, it does provide benefits that outweigh the risks of blistering sunburns.

So it's, it wants to do the right thing. The problem is the way it's formulated, the way people use it is not perfect. So I can't give it a DRF because their traditional sunscreens are intended to do their job. They're intended to provide protection. The biggest problem is the cosmaceutical industry has played a big role in making a lot of subpar chemicals that are, you know, panda sunscreen. The second problem is most people don't even put on enough. And the third, the third factor is we know that other forms of sun protection, shade shelter supplements, actually have a better role of protecting your skin than sunscreen. So if you pick the rights, there's a lot of asterisk to that. If you pick the right sunscreen if you use the right amount on your skin then it would be a you know B or

a or I probably wouldn't put it as S but but there's a lot of chemical sunscreens that are not great for the body there's a lot of emerging or smoldering data suggesting they actually may be even deleterious to certain hormone messaging signals and endocrine disruption and even some of the breakdown products are carcinogenic themselves so that's a huge problem number two is most people don't put on enough to get the SPF that's written on the bottle itself. So I don't know about you, but I, ever since I was a kid till almost adulthood, I didn't know I had to put a shot glass worth of sunscreen on, you know?

Crazy. I put a little bit on and I assumed that was it. Like, that's what my parents told me, you know? So C, because I think it's well intended, it's trying to do good, but it's not a B or A because there's better forms and the stuff out there, a lot of it's crap, man. A lot of it's not great. Well, said.

Well, you brought up a really important point. before we get into some of the super controversial things that are related to the skin, including seed oils and antioxidants and alcohol, those are all coming up, so stay tuned. But you brought up an important point, which is that for as long as human beings have lived, and you look at some of these more traditional societies

that are used to a lot of sun on a regular basis, societies in maybe some of the Aboriginal societies in Australia, places in Africa, like where I'm from in Kenya, India. You know, they'll often use physical barriers, right? And I'll have you explain what that is as a way to protect themselves from being out in the sun, which sometimes they have to be because they're working outside during the day. They're doing other things. In America, it's always funny.

When you see somebody working outside or being outside for a little while, like let's say we're here in Santa Monica, on recording. You see a jogger and it's hot outside. They'll take off all the clothes that they possibly can. And they'll be in the sun on a regular basis. In other countries, you'll see that actually almost their entire body is covered, often with very breathable clothing because they know something that maybe we don't. So talk to us about physical barriers and why they are supreme to things like sunscreen. 100%. So in every single state, and I will paint this and even a simpler image, you literally cannot burn if you're in the shade. Like you cannot burn if you're in the shade, but you can burn if you put on sunscreen.

If you're out and long enough, you don't put on enough, it washes off, it wears off, you sweat it off. So just that concept to grasp, you literally cannot burn if you're in the shade, whether you're outside for 24 hours or two hours. We know in every single study that's looked head to head at physical barriers, so clothing, hats, shade shelter versus topical products, meaning sunscreens. the physical barriers have outperformed every single study compared to the topical sunscreens in protecting you against sun damage, sunburns, and downstream effect. So we know, you know, you can see actually you bring up Kenya as a good, great place that, you know, they are world-class marathon runners. And you see these guys training for marathons running and they're running with clothing.

And you assume you're scratching your head. You're like, well, he doesn't look like somebody that can burn easily. And it's hot. Why the heck is he covered up? Because they know eventually the sun will win. It's like it's a glowing star that's thousands and thousands of degrees. Our skin is not meant to do that. You put a car outside and it russes after 50 years.

Imagine our soft skin, right? But we know that physical barriers, one, will always provide the same SPF protection. So it doesn't change as the day goes on, unlike topical sunscreens where you get a change as it washes off, a change as the chemical structure changes with related to UV. exposure. And we know that you can layer, you can provide protection, you don't get absorption of physical barriers like hats and shade and shelter. So if I were to pick one, and I do this all the time, I personally tend to prefer physical barriers over sunscreen. I'm a skin cancer surgeon. I just, I don't wear sunscreen that often. I don't like it if I can avoid it. If I need to

or I'm going to be outside where I know I'm going to burn, I will wear it. I'm not saying don't use it. But for me, shade and shelter and hats and SPF clothing provide much better protection for me. So I tend to use that. So if we had to rank that here, and I have that in the form of hat and sunglasses, but that obviously means just any form of shade. There's even now clothing brands out there that are really trying to tell you that these are lightweight things that you can use during running. Where would you rank that on our tiered system over here?

If the sun is an S, I'd put that as an A. As an A. Yeah, okay. For sure. There's no downsides. It's only going to be upsides. It's easy to use. Yeah, 100%.

The only downsides are honestly just, you know, cost. You've got to find some form of shade. And then, you know, if it's hot, some people don't like, you know, SPF clothing or hats or things like that. But honestly, the downside is very minimal compared to topical sunscreens and their questionable changes that can occur. In fact, there's actually an interesting thing that you bring up in that a lot of patients, a lot of people, communities, populations, indigenous populations in Central America and Africa and South America take forms of sun protection that we learn from. There's a group of indigenous people that live along the Amazon River in Brazil and mostly in Brazil. And they tend to go on expeditions on the river for fishing. And we found that they consume a fern before they go on these three-day fishing expeditions.

They eat like this plant. And we couldn't figure out why until somebody studied it. And they found that when they ate this plant, they burned less when they were outside. they didn't have topical sunscreens the way we have at, you know, our local drug store. They had physical clothing barriers and this plant. And they found that there's a fern called polypodium that they consume. And when they consume it, it increases the time they can spend in the sun before their skin burns. So just learning from populations and why they do things a certain way can just, you know,

also open our eyes to other options. I think unfortunately, sunscreens have been shoved down our throat. But there are also other great options and greater options out there. That's amazing. And we'll come back to that for turn, because I know you'll know a lot more about it. One other question that I have for you, so take somebody like yourself. Yeah. You have more of an olive skin complexion. Your family's background is from like Middle East area. Yeah. And, you know, my family's ethnic background is from India. Yeah. And I'm also a little bit darker than you. Yeah. You know, how does your skin color play a role with how you think about being mindful about the sun, but also about

how much son you need to be healthy. Yeah, totally. Great question. Actually, funny, you say that my dad still doesn't understand what I do for a living. You know, I say I have a skin cancer surgeon. He's like, where did the cancer come from? I'm like the skin. He's like, yeah, but what organ to the skin?

My dad's tan. He's all in my family. He's not just a whole family. He's not. He loves that. He's like, well, what's a skin cancer surgeon, you know? So I think you bring up a good point. Generally speaking, it's an SPF somewhere between 5 to 10.

you're just your native skin type. If you're a little bit darker, you can get a higher equivalent, SPF equivalent. I know I can tolerate an hour out in midday sun without turning red or burning. It's very different than a northern European skin type. We define them by Fitzpatrick types. In my family, there's very little skin cancer. I'm ethnically Armenian, but traditionally, Armenians are blonde-haired blue eyes.

They're of the Caucasus mountain region. So somewhere in my genetics, there's a little bit of predisposition from our ancestry, but there's some protection in the more Middle Eastern blend that I have. I have all of skin. You're absolutely right. So I know my personal risk for skin cancer is lower than somebody from Northern Ireland. My form of sun protection primarily is more for premature aging related to sun than it is skin cancer. Now, I'm not saying I'm immune to it by all means. I just know that my risk factor is a little bit less. So my desire to protect my myself from the sun now at this age is primarily to prevent premature aging. I know I need some sun.

I feel better. I perform better. I sleep better. I can focus more when I get normal sunlight. So I know I try to get 20, 30 minutes in a day, unprotected. Typically in the morning? Yeah, typically in the morning. I'll go for a run in the morning or late afternoon when I get home. I'll play with the kids outside and I don't have any form of protection on. I know my skin doesn't turn red. I don't burn. So I know my threshold. If, you know, you know, Drew, you could probably go outside and tell me you can be out an hour and a half and your skin really won't turn red. That's your skin's tolerance. Now, that doesn't mitigate premature aging. You know, you still, if you really want to prevent UV-related changes that collect over time, then you take

some form of sun protection. But in terms of your skin health risk, you have a higher tolerance and even myself per se. So I think just knowing, you know, individualized medicine, we talk about this all the time. And what does that mean? It's just knowing your body's specific capabilities and in capabilities. You know, I have patients who, ironically, my highest burdened skin cancer patients are ones that avoid the sun, like, are deathly avoidant. They are not in the sun. The last time they were in the sun was 20 years ago, but they're on their 30th skin cancer. So those are things that go back to what we were talking about in that there's a huge genetic component to that, to it that we ignore as dermatologists.

We say, wear sunscreen, nothing will happen. Well, I don't know about that. Well, I'm glad you brought up the premature aging because obviously a lot of people listening today, for sure, they want to be smart about sun so that they can, and smart about their skin so that they can avoid skin cancer. And obviously the next best thing is catching it early. Yeah, 100%. So most of our conversation moving forward from here is not going to be just on that.

Even if you care about those things, you also still care about, and probably your main priority is premature aging. 100% right a lot of people who listen to this podcast are 40 years old plus and they're 50s 60 70s and beyond and they're thinking about how do they maintain a healthy level of skin so something that you mentioned which is that look the more time you spend in the sun that will prematurely age your skin there's no way getting around that is that accurate absolutely okay absolutely so it's something to know about because I think sometimes you know we put a little bit of criticism on traditional dermatology there's probably, you know, wellness is a wide spectrum too. Totally. There's some individuals inside of there that are like, you're not going to age at all from being out in the sun. No.

And you just can see it with your own eyes. Your friends that even eat healthy that are avoiding seed oils and this and that they're spending a lot of time in the sun, they're going to be getting aged skin if they're overdoing it and not taking corrective measures, which we'll be talking about some of those corrective measures. Totally. Everybody's going to age. Mother Nature, Father, time will always win.

If nobody's living finite, right? The question is, are you aging at your natural predetermined biologic clock or chronologic clock? Or are you accelerating by things that you're doing? And the example I give this, I show my kids this all the time. We take a grape and we put in the sun. You put one grape out all day, it'll start to shrivel by the end of the day. If you take a grape and you give it 20 minutes a sun, it won't shrivel for about a week or two. But it'll eventually shrivel, right?

So the same premise exists. The sun protection or UV protection, and we talk about the sun, but the sun's, you know, a whole spectrum of wavelength of light. The predominant ones that are a problem is in the UV region, both from a skin cancer standpoint and an aging standpoint. And when we talk about aging, it's UV-related breakdown of collagen and elastin, which is what gives our skin, it's elasticity, it's suppleness, its volume, it's look. sun avoidance plays a much more direct, predictable role for premature aging than it does the cancer side. So if you are somebody that wants to maintain the skin that you had as a baby, which I'm not sure why you'd want to do that, but if you wanted perfectly flawless skin for the rest of your life, then you would take much more sun protective measures. We know that that association or that correlation is very linear. Now, that being said, there are things that you can do to mitigate sun and sun damage that you've had in the past. So it's not like, oh, you know,

the stuff you did in your teens and 20s and 30s, that's it. And if you're going to, you're going to be a shriveled raisin in your 40s and 50s. It's not the case. But just like, and no offense anybody who's a vegan or doesn't believe in like leather or whatnot, you, but when you take hide and you leave it in the sun, it turns into tan, wrinkled leather. Same thing as our skin, right? So if you are aesthetically conscious, then your desire for sun protection may be more than somebody who's not. Sure, sure. With also understanding the holistic aspect of health, which is if you go too overboard,

which we see a little bit in Los Angeles. Yeah. Are you missing other downsides related to the benefits and the healing aspects of the sun? 100%. Mood, you know, other cancers that you might be avoiding. Cardiovascular health, like you mentioned. I know it's still a highly debated area, but I tend to be pro if we overdo it and we completely avoid the sun,

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They're ill. And when you look at people who avoid the sun strictly in big cities, New York City, Los Angeles, Chicago, etc., they have a similar appearance. And one cohort of patients are not sick, another cohort of patients are sick. But your body has a very keen ability to tell you, hey, something's a little off. And I'm not saying tanning means you're healthy. But there's a reason when you come back from vacation, you have a little bit of a vacation glow. your body has rested. It's tend to calm down. Usually we get a little bit more sun exposure and things like that when we're on vacation, especially summertime vacation. The problem with that is being able to measure that.

And no doc will be able to measure your exposure to sun and say, hey, Drew, you're healthier because you're, you know, getting some sunlight. Yeah, important point. Okay, let's get into some of the controversial things that are out there. I hinted at this a little bit earlier, but one of probably the most controversial things in health right now is the topic of seed oils. You have institutions like Harvard University saying that not only are seed oils not bad for you, but they're not pro-inflammatory. They're not things that are going to increase chronic disease risk, places like Tufts and their nutrition school that are out there. Everybody has different thoughts. I've shared my own thoughts. I've shared my own bias. I tend to not feel great when I'm having a lot of seed oils and I'm exposed to. I know that I'm not cooking with

seed oils. So if I ever have them, it's going to be in eating out, which obviously tends to be higher calories, you know, a lot more ingredients that are inside of that. But tell us about seed oils and their relationship to skin premature aging. How do you look at it? And where would you rank them on our tiered system? What's below F? Can I put it? Can I put it below F? So so many, things to talk about in this. And a lot of the institutions have outside funding that affects their studies. Unfortunately, institutions are not immune to bias. We see this all the time. Also, just, and this is anecdotal, but almost every single person will agree with this. When you go to Europe, you can eat the stuff that you cannot eat in the States five days a week and you

feel fine. The amount of industrialized products in our foods is monumental in the States. It's a huge problem. I tend to be on the camp that think seed oils should not be in our diet. Seed oils are pro-inflammatory. I notice, and we see this, when you eliminate this in skin conditions that are inflammatory, psoriasis, eczema, their skin improves. We actually put patients on anti-inflammatory diets. We did this up at Stanford. I do it in my practice. When you get rid of inflammatory foods, including seed oils, you can get an improvement in actual quantifiable skin disease. I have psoriasis myself. Every time I have a junk diet for a couple weeks, my psoriasis flares. And it's reproducible. So I know it's not just a one-off. I can consistently make it flare with my

diet and improve it. Now, will it go away? No, but it's one less added drug or medicine that I need to use to cure something that I'm trying to cure. So seed oil, there's a huge connection between the skin and the gut and the microbiome and the immune system. Immense connection. We're only just now unveiling it. We know that the gut microbiome plays an important role in our skin's immune response. The organisms in our gut that metabolize the food release metabolic byproducts, kind of like the exhaust of your car, right? It emits essentially invisible gases that are byproducts of your combustion engine. Those microorganisms food breakdown byproducts modulate and affect our skin's immune system. So when our microbiome in our gut is metabolizing things that it normally doesn't

like to metabolize or cannot tolerate metabolizing very well, you see immune dysregulation in the skin. And that acutely leads to common things like rashes, eczema flares, different, you know, itchy red changes in the skin. But long term, I do think there's a lot of data that will come out in the next 10 years that shows you pro-inflammatory foods like seed oils lead to premature aging and lead to skin cancer. We're only now at the tip of the iceberg and elucidating that in a lab. Fascinating, fascinating. So, you know, just to make sure we add this to the context, there's a wide variety of seed oils. 100%. Universally, I've heard from most people, and I feel this myself with my own immune system,

I feel like my throat is often my Achilles heel. So the first thing that I see is that the worst form of seed oils, and I'd like to get your thoughts on this, are going to be deep fried oils. Yeah. Is that your... Yeah. Do you agree with that? Yeah. Hydrogenated soybean oils and safflower oils and canola oils, especially the hydrogenated versions.

They tend to be a big problem. They're not meant to be consumed. Right. And on the other side of it, and obviously there's a lot of things in between, you're going to eat out sometimes, I'm going to eat out sometimes. A lot of restaurants, they haven't gotten the memo. A lot of restaurants have. True Food Kitchen does a great job.

Parakeet does a great job. Sweet green does a great job. You know, it's now people are waking up to the fact that consumers want this. So shout out to those restaurants. But you're not going to, you know, be obsessing over the fact that, hey, you just ordered a nice piece of grilled salmon with some side of veggies. You're eating out with your wife, your kids. You guys are having a good time. They used a little bit of canola oil.

It's not a big deal because it's not the base of your diet. 100%. Look, I have the saying moderation is key, even moderation itself. Right. So, no, I have three kids trying to stop seed oils and their diet entirely is impossible. But can we avoid it? We cook mostly at home. I can avoid it.

If we're going out and I don't know what's in it, will I lose sleep over it? Not really. But if it becomes their meal three times a day, seven days a week, then we got a problem. Yeah. Right? That's, I think fundamentally all of medicine is that way. You know, I think patients with diabetes, if they have a slice of cake one time, will it destroy their body? No. But we know that over time, over many years, the chronic sugar increases in the insulin that's pumped out as a result will lead to downstream problems. But we know diabetes, just like skin cancer, just like anything else, is it not, is usually not one time you did it and that's the end of it, unlike, you know, hard attacks and things like that. But, um, I'm fine with it.

I try to avoid them, but in the U.S., it's intertwined in literally everything. I mean, it's in everything. I don't know if you saw, but one of the major chains that made an announcement, you know, a few, like a month ago, that they're going seed oil free when they came to their fries. Yeah, yeah, yeah.

It was a burger place called Steak and Shack or something like that. Then a bunch of people found out that the fries that they order are pre-cooked in seed oils. And it's not a knock on them. It's just goes back to what you were saying. We're just sort of, whether you're trying to avoid seed oils or not, even things with microplastics and thallates and bisphenols, they're so intertwined in our food system.

It's going to take a few years for us to really figure out better options, but at least the awareness is there so people can choose so that companies can start looking for better supply chain processes. For sure, man. And you see this, awareness is key. And number one is just awareness of a problem that you didn't know existed. Whether it's something in medicine like awareness of cancer, awareness of high blood pressure, awareness of skin disease.

Awareness is the first thing. When you're blind to a lot of things that's going on, you take things for granted or you don't know and you can continue about your day. I think as we try to re-correct the course, I think we'll make an improvement in our kids' life. I grew up in the era of fruit roll-ups and gushers and the stuff that now we're like, how the heck could we give this to our kids? But that's what I ate in the 90s.

We didn't know any better. Same. You know? And we're okay now. I mean, I don't know what the future holds, but it's not that like, you know, we're all dying and dropping dead. So I think fear mongering is a problem, but we do know that inflammatory foods,

particularly seed oils, disrupt both the gut microbiome and disrupt immune homeostasis. That's the biggest problem that we will see what the long-term downstream effects are in modulating our body's immune balance. If our immune system cannot tolerate something, that's where a lot of disease comes from. Even skin cancer.

We know patients who have a weakened immune system have a 65,000% increase in skin cancer risk. So it's not just the sun, it's not just the diet, but it's the myriad of all the things playing together. Besides, just to touch on that, besides medications that people might be on that lower their immune system because they're fighting one thing and they're lowering their immune system,

what are other things that dramatically, you know, lower people's immune system that they would be 65,000 percent more susceptible to skin cancer. Yes. Number one thing by far are obviously medications that are immunosuppress and illnesses that are immune, I don't want to say immunosuppressive illnesses, but immune deficient illnesses. For example. You know, the most common one that we think of is, you know, HIV. Okay. You know, and there's other conditions, autoimmune conditions, you know, lupus, things like that,

that affect or modulate your immune system, have some weakening of immune surveillance. Because your body, in the case of autoimmune disease, is so busy dealing with the autoimmune disease. It's confused fighting what is normal and what is. It has not as much resources. Yeah, with autoimmune diseases, basically our body doesn't know what is bad and what is normal,

so it fights the wrong thing. That's all autoimmune disease is. It mistakes self or it mistakes normal for bad. And it fights that. So medications, autoimmune diseases, the immune immunodeficient states, things like that. But I do think our diet has a huge role in implicating immune weakness or some sort of relative immune deficiency.

And that's what a lot of people who are so, so strict about seed oil avoidance and holistic diets and things like that are touching upon without knowing that that's what they're alluding to, is that chronic disease we think is an immune problem. It's a metabolic and immune problem, whether it's diabetes, whether it's cancer, cancer, all organ system cancers. It's thought to be a metabolic and an immune system problem, which is why actually the Nobel Prize in 2018 was given to the drugs that unleashed the immune system to fight cancer.

And so now we're just understanding that. And the question, the big question, which I don't have the answer to, and I don't know if anybody does, is how can you modulate your immune system through lifestyle and diet. And we have little ideas. We have thoughts of certain supplements, you know, that actually the Indian diet, the herbs and supplements that are used in Indian cooking

are one of the most potent ways that you can modulate your immune system for the better. But we're now just understanding diet, lifestyle, you know, environment, and ways to improve our immune system. That's not just go to the doctor, get this pill, go to the doctor, get this injection. Yeah, well said.

Amazing. So I've placed it there for, you because we didn't have lower than a F, but you'd put seed oils as a frequent usage. That's a problem. Which even if you are, even I'm sometimes a little bit confused by the science that's out there because I'll have people on the podcast that say, no, like when you look at it, you know, in these studies, we haven't seen the inflammation. I say, look, there may be a lot of confusing things that are out there about seed oils,

but I think the simplistic aspect is you can easily avoid them at home. Yeah. And you don't have to cook in beef tallow if you're worried about. excessive saturated fat, your diet. You can cook with avocado oil, olive oil, right? There's plenty of options that are there. And traditionally, seed oils come with processed food,

excess calories. So that's a great reason to avoid those because you're not gonna be overeating and packing on extra weight from eating too much processed foods. 100%. So easily an F on our system. Okay, great. You know, I wanna go back to something that you mentioned before.

You said, when you see patients, in the hospital who have been bedridden and are dealing with something. Yeah. You know, these patients, they're not getting sun. Their immune system is down, a bunch of things. And it's natural to see these patients, and they often look, as I've had in my own family, people that might look a lot paler than they normally would be. They look sick.

Yeah. And you look at people that are super sun avoidant, they almost have a very similar skin complexion. I know some of those people, I'm not going to mention any names. Yeah, yeah. On the flip side, is it fair for me to say that when somebody is tanning, you know, when you go to places where you see people who have been probably tanning since like the 70s, 80s, and they have very beat up leather skin, that's also another extreme version. Yeah, man. And I think mostly people have gotten the memo. They're not into tanning. But just so that we hear from you, I think I have tanning here here.

I think I have tanning here on here somewhere. If you had to rank tanning somewhere on our tiered system, where would you rank it? Intentional tanning. Intentional tanning, traditional lather up. You're trying to get dark. You've been doing it for years. I put that as an F. As an F.

Intentional tanning, I'd put that as an F. Intentional tanning. Yeah. It's one thing to be out in the sun and get darker. If I spend two or three days out midday and I'm like out in the sun for like two hours, I will be maybe like one shade darker than I am right now. Like I'll tan pretty quickly. Yep, yep, yep.

That's different than this intentional tanning. Yeah, 100%. Typically people who are very light skin, who feel like they want that European look. Always, and they're overdoing it. Yep, it's always, we always want what we don't have, you know. In Asian societies, the cast always wants fairer skin because it relates to, you know, higher social stature and royalty.

In fair skin individuals, they always want that, you know, Mediterranean olive glow. So we're always chasing things that we can't have. But the Palm Springs, Florida, retirement community look is a big no-no. Your body is struggling. Your skin is struggling. Don't do that. You're eventually going to be my patient.

But I think your body's natural ability to produce color because you're doing things normally without the intention of burning to a crisper tanning, I think is fine. I think, you know, tanning beds, intentional tanning, F. There's no reason to do it. Absolutely no reason. What about another one that people ask about sometimes? And that's coffee. They're wondering, does that have anything to do?

And specifically in the category of premature aging, you'll hear some ideas on social media. I'm sure people have seen the reels. Oh, coffee will dry you out. It's this. It's going to make your skin look like that. And then some people talk about how coffee is literally the highest source of polyphenols in a lot of people's diets. It's unfortunate, but that's what it is. And that there's a lot of benefits to having coffee.

So where would you rank coffee on our list and why would you put it there? Probably put it as a C. As a C. Okay, great. There are pros to coffee. There are some questionable cons to coffee. I'll tell you what we know from the science. So coffee, majority of the time we drink it for the caffeine content, not the flavor.

Some people drink the decaf for the flavor. But generally, most of the Americans in the world drink it for its, you know, cognitive boosting. It wakes you up. The caffeine is great. I love coffee. I drink a ton of it myself, and I drink more of it as more kids I have. The thing that we know about caffeine is caffeine's a mild diuretic and a vaso-constricter. So at higher doses tends to constrict the tiny vessels that feed skin, the tiny vessels that feed certain parts of our body. It's also a diuretic, but very mildly, which means it makes you pee a little bit more, which in theory could dehydrate you. It's not enough for us to see in most people and the amount that they consume a really big gradient difference

in skin hydration status. So the premise that coffee dries you out or makes your skin a little bit more dry is not really the case. Now, some people are sensitive to caffeine metabolic byproducts. So what their body does in compensation is actually will produce more oil in response. And I'm one of those people and I see this all the time is after, you know, by midday, caffeine consumption will increase the amount of oil I put out. So how will you notice that? My skin's oilier. My forehead's shinier.

My nose is shinier. And it tends to be more of a compensatory response than anything. We know that they used to be thought that caffeine would make people flush a little bit more, or make their rosatia worse or make their acne worse. And we've actually figured out it's not the coffee itself, but it's the temperature of the beverage. So iced coffees, caffeine tablets, if you're into that stuff, don't do the same thing. So if you tend to have rosacea, that kind of redness that flushes in the sun with emotions and beverage and spicy foods, it's not the coffee, it's the temperature of the coffee you're drinking. I think in my personal opinion, I'd probably actually put coffee a little bit higher than a C, maybe a B because of all the good things that it has.

Okay, it gets a little bit of a bump. It gets a little bit of a bump as the more I think about this. But just like with anything, overdoing, it's a problem, right? So if you're having 1,200 milligrams of caffeine a day from coffee consumption, it's not going to be good for you. It's not going to be good for your nervous system, not going to be for good. for your kidney filtration system, not going to be good for your skin. If you're having a relatively normal amount, normal is a range in the in the world, anywhere from, you know, 100 to 400 milligrams a day. Which is usually like a cup or two. Yeah, a cup or two, though in the US, our food

system is wild and that we hybrid make the beans, you know, Starbucks beans are are engineered to produce more caffeine than any other bean, but that's a- Oh, interesting. Yeah, that's a totally different story. It's funny because I recently went to Japan, side note, And over there on the menu, they'll literally write, do you want American coffee? And in parentheses, it'll say weak. Are you serious? Or do you want Japanese coffee, which is assumed to be strong? And it actually is very strong.

That's very interesting. I think part of that is also, too, they like their coffee very pure. We're having these crazy fapuccinos where you have all sorts of sugar and other things. It's almost like three beverages in one. Yep, yep, yep. And with the sugar, with the amount of liquid and everything else, that probably adds to it as well. 100%. But I think if you're having the normal amount of coffee,

coffee. And if you're having relatively good quality coffee without like the, you know, the Dunkin and Donuts, 70 scoops of sugar in there, the polyphenols, the antioxidants that come with it are a good thing. I tend to drink my coffee black because I'm, it's on a mission. It's going to do its thing. It's going to wake me up and get me going. I think I would put it as a bee. I don't think it has any dilaterious effects on the skin that we should be concerned about. That's awesome. I'm an Americano guy. I do usually even just a single shot in the morning, adding a little bit the honey, which I know people think is crazy, but I like a little bit of honey.

I'm talking about a quarter of a teaspoon. Nothing wrong with it. Makes me feel great. You know, you mentioned something, which is antioxidants. Yeah. Let's talk about that. You know, we're kind of switching back and forth

in this conversation between protecting the skin because, you know, we have you here on here, where literally your bread and butter is taking care of people who have skin cancer. Yeah. Right? So we all want to know how to protect ourselves. Because from my understanding, skin cancer,

is growing every year. Is that right? Yeah. Yeah. It's the only cancer that's still increasing in incidence. It's the only cancer that's increasing in incidence.

Every year on year. Every year on year. And there's so many things to talk about on that. You bring up, you know, antioxins. And to backtrack, and I know, I think I'm jumping around even more than you are, spray sunscreens, I would put as an F. Oh, wow.

Spray sunscreens, you know, the stuff you buy at, you know, regular drug store that you see in the spray ball, F by far. Okay, got it. I think sunscreens is an umbrella, I probably put as a C, but sprays F by far. That includes even like the healthier sunscreens inside of there. So the mineral, pure mineral, safe.

Those are safe. Those are, I put those as an A, the sprays put as an F. So collectively will come as a C, but sprays avoid. I don't have an icon for a spray, but if we did and you're watching on YouTube, just know that that's going to be an F. Yeah. And again, why is that? There's two reasons. One, you never get enough coverage that you see as the SPF label.

on the bottle, that's number one. Sprays tend to be chemical sunscreens, which the chemical ingredients are now being shown to be endocrine disruptors and also some of their breakdown products are carcinogens. And number three, the majority of the spray sunscreens use a propellant, and the propellants tend to be benzene derivatives. So you're inhaling benzene as well as a lot of these chemical sunscreens. There's been many class action lawsuits for spray sunscreens because of the consequences to them. Even if the sunscreen is not chemical, it's a mineral, your inhalational hazards for minerals as a spray is a problem. So just avoid the sprays altogether.

And you see a lot of people, especially use them on kids. Yeah, yeah, huge problem. Oh, it's easy. Yeah, yeah. Kids don't like sunscreen being put on. It's easier to just spray them. But I can imagine kids are a lot more susceptible to these things. So it's a no no for using spray sensor.

Absolutely not. Does it also mean avoiding the, there are a lot of mineral base sunscreens that now are getting into the spray category. Yeah. Should you still avoid those? I tend to avoid them. Okay. Number, number, for two reasons.

Number one, you don't know what the propellant is that gets the spray out. Is it compressed air or is it a actual propellant that tends to be in the benzene category? And nobody in the right mind should be breathing in benzene as a way to protect another organ. And number two, in, in inhalation of micronized minerals, zinc and titanium can have consequences long term in the in the lungs. You got to remember, we're telling people. to use sunscreen for 40, 50, 60 years of their life, the problem won't be the one-time use. The problem will be the daily use over 40 years.

Yeah. That's where we, it's so hard to gather that type of data. And we digress a little bit, but I just want to explain how mineral versus chemical sunscreens work because when you know that, it kind of makes you a little bit more concerned as a consumer. Mineral sunscreens tend to act as a shield. Think of a metal shield on the skin

and they tend to bounce off UV rays and sometimes they absorb them and they just hold them on the surface of the skin. Right, that's why a lot of people don't like them because they're like, oh, it doesn't, my skin looks white.

Yeah, but it's supposed to because it's actually a shield against it. Exactly. It acts as a cast or a shield. Chemical sunscreens, the way they work is they have to absorb the energy of the UV undergo a chemical transformation in your skin and then release that UV energy as heat. So the way chemical sunscreens work is they are undergoing chemical

reactions biologically on your skin. Big question. Is this normal? Is this not? Is this safe? Long term, 40 years of using this is a problem. And I tend to be on the side of no chemical sunscreens. I don't recommend it.

I don't carry it in my practice. And typically people use it because they're like, oh, great, it blends into my skin. Exactly. Exactly. In the 80s and 90s, sunscreen was predominantly the white, you know, 1980s, lifeguard nose, chalky, zinc, zinc oxide. The problem is you can't wear makeup over that very easily. It goes on cakey, it goes on gritty. You look like you have sandpaper on your face. So, cosmaceutical companies said, okay, how can we make a different form of chemical tend to be organic or phenol-based chemicals that will go on smoothly so that people who want to wear makeup on top

won't see this gritty chalkiness, and that's how chemical sunscreens came to be. Wow. The problem is it's now, after 20, 30 years of data, we're saying, the stuff we claimed in the FDA's 1999 study is generally recognized as safe and effective is no longer safe and effective. It's not true. Yeah, and sunscreens are an interesting thing. They're actually drugs.

They're controlled by the FDA. They're considered over-the-counter drugs. So you can't just make yourself a sunscreen. It's a controlled substance. The FDA has to approve it. You have to show that it does the things that it does in very, very elegant studies. So the original manuscript that defined all the stuff we saw in, you know, Myrtle Beach and Florida and, you know, all the Palm Springs and everything that you saw, copper tone and a banana boat and sunbum and stuff that you saw in stores were defined in 1999 in the original manuscript. And there was 19 or 20 chemicals in that list.

Now I think 12 of them are considered not safe. Wow. In fact, two of them are pulled out of all the European Union because we know that when they break down in the skin, the breakdown product, benzophenone is a well-known carcinogen. Yeah. So, crazy. It's like you're putting this on to protect from cancer. Yeah, yeah, yeah, and we're doing all this other. Yeah, yeah, exactly.

That's nuts. That's nuts. But antioxidants, you were talking about. Yes, yes. I was saying we're going to be switching back and forth in this conversation between skin prevention, skin prevention, like healthy aging, how to prevent, you know, premature. aging and then also skin protection, cancer avoidance and everything, because obviously we have you here. So, you know, just for the audience that's following along, we're going to switch back and forth because these things are often related to each other. So I'm bringing up antioxidants, right?

We have a bowl full of raspberries and berries here that I want you to rank and kind of piggybacking off of coffee, does us going out of our way to include a healthy amount of antioxidants in our diet, does that help out in protecting our skin? S. S. S. You're gonna put that as S. I'm gonna put that as S. What are your favorite forms

and why do you put it as an S? Great question. So my favorite forms for antioxidants, I tend to like a few specific ones. I tend to like vitamin C. It's a huge one in skin. Topical and food. Topical and food.

Yeah, and oral. It can be oral supplementation and it can be both as a topical form. As a topical form, the simplest study that you can do is take an apple cut it in half, put a little bit of orange juice on one side or a crushed up vitamin C tablet, and leave the other side untouched. Leave it out for a day. See what happens. The untreated side turns brown. The treated side stays nice and crisp and healthy. Same concept on your skin when you apply it topically. It's a great form of protection from environmental pollutants. When we consume it, it's obviously an amazing antioxidant internally. It's also the most essential thing that your body needs to produce collagen. Without, vitamin C, you cannot make collagen. It doesn't matter whether you take supplements, you eat all the protein you want in the world. Without vitamin C, your teeth will fall out, your hair will fall out, everything will fall out. I actually see probably twice or three times a year, patients with scurvy.

And how do they end up getting it in this modern day and age? It's a great question. I saw it in New York City. I see it here. Very restrictive diets and lifestyles and religious beliefs. Okay, got it, got it. So it's not somebody who's like on the carnivore diet. It's somebody who maybe has just somehow ended up feeding something. You know, we've seen it in patients with carnivore diets. They have very restrictive diets that avoid all sources of vitamin C. And then other people who are food avoidant for other personal or religious beliefs. Usually I see this in patient, you know, and it's very rare, but you still see it a couple times a year in the big cities is people who have a very specific white diet.

They're only eating rice and white bread or they're only eating, you know, potato. and starches and they have no form of vitamin C. And they come in, their gums are bleeding. They have what we call corkscrew hairs, or the hairs are starting to twist and bleed into the skin. Oh, wow. Yeah, and you're like, hey, have a little orange or have a vitamin C, they correct.

So that's my number one, if I got to pick one antioxidant, probably vitamin C. There's two close next ones. The next one I like Astazanthan. I think it's an under-talked-about antioxidant that it's not common in the Derm world, we don't know why, but it's really common in the wellness and function world. There's a lot of good data showing it has really good antioxidant properties. You usually

find it in things like microalgae, krill, shrimp, salmon. But we actually have done several studies in skin, and it shows that it improved skin appearance objectively by 30 percent, elasticity, hydration, status, fine lines and wrinkles, signs of aging. And it's an easy supplement that can be consumed. You can have it in your diet. You can take it as a supplement. So I love astazanthan. and another antioxidant that I absolutely love. And these are isolated forms, you know, not like you get a myriad of compounds when you eat blueberries or pomegranates or raspberries, but isolated antioxidants. I love nicotinamide or niacinamide. And it's a B vitamin derivative that has been shown as an antioxidant to allow your skin to correct DNA damage from the sun.

And this has been shown both in laboratory studies, animal studies, and human studies. In fact, there was a landmark study that just supplemented patients only with nicotinamide, which is a B3 derivative, nothing else, and their cancer risk dropped by 30%. Wow. Their skin cancer risk. And how were they taking it as a supplement? A supplement. Okay, got it.

Yeah. A thousand milligrams a day or 500 twice a day. And is it true that I've seen like skin products that have it now in it? Yeah, yeah. Do those work? Do those not work? They help improve complexion. They help improve redness from the same antide.

probably hard to get that same dosage. Yeah, yeah. And the correction, the DNA correction that is needed is from the inside out. So the oral supplements. But, you know, we know patients who eat the full rainbow diet, the antioxidant diet, the anti-inflammatory diet, they have a reduced risk of skin disease. They have improved skin tolerance, immune tolerance of the skin. We know that they're inflammatory things like eczema and psorias tends to improve.

So antioxidants, S, you cannot go wrong. Nobody will ever say, hey, you ate too many good food. You know, I love it. Yeah, I love it. All right, we got it on S. Yeah. I want to give a little shout out to a project that you're involved in. Yeah.

You actually have your own supplement that's there. Yeah. I always, first of all, I love any entrepreneurs that are out there that are creating, you know, evidence-based products, things that can help people that can work. So I have no problem giving a little plug. But I also want you to rank it. So tell us what we're ranking and what the product is. Yeah.

I'm biased. So I, this is a product called Sunpowder. It's the first daily. drinkable skincare supplement. It's the first supplement of its kind to protect and repair your skin from the inside out. I describe it. The simplest way to describe it as think of it as AG1 for your skin. Got it. And I'm biased. I will rank it as an S, but I will tell you why I'll rank it as an S because any other dermatologist and you're going to see some dermatologists in your future talk about this across the United States would rank it as an S as well. For several reasons. There's nothing out there

like it. It's the most comprehensive package for skin health that's taken once a day as a powder that's mixed into water. It originally came from a necessity for our skin cancer patients. We had a high-risk clinic when I did my training at Stanford that had patients with innumerable skin cancers. And I ran a high-risk clinic over at UCLA where I was a professor. And we looked at ways that we can protect patient's skin that was not just tell them to wear sunscreen, because God knows these patients were avoidant of the sun, and they would still get numerous skin cancers. Some of them, you know, disfiguring cosmetically or functionally.

So we looked for a way to reduce their risk. And in doing so, we also looked for a way, well, if we're doing that, how else can we improve the quality and appearance and the health of your skin? So I partnered with my colleague over from Harvard. He's a cosmetic dermatologist who practices in Miami, and his patients are a little bit different than mine. You know, 80% of my patients are skin cancer patients

and probably 20% are cosmetic and regular. His are 100% cosmetic. So he had a need for keeping patients' skin healthy and making sure whatever they did would maintain. You know, if you do all these amazing things for your skin, you spend all this money, you get a beautiful, youthful complexion. You go back out in Miami Beach in a week. You're going to get all that stuff come back

and you're like, what the shit did I do? So we formulated a product called Sunday. powder that has eight clinically studied ingredients in the doses that was studied in the published journals that not only protect you from sunburns, it reduces the likelihood of you getting a burn while outside, meaning it increases the time you can spend outside before your skin turns red. Now, it's not a replacement to sunscreen. I want to make that clear, but it works in addition. It's an internal form of protection. It helps reduce your skin cancer risk. So we publish that data and looked at over 500 patients who had two or more skin cancers in the past.

And when they took the active ingredient for a year, their nicotinamide at 1,000 milligrams, their skin cancer risk reduced by up to 30%. The ingredient that helped reduce sunburn risk is this fern from the Amazon rainforest called polypodium. And when consumed, and we're running a clinical trial right now in my practice and another clinical trial in Miami, when consumed, shields your skin from turning red from too much UV exposure.

So I can take it, surf, go out and swim, do all the things that I do. And it allows me to be in the sun longer before my skin says, hey, hey, like, I'm starting to burn. Take it easy. How much before you go out and surf, do you take it? Yeah, right. I usually take it about two hours before. It's in my morning mix. I'll mix it in my smoothie.

Make a smoothie. Drink it. And then I go, ironically, the times that I need sun protection the most are the times that I can't apply. I'm either in the water. I'm hiking. I forgot to bring it. I'm skiing. You know, I just don't think of, you know, I shouldn't say this. I don't think to apply or reapply when I'm on a mountain and I've gotten some of my worst sunburns when I'm skiing, ironically. And then there's other ingredients. We put a full dose of astazanthin in there. There's bioactive collagen peptides with vitamin C. You know, there's haluronic acid, which is the stuff common cosmetic fillers are made

of. It hydrates the skin. There's biotin. There's a lot of great ingredients in one single scoop. So it was a lot of work in the making originally dedicated to our patients. So I said, there's nothing there besides telling patients avoid the sun, wear sunscreen, and see you later, buddy. So we said, why don't we find out a way to improve the skin? It's been an awesome venture. Amazing. We'll appreciate that, man. The show notes, but for people listening on audio, where can they find it? Yeah, sunpowder.com. It's our website. It has all the published data. We have a social media handle on Instagram. It's Drink Sunpowder. There's a TikTok called Drink Sunpowder. And It's the social media handles show skin cancers and lasers.

And there's a lot of skin education. It's not a page about selling supplements. I think the supplement world is very saturated. But there's amazing data that's evidence based in all the ingredients in this. Amazing. Awesome. I appreciate that, man. Thank you.

Thank you. On that note, you know, you were talking about some of the content you guys feature. One of the things that you're big on. Yeah. And that you like to tell people is when it comes to, to protecting our skin from potential problems later on, it's important to get screenings done. Yeah.

So that's the next thing that I want you to tier rank and talk a little bit about the hows and the wise. Yeah. For especially my audience, including myself, I don't think, you know, I'm 42, turning 43 this year. Amazing man. Thank you, brother. Appreciate it.

Dermatologist. And I have like some moles that are like the bottom of my neck over here. And like every so often when I'm swimming or I'm hanging out with my wife somewhere, somebody might say usually somebody older is like, you know, you should really get those things checked out. Yeah, yeah. And I have a natural bias. And I'm like, yeah, yeah, I'll get them checked out at some point in time.

But I'm also generally feeling like I'm son smart. I'm not too worried about it. But at the same time, too, like I don't want to end up in some situation where I have to deal with skin cancer and I could have detected it. Could have detected it a lot earlier, right? And I ended in your office. Yeah, yeah, yeah. So what are the do's and don'ts and where do you rank screening?

And let's put it at different, feel free to contextualize it based on either ages or risk profile, like you mentioned. One of the top things that will increase your risk profile for skin cancer is if you've already had a parent or family member who has been diagnosed with some form of skin cancer. cancer. So can you talk about that? Yeah. So to take a, you know, a bird's eye view of that statement, in the U.S., we tend to be more reactionary to our health care than proactive. And that's across all specialties. We tend not to see the doctor until there's something that needs to be treated, as opposed to seeing the provider for preventative or screening measures. And that's not just skin.

It's every organ system. I love skin screenings because it's probably the least invasive screening of any body system possible. So I put screenings as an A, and I'll tell you why. If you go see your regular primary care doc, and they're going to see how you're doing, you're going to get a blood draw just to see your basic lab functions. I don't even poke you when you come to the office. I just see your skin. It takes five minutes for me to examine, maybe a couple minutes less, a couple minutes more,

for me to examine every square inch of your skin. And it's just by looking. And we're trained to know what should be there, what shouldn't be there. It's not like getting a colonoscopy, you know. We're getting to the age where we need to do things like colonoscopies. And heaven knows that's much more invasive and that's a simple screening. You know, you know, smokers and there are CT scans for their lungs. So it's the least invasive screening of all body systems to detect cancer and things that shouldn't be there.

So why not do it? you know, once a year is all you need for pretty much everybody. And maybe even every other year, if you have absolutely no family history and you have no personal history and your skin's doing fine, maybe even every other year. But it's a five-minute check. Any particular age where you recommend that people get started on that?

Yeah, I tend to like, well, it depends on family history like we talked about. If you have a very, very strong family history of melanoma, I tend to recommend at the beginning of puberty. Moles change with puberty, particularly progesterone hormones. So as you go through puberty, you will make new moles. Your moles will change. that's something that a good dermatologist should be able to survey.

If you don't have a family history or personal history of melanoma or any other form of skin cancer, then I think after puberty, adulthood, somewhere around 18 once a year is just an easy way to upkeep and monitor your skin. And what I like about screenings is just like any cancer in the body, whether it's breast prostate, lung, colon, skin, anything else. early detection dictates better outcomes. So when you catch things early, it doesn't matter whether it's a melanoma or a lung cancer or a prostate or breast cancer. The earlier you catch it, the more likely you're going to cure it. Right.

So we make a big stink about, oh, I went to the dermatologist, they biopsyed something small on my nose. I tend to see the consequence of the things that haven't been done. Now I'm taking off an entire nose and taken off an entire ear. Or worse yet, we're talking about this thing is now in the neck or in the lungs or, you know, cats out the bag. So I love screenings. Ironically, you bring up screenings tomorrow.

I'll be screening all the firefighters that were implicated in the Pasadena Altadena fires for just a screening exam. These guys, there's over, you know, 250 firefighters we're going to see tomorrow. And these guys have an occupational hazard, and many of them don't know that. And it's such an easy thing that I can do that. I can set this up at the fire academy and screen them there. No other organ system will allow you to do that. You know, you have to go to the doctor's office. You have to get a blood draw.

you know, even screening for diabetes, you have to get a poke to see what your blood sugar is. Here, I can go to the patient. I can tell them about, hey, you're outside fighting fires. You're keeping us safe and healthy. The Palisades, Malibu, you guys are outside all the time. Here's a hazard. Here's something that you guys should watch out for. And let me just take a look at your skin.

Yeah. Greatest thing, we catch something. Worst thing, I wasted five minutes of your time. Right. Right. Any do's and don'ts for people who are like, okay, well, I can't go to my regular doctor because they're not trained in this. I have to go and find a dermatologist.

Are they looking for anything special? No, I think any good medical dermatologist in this DNA should be able to screen you. Unfortunately, in a lot of big cities, things have migrated more towards cosmetics and cosmetic dermatology. So if you're looking for a screening, any good medical dermatologist should be able to do that.

Unfortunately, you're right. There is a little bit of a gatekeeping, meaning oftentimes there's a weight that's several months for some providers. And if you need to see something urgent, see your primary doc at least first, as opposed to waiting six months for something that could be a problem. But if you have no concerns and you're just going in for a screening, any good dermatologist should be able to do that. Okay. Great. All right.

We're going to pop into a few other areas that I want to talk about. And then we're going to chat about a bunch of treatments that people have questions about. Does this work? Is it harmful? What's the best? because now we're starting to get into the part of the conversation where we know about the important about being sun smart. Yeah. We know about the importance about being sunsmart.

We know about physical barriers being supreme. Yeah. And how we can rely on those, minimizing, you know, sunscreen use for especially sunscreen misuse and the harmful sunscreens that are out there, relying more on the mineral ones, but not the spray ones. No sprays. They're out there. We've talked about the importance of screening and avoiding tanning. Yeah. sunpowder and the role that that can play in a healthy diet as well too.

Coffee. So a few more things we want to touch on. And then we want to go into, you know, some of the treatments that are out there that are the common ones. Anytime I tell somebody like, I mentioned to my sisters that you're coming on. They're like,

oh my gosh, can you ask them this and this and this and this and this. Absolutely, man. This is the fun stuff. Not that it's only women that are asking about it. Men are super into their skin as well too. Totally. So a couple more items that we want to touch on.

And then we'll get into these restorative, regenerative therapies, tools, techniques, practices. All right, alcohol. Let's talk about that for a second. What do you want to say about alcohol and the skin and where would you rank it on our tiered system? F.

An F. F. Okay. F. That doesn't mean I don't consume it. Okay, got it. But it's an F. There's no amount of alcohol that's good for you.

No amount. That being said, it is something that's socially consumed and to an extent over consumed. But from a skin standpoint, in a biology standpoint, it's a toxin. And alcohol itself is broken down into a metabolite called acetaldehyde, which is what creates a lot of the problems in the skin. So first, alcohol tends to be a mild diuretic,

which is why when you start to drink, you feel like you gotta go to the bathroom more, or at the bar, you're like, oh, I started to pee and there, there it goes. It's because there's actually a diuretic effect. So number one, tends to dry you out. And that becomes a problem, especially the next day, because we tend to wake up in our bodies trying to overcompensate by holding onto the water we peed out. So you wake up with puffy eyes, that hangover look.

There's an actual biologic change related to the alcohol that was consumed in your skin that makes you look like shit, which is the hangover look. As a result, we tend to overcompensate for that dryness by producing more sebums, so more oil, more likelihood for breakouts. our skin isn't that happy as a result of the secondary changes that occur from alcohol's mild diuretic property. So that's number one, which is why you always look funnier, you have puffy bags under your eyes, is the fluid shifts that occur from alcohol consumption. Number two, the acetaldeid is a toxin. And some populations, particularly Asians, have no ability to break down the acetaldehyde so it collects in their skin. There's this thing we incorrectly call the Asian glow. and there's a reason for that, the acetaldehyde actually accumulates and dilates blood vessels in the skin.

There used to be what was thought as, you know, the sailor's nose or the drinker's nose in which patients would have really big vessels on the nose and the nose was growing, you know, the pores were growing, the nose itself was growing too much. And they thought that that was due to too much alcohol consumption. We now know it's mostly due to a condition called rosacea or rhinophyma as a result of rosacea. But there's some truth to that. alcohol and acetyldehyde accumulate and basodilate the skin. So you looked flushed, you looked redder. You can even get that surprised or shocked look when you're drinking and your face is flushed. And that's because your body doesn't like the metabolite.

So there's no good amount of alcohol that is safe or healthy for your skin. We know it's a consequence during surgery and procedures. It makes you bleed more. It slows down wound healing. So if you're undergoing any sort of cosmetic surgery, reconstructive surgery, or even a cosmetic procedure. We avoid alcohol because of its blood-thening properties and bruising properties. So there's a lot of problems with alcohol and not very many good benefits.

Now, do I enjoy a glass of wine or a cocktail? I do. Do I try to avoid it? I do. I think if I pick my alcohols, I tend to pick ones that at least come with some theorized benefit, which tend to be the red wines and things like that. But for skin, I put it as an F. I heard you say on another podcast,

that in particular grain-based alcohols are the ones that you are most worried about people over-consuming? Yeah, yeah. Grain-based alcohols for several reasons. One, the volume we tend to consume is a problem. And number two, it tends to be inflammatory. So grain-based alcohols will cause an inflammatory shift in our diet and our skin's immune response. We know that it flares certain skin diseases, you know, eczema, psoriasis will get worse when patients are constantly consuming grain-based alcohols. And then we basically acts as a seed oil equivalent.

I tend not to like them. So that's like a whiskey, barley. Yeah, or yeah, you know, beers. Bears. You know, beers, certain vodka, certain whiskeys, colored whiskeys, you know, they tend to be very inflammatory. And you see both the acute problems and the downstream problems. People with certain gluten intolerances.

And gluten intolerance has become this unfortunate catch-all in the U.S. everybody who eats a pizza and gets an upset stomach says they're gluten intolerant. But true gluten intolerance like celiac disease, these grain alcohols wreak havoc on the immune system. So I tend to avoid them. Okay. Let's get into some of these restorative modalities that are out there, the fun stuff. All right. One of the ones that is a spectrum, but it's gotten a lot of attention over the last few years, is the spectrum of red light therapy. Yeah. Yeah. So let's talk. I have a red light mask here, just as an easy icon.

Talk about it and then rank it on our tier. B. B. B. Yeah. Okay. B. Maybe an A. Maybe an A. Maybe depending. We have to see a little bit more data. It was five years ago a D to most dermatologists. Yeah. And data started to come out more and more and randomized trials have come out more and and bumped it up from a B, a C to a B. There's some benefit. The problem is it's such a broad spectrum to use the term red light. There are devices that are battery powered. There are devices that are AC powered.

There are devices that have high density of lights. There are devices that have low density of lights. The jewel outputs vary from product to product. So the overall encatchment is broad. And it's hard to control for the shitty products out there and hard to account for the ones that are good. I like it. I have it in my practice.

We use it post-operatively for certain things. Like when we do injections for hair, we will use red light that's powered right. Typically, that's a what? Is that like a cap or is that like a medical light? Yeah, we tend to use the medical light. It's a three-panel light that we shine on the scalp. We also use it post-laser procedure, especially if we're doing ablative lasers where we're destroying the top layer of skin intentionally.

we will use the red light to speed up wound healing. There's some good data that shows that it increases vascularity in blood flow, which is how it works to improve wound healing and anti-aging. So I like it. It's a B. It could be an A if we have enough data that comes out and we see which specific devices and energies are needed to get those effects reproducibly. But just like when anything is good in the market,

you get a flood of products that are inferior or don't work and things like that. And that's a problem. But I give red light a good B. Okay, amazing. Yeah. On that note, and I don't have an icon for this, you don't have to rank you, you could talk about it. What about things like microneedling? Yeah.

Radio frequency, microneedling, which has become very popular. Yes. I heard you have some nuanced thoughts about that. Yes. Radio frequency, microneedling, I will put as an F. Okay. Microneedling, I will put as an A. Okay, great. Huge difference, right?

Huge difference. So we're tapping into the world of things that you can do to your skin to improve its appearance in health. Yeah. And that's light-based devices, energy-based devices, mechanical-based devices, things like that. Why I don't like radio frequency microneedling? Several reasons.

Number one, radio frequency treats a whole different part of the skin than does microneedling. Microneedling, the general depth that it can penetrate at most is somewhere around 2.5 millimeters. And when we use microneedling, our goal is to stimulate collagen induction through making microscopic pokes in the skin. That's what it does. And it does it without heat.

The beauty of microneedling is its mechanical injury, not heat injury. So historically, ethnic skin, like yourself, myself, you know, African-American skin, what have you, could not tolerate a lot of laser devices. The heat would destroy the cells that produces our skin color, the melanocytes. So we could do all these things amazingly in white skin, and it was studied in white skin, but ethnic scene, we're like, yeah, you can't use this laser, you can't use this laser, et cetera, et cetera. We have nothing for you.

Microneedling came about. It's actually an old technique, very popular in India, in the Middle East that was around for many, many years and caught popularity in the U.S. more recently as a way to induce collagen without heat, but mechanical injury. So now we have a way to improve scars, to improve texture. Radio frequency is heat that's deposited in a layer below where the microneedle reaches.

And the problem with radio frequency is it falls in this like, ambiguous, doesn't work really great zone. It's not deep enough to cause tightening in the fat layer, and it's not shallow enough to get the benefits that we're looking for things that treat the top layer of skin.

So what I see often is it's, you know, whenever you get something that is too good to be true, they say it treats everything or it does everything. You should start to question it. Like, does it really treat scars and redness and blemish and wrinkles and fine lines and brown spots can't really do that you start

to see the the consequences and the biggest area where i see a lot of patients with problems with radio frequency microneedling is an ethnic skin where they come in with stamp or pigmentary changes so you see the heat from the radio frequency cause skin color changes because their body couldn't tolerate the heat microneedling alone amazing love it for acne scars love it It's for scar revision, love it for texture changes that we can improve. Radio frequency, combining them, too much injury in the skin, too high of a risk, F. Got it. That's great.

Well, a lot of people will be happy because at least when you see the ads for and everything else like that, or I hear for my wife or what her friends are doing, radio frequency microneedling, which has become so popular, they also, it's a premium. Yeah, yeah, yeah. You're paying a premium for that. So microneedling good enough for most people and is going to work fantastic if they choose that as an option. And to simplify things even better, all of these energy-based devices are made to target one thing. They target a certain either depth or color. All lasers understand is color.

So when somebody tells you this device will target a myriad of things as a provider, and we do a ton of lasers, usually my Fridays or my cosmetic surgery or cosmetic days, we do. We do a lot of We do a ton of lasers and we have a myriad of devices. You know that the best devices only target one thing, but they do an excellent job at it. It's like, you know, a car. If you're saying your car can haul lumber, can tow a boat, can also race around the track,

and can also take eight people. And as a sports car, you're like, that doesn't make any sense. It's either a pickup truck or a sports car or a sedan. It's one of those things. Same thing with lasers and energy-based devices. devices. They target a specific part or a color in the skin. So I tend to shy away from things like radio frequency, microneedling when they claim it can do all these things. It probably does a

shitty job at doing all of them. And in fact, the consequences outweigh the benefits, particularly in ethnic skin. Got it, got it. So the classic adage, if you're everything to everyone, you're nothing to me. Yeah, yeah, 100%. Jack of all trades, master of none. So on that spectrum, what have you seen? I'll ask you to sort of come up with your own list. What have you seen? What have you seen before we get to full-on surgery. Yeah, yeah. And that's a spectrum. Obviously, there's like full facelifts, there's little microsurgery that people can do.

Separate from that, what are the biggest bang for the buck when it comes to repairing damage that people might have had from their youth from over sun exposure, maybe crappy diet, whatever else was there? And also too, just the natural aging process that we all go through where we're trying to to bring some of that youth back, which isn't everybody's priority, and I get that, but for the people that it is, what has the biggest bang for the buck that is in surgery? If I were to pick one device and one device only,

and I have no affiliation with any medical device out there, so I'm not speaking with a bias. And most dermatologists will agree with this. If I were to pick one device, it's the fractal device, and it's basically fractionated, non-oblative resurfacing. And this... This... Is it a laser?

It's a laser. Okay. Got it. And we love this laser. It's been around for a long time because it does three things and it does it remarkably well. Number one, it improves sun damage. So sunspots, browns, wrinkling. It improves fine lines and wrinkles by stimulating collagen. And more importantly, at least to me, more recently, we found that it decreases cancer risk when it's done yearly by up to 50%.

And we knew this, you know, for the past 10 years, 15 years that the device has been around, that patients who would get this laser resurfacing done for their face, they had less sun damage, less cancerous changes, and less skin cancer. But now the Harvard study last year validated that in a beautiful study that looked at patients who got fractal treatment and their skin cancer rest dropped by 50%. And how does that work just to cut you off? Or you can add that into your answer. Yeah.

Yeah. So and to go into that, and I can assure you almost every one of your favorite dermin has had fractal or wants to do fractal to their skin. You know, it's the gold standard, in my opinion. The way it works is the laser drills microscopic holes to a certain depth of the skin, targeting a certain region of the skin, without destroying the top layer.

So, and this is the elegance of lasers, is it provides heat-based destruction to a certain depth, targeting, let's say, the sun damage brown spot, the freckles that are from longstanding sun, fine lines and wrinkles as a result of collagen breakdown in that area, while leaving the surface untouched. So you don't have weeping, bleeding wounds

that you used to see from other older lasers, CO2 laser being a popular one in the 80s and 90s and 2000s. Your skin is not raw when you go home. You don't have any open wounds, but your skin starts to peel in the week and you look amazing. If I were to pick one device and only have that, that would be it. And how does it specifically reduce your risk of skin cancer?

Yeah. By targeting that layer of the skin in which sun damage accumulates, it turns that skin over. Okay, got it. So all that damaged skin sloths off within a week. So the skin on the surface now is healthier and younger. And we actually studied this up at Stanford where we took biopsy samples of skin that was treated with these, these, these wavelengths of light and looked at the genes. And before laser treatment and after laser treatment, there was a shift back to more youthful gene activation in the skin.

So it's not just the appearance. It's biologically younger. It's biologically healthier. So it's helping your skin do what it does naturally, just accelerating the process. Yeah, and getting rid of all the gunk that's been accumulated from sun. That's amazing. Yeah.

I love this device. And typically, you know, obviously it'll vary. based on city, but as people are trying to prioritize and biggest bang for the buck, what do treatments cost and how long should they, you know, what's the expectation of how many treatments they should do and over what time period if they're interested in pursuing it? Yeah, treatments, you know, and most docs, I don't know why they don't talk about costs, whereas everything else is transparent. I think it's, I think it's silly. The discussion about costs is it's widely variable, right, depending on what is done, what device is used,

if there's additional things done. But it falls somewhere in the $1,000 range. Maybe it's a little bit more in certain cities. Per treatment or is that like a package? Usually per treatment. Okay, got it. Somewhere around there, maybe $1,200, maybe $1,500, maybe a little bit less,

but somewhere in the $1,500 range. I, as somebody who runs these lasers all day and night, you know, in our practice, I tend not to like packages. I think just treating the patients, seeing how they respond after one treatment a tailored approach is the best way to do it. You may not need a package.

You know, you may come in and say, hey, Doc, I'm tired of looking like this. What can we do? We come up with a tailored approach and we say, hey, let's try one. If you need it again, then we'll do it again at this time point. If you need it again down the line, we'll do it again. But I think kind of a customized, personalized approach is the way to do it. I think packages are very common in things like med spas and things like that. People do Botox.

Yeah, yeah. And that helps the bottom. dollar helps you save a few bucks. But I think when you're doing things like laser resurfacing of your face or kind of these more elegant or complicated treatments, I think, I think it's a one step at a time. And I have no familiarity with lasers besides the fact that I know that my sisters have done them sometimes. I love them, man. So this fractal laser, you know, you put at the top of the list. So that means that if somebody's going to, it's an S. Fraxel is an S. FRAXIL is an S. FRAXIL. Sorry, I said fractal. So one treatment is enough for somebody to see,

a pretty big difference? Yeah, usually it's like once a year, if anything. Last time my wife did it was like two years ago. Great. So you have people spending hundreds of dollars every month on cosmetics that may or may not work. Not that it's either or, but this could be something that somebody might want to consider. Yeah. And obviously what concerns you will dictate what devices used, right?

Like if you come in and say, hey, I'm like, I hate this redness. Every time I'm talking, I'm at a social event, I flush, you know, this redness. bothers me. It looks like I'm embarrassed, but I'm not. I have spicy foods. My cheeks turn red. There's a different device for that. Fraxil will do absolutely nothing for that, but there's a device called the V-Beam laser that I use to treat the redness. So what bothers you will dictate what the best device or treatment option is. And we do a ton of surgery, but what I've noticed is people are falling, especially in the big cities, falling out of favor for things that have a lot of downtime. We live a 24-7 lifestyle. We want our results. We want it immediately and we want

nobody to know that we had it and we don't want it to slow us down, right? And we can't really achieve that. But, you know, a traditional face lift has downtime. The results are remarkable when done right. You look markedly younger, but it's surgery. It's redraping your face. It's making incisions and repositioning things the way they need to. So come with it, the consequences and the cost. Now, I'm not knocking facelifts. I love it. They are an amazing tool. But the younger and younger patients, I think, in my opinion, shouldn't be jumping straight to surgery. I think it's nonsense to have 20, 30, early 40-year-olds coming in for big surgeries. Yeah. Especially with what we know about diet and lifestyle.

all these other things that play a huge, 100%. A huge role in things. You know, on that note, are there other things that are low-hanging fruit? Yeah. That is not a device. Let's go back to lifestyle for a second. Low-hanging things.

Just even like what moisturizer you use or how much water are you drinking a day that are like no-brainers. We're all doing them. But by tweaking it a little bit, you could significantly improve the look of your skin. in over a period of time. Yeah.

So if we're looking at look, I'm going to play devil's advocate a little bit on my own words. Sure. Sun protection takes a little bit of a bigger role. If we're looking for aesthetic improvement or protection, then some form of sun protection consistently is key, whether it's a broad-brimmed hat, whether it's some sort of shade or sunscreen. That's very easy to do. And is that typically correlate with the UV index?

What is your thoughts on that? Yeah, I tend to, I have a pragmatic approach. Trying to avoid the sun day in and day out to make you look younger actually makes you look weirder. You know, so I think obviously midday suns summertime, you want a little bit more protection. I 100% agree. You follow the UV index, look at the weather pattern, look what you're going to do during the day and then decide. You know, I bless my heart, my wife's heart, but she isn't a big sunscreen fan. You know, she just doesn't like it.

She forgets to put it on. You know, she's always lived this. She has all of skin. She's always had the ability to tolerate the sun well. to get this new thing into her lifestyle has been hard. She's like, you know, my skin looks great. Why do I need sunscreen? She's not wrong.

She's on to something because clearly it's helped her this far, but she's only going to get older. She's not going to get any younger. So we make small lifestyle changes. Maybe now that you're going out to the park for baseball, honey, wear sunscreen or wear a hat. You like hats, great. You know, you weren't 20.

You're not going to be 20 forever. Should we clip this and put it on social media with a tagger? Yeah, exactly. That'll be the end. that. But those are simple tweaks that you can make as you see your body change. The other simplest thing is a retinal, a prescription retinoid. Every dermatologist's secret, it's a simple, effective way to improve the quality, appearance, and health of your skin. It's the only medicine that we have, and it's the active forms of a prescription, and I'll go into that in just a second, but

it's the only medicine we have that has been shown to reverse the biologic age of our body when it's applied. It's freaking amazing. And it's just a cream. It originally came up. People put it on at night. At night. Right. And it originally came up for acne. You shouldn't wear it if you're trying to get pregnant or if you think you're pregnant. Yeah. Yeah. So it looks like you're well versed on the retinoids. And the reason for that is the sunlight inactivates Tretanoin, which is the most common prescription retinoid that we give. It's not that you can't wear it in the sun when you get a lot of UV on the medicine, the medicine becomes an inactive form. So you've wasted the efficacy. It's not that you'll have a problem. You should not use it if you're trying to conceive or become pregnant, but that data comes from

the oral version of this cream, which is acutane. There isn't strong data to show that, and the reason I'm saying this is I don't want people who are trying to conceive to all of a sudden freak out because they've been using some retinae and now they're like, oh my God, am I going to have a problem? But because it's the same medicine, same drug, we assume that you will get some absorption from the cream, which means you will have the same consequences. So avoid it during pregnancy or conception time. You can use it while you're breastfeeding. And this is a common misconception. Women think you cannot use it while you're breastfeeding. Absolutely no problem. You can use retinoids all you want while you're breastfeeding. The problem is a developing fetus. It can affect the development.

of a fetus. Got it. Yeah. Another question that I often hear from males and women that listen to my podcast. If they've struggled with really bad acne, I had a little bit of this through a combination of a crappy diet, hormones, other stuff, and actually a dairy intolerance, I had terrible acne all throughout high school. The crazy thing is, is when I left high school and I started my freshman year of college,

I started reading a little bit about how dairy doesn't work for everybody. I got off a dairy and my acne went away in literally two weeks. And I thought, oh my gosh, I just wasted four years because I was drinking milk every day. And that's not the case for everybody, but I think that was the case for me, gut inflammation being tied to acne mixed in with some hormones. But as my skin started to repair, I noticed that I had a lot of scarring. And then I don't know the medical term for it, but there are these little craters in the skin. I, they've gotten a lot better.

And I don't know what I did. I didn't do anything specific for it. I didn't do any treatments for it. Probably had a little bit of, you know, collagen in my diet. But is there anything for people who feel like they have these little craters from having really bad acne back in the day?

And is there a medical term for it? Yeah. What you're describing is a form of acne scarring called ice pick scars. They're like, essentially like an old ice pick that poked your skin. And that's a result of inflammatory acne eating away the collagen and the skin as a result of the inflammation.

And we see this a lot. And there's actually amazing treatments for it. The simplest form that you can do at home is to use a topical retinoid. So topical retinoids improve the appearance of acne scars. They remodel collagen and they increase collagen density in our skin. So at the minimum, I love patients to be on just a cream at night, which is a topical retinoid. Now, if that isn't enough and you want to address this, there are many ways we can treat this. I tend to treat ice pick scars with a technique called TCA Cross,

which is an old school chemical peeling agent that we place in the scar itself. And it stimulates the scar to fill in on its own. Another option for ice pick scars that's great is microneedling. We love micrneedling at a certain depth that stimulates collagen induction. Everything that we're doing, everything that we try to do is just to get your body to fill in that voided collagen to get the skin to come And then fractal laser or ablative, non-ablative resurfacing, kind of resurfaces everything on the second layer and helps improve that tone. So there's a lot of things you can do.

But at the minimum, just start with a prescription retinoid. Great. So we were asking and we were on the topic of low-hanging fruit. Anything else you want to put in that category? You mentioned retinol. Yeah. Yeah. A retinal, a sunscreen, that's like 90% of your regimen.

Then simple things that you can also do, obviously improve your diet. your diet. That's, you know, if you're eating crappy, your skin's going to be crappy. If you're eating clean, you'll see the change in your skin. And then, you know, knowing your skin, if you're oily, you should, you should wash the oil off. You will eventually break out. They will clog the pores in your skin. You'll get blackheads and white heads as a result. So if you're oily, you know, wash that oil off. If you're dry, replace that moisture in a common misconception I hear all the time is, oh, I'm drinking eight glasses of water. I'm like, drinking water has absolutely no bearing on skin hydration. The amount of water you consume will not affect whether your skin is dry or oily

unless you're clinically dehydrated, which most people are not. So just do your normal diet things for fluid intake. But if your skin is oily, clean that oil off. If your skin is dry, you know, moisturize. That in and of itself, some form of some protection, some retinoid and, you know, simple things is more than 90% of having easy access, low-hanging fruit to skin. health. I myself and this is no plug but I do it every day I take my sun powder. It provides the things that sometimes I forget, provides all the antioxidants that I may not get on a busy operative day. It's a way that I can protect my skin. If that's not, you know, if you don't have to pick that, you can pick another form of an antioxidant, take your, you know, multivitamin, provide your vitamin C. If you

like ascentin supplement with that. These are things you can do at home. You don't need to see a doctor for. Collagen. Yeah. Yeah. Collagen. I love collagen. collagen. Collagen used to be, like, collagen was an F in dermatology five years ago. Right. And it's an A now. Yeah. I love it. I think we have it somewhere on our list over here, so we'll bump that up to an A.

Yeah, I love it. And it's because of the amount of studies that have come out on it. Yeah, the amount of studies, and we're understanding, okay, there's a few things. Collagen itself is made of three amino acids that are non-essential, meaning your body can produce these amino acids with just any diet. So for many years, you know, scientists, physicians were saying this is non-essential. Your body can make collagen even eating a pure carbohydrate diet. So supplementing is useless because our body can make a ton of it.

We found a few things. As we've gotten more and more into 20 and 21st century, restrictive diets, fad diets are much more popular. People don't consume the same diets that we used to in the 50s and 40s, which was a little bit more umbrella-like. and we found that protein collagen consumption and just overall diet quality is poor. So when we've looked at recent studies over the last five years, including randomized studies that gave patients collagen supplementation versus not, there was a measurable improvement in the quality of their skin. And one thing we didn't account for is that when you consume collagen, water comes with it.

You get intracellular and intravascular water uptake. So your skin actually plumps up more. You look a little bit more hydrated. We call it the uncotic pressure of our blood or the osmotic gradient goes up, so it draws water with it. So there is a measurable improvement. Collagen is easy to take. It's usually very well tolerated. It's very cost effective.

So it's become a really popular thing that a lot of people recommend. Now, most of the time, our bodies can absorb five to 15 grams. The rest of it actually is pooped out, and you can measure it in the stool, the amount of collagen you consume, and you measure the stool output. And most of it's in the poop. So you don't need as much as you think. But collagen is great. The other problem with collagen is it's a large molecule. It doesn't cross the gut very easily.

So forms that are broken down, we call collagen peptides or hydrolyzed collagen peptides are much more bioactive and absorbable. It's actually one of the reasons why that's the form we have in sunpowder. But you want a form that's easily absorbed and you also want to have it with vitamin C because you can consume all the collagen in the world. But if you don't have a form of vitamin C, Most people, you know, have a diet that will, you know, have the daily recommended amount. You can't remake that triple helix.

The way collagen works when you consume it is your body breaks it down into the letters. And then your body will reform the sentence that is the collagen triple helix. So you need that vitamin C. But I love it. Great product. I take it myself. Fantastic. Yeah.

You know, on the, so we talked about the lifestyle things. Yeah. Just as we're winding down over here, touching back on the screening aspect. Obviously, you know, find a dermatologist, somebody that you can go to. Yeah. It's a non-invasive exam. You know, they're going to check you out. Is there anything else that you can do or if people have done there?

Because you mentioned that so much of skin cancer is genetic, family history, hereditary. Is there anything in our typical genetic screenings? A lot of people have 23 and me. They have all their stuff. Is there anything there that people can be looking at to look at their risk of skin cancer? So that's, so I want to digress and make a couple points on this. Family history, genetic history is one of the largest implicating factors in skin can't. And that doesn't mean that Dr. Soleimani said, son plays no role.

Go outside and burn all you want. Obviously, be son smart. Don't burn. Just, you know, be cognizant of the fact that too much UV will increase your genetic predisposition. But that doesn't mean we should be sun avoidant. So you can enjoy the sun. wisely. That's number one. Number two, and I emphasize this all the time because I see such bad cancers

and things in patients that could have been caught earlier. You know your body better than any doctor does. You know your intuition, your second brain, which is the nervous system in our gut. It's the same reason why you get like a weird feeling when something bad is about to happen. Your gut intuition will tell you that something is not right better than any doctor. So if you feel you, you feel you, you like something is off, don't be blown off by your dermatologist, your primary care doc, your orthopedic surgeon, what have you. I see this all the time where patients come and say, hey, I'm not sure about this and say, oh, it's nothing.

Fast forward five years, it's been neglected. Now there's a wonking something that shouldn't have been there. So if you don't feel comfortable about it and you didn't like the way your doctor approached that, seek a second opinion. You're not insulting anybody. You're advocating for your health. And in the United States particularly, we have

to advocate for ourselves more than any other time in our lives. So that's one important thing. You know yourself better. The other things that I would say, you know, things that you want to watch out for, most common things is a pimple or what looks like a bug bite that doesn't heal in a month. That's a first sign that you should see a doctor. One month is our cut off from things that are inflammatory, acne, zit, mosquito bite, etc. They should go away within a month. After a month, then we start to think, could this be a skin cancer? Could this be something that shouldn't be there? So a pimple or bug bite that doesn't go in a month,

something that bleeds easily, that's the most common presenting sign for basal cell carcinoma's patients, you know, wash their face and they see a spot of blood on their nose or a spot of blood on their cheek. And they haven't really done anything for it to bleed. And then the third is a newer changing mole. So if you see any of those things, these are fundamental screening things that you can do at your house

before you even seek a doctor. If you notice any of those things, go see your doctor, go see your primary care, go see your dermatologist. In terms of genetic screenings, when we talk about genetics, we look at, traditionally we talk about what's called Mendelian genetics, meaning the genetics that are inherited predictably from mom and dad to children, blue eyes, you know, height, things like that, things that are, okay, if you have, I don't know, red hair and dad has red hair, you have a 50% likelihood of get it. The problem with cancers is it doesn't follow Mendelian genetics. It doesn't follow hereditary

patterns. I loved 23 and me. And I say it in the past tense because a lot's changed way back when I was up north. I did 23 and me. And I got a bunch of data that was meaningless at the time, except the fact that I can explain to my wife why I drink six cups of coffee a day. But other than that, other than that, it didn't provide much. And I don't really drink that much. But you get my point. That testing for cancer Genetics is convoluted. It's really complicated. It's all over the place. There's question about penetrance, cancer

genetic expressions, incomplete penetrance, things like epigenetics that play a role. When we talk about cancer genes, we talk about things like the common people think about BRCA, breast cancer, BRCA. That's a hereditary gene that if you have

almost guarantees that you're going to get breast cancer or ovarian cancer. We talk about the retinoblastoma gene, the RB gene. If you have that, you're likely going to get a retinoblastoma. It's what you see in kids when they take a picture of their eye and one eye looks a different color in the old polaroids. You just say, oh, you know, most cancer genes aren't that hereditary like that. So to go and seek a test for skin cancers,

with the exception of a few rare conditions, is unlikely to be fruitful. Don't waste your money. Yeah, you're better off just going to a standard. Yeah. Yeah. And you would know if you have the genes. genetics already. You mom had it. Mom's mom had it. Mom's sister had it. You're like,

okay, there's something there. I haven't tested the gene for it yet, but I know my family lineage has it. There's melanoma has two or three genes that are really important like that. And then basil cell has another genetic group that's like that. But aside from that, when we talk about family history, it's a whole myriad 200 plus genes that are implicated in this that are passed down in not well understood ways. But Just simple pedigree, looking at your family. Hey, dad's, dad's on his sixth cancer on his ear. Dad's dad had it.

You know, I burn easily. So you're like, oh, shit, my family history is like, I'm likely going to get something. Important, important. Yeah, 100%. Dr. Teo, this has been fantastic. Yeah, man. You've covered so much here.

And most importantly, I want to acknowledge you because not only are you a wealth of information. I appreciate that. From both understanding the evidence-based, but also something that people, don't often remember is that part of evidence-based medicine is clinical experience. And you're bringing all your clinical experience. I appreciate that.

To the table, especially when it comes to some of these more controversial topics, like seed oils and other things that are out there. And some of your other, you know, takes that sometimes go against the grain of what people talk out there, but you have the experience to back it up. So you've brought that evidence space, your clinical experience, your understanding, and you've packaged it all with the fact that you're a great, communicator who also has good skin. So shout out to you and your genetics. Thank you. And you've made it all easily to understand and made it super digestible for an audience today for a

topic that, you know, the truth is that people find themselves going on all these sorts of wild goose chases. Yeah. They spend a lot of money or they get caught up in the marketing of stuff. And that goes on both sides of it. It could be somebody in the health space saying, I don't worry about the sun ever. When the truth is we've all seen that, you know, you have one summer where you've spent a lot of time in the sun, even if you're super freaking healthy, you're like, wow, my skin has aged. Yeah, and I'm young and I'm healthy. So we have to be smart about it based on our goals that are there. And you've definitely helped us do that contextually in today's conversation. So thank you so much for that. I appreciate that, man. I know our audience is going to be a

huge fan of yours. Thank you. After listening to this episode, where is the best place for them to follow you? Where are you most active? I appreciate that. I have a small social media presence. it's Teosolamani MD on Instagram. We have a practice website, which is CDMS or California Dermatology and most surgery specialists. You can find us on our website, which is just California Dermatology.com. Pretty straightforward. But anywhere, you guys can message me, email me. Everybody has my phone number.

My patients have my phone number. So you guys can call or text. I will try my best to respond to everybody. But I say this all the time. My goal, my role will always be to be a doctor first. you know, my practice, you know, my group, we see 250 patients a day. And we will always be centered on patient care, myself, particularly in skin cancer, skin damage, surgery, and things like that.

And I think there's a lot of information out there. There's a lot of data out there, but not a lot of information. And the problem with data is you can chop it up in any which way you want to get the message that you're trying to push across. I mean, we didn't even talk about the most common things like, you know, Botox and things like that that people spend a lot of money on. There's so much to talk about. But I think to look at an overarching picture, look at what happens to patients in real world settings, and then say, hey, maybe we shouldn't be heavily leaning on this side. Maybe we shouldn't be heavily leaning on this side.

But somewhere in the middle and picking a step this way or that way to optimize our health is the right way to do it. We've skewed so far on one side in health care in the United States in general that we've replaced common sense things with a pill, a prescription, a surgery or a device. And I don't think we need to do that. Well, said. Well, once again, thank you. Thank you. For being on the show.

Thank you. Thank you. Thank you. I, everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me.

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