Pursuit of Wellness - Skin Cancer (The Truth) w/ Dr. Teo Soleymani: Prevention, Detection, and Skin Health

Episode Date: December 2, 2024

Ep. 155 On today’s episode of Pursuit of Wellness, I sit down with Dr. Teo Soleymani to dive into the complex world of skin health, aging, and cancer prevention. We unpack the misconceptions about skin cancer, the role of our skin in reflecting internal health, and the surprising effects of diet and lifestyle on skin quality. Dr. Soleymani shares invaluable advice on sun exposure, the pros and cons of different sunscreens, and the impact of products like Melanotan and retinoids on skin health. We also explore how common issues like acne and premature aging relate to factors like hormone mimickers and pore-clogging ingredients. Whether you’re looking to protect your skin or decode your acne journey, this episode is packed with essential tips and insights on taking care of your skin for life. Leave Me a Message - click here! For Mari’s Instagram click here! For Pursuit of Wellness Podcast’s Instagram click here! For Mari’s Newsletter click here! For Dr. Teo Soleymani Instagram click here! Sponsored By:  Save time and money by getting it all in one place with Thrive Market. Go to ThriveMarket.com/pow for 30% off your first order, plus a FREE $60 gift! That’s ThriveMarket.com/pow.  Bite is offering our listeners 20% off your first order. Go to trybite.com/POW or use code POW at checkout to claim this deal. That’s trybite.com/POW. Control Body Odor ANYWHERE with @lumedeodorant and get 15% off with promo code POW at LumeDeodorant.com! #lumepod Visit clearstemskincare.com and use code POW at checkout for 20% off your first purchase. Again, that’s code POW for 20% off your first purchase on clearstemskincare.com. Show Links: Sun Powder  Topics Discussed 00:00:00 - Introduction  00:01:39 - Welcome Dr. Teo Soleymani 00:02:34 - Dr. Teo’s background 00:04:10 - Recent changes in skin cancer research 00:05:54 - Skin being a marker to what’s going on inside 00:06:37 - Biggest misconceptions around skin cancer 00:10:28 - Preventative measures 00:15:29 - Treatment and fatality rate of melanoma 00:18:20 - Checking your own skin 00:20:12 - What is a mole? 00:21:47 - Melanotan and spray tans  00:26:46 - Thoughts on sun protection 00:33:40 - What to avoid  00:34:50 - Thoughts on tallow 00:36:33 - Different sunscreen for face and bod 00:37:40- The sun and premature aging 00:39:43 - Diet and water’s effect on aging 00:42:23 - “Beard Distribution” of acne in women 00:44:06 - Overcleansing and “fungal acne” 00:46:32 -  Stanley mouth 00:47:47 - Pore clogging ingredients 00:50:28 - Figuring out your skincare routine and retinol  00:55:22 - The “purge” 00:57:11- Ozempic Face 01:01:20 - Ozempic and acne 01:05:25 - Preventative care and artificial intelligence 01:08:01- What wellness means to Dr. Teo

If people go through a bad divorce, bad breakup, their hair falls out. Their skin doesn't look the same. Women who are pregnant start to get this glow. It's not just a look, it's an actual change in your skin biology. So, the skin's an amazing organ that will tell you in real time, oh, something's going on or something is not right and no other organ can do that. This is the Pursuit of Wellness podcast and I'm your host, Mari Llewellyn. Hi guys, welcome back to the Pursuit of Wellness podcast.

Today I sit down with Dr. Teo Soleimani to dive into the complex world of skin health, aging and cancer prevention. I am so happy we did an episode on this. I have melanoma in my family. It's something I'm aware of, but I really don't know how to avoid it or what I can do. And he was so knowledgeable. We unpack the misconceptions about skin cancer and the role of our skin in reflecting internal

health, the surprising effects of diet and lifestyle on skin quality. He shares invaluable advice on sun exposure, the pros and cons of different sunscreens, and the impact of products like melanotan and retinoids on skin health. We also explore how common issues like acne and premature aging can relate to factors like hormone mimicas and pore clogging ingredients. Whether you're looking to protect your skin or decode your acne journey, this episode is packed with essential tips and insights on taking care of your skin for decode your acne journey. Dr. Tao, welcome to the show. Dr. Tao Tse-Kiang, MD, M.D., M.D.

Thanks for having me. You have a very impressive resume. Let's see if I can get this correct. You are a Stanford-trained, double board certified dermatologist and fellowship-trained skin cancer and facial reconstructive surgeon. Sounds better on paper than in real life, but yeah, thank you. No, this is very impressive and I'm so excited to dive really deep on skin today. I've done a few episodes on acne and aging, but I really, really want to discuss skin cancer,

sun exposure, sunscreen. I think all of us are aware that skin cancer is dangerous and something we should avoid. And I think people are more aware of it now than they used to be. But I still think there's a lot of misconceptions. And I think even I have misconceptions about it. So I really want to dive deep and learn.

Totally. Let's start with just how you became interested in this field. How did you find dermatology? So I had somewhat of an unusual route, which I realized isn't as unusual as I thought it was. I started in brain surgery. So my training was originally geared towards neurosurgery. And I think it was like, I was 28 hours into the hospital and I realized I wanted to have a family more than I wanted to be in the hospital and no knock to any neurosurgeon out there. but it just wasn't conducive to what I saw my life to be. So at the time, I decided to make a career change and I picked a specialty that would be the furthest

from being in the hospital, which became dermatology. And I was fortunate enough to go up to Stanford to do my training, but while I was there, I still got really interested. I always liked cancer biology. I always liked working with my hands. I felt like I was pretty good at surgery. So that kind of resonated and continued in my like mindset as to what I wanted to be. But one thing I noticed being, you know, going through med school is whenever I'd go

to a family event or like a gathering, nobody ever came to me and said, hey, what does my like liver look like? They would always point to like, can you take a look at this? And can you take a look at this? And can you take a look at this? What do you think this growth is? I'm like, you know, I have a lot of Derm questions.

Why don't I like decide on dermatology? And I think it was the best thing that ever happened because it's such a cool organ. And it's probably the last specialty in which you can do a lot of things. So I'm very, very lucky to practice what I practice and in the city that I practice. Since you started to now, what have you noticed has changed with skin cancer research? So the skin's an amazing organ, right? I think it's the only organ that will tell you in real time

if something is going on with your body whether it's your physical health or your mental health or your psychosocial stressors I think there is an alarming rate of skin cancer in young adults. I see probably in my practice a dozen patients a week that I operate on under the age of 30 and This wasn't the case even 20 years ago. The adage that this is all a problem of elderly or a problem of aging adult populations is no longer true. And in our generation, people aren't tanning the way they were in the 70s,

80s, 90s, so there's something else we haven't pinpointed yet. we're in the 70s, 80s, 90s, so there's something else we haven't pinpointed yet. And I think eventually there will be a big connection between environmental factors, diet, gut health, all of these things that will show itself in the coming years. We used to say it's a problem of people who laid out on the beach, which it still is to a certain extent, but it doesn't account for my patients who are 18, 19, 20, you know. And in fact, my deadliest forms of skin cancer are usually in young adults in sun protected areas. So that's an area we just don't understand very well. And there's a lot of research being done as to why that is.

So, okay, I'm thinking of of Chloe Kardashian as a standout example. And it was kind of cool how she publicized and it was on her face. Correct. Yeah. I think it was really cool how she publicized that. I also just want to touch on, you mentioned the skin is a really cool organ because it's one of the only organs that shows us when something's wrong. And I personally went through a 10-year acne journey that I couldn't

figure out, but my skin was repeatedly telling me something's wrong. And it was just a really interesting experience because obviously it was like awful to have such bad acne for so long, but when I finally got to the reason, it was H. pylori. My listeners are probably tired of me talking about H. pylori, but I just think it's really interesting because if I had not had the acne, I would not have gone to the extent that I went to to find out what was going on in my gut. So I do think that's a really important point. What would you say are the biggest misconceptions with skin cancer?

So I mean, before we even hone in on skin cancer, what you mentioned about the skin and being a marker is what's going on inside is 100% true. I mean, just the simplest thing, like kids in college during finals, and when we talk about skin, we gotta talk about hair and nails, because they're all connected,

they're the same organ system. Kids in finals will come to my practice with their hair falling out in clumps. The hair is an excellent biosensor of all the stresses in your body. People who have gut infections exactly like what you mentioned, I have a patient right now who's a very close family friend who has been dealing with very refractory hives head to toe. And H. pylori was one of the culprit. Yeah. So there's a huge, huge connection

between the gut microbiome, the gut immune system, and then the skin's response to it. So it's all about kind of immune homeostasis and wellbeing. If people go through a bad divorce, bad breakup, their hair falls out, their skin doesn't look the same. Women who are pregnant start to get this glow. It's not

just a look, it's an actual change in your skin biology. So the skin's an amazing organ that will tell you in real time, oh, something's going on or something is not right. And no other organ can do that. In regards to skin cancer, I think there's a lot of misconceptions. One, it's not a problem of the elderly. In fact, most of my patients who die of melanoma, which is historically our deadliest form of skin cancer, are young adults. It's the second most common cause of death in women ages 25 to 35.

But nobody ever talks about that. It's not just son related. I get this misconception all the time. The majority of melanomas that I see in young adults are in sun protected areas. There's other causes things like HPV, things like environmental triggers, like people who drink from well water. So why I bring this up is unfortunately in dermatology there's a lot of fear-mongering and I don't want to say fear-mongering but there's a lot of fear-mongering and I don't want to say fear-mongering, but there's a lot of

There's the sense of making people feel guilty that they brought this upon themselves or they did this that one time you went to the beach You didn't wear sunscreen. That's the cause and it's it's not true. I enjoy the Sun. I'm a skin cancer surgeon I'm outside with my kids all the time. Do I burn? No, I try not to but I also know that's not the only culprit. Probably the biggest thing that people don't look at is just your family history. If you have a strong family history, maybe you should take some additional forms of protection. If you don't have a strong family history, maybe your genetics tolerates a little bit more UV exposure and other things, but definitely misconceptions are young adults are not implicated. That's not true.

Sun is the only cause. That's not true. Okay. So those extra measures, I'm kind of coming from a personal standpoint here and I'm hoping people listening can relate. My mom had melanoma and had to have it removed on her back. And like you said, she blamed herself because she was like, oh, I used to, she lived in Portugal as a kid. She was like, I used to lay out on the tin foil thing with the oil. And, you know, I think she did probably lay out in the sun too much, but there definitely is some like shame connected with it. And I went through a phase and I'm going to put my hands up and say,

I went to tanning beds probably for a year straight in college. I've done it. I've done it. It's my biggest regret. We didn't know any better. I went to college and everyone there was from New Jersey. Everyone did it. And I was like, oh, I guess.

Everybody wants to be tan. Yeah. And I'm from the UK. I'm not a tan person. So I was like, this makes me look better. I'm going to go. But now I'm pretty paranoid about melanoma. So I go to the dermatologist. I get full body skin checks

What other things should I be doing to couch it early if I get it? So more likely than not your mom's Melanoma was probably not purely driven from the Sun because it was on her back if it was purely Sun related usually we see it on the head and neck or areas of chronic sun damage. So that's one What is worrisome is usually those melanomas have a strong hereditary components. You have probably an increased susceptibility, so you're doing all the right things. Okay. Obviously, don't burn when you're out in the sun, but you can enjoy the sun.

There's a component of being outdoors that makes you feel well that translates into actual physical wellness. So if you're outside, you're being healthy, you're being active, that gives you a sense of wellness and health that I can't measure in a test tube per se, but you're obviously healthier, so it's good for your overall well-being. Additional things that you can do aside from surveillance, aside from sunscreen, you know, there are supplements that reduce your skin cancer risk. I like nicotinamide. It's a know, there are there are supplements that reduce your skin cancer risk. I like nicotinamide. It's a supplement that's been shown to reduce your non melanoma skin cancer risk by up to 30%.

There is a supplement called polypodium leukotomus, which is a from a fern in the Amazon rainforest that you can take that will reduce your chance of burning while being out in the sun. So you can be outside longer before you need to apply or reapply. I personally take a product called Sun Powder that has all that in that, something I formulated originally for my patients, but just being somebody based in Los Angeles, sun is 24 hours, 365 days a year. So it's sometimes impossible to protect yourself or reapply for swimming, surfing, things like that.

Aside from that, being proactive is the number one thing you can do. Surveying your own skin. You go to the dermatologist maybe once a year, maybe twice a year, right? That's two time intervals. Simple exams, looking at your skin, having a significant other or somebody that can help you out survey your skin is really, really powerful. Early detection, just like any other cancer, whether we're talking about breast, colon, prostate, skin, early detection is what dictates good outcomes.

So one, the guilting thing sucks. Your mom didn't do it to herself. And even if she did have some son, it was in an era where we didn't know any better. Number two, I think if you catch it early, and hopefully she did, the outcomes are phenomenal. Now, some people unfortunately will succumb to skin cancer. It's just a dark reality that we have.

But unlike looking at your lungs or looking at your liver or looking at any other organ system where you can't really see it, the skin will tell you right away, hey, something's here that shouldn't be here. So just being proactive is really, really important. Greg and I are both very particular with the ingredients and foods we have in our house, and sometimes the items we're looking for are a little bit niche. And that's why we love Thrive Market. We've been using Thrive Market for years now. It's absolutely amazing.

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And that is why Bite makes dry toothpaste tablets made with clean ingredients that are sulfate-free, palm oil-free and glycerin-free. The bits are so convenient, you just pop it in your mouth, chew it up and start brushing. It will turn into the paste you're used to, but with no plastic tube or messy paste. Plus they come in refillable glass jars and send refills in compostable pouches. So it's better for our bodies and the earth. Byte is offering our listeners 20% off your first order. Go to trybyte.com slash pow or use code pow at checkout to claim this deal. That's t-r-y-b-i-t-e.com slash pow. You mentioned the fatality rate of melanoma, which obviously is like a dark topic, but just to, I guess from my own ignorance, I don't understand if someone has melanoma and

it's bad, is that because they didn't catch it early enough? How do you determine when it's bad? And then do they go through the same treatments as someone with regular cancer? Do they do chemo? Great question. So when we talk about skin cancer, there's generally three main forms. There's basal cell carcinoma, squamous cell carcinoma, and melanoma.

For every one melanoma, melanoma has been historically our deadliest form, but it's also one of the more rare forms. So for every one melanoma, there's 10 of the non-melanomas. So in the United States alone, about one in four Americans will develop either a basal cell or a squamous cell carcinoma. Melanoma, the average number of patients that dies one every 52 minutes in the United States. Nobody ever talks about that. Now, the good news is that trend is it's down trending, partly because of the development of what's called immunotherapy. It won the Nobel Prize in 2018 in the way we treat cancer. And it started from skin. And now we use it for every cancer under the sun, colon,

breast, lung, kidney, you name it. But it changed the way we treat patients with melanoma. And the good news is we see the death rates decreasing more and more. Is it because we didn't catch it early? Partly. But there are some melanomas that are just really unfortunately bad players. They just, from the time they start

to the time they spread throughout the body can be as short as a month. Now, importantly, melanomas fall in second in line in the United States to skin cancer deaths. The number one thing has become squamous cell carcinomas and people don't talk about that either, but that's about a death every 40 minutes in the US. Wow.

And that's much more heavily sun related, but fortunately not a problem of young adults. It is something that is chronic and requires a lot of accumulations of sun damage for it to develop. So if usually you can pick that up before it's too late, unlike sometimes melanoma. There's been a lot of very well-known celebrities, very well-known athletes that are dealing with melanoma, including metastatic melanoma. So everybody from Bob Marley to Jimmy Carter, Bob Marley famously passed away from melanoma. And Jimmy Carter is kept alive because of those immunotherapies.

So a lot to unveil in the skin world. And I don't want to bring fear into people's minds, but it's an easy organ to check. So just get it checked. When you check your own skin, I think something that I get confused about is what constitutes as melanoma. Like how do you know? Does it always look like a weird shape? confused about is what constitutes as melanoma? Like, how do you know? Does it always look like a weird shape or like, what should you look for?

Simplest things. There's all these like rules, the ABCDs, et cetera. The simplest things is if you have a growth that doesn't heal in a month, the one month is a cutoff between something that was like a pimple or a bug bite or an ingrown hair to something that should probably be checked. So if you develop something that doesn't heal in a month, if you develop something that bleeds easily, those are the first two signs of skin cancer. Now for melanoma, melanoma historically has been what looks like an ugly mole. So when we talk about moles, finding a melanoma, melanoma historically has been what looks like an ugly mole.

So when we talk about moles, finding a melanoma is like playing where's Waldo. Right? You have a field of normal moles and you're looking for that bad player. The things that you want to look out for historically have been the ABCDs that we talk about. So if you have a mole that's kind of asymmetric, you can't fold it upon itself evenly. If you have a mole that has multiple colors, if you have a mole that's kind of asymmetric, you can't fold it upon itself evenly. If you have a mole that has multiple colors, if you have a mole that has irregular borders, if you have a mole that's large, so we say a number two pencil tip eraser. But my biggest one

is the E, which isn't even in the ABCDs is evolution. So if your mole is changing, you have a new growth that wasn't there before, you have something that was stable and is now changing shape or color, you should get that checked. Now young adults can develop new things up until around age 35 to 40, but that doesn't mean you get a carte blanche to say, hey, that doc said up until 40, I can make new things. But generally our skin is a little more dynamic. And then after around 35 to 40, we shouldn't really be making new moles.

So anything new, there's that evolution part, should be checked. What is a mole? Like, what are they? That's a great question. A mole... I've never thought about that till right now. I don't know if I've ever been asked that. So a mole is a collection of cells called neva cells.

They are like the cells that produce the color in our skin. They're a derivative of those cell lines that cluster together in the skin. They usually look as a brown bump that's been there since childhood or early adulthood. They tend to be hereditary as well. So if mom or dad was moly, you may be moly. What's important to know is that almost 90% of melanomas don't arise in an existing mole. They arise in normal skin.

Why we make a big stink about moles is that melanomas look like moles. So only 10% arise in existing moles. That's why being proactive, having somebody look at your skin and say, okay, I remember that mole on the shoulder. That's always been there. I remember that mole on the belly. That's always been there.

And then looking for change over time. Hey, that one on the upper back wasn't there before. What is that? That's how you detect it. So there's the where's Waldo game to play. But moles are usually just a beauty mark. wasn't there before, what is that? I don't know why I thought that. A lot of people think that. Almost 90% of melanomas arise in normal skin. Have you heard of this stuff?

I don't know the scientific name for it, but I remember there was a kind of phase of it being popular when I was in college of melanotan. Oh, yeah. Do you know what that is? Yeah, yeah. So melanotan and melanotan 2, which it's come back, is this hormone mimicker that mimics

a hormone that's released from our pituitary that increases the amount of cells that produce our skin's color. So women and men snort this. Snort? Yeah, they snort it to spray. They spray it up their nose. It used to be a pill, it wasn't very effective. Then they made it an injection, but it wasn't very effective. So the quickest way to your pituitary, which is right like sitting in the

center of your forehead area, is through the nose. So they snort this artificial hormone in hopes to stimulate the brain to release more of the natural hormone to produce our skin's color. To be more tan. Yeah, to be more tan. There's a lot of problems. I mean, I wouldn't start anything to begin with, let alone something to tan you. I mean, there's easier ways just put on spray tan. Yeah. There's a lot of consequences because it mimics a few other hormones that are really important in blood pressure control, really important in salt management and hydration status. So those often overlap.

And we've seen a lot of consequences in young adults, especially in Australia and a little bit in Northern Europe countries, Northern European countries, where patients have had bad outcomes. Now there's been a couple of reported cases of melanoma developing from them. I don't know how often they used it,

but you can theorize if you're snorting this stuff a lot, your body just doesn't know when to tell the skin cells to stop growing and they turn bad. But I just I wouldn't recommend snorting anything for skin color. Yeah, that sounds really sketchy, honestly. It's just crazy. But people do anything to be tan. Listen, I can relate. I love to be tan, but I went through a major spray tan phase. Now I put self-tanner on. Maybe it's not the best thing ever for my skin, but like, you know.

You know what's interesting? I see this a lot. Patients who are tan come to my office asking to get lighter. No. And patients who are from fair skinned ethnicities, fair skin countries, always want to look tanner. We always want what we can't have. The grass is always greener. And the stuff, 100%. And the stuff we try to do is just crazy.

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Please support the show and tell them we send you. You guys know I am so particular when it comes to skincare. I'm very acne prone, very sensitive, and that's why I love ClearStem. It is the first skincare line that combines all three categories, anti-acne, anti-aging and clean, meaning free of hormone disruptors and pore clogging fillers. Danielle and Kaylee are the founders and good friends of mine and they have both had acne in the past as well, so they really get it. They know what ingredients should and shouldn't be in these products. Some of my favorite are the Gentle Cleanser, the Lip Balm, the Body Lotion. I also what ingredients should and shouldn't be in these products. Some of my favorite are the gentle cleanser, the lip balm, the body lotion. I also love the shampoo

and conditioner because I feel like it's not triggering my skin and getting in my pores. And I also love that they have the acne lab test on their website, which is helping thousands of people get to the root cause of their acne through comprehensive lab testing and lifestyle based recommendations. So sunscreen. I feel like this is very debated slash controversial. I've crazy. I've had different guests on the show. There's this trend of like, you know, carnivore lifestyles. And I feel like those people tend to be more sun exposure, no sunscreen.

They just put tallow on their skin. That's like a movement right now of people who don't believe in sun protection. But then I have skin experts on the show who are super pro sunscreen. Which camp do you fall in? Okay. A lot to talk about here. In my practice and in the area of practice, I see a lot of complex and high-risk skin cancers. I've developed a reputation for treating some of the worst and the worst in Los Angeles. There's a lot of things about sunscreen that should be considered true and a lot of things that should be questioned.

So first and foremost, and I'm going to get a lot of heat for this. I know it There has not been a single study to date that shows that if you diligently put on sunscreen every day it Decreases your chances of dying from skin cancer That's number one Number two the most common form of skin cancer, which is basal cell carcinoma, almost one in three Americans, fair skinned individuals will develop it. In every single study we've looked at diligent sunscreen use versus no or minimal sunscreen use.

There has not been a change in the incidence of basal cell carcinomas developing on sun-exposed skin. Wow. So why do we push for sunscreen? There's two reasons. One, we know it protects against premature aging. So if you just want to look good, you want to protect yourself from looking like a wrinkled leather bag, you should wear some sunscreen. Number two, it does decrease the incidence of some garden variety skin cancers, namely some melanomas and some squamous cell carcinomas. But the jury is not out yet as

to whether that makes a difference in survival. That's a totally different thing. Now, sunscreen is a regulated drug in the United States. It's considered an over-the-counter non-prescription drug. So the FDA regulates it, unlike other countries. So the US is a little bit slow in putting out new compounds that will provide sun protection. There's been a lot of discussion over the past five years about chemical sunscreens and what they do to our bodies. Before we even dive down that way, that path, we know for babies, six months and younger,

historically the stance from the American Academy of Pediatrics and the American Academy of Dermatology is that we don't recommend chemical sunscreens for babies because baby skin act like mucus membranes, like the inside lining of our mouth and they absorb what you put on. So for the past 20 years we've not recommended chemical sunscreens for babies. Now in the original FDA approval for sunscreens that came out in 1999 there was about 19 chemicals that we had originally considered generally safe and effective. All that's changed in the last three years. The majority of those chemicals are now questioned to be no longer generally

recognized as safe and effective. There is a really publicized study that came out two years ago that showed that with even one application of a chemical sunscreen, when we drew patients' blood, you can see that chemical at 500 times the upper limit of what's accepted as normal. Oh. So there's a lot of data and a lot of people questioning what the hell are we doing? What are we putting on our skin? Do I wear sunscreen? Yeah. Do I forget to apply? Yeah. Am I a typical guy with kids? Yeah. So I tend to like mineral sunscreens better. If not that I am against chemical sunscreens, but there is enough smoldering data questioning the safety of some chemical compounds as endocrine disruptors, hormone mimickers, and very minimal to no data for the minerals. So if I have to pick between the two,

I'll just pick the mineral. Now, I know the application under makeup, the feel, the grittiness all play a big role as to whether you're gonna use it or not. The simplest recommendation I get in my office, they're like, what sunscreen are you gonna use? I say, whatever you're gonna put on, because it's gonna be a glorified paperweight

if you buy it and you don't use it. If I were to pick though, I pick mineral sunscreens. I like zinc or zinc and titanium. They do provide better broad spectrum coverage. They last longer. There's no endocrine or chemical mimicker of our body's messaging molecules. But if you're not going to wear it, I think chemical sunscreens are okay. There are a few that I would avoid.

Octocrylene, some of the oxybenzones, avabenzones, I tend to avoid those. Not only are they maybe problematic, they're well-known contact allergens too. My wife has an allergy to all the avabenzones and cinnamates. She has an intense one to octocry She is a intense wonder octocrylene Yeah, so octocrylene is notorious. It's actually banned in Europe. Oh Because the breakdown product of octocrylene in the Sun is benzophenone, which is a well-known carcinogen. So Octocrylene. Yeah, I know and we considered it safe and effective because we thought that when you smeared it on your body Yeah, I know. And we considered it safe and effective because we thought that when you smeared it on your body, nothing would happen until that study came out showing, oh shit,

we can detect it in the blood at way higher levels. Now, the other thing is we didn't have sunscreens, really effective ones 25 years ago. Now that we have them and there's a lot of pushing for them, people start using them at a younger age. Let's say you start at 18. By the time you're 58 or 68, that's 50 years of daily application of something. Yeah Surely there's got to be something that's gonna go awry and some patients maybe not all maybe a small subset The other thing that I found is that Shade and not found. I mean the evidence points to it shade clothing physical barriers will always outperform Anything you smear on your skin?

Majority of the United States doesn't even apply the right amount. I mean you got to put a shot glass of sunscreen on to be adequate and I don't do that most of the time and I'm I Should know better. I just I'm in a rush. Usually my kids are running around I'm like, let me just not burn. Let me get out there and take care of them. So there's a lot of variables to sunscreen. Do I think you should wear it? Absolutely.

Do I think it's the only way to protect your skin? No. Do I think there's good ones? Totally. Do I think they're bad ones? Totally. I don't want to get you in trouble. No, no trouble.

Can we say like what brands should we avoid completely? I don't know about brands because there's so many brands out there all the time. I tend to avoid chemical sunscreen. So when you look on the back and if you go to a store, about 90% of the sunscreens available or readily available at pharmacies, places like Sephora, Alta Beauty, whatever, are chemical sunscreens. What's the chemical? There's Avobenzone, Oxybenzone, Octocrylene, several other chemical sunscreens. Those are the three most common ones that I see.

What you want to look for is zinc or zinc and titanium. A lot of the products that are made to go on really nicely a little more elegantly Tend to have chemicals or chemical boosters for that feel. Yeah zinc and titanium unfortunately can feel a little gritty Okay. Have you heard of the brand? Sol and sky Is that what it's called? Yeah, I don't think I have. Okay. It's new. And I'm curious what you think about it. I'll show you afterwards.

But it's new beef tallow zinc. Interesting. Very simple sunscreen. And I'm curious what you, I would put it on my body. I'm scared to put tallow on my face. So I'll tell you a few things. I'm fine with putting tallow on so long as you don't have acne. See, yeah, I'm so acne-prone.

I think tallow is fine as a mediator. It behaves almost the same way as petrolatum, like Vaseline or Aquaphor. You can't put it on acne-prone skin. It clogs your pores. You break out. If you don't have that history, I'm fine with it. What is more important to me is the active ingredient.

So zinc is great. I mean, people formulate their own sunscreens at home. The problem with that is having a good sunscreen requires some actual science. You have to check what's called the minimal erythema dose or simply put how red your skin gets in a certain amount of time. So to be able to test for that's not that easy. And most of the time when people are formulating things at home, it's

not a perfect science. So they're either putting not enough active ingredient, incorrect formulations of active ingredients, so you don't get the coverage or protection that you think you should get. That being said, if you're not going to use anything at all versus that, I'd rather you use that. You just can't put Talon acne prone skin. I can't partake in any of those trends. Yeah, I wouldn't recommend it. If you tried it and it works, no problem.

I don't see a harm to it. I think I'm open to ideas and trends and fads. If it works for certain people, why not? I don't think there should ever be a hard no or yes, except if it's truly a problem. Women I feel like use, I mean, I'm speaking for myself here, but I think my friends do this too. We use different sunscreen on our face than we do on our bodies. Is that okay?

So, yes, I think it is because we know that what we consider chronically sun damaged is sun exposed skin. Yeah. So your face is way more sun damaged than is your abdomen or your mid back unless you live at a beach or live at a nudist colony or something. Yeah, exactly. But even then, you're getting it on your face as well as your body. So your face will always have more UV related mutations than the

rest of your body hands as well. So I think that's totally fine. What is a problem is women who rely on their makeup sun protection factor. Because again, you're unless you're applying a heavy load of makeup, you're usually not applying a shot glass worth. So the SPF of 15 in your makeup, you're really getting about a seven, which is the equivalent to my skin type in and of itself. So I wouldn't rely on your makeup. So back to the aging conversation. And I think we covered a lot with skin cancer. I hope we answered a lot of questions there with the premature aging How much is the sun impacting that?

So I would say I know this is going to get me in trouble again. That's okay, but premature sun is probably 50 Okay, what makes up the other 50? Genetics, okay, so you can see families ethnicities that tend to age faster and Families and ethnicities that tend not to age as fast the genetics of certain ethnic skin Allows for longer collagen and elastin formation decreases than the the risk for UV damage.

Now, we can't control our genetics, right? But what we can control is environmental triggers. So that's where the sun plays a huge role. And I give this example all the time. You can put a brand new car in the sun and what's stronger than steel, not our skin, and give it 20 years and that steel starts to rust, right? Or you put a beautiful piece of leather in the sun and don't take care of it, that leather will

break down and start to wrinkle and crack. Same thing with our skin. So as we get a lot of UV accumulated mutations, what happens over time is there's breakdown of our skin's second layer, which is the dermis. That's where all the fun is. That's where collagen is. That's where elastin is. That's where our blood vessels that volumize our skin reside. So UV will break that down over time. So if you want to look good, you should protect yourself from the sun. Now, you shouldn't have beef with the sun, but you should like not burn. You should probably protect yourself from when your skin starts to turn red Okay, I'm thinking about my husband's mom right now. She's Italian. She's I don't know I think she's almost 60 and she looks amazing. Yeah, but she also is very healthy good takes care of herself

Yeah, she gets quite brown in the Sun, but like she really takes care of herself. How much is brown in the sun, but like she really takes care of herself. How much is lifestyle, diet, stress, how much does that impact aging? It impacts everything in the skin. So we kind of knew this for many, many years. And when I trained up at Stanford, we had a really good center for understanding gut, internal immune homeostasis and skin health. There's an incredible connection between immune dysregulation, what we put into our bodies, our gut microbiome and how our skin looks. So there's a few things. Diet plays an immense role.

Why? Because things that are pro-inflammatory to the gut tend to be pro-inflammatory to the skin. And inflammation, whether it's in the skin or in the colon or any other organ system tends to wreak havoc. So if you're constantly eating a shitty diet, you're constantly not doing all the things that you should do to keep inflammation under control, your skin will show that faster. It's a reason why smokers, drinkers tend to age faster. There's a reason why people who are under high periods

of stress, namely look at US presidents, there's several aging studies that will show they age much faster than the average matched person. So lifestyle plays a huge, huge role. I mean, and the other thing is it's hard if you do things that are probably not in the healthy wellness category, they're not isolated activity. So you're not one, generally people are not one to protect themselves from the sun but

also go binge drink and eat shitty food. If you're, you know, being sun smart, you're also probably more likely than not watching what you eat, you know, taking care of your body overall So they they tend it's hard to tease out what the actual Thing is that makes the improvement but they go hand-in-hand. Yeah and drinking enough water 100% that being said drinking water does not affect skin hydration status. Oh, really? None. Oh zero whatsoever Except when you're truly clinically dehydrated, which most of the people are not.

So we know from a lot of different very good evidence-based studies, the amount of water that you drink or fluid equivalents does not change the trans-epidermal water loss or the amount of water that's being lost in the skin. Only when we're actually clinically dehydrated do we see that in the skin. That's when you need an IV bag for our rehydration. Doesn't apply to most of us. Okay, got it. But if you're thinking about drinking all your water,

you're probably thinking about being sun smart. You're probably thinking about a good diet. So all of those play a role. But if you miss your glass, it won't affect your skin. You know what I'm thinking of when I had the acne H. pylori situation, the thing that frustrated me the most is I was like, I'm so healthy. I know.

I'm so focused on diet. I drink enough water. I do all the right things. And it was almost like I could see under the acne that I did have good skin, but it was just like this infection almost getting in the way. Yeah. Which I just think it's so interesting. So you probably had, there's a few things that probably happened. One, obviously there's gut immune dysregulation.

So there's something triggering your immune system and it's also showing up on the skin. That's number one. Number two, you're young and healthy and very active. So young adults, particularly women who are very active, tend to have a hormonal component of acne that's really stubborn. That's what we call the beard distribution or the bottom chin jawline area.

And that's just a marker of hormones that are a little bit more sensitive in your skin's response to them. Whether that's aggravated by an infection, that's aggravated by working out and being anabolic in that category Possibly the other thing that makes it better is we often give antibiotics for acne not because it's an infection But because it regulates the inflammatory response. So in your setting as you cleared the Infection you also helped reduce the inflammation in your skin.

So things got a lot better. It hasn't come back since. Good. Good. Yeah, I was just going to... That's awesome. Yeah. I mean...

I pray that it never comes back, but it was all here. Yeah. Like here up, I didn't have anything. It was bizarre. Yeah. Hormone acne is stubborn, man. It's a really different... It's a different stubborn condition to treat.

It's not regular acne. Yeah, it's wild. And I'm noticing, you know, Alex Earl, she has acne under the chin. And she said it keeps, I mean, she's been on Accutane four times, I think. So, so that may be actually something totally different, which looks like acne, but what we call, I hate this term, it's disgusting, but it's not fungal acne. And it's usually a culprit of being on Accutane or antibiotics repeatedly over time. It clears your skin so that other pathogens that normally aren't there can take residence. Interesting.

It's really frustrating to treat. I see a lot of young women who are very clean, who maybe over cleanse their skin, have been on repeated bouts of antibiotics or repeated bouts of Accutane with this persistent breakout that's kind of neck, upper chest area. And usually we look for yeast called piterosporum or we look for a mite called Demodex. And those are usually the two culprits. Once you eradicate it, it's usually gone. Oh, and is that eradicated through medication or? Usually topicals, topical prescriptions.

If not, sometimes we use oral medications, but usually topicals. When you say over-cleansing, what would, because I feel like I've done that before, because it's almost this feeling of like, I'm fixing it, I'm fixing it, I'm fixing it. You and I both. Yeah, what would classify as over cleansing?

I don't think there's a fixed answer to that. I think I tend to get oily. I mean, by mid afternoon you can fry a cutlet on my forehead. I'm like, I get greasy. So I feel like I got to clean the oil off so I don't break out. Whereas my wife has very dry skin. She washes her face once a day and she does totally fine. If she over washes, she starts to get dry and flaky. In the US and most Western countries, we tend to over cleanse, thinking that if we clean the bacteria and grime off, it'll reduce breakouts, inflammatory rashes, eczema, psoriasis, etc. But we now know that a lot of that's

driven from the inside out a lot of that's driven from the inside out. A lot of that's driven from the skin's immune response. So I don't think we need to over cleanse, but every person needs to know their skin type. I know that if I don't wash my face, at least get the oil off after working out or after a long day in surgery, I'll start to break out next few days.

So you kind of got to know your skin. This is a completely random question, but something I was just curious about when I was prepping for this discussion But all of us girls are drinking out of Stanley cups Hydroflosks with the straw like we've all become straw babies kind of are we all gonna have wrinkly mouths? It's the same as smokers lines. Ah Yeah, the reason why well not almost there the smoke itself accelerated What we call radial righted or smokers lines and lips. Yeah, but it's the same thing. So Repeated person contracts those muscles now. There's a lot of things that we do now that we didn't have 20 30 years ago

those muscles. Now there's a lot of things that we do now that we didn't have 20, 30 years ago. Neurotoxins, botox to support zeomin that can soften that. There's laser resurfacing that can help soften the line. So we have the tools that we, you know, our mother's era didn't have, but yeah, if you're really worried about those lines or if you look at a family history and that you have a strong genetic risk for those, probably avoid this dross. It just, it makes me drink more water, which is really like it. I know, I know, which is crazy. I know. It's like the pros and cons.

Do I want to drink more water or not have the wrinkles? I think you can treat the wrinkles. Yeah. You can't, you can't treat the wellness as easily. So don't worry about it. Oh, these cups. I know it's, it's, it's always two steps forward and half a step sideways. Believe me.

I think we're all drinking out of these cups. I know, I know. It's like a cultural phenomenon. I know. I have like 60 different glass bottles and every time I get a new one. I think we're all drinking out of these cups. I know. It's like a cultural phenomenon. I know. I have like 60 different glass bottles and every time I get a new one, I'm like, this is going to make me do it. And then at the end of the day, I'm like, shit, I didn't drink anything. I know.

I go through a lot of those. So a lot of when I talk about skin on this show, we talk a lot about pore clogging ingredients. In your mind, what classifies as a pore clogging ingredient? What does that do to our skin over time? So anything that is comedogenic, namely things that mimic, things that mimic ceramides or are occlusive tend to be pore clogging. Think of things like Vaseline, Aquaphor, Petrolatum, ointment-based products tend to be clogging. Some oils do the same.

So what they do is they basically go into the pores and they can't make their way out. So it creates a little incubator of the normal bacteria in our skin to start to grow and cook and then our immune system finds and says, what the hell is going on? That's what a breakout is. So the first thing you want to do if you tend to have what we call comidonal acne, blackhead, whitehead acne, you want to avoid anything that's comedogenic. So whatever skincare product you're using, the first line you want to see if it's been tested to be non comedogenic.

And most good derm products are most, you know, cost-effective over-the-counter stuff have been tested for that. If you still can't figure out the culprit, oftentimes, it's not the product you're putting on, it may be just your activities of daily living that are affecting it. So you get home, you don't wash your face after working out, or you get home, you sleep with your makeup on and you tend to have comodonal acne, it's going to be a problem. Now, I know people that swear that I sleep with my

makeup on all the time and they do fine. They don't have the predisposition to it. So there's no one size fits all problem with poor clogging, but more often than not, when you use occlusive greasy substances, you're going to have a problem. Sleeping and makeup is like my worst fear. It's a disaster. I mean, you shouldn't do it just like, I mean, you take your, I assume you take your clothes

off to sleep, you should do the same. You should just clean your face. It's disgusting, but I'm not judging. And there's like, there's other things that I think there are other things that play a big role in that. Once you get past the age of acne, people can apply more occlusive things. In fact, older adults or my mom's era, they can put that. I recommend them to put petrolatum.

It's the best moisturizer for their skin. It's the closest thing to our natural ceramides and oils that we can get. But in young adults who have well-functioning sebaceous glands that are producing oil in and of itself, now you're competing with each other and that's where you run into problems. With today's day and age, like on TikTok, I mean there's so many crazy skincare products. The skincare business is insane. I found a brand that I really like and I feel good about as an acne-prone person, but how do we differentiate what's good, what's bad?

Should our routine be 10 steps long? I feel like the 10 step long routines are kind of glorified. How do we know what to do? Great question. It gets harder and harder the busier social media gets. I think one, skincare doesn't need to be expensive. That's number one. There's actually, there's an inverse relationship

between the amount you pay for your skincare and the result of your skin that's over-the-counter products. Procedures in office treatments, totally different story. But your skincare should not be expensive. And multi-step procedures are always a higher risk for having some sort of problem go awry with either competing ingredients or your skin's response to them. So I have a very simple statement.

I call it kiss or keep it simple, stupid. The simpler, the better. You need to wash. If you're oily, get the oil off. If you're not oily, moisturize. And then you need something to protect you from the sun. And you need something to turn your skin over. That's all fundamental skincare needs to be.

Now, that's building your foundation or building your cake. Everything else on top is like the cherry on top or the frosting, vitamin C and BHA or AHA acids, things like that, or tweaks once you've gotten your foundations down. But a good washing regimen and product is fundamental. A good sun protection regimen is fundamental. Doesn't have to necessarily be sunscreen, but that's probably the easiest. And then something that turns the skin over. So the retinoids are the best single thing that you can use for your skin. The brand name used to be Retin-A. Now brand names have fallen out of favor

so Tretinoin or Adapalene which are prescription retinoids. They are the only thing in the world that will grow new collagen. It's the only topical product in the world that will reduce acne, prevent skin cancer, and improve fine lines and wrinkles. Reduce skin cancer? Yeah, absolutely. Reduce pre-cancer, reduce skin cancers over time. So topicals require work, they require time to take effect, but they've been around for 50 years. They are every dermatologist's best kept secret and friend. And hopefully the word will get out. Now, when we use the term retinoid, we interchangeably use them with retinol.

You'll see a lot of retinol over the counter. You know you go to Sephora or Bloomingdale's or wherever and you see retinol. There's an important caveat to that. All retinols are inactive. All over the counter retinols are pro drugs. They cannot be active so they're made to need to convert into the active form. Why is this important? Because retinoid, prescription retinoids, the effective form, when they're absorbed internally,

and this important to note, topical retinoids are just the creams versions of Accutane. So not very many people know that, but Accutane is the oral version and anything topical retinol retinoids Tretinoin and adapalene etc are just the cream versions of that. Okay when The retinoid is absorbed. There's some theoretical risk of birth defects that can happen while you are actively using should you get pregnant? That's why they're really heavily controlled by the FDA

in making them prescriptions. In the 70s and 80s when Accutane came around, when topical retinoids came around, and we didn't know this, people were sharing pills, people were sharing creams, and some bad things happened. So we made it really strict to say, hey, this should be controlled by your physician. Well, as you mentioned, the cosmeceutical industry is a multi-billion dollar industry so they

said shit there's a lot of money to be made on this. How do we circumvent this? So they came out with an inactive pro-drug form called retinol that allows you to put it over the counter without a prescription. That being said it's just not as effective as the prescription. So if you're going to use it, both are risky during pregnancy. Get the prescription form. It's effective. It works better. And stop it should you try to conceive or become pregnant.

Okay. Because I was literally in my head going to text my esthetician and be like, why am I not on retinoid? But I'm trying to get pregnant. So I should not do that. You shouldn't. Got it. Got it. Got it. Okay. But my question for you is when I did have really bad acne, I tried a retinoid and I swear it made my acne explode. Yes. And I've heard that that happens. Yes.

Why? You should be, one, somebody should have told you about that. And number two, we call it the purge or the turnover. So you do- They did tell me that. Yeah, good. Yeah. Because you flare in the first month me that. Yeah, good. Yeah. Because you flare in the first month or so because it speeds up how quickly your skin

turns over. So our skin is brand new every 28 days. We have brand new skin every 28 days. When we use a topical retinoid, it increases that speed to every seven days. So when you have things like blackheads and whiteheads and kind of juicier pimples, they may flare a little bit as the first month goes by. And if you're not warned, people think, this doctor's an idiot, what the hell did he give me?

I'm looking worse than when I went into the office. But that's actually a good sign. That tells us, one, you're responding to the retinoid, and two, clear skin is in the future. So is it pushing things out that may be not visible yet? It can, yeah. It does that. And what it does is it permanently shrinks oil glands.

That's why even if you don't have acne and you have a heavy sheen or you're very oily, retinoids help reduce that. There's a popular trend in Los Angeles and New York and a lot of cities where celebrities are is to actually microdose Accutane. I know. Just to keep their skin clear and to help prevent that sheen that is a problem when they're on the red carpet. I see a lot of patients who ask for microdose Accutane.

Really? Yeah. That's wild. It prevents breakouts. It's not the right way to do it, but it can be done effectively and safely. It's just a little off label. With the rise in ozempic usage, are you seeing patients come in with like hair falling out or changes in their skin?

Yeah. The ozempic face. Yeah. Yeah. It's a problem. Ozempic, Wingovi. Yeah. So it's funny you say that. I, not very many people know this. So I can feel the like vulnerability come out. But similar to your story, in high school, I used to be very overweight. And somewhere around senior year, I lost

about 70 pounds. Wow. Really into working out and fitness. And in year, I lost about 70 pounds. Wow. Really into working out and fitness and in college, I was a total gym bro. That's just what happened. A lot of it was lifestyle and transformation and wanting to change my health and my self-esteem, et cetera. Yeah. So during that time, I noticed my hair, I lost a lot of my hair and my hair grew back different in a different pattern. I noticed a hollowing in my face. I noticed

all the things that you notice with a rapid weight loss. I'm seeing literally the same things I personally went through in all the patients that are on these GLP-1 agonists. And it's really a problem because the first place we tend to lose weight fastest after especially around age 30, 35 is our face. And it's an evolutionary protective mechanism. We protect our girdle, assuming we live in hunter gatherer eras. Our body doesn't like to lose the weight around our pelvis because we don't know when we're going to eat again, but we lose it in our face.

It's a frustrating problem because the changes are drastic and they're persistent when you're on the medicine. You know, you know, limp, lifeless, sheenless hair, women come and men come in, but men tend not to complain about their hair as much. Come in saying, what can I do to improve my hair? And so long as you're on the drugs and so long as you're losing weight, not much that we can offer besides some small improvements with medication. With face fat loss, it's become a plastic surgeon's dream because there's a lot of demand for

procedures now to re-volumize, re-drape, re-surface all the changes that occur, especially around the eyes, especially around the cheekbones. Even the color of skin is different. With the amount of weight loss and the desire not to eat, which is what a lot of these medications do, you see this like lackluster color that we used to see in patients who used to be sick or who were in the hospital or who were dealing with major medical illnesses. This loss of turgor in their skin as a result of the drugs. It's hard to treat, but there

are things that we can do, especially in the cosmetic world. Do you think it's like just a lack of nutrients? Yeah, you're not eating. Yeah, right. For sure. You're not eating, you're not drinking. And if you lack of nutrients? Yeah, you're not eating. Yeah, right. For sure. You're not eating, you're not drinking. And if you eat or drink a lot, you feel nauseated. Yeah. Totally.

I feel like, I mean, I put when I lost weight, I did lose it rapidly, but I was still eating and getting my nutrients and I don't think I had hair loss or anything like that. So your body was like well equipped to handle it. Yeah. And some people have that sensitivity whereas others don't. That shock loss is called telogen effluvium. My body was very sensitive to it. I mean, I lost that in a four-month span.

Oh, wow. It was really fast for a guy. Yeah. It was really fast for a guy. And as I ate again and gained some muscle and got big at the gym, things kind of returned but they returned different. And we're seeing that with Ozempic and Wingovi patients. When they stabilize their weight and we see them get off the drug, things don't go back to what they were baseline. They're just inherently changed.

Now we don't know if that's just accelerated what their body was going to do in the future or if there's something inherently different about the drug, but their skin, hair, and nails permanently look different. Interesting. Yeah, it's crazy. I've also heard that it helps with people who have PCOS and certain like inflammatory issues. Does it help with acne? So we can partly.

If your acne is driven because you have PCOS, if your acne is driven because there is some sort of hormone dysregulation, or if your acne is driven by your dietary habits, which tend to go hand in hand, patients with PCOS tend to not tolerate sugars very well. They tend to be a little bit more insulin resistant. Those patients' acne does get better, partly because they're not consuming

a high glycemic index and partly because it helps reduce their body weight, which decreases this insulin resistance. Usually you see that in the hormone distribution acne, not in the upper half. But totally. I mean, it improves so many things. I see a lot of women with this frustrating condition called hydradenitis, which is like acne of the sweat producing regions under arms, groin area, it's repeated boils, it's really

frustrating. Patients tend to be a little bit more overweight who deal with this. And we haven't had great treatments, but as they get their sugars under control with these drugs, their skin disease gets better. We even see it with psoriasis and eczema. As they get their sugar under control, their psoriasis and eczema improves. Wow. That's the cool part about these drugs, but the ozempic face kind of sucks. Yeah. That's so interesting. I mean, I'm sure LA is just like-

Oh my God. ... full of it, right? I get asked to prescribe it every week, and I'm like, probably not the right person to ask. Like, I don't do that. Yeah. I don't condone it, but there's so many places that do it. And look, diet's a big problem in the United States. Yeah.

You know, food quality is a big problem in the United States. Morbid obesity, I mean, we're like kind of laughed at by the rest of the world. I think the drugs are great. Are they being overused? Sure. A lot of drugs are being overused. I mean, anything that'll give you a good outcome will be abused in the United States, whether it's Accutane, whether it's Ozempic, whether it's any of

the stimulant drugs, you know, there's so many things, you know, we live in a culture that wants, if this is good, we want better. It's just, unfortunately, the way the game. Yeah. No, it's been very interesting to have people come on the show and just hear everyone's opinion on it. I mean, like, there are some very interesting to have people come on the show and just hear everyone's opinion on it. I mean, like there are some side effects and long term effects that are concerning, but at the same time, you're right. Like obesity is the number one issue in the US. If it's used well, I think they're awesome. The long term effects of you dying from a heart attack, stroke, complications from diabetes will far outweigh the rare risks

from the drugs. It's when young, healthy patients who really don't need the drug start to use it that the body's like, what the hell? What are you doing this for? We're okay. You could change this with lifestyle. But we unfortunately are a pill popping culture in a country. It's easier to take an injection or a pill than it is to change your entire lifestyle.

Mm-hmm. And that's like- No, so true. It's real, that's the hardest part is the mental strength or stamina to be able to tolerate it. And the people that don't have it, you see when they stop the drug, rebound right away. Yeah. It's like that with any weight loss journey. I know.

Well, it's funny because I've talked about on here whether someone has asked me whether I would have taken it back in the day and I'm so grateful I didn't have the option because I learned so much about, I mean, I wouldn't be here right now. 100%, 100%. And I'm sure you feel the same, your senior year, yeah. 100%, I think that transition, it just changes your thinking about things.

And it's not just your weight, it's your approach to your health, your approach to career goals, your approach to not popping a pimple because you know you want to but you shouldn't. It's not like the single target, it's the change in your outlook. Totally. 100% again. Yeah, changed my whole identity. Yeah, same. Looking forward with skin cancer, dermatology,

what are you hoping we discover? I think having trained in Silicon Valley, I think I love the idea of artificial intelligence incorporated in health care, in diagnostics, in therapeutics. I think that's where the future is. So the need or the accessibility to high quality care is closer than we think. I think kind of, I wish we could revert back a little bit from this split in opinions. And it's not just in dermatology, it's in everything in the United States. You're either in camp A or camp B.

And it's blasphemy for a skin cancer surgeon to say you can enjoy the sun. I wish we could kind of revert back a little bit and realize like, hey, we can do all the fun things we want with some caution and certain characteristics. But I think in the future, if I never have to cut on a face again, that's what I specialize in unfortunately, is operating on people's faces, I will be very happy.

A lot of people talk to me when I first came out with the idea of sun powder. They're like, what are you doing? I'm like, listen, if I never have to operate on a young or old person's face, if I never have to remove a nose, an entire lip, an ear, I am happy. My job here is done. So I think that's the future is preventative care. I think the future is AI integration. And you're realizing it's not all of it's not in our control. So yeah, enjoy while it can. I think I'm going to start putting a scoop of sun powder in with my greens. I hope it works. I mean, it's amazing.

I'm going to because I'm fair skinned and it's something I'm worried about because it's genetic for me. Totally. And I think when we look at these things, I think it takes some time when there is a challenge to the dogma. You know, 30 years ago, sunscreen was like crazy. You know, you wanted that copper tone color. You want it was healthy to have a glow. We moved, we shifted this way and saying the sun is horribly bad for us. And now we're shifting a little bit more saying, well, wait a second, I don't know if it's horribly bad for us because there's consequences of not being outside, not getting vitamin D, et cetera.

But anything that challenges the dogma will take some time. It's like there's a gray area to everything. Totally, totally. You just figure out what works for you. Yeah. This is the question I ask every single guest. What does wellness mean to you? It's the ability to be there for my family without having to worry that I will or not.

I think a lot changed for me, one becoming a husband and two becoming a father, that my perspectives used to be in wellness a lot more self-centered. Yeah. And now my wellness is what can I do with my life so that I can take my worries away, so I can spend time with my kids and family. And I think it, I don't know if I've ever thought about it like that until now, but wellness changes. It changes a lot.

And your meaning 20 years ago to 10 years ago to five years ago is very different. Yeah. In college wellness to me meant the most striations of my shoulder muscles and like the leanest weight and the lowest body fat percentage. Yeah. You know, and then going through med school, it was every student goes to this not dying from some rare disease because you read about it in a textbook.

And then as you get a little bit older and you see like your priorities change, I think wellness is an ever shifting target, but now it's geared towards somebody else and not me. I think that's beautiful. And I so agree with you. Mine has changed so much since I first started. So really appreciate you coming on. Thank you for having me. Of course. Where can everyone find you online? So I practice in Los Angeles. I have a small social media presence. It's just my name, last name MD Teo Soleimani MD. If anybody's interested in sun powder, we have a website, sunpowder.co. I think it's an awesome product and evidence-based. We did a lot of clinical trials on the product, but you guys can email me,

you know, any which way, every, almost everybody has my cell phone, so feel free to text me. All my patients have my numbers, anybody I've ever operated on, my colleagues, everybody has my number. Fantastic. Thank you so much. Yeah, totally. Pleasure. Thanks for joining us on the Pursuit of Wellness podcast.

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