The Dr. Hyman Show - Why Your Skin Isn’t Healing: The Gut, Hormone & Inflammation Connection

Starting point is 00:00:00 You said that muscle building is one of the best ways it's a non-skinned care intervention for healthier skin in midlife. Can you kind of unpack that? There is a study that was really interesting. Women in their kind of midlife age range. They compared them doing aerobic exercise to strength training. The participants who were strength training actually had a thicker dermis. So dermis is where our collagen sits. When you're strength training, you're increasing insulin sensitivity.

Starting point is 00:00:25 And then that kind of takes a load off of your cells. You're decreasing inflammation as well. your mitochondria are optimally functioning when your cells in the dermis are affected by that. They're going to work better. They're going to build more collagen. Aging shows up in two ways. There's the aging you can see, the lines around your eyes, changing your skin, the face looking back at you in the mirror. And then there's the aging you can feel. The workout that takes a little more out of you, the hike that feels harder than it used to, less energy, slow recovery, that creeping sense that maybe this is what getting older means,

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Starting point is 00:02:59 about menopause, women's health, and why we completely need to rethink how to support women through this stage of life. We're also nominated for my thought leadership for my conversation with Dr. Michael O'Koon and Ray Dorsey about the alarming rise of Parkinson's disease and what the latest science is teaching us about the connection between the gut and the brain and environmental toxins and a whole bunch more. And I'm really proud of both these conversations. And now we need your help. Please help me. Voting is open through October 15th. Just head to vote. signal award.com and vote for the Dr. Hyman Show. And as always, thank you for listening, for watching, for sharing these conversations and being

Starting point is 00:03:36 part of this community. We couldn't do it without you. Mamina, welcome to the podcast. Thank you so much for having me. You know, I've never had a dermatologist on. I'm very excited about this because when I started practicing functional medicine 30 years ago and treating people's health issues, I would notice that their skin would get better by improving their nutrition, by optimizing their gut flora, by helping them get rid of toxins, by dealing with, you know, food sensitivities. And it was quite amazing to me how things that were really chronic, persistent conditions, like dermatitis issues like eczema, psoriasis, acne, rosacea, like a lot of the bread and butter stuff.

Starting point is 00:04:17 Just people have. It doesn't go away. And it has to be managed. It has to be managed. It has to be treated with medication. And traditional dermatology is at least the way I learned it because I'm a family doctor. I learned dermatology. Yeah.

Starting point is 00:04:31 You know, basic dermatology. I do basic stuff was to put lotions, potions, gels, salves, creams, whatever you could put on the top to actually fix the problem, whether it was steroids or antibiotics or any fungles or whatever the thing was. If it's wet, dry, it's wet, if it's dry, wet it, whatever like the... Right, right. Yeah, that's how they would teach that. And I came to quickly understand when I started practicing folks on medicine was that the skin health is really coming from the inside out. Yes, if you have sun damage,

Starting point is 00:05:00 yes, if you, you know, do things that harm your skin from the outside, it can be an issue. But a lot of skin health and the treatment of chronic skin conditions, which a lot of people suffer from, is from the inside out. And it's dealing with the foundational things of nutrition, of gut health, of optimizing nutrient status. And so I think that I kind of want to get into, you know, how you came into this field from a traditional dermatologist and sort of had this awakening that in, and I know you kind of were sort of a little bit open to this because your mother's Japanese and you learned about Eastern medicine and how you really kind of flipped the switch and said, oh, maybe there's a different way to approach these chronic neurological conditions that

Starting point is 00:05:43 cost so much suffering. So tell us how you kind of started to kind of understand that there was a different way of thinking about it. And let's sort of unpack some of the basic foundations of integrative functional dermatology. So like you mentioned, my mother's Japanese. So just from a young age, I've been exposed to alternative approaches to healing instead of just, you know, suppressing symptoms with, you know, an over-the-counter medicine or prescription medicine, my mom would incorporate modalities to really get to the root cause, or what I would think. And so it just kept me, you know, you know, gave me an open mind. And when it came to applying to medical school, I was like, I want to go to a naturopathic medical school versus like an allopathic conventional medical school.

Starting point is 00:06:25 And I was so torn. And I decided, you know, if I went the conventional route and got my MD, I could always practice, you know, holistic forms of medicine, functional medicine with that background. That's kind of the same behind me. I was going to study Chinese medicine. I was like, yeah, you know, like, I think about an MD behind my name, I can do more stuff. Yes. Yes. Yeah.

Starting point is 00:06:46 And oh my gosh. And as you know, like when you're in med school and residency, I just feel like I just got sucked into this vacuum. I was barely just trying to survive, like just studying all the time, not sleeping. It's hazing. It's brainwashing. It really is. It's so ironic, like just the health, like stress that we put our bodies through with medical residency and medical school. And so I definitely experienced a lot of health issues just going through all that. And really, there's Durham residency. Even though Durham is kind of a fun, more, you know, people think it's like a fun field. It's not as, some people don't take it as seriously as, like. like, you know, thoracic surgery. But it's such a hard residency. There's such a learning curve because there's so much to learn in Durham residency that you don't learn in medical school. And so I just kind of got sucked into that and went into conventional private practice. But I was always so interested in taking a holistic approach. Like I was president of Integrated Medicine

Starting point is 00:07:39 Interest Group during med school. And as I was practicing, you know, as you mentioned, we put a lot of, we focus a lot on skin, like topical treatments. We do a lot of systemic treatments as well, but so much of it revolves around suppressing inflammation. Oh, steroids. You can use oral steroids, but that's another. Yeah, oral steroids. It's like using a nuclear bomb. It's so, yeah, it's like a nuclear bomb.

Starting point is 00:08:03 And long-term use, there's so many issues that come with that. But also even like biologics, too, which are, they're safer than steroids, but there are also a lot of ramifications with biologic use. And biologics is, to interrupt your first segment, is basically this class of drugs that suppresses your immune system. Yes. And, you know, generally works well and doesn't have as much side effects, but does increase the risk of cancer and also lowers your immune system functions, so you're more likely to get serious infections. Yeah, more so with the anti-TNF class, the newer classes, they're becoming more

Starting point is 00:08:36 specific so they are more safe. But still, yeah, it's the premise of they're all suppressing your immune system. And it's just like, let's just shut up the immune system so that you can live in piece, but what I've noticed just practicing more and more is that it's not really getting to the root cause. Like, I'm so grateful for these treatments because it makes people more comfortable. It makes them survive their day-to-day, but it's not really getting to the root cause. So how do you then think about approaching dermatology now from this new set of lenses and perspectives that you have about how skin health is really from the inside out? And it's a systemic problem, not just a skin problem, your skin is a reflection of what's happening in the rest of your body. So how do you

Starting point is 00:09:17 think about that, how do you approach these patients who come in with these really intractable conditions that, you know, require basically a sledgehammer. We use sledgehammer in medicine. I know we do. And it's just, no, there's a different approach. So when somebody comes in, obviously take a thorough medical history, look at their background, but I also go beyond that and look at what they're eating, how they're sleeping, what the stress is like in their life, what hormonal changes they could be going through? Are they going through menopause? What are their environmental exposures, are they traveling a lot? What kind of environment are they living in? And, you know, what's their exercise habit like? So really taking all of that into consideration

Starting point is 00:09:57 and taking that into account before I come up with a treatment plan for them. So what tend to be the root causes that you're seeing, like clinically in practice? Like, what are the things that are coming up over and over again that you're like, oh, I didn't learn this in residency or medical school, but this is actually something that it's real, that when I change this thing, it works. I would say, gut and hormones are like the two biggest things that we see when it comes to a lot of the major skin issues, whether it's acne, eczema, psoriasis, rosacea, hair loss even too. You know, we're not really addressing those in conventional dermatology. We have a lot of wonderful treatments. Like I said,

Starting point is 00:10:37 to suppress the symptoms, we have a lot of things that can help acne, whether it's spronalactone, Iso-tretanoin, but, you know, it's not really healing the underlying triggers. Yeah, that's true. Like, I find that, you know, you start with nutrition and the gut, and then you kind of work on optimizing that, and then you kind of see what's left over. And then, you know, there are other things that might be playing a role. Like, you said, hormones, we'll get into that. Mitochondria, we'll get into that.

Starting point is 00:11:03 Yeah, insulin sensitivity. Insulin resistance, which is a big thing for skin health, which people don't realize, which is affecting to some degree 90 plus percent of Americans, you know, function health with our diagnostics, we measure insulin on everybody, which is not something most doctors check. And, you know,

Starting point is 00:11:21 we're looking at the reference range from Quest, which is 18 or above is abnormal. I mean, really optimal is probably less than five. I mean, I'm three, two to three. You know, someone who's 66, who's healthy, who's fit, who's like metabolically okay,

Starting point is 00:11:36 because I know what to do. That's kind of optimal. But we're seeing, even at the reference range of Quest, 65% of our over half a million members have high-ins levels and have inflammation. You know, you're probably familiar with Nicholas Perricone. And he wrote the wrinkle cure way back right. And it was all about like inflammation and oxidative stress. And so the question is like, what is causing this inflammation? What is causing all this damage?

Starting point is 00:12:07 And it's things that we can actually identify. So diagnostically, how do you think about approaching these patients with these chronic illnesses? What are you testing? What are you looking for? How do you sort of do an essential differential diagnosis, but based on a new set of lenses that you're looking through? There's people who come in wanting to help their skin with wrinkles and, like, kind of coming in for anti-aging treatments. So that's a separate kind of diagnostic approach. But for people coming in with chronic inflammatory issues, whether it's acne, psoriasis, eczema, I do think.

Starting point is 00:12:39 think that it's really important to look at their gut health. And I will often collaborate with other functional medicine docs or naturopathic doctors to do gut testing and really do a thorough examination. Is there yeast overgrowth? Is there an imbalance somewhere there? We do know that there are higher rates of SIBO in rosacea. Like that's been established higher rates of helicobacter pylori. And, you know, we see that in acne as well. Really looking at that and targeting those things if they show signs. Even fungal overgrowth for rosacea. Oh, fungal overgrowth, definitely.

Starting point is 00:13:11 When people come in with acne, another thing I really like to look at is their insulin sensitivity or their resistance, testing their insulin level. And even looking at the ratio of insulin to their fasting, glucose, I think, gives even a more accurate picture of what's going on with their insulin sensitivity. And, yeah, in terms of testing, those are the main things. And like I said, if we need to do more extensive testing, like Dutch tests to look their hormones more closely, I will include, you know, another collaborative physician who has more experience than that. But I do think that patients get frustrated and they're like,

Starting point is 00:13:44 I just want to know why I have this. They're grateful for medications, but they're like, if I stop it, then it comes right back. So it's not really solving, you know, the deep issue. I also find that checking gluten sensitivity in antibodies, gluten is a big one, especially for certain conditions, whether it's psoriasis or there's a lot of data that gluten can be a player. Yes, yes. There, yeah, even like in non-celiac patients, gluten can be a player in certain forms of psoriasis. Because some people with psorias can test positive for those antibodies. And for those patients, I do tell them to stay away from gluten.

Starting point is 00:14:18 And then, like, some random other, like dermatitis flares, we can see gluten sensitivity. And acne is another one. Acne is a big one, you know. You mentioned insulin resistance. But again, like, you know, when you have. high insulin, in women particularly, it can cause high testosterone, and then sugar. So sugar is a big factor in causing acne. People don't realize that.

Starting point is 00:14:41 Oh, huge. Yeah, sugar and dairy. Sometimes when you're craving something sweet, the answer isn't necessarily to have more willpower. It's worth asking what your body might actually be asking for. And one thing I paid attention to is whether I'm getting enough protein throughout the day. Protein is important for satiety, for muscle, for providing the essential amino acids our bodies need. And that's one reason perfect aminos has become part of my daily routine. I take it every

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Starting point is 00:16:31 Dairy is another one. And I personally have that. If I have dairy, like, especially if it's like an American, you know, regular dairy, but it's not, or A2 or regenerative or whatever, like, or sheep or goat, I get pimples. I'm like, it's like clockwork. Yeah. If I eat much dairy, I get pimples. And so, you know, and I've seen this to my patient.

Starting point is 00:16:54 So dairy and sugar, and you think about the acne industry. I mean, it's huge. Yeah, well, it's huge. And, like, if you talk to, you know, like my partner who'd been practicing for 40 years, she said we did not see this much adult acne that, I mean, teenage acne has been around for a while. But adult acne has been rising in the last few decades. And it's like, it just makes you wonder what else is going on in an environment. Yes, I think that agricultural practices have changed, like what we're feeding cows, and, like,

Starting point is 00:17:21 that could be affecting milk, the meat, all like the other endocrine disrupting chemicals that could be out there. And glyphosate destroys the microbiome. Yeah. I mean, we're seeing more acne alongside, like, more rates of hypothyroidism, more hair loss, more infertility. Like, there's something going on in our environment that's affecting our whole endocrine system, I think, because these are all hormone-based, a lot of it. Yeah.

Starting point is 00:17:45 And, like, I also have my other theories. Like, I do think that we live in a more stressed environment, too. Stress is so huge when it comes to acne, as well as, you know, all these other inflammatory skin issues that we see. stress can increase cortisol. So cortisol just sends a whole cascade of signals, including just like increased inflammation in our skin, increased. It makes our sebum more sticky. So like we get more acne from that too. And yeah, so we see that. And I'm telling people to stop drinking coffee. But sometimes I do think that it can, if people drink too much caffeine or consume too much,

Starting point is 00:18:19 that can artificially increase like their stress response in their bodies too. So that's something I also talk about with patients. I'm like, what's your sleep like? How much caffeine are you consuming? I sort of go in there as well. Yeah. I don't know if you would kind of adhere to this theory, but a lot of these skin conditions are inflammatory.

Starting point is 00:18:35 Oh, yeah, yeah. Inflammation, I would say, is the base for everything. Yeah, and so typically in medicine, we use anti-inflammatories or immune suppressants or steroids basically to calm inflammation down. But rather than going to the root of, like, why is there inflammation? So could you share a little bit about, like,

Starting point is 00:18:51 your experience with some of these things and what you've seen? When it comes to, you know, I'm just trying to think of like patient examples. I had a patient with terrible acne, and she had all these side effects to the conventional treatments, spronylactone and isotretin. No, and she would respond to them, but she kept on getting, like, so spronolactone can affect your periods, and she was not having her periods, which which wasn't the problem, but she was also just getting a little bit too dehydrated from it, like it was causing her heart to race.

Starting point is 00:19:28 It's kind of a diuretic that also blocks testosterone so it can help with acne. Yeah, and then with isotretinone, and she was getting joint pain. So we were working with a functional medicine doctor, and she did some gut microbiome testing on her, and saw that she did have yeast overgrowth and fixed her yeast, but she also did some hormonal testing as well, and gave her certain supplements to just help kind of with the hormone balancing. And her skin clear, she didn't need any conventional treatments,

Starting point is 00:19:58 which I was thrilled about, honestly. And then, you know, when I talk about, when patients come in, like psoriasis too. So with psoriasis, I find that these patients have so many other issues going on. They have cardiovascular issues like metabolic syndrome. And then pre-diabetic. They have hypothyroidism. They have low vitamin D. It's like a full picture with psoriasis. So I try to also do other workup. I do look at their thyroid. I do look at their lipids and the vitamin D and make sure that we're addressing all of those things. They're usually sleep deprived. I find that a lot of people who do like night shifts where their circadian rhythm is completely flipped upside down. That really sets off psoriasis. It sets up a lot of inflammatory skin issues. but we do see circadian rhythm disruption being a huge one with psoriasis. I've seen a lot of cirrhizabeth patients,

Starting point is 00:20:55 and I find it's one of the slam dunks of functional medicine, even though it's such a, like, called the heartbreak of psoriasis. You know, and the things that I found were gluten are really top of the list. So anybody who's got that, I get checked for sure. Gut issues and particularly leaky gut and food sensitivities on top of that, and also overgrowth of yeast, which is a common word. And then heavy metals, which are kind of often overlooked. And so if you kind of dig around on those, you usually can find a way through.

Starting point is 00:21:24 You need to find a good practitioner like you or a functional medicine doctor to do because it's not something that traditional doctors even think about. They don't. I don't know. And I wish there's a lot of like people, I don't know, I feel like there a lot of controversy out there on like doing some of these forms of testing. But to me, we don't have all the answers with the conventional testing. And so, yeah, I know I really appreciate like your mission to really bring about these other forms. of how do we find out the root cause of these patients, whether it is with heavy metals or gut microbiome costing?

Starting point is 00:21:55 And to the truth is, there's not a lot of research money going towards these modalities of nutrition, of gut health, things that are really kind of not long-term treatments. Because think about it, like if you get someone on a drug for, you know, acne like a retinoid, I mean, they're kind of on it. So it's like, it's great for the drug company. Like, but if you treat someone and they get better and they're off everything, thing. It's not so good. So there's not a lot of incentives for doing the foundational things.

Starting point is 00:22:24 It doesn't mean that because there's a lack of like large double-blind randomized controlled trials that it doesn't work. I would say the absence of evidence is not the evidence of absence. And I think, you know, as a clinician, I'm observing things over and over like you are. And I'm seeing that, you know, there's a there. And yes, we need more research and thank God that the Medicare, the Center for Medicare and Medicaid Innovation put up $100 million to study chronic. diseases using functional medicine and lifestyle medicine, which is amazing. There's, there is some things happening, but that doesn't mean we can't already just take advantage of these things because they're generally low cost or low risk and they're very safe to do,

Starting point is 00:23:02 changing your diet, changing your lifestyle, exercising, taking a few supplements. Let's talk about nutrition in the skin. Tell me your philosophy around what should be like a healthy skin diet and also like what do you use when you start to treat these chronic issues like psoriasis or eczema or acne or so forth. Yeah. When it comes to a health healthy skin diet. Most of the evidence comes back to a Mediterranean-based diet. Basically, I would just call it like a well-balanced diet. So adequate protein, adequate healthy fats, low sugar, adequate fiber. I think fiber is also an underrated thing. We're seeing definitely low fiber correlate with a lot of issues, a lot with acne. But anyway, so that's the basic

Starting point is 00:23:42 premise. But we also want to make sure that we're adding like adequate nutrients, vitamin C, polyphenol rich foods or supplements, but I would say foods would be the best route if you can do it and other flavonoids as well as like carotenoids are huge as well, whether it's like beta-carotene or astisanthan. So foods rich in those ingredients. It's tough because I try not to be overly restrictive with patients. I feel like it ends up backfiring. But I'm like if we can at least make the goal of making it more balanced, you know, making sure you're having your fruits and vegetables. I know that sounds so cliche, but doing that and making sure you're having adequate fiber, healthy fats, minimizing the processed foods, minimizing the sugar. That's where we have the most

Starting point is 00:24:25 evidence. Those are foundational principles for general skin health. But then when it comes to people with chronic conditions, like I find that elimination diets can be a great place to start. Yes. Basically gluten, dairy, sugar, processed food. It's like, it just makes such a difference. It makes sense. So where we have the most evidence for acne, it's dairy and with sugar. When it comes to dairy, it's more so skim milk than it is whole milk, but the evidence is pretty compelling for really all forms of dairy. And then when it comes to, and then increasing fiber, too, we were seeing that lack of fiber is also contributing to acne. Okay, that affects the microbiome.

Starting point is 00:25:05 Yep, exactly, yep. And then there's also this idea where if you're not, you're in a regular with your bowel movements, it can cause a buildup of like certain hormone metabolites as well. that could potentially contribute to acne. So something to think about. When it comes to psoriasis, most of the evidence, like I mentioned, is Mediterranean diet, healthy fats. I try to supplement with omega-3s and vitamin D.

Starting point is 00:25:27 And then gluten. It's interesting from what I learned is that if they do have a sensitivity to gluten with certain antibody testing, then I would definitely have them go gluten-free. I'm not as adamant about it if they're negative with those tests. I find it's worth trying

Starting point is 00:25:43 because there's two parts of your immune system. as obviously you know, but for people listening, there's the one that's forming antibodies, which we can test for, and there's the one that doesn't form antibodies, which is the ancient immune system or the innate immune system that doesn't form antibodies. And there's a good body of literature that a lot of people react to gluten from the innate immune system,

Starting point is 00:26:03 which is not measurable. So I find it often like a good, you know, just is a good kind of test for like two or three weeks, and not forever. And then you see. Are there foundational nutrients you recommend for the skin? You mention omega-3s, vitamin D. I keep it pretty basic.

Starting point is 00:26:19 Omega-3s, healthy fats in general, whether it's, you know, avocado, nuts, fish. I mean, not all the time, but, you know, kind of, you know, incorporating the ones that are smaller, like I like sardines. I mean, if you get wild-caught salmon, great. And then when it comes to other things to incorporate more fiber, so that's just vegetables in general, fruits in general. but there's really not like one specific thing. You know, like I mentioned, carotenoids, I tell people really try to eat the rainbow, and I know you've mentioned this too,

Starting point is 00:26:52 in general, for, like, for skin issues, but there's not like, oh, if you eat more of this specific food, you're going to get all better. Yeah, well, Nichols-Peron was talking about, like, wild salmon. I think the omega-3s are so big. I find that if I would say, like, what is the one clearly, like, clinically effective skin nutrient that I've used over and over again,

Starting point is 00:27:11 for skin, hair, and nails, it's omega-3s. If someone's low in omega-3s, at a function health, we test everybody for the omega-index. And you know, you want to be over 8%. Most people are not. Most people are quite low. And so, you know, we don't get a lot of wild animals or wild plants or wild food,

Starting point is 00:27:31 which is where typically these omega-3s are. So I think it's important to supplement. Talk about how hormones play a role in skin and how, I know you talk a lot about sort of female health and reproductive health and some of the things that happen on menopause. Like, tell us about how you help women think about their skin health. And then we will get into the aging and that like, because I think we've been talking clinically about what of the health pathologies, let's say, which are, you know, diseases

Starting point is 00:27:59 of the skin. But then we're going to get into like, just how do you make sure your skin age as well? Yeah. And that's sort of topic too we'll get to. But I want to sort of sort of just talk about sort of hormonal diseases. regulation because you didn't mention gut and hormones as key drivers of skin dysfunction. Huge. Yeah. There's different types of hormones. There's estrogen, progesterone, testosterone, the sex hormones. And then there's also thyroid hormone, which plays a big role with a lot of

Starting point is 00:28:22 skin issues, and then insulin being another hormone. So I see all of those playing a role with how we age and how that can contribute to inflammation in our skin. So, I mean, just to kind of touch on each of them, when we see thyroid issues. We see more dry skin, we see brittle nails, we see more hair loss. We see, yeah, just like decreased wound healing time, just like the circulation is not as robust. So, you know, when I see those issues, anytime somebody comes in with hair loss, I always check thyroid. When it comes to insulin, we talked about acne, so insulin resistance, we see more so in acne. We can also see it in psoriasis.

Starting point is 00:29:03 It can also contribute to accelerated aging, so that's something we like to look into. and then when it comes to the sex hormones and you mentioned menopause. So, you know, we have a drastic drop in estrogen when, like, within the first five years of menopause. And estrogen is huge when it comes just overall skin health. It plays a role. And testosterone as well. Testosterone goes down too. And I'll talk about what the benefits are. But with estrogen, it activates fibroblast activity. These are the cells that help build collagen. So that's how, you know, collagen production goes down. It also, it also. contributes to increased like hydration in the skin, whether it's increased hytheronic acid or just increased lipid production in our cells. So, so our skin barrier becomes altered. Our skin becomes more dry when we have less estrogen. And it also plays a role in like the thickness of our skin. So we have what's called epidermal atrophy. And that's where you get like that kind of that creepy skin, kind of in that post-metapausal period. So estrogen plays a really big role with that. It works alongside progesterone. And then like testosterone, testosterone, testosterone's really huge.

Starting point is 00:30:07 when it comes, and the androgens in general when it comes to, like, oil production. And so that plays a role with skin barrier dysfunction. That's why we always see dry, itchy people as they get older. Everyone just gets more dry. So are you a fan of hormone replacement therapy for women? I am a big fan. I think it does wonders for your skin. Yeah. And how good is the, how good is the data on that? We haven't really there. I don't think there's, like, been a lot of amazing studies that are dedicated to looking at skin health. And I would love for there to be more. It's more just, it's kind of a side effect that we've been seeing. So you basically clinically observe this, and

Starting point is 00:30:40 I think it's true. I think women do notice that. And I think, you know, like you say, these hormones are really play a role. So you've talked about insulin resistance, you talk about thyroid dysfunction, then you talk about, you know, sex hormones, all playing a role. So I think, I think, you know, getting your hormones tuned up is super important. And as particularly women, as they go

Starting point is 00:30:56 through parimenopause and menopause, there's so many things that start to happen. They get more insulin resistant. Their thyroid's often go wacky. Their sex hormones are going wacky, and everything is going on it. And then And of course, their stress hormones are going wacky because they're in the middle of the sandwich generation with older parents and younger teenage kids and, you know, careers. And it's like, it's kind of a soup of dysfunctional hormones of insulin, thyroid, sex hormones,

Starting point is 00:31:21 and cortisol and stress hormones. So I think that that's often not really well addressed with traditional medicine, but there's ways to look at these things. There's ways to understand where you are. There's ways to work to optimize your health with these, both with, you know, hormone replacement therapy, but also lifestyle, diet, and so forth. Let's sort of get into skin aging, because I think it's sort of a separate topic that I want to dive into. But I just before we do that, I just want to close on this first bit by saying that if you have a skin issue, if you have psoriasis,

Starting point is 00:31:50 or eczema, or rosacea, or acne, which are the most common ones that I forget any, that I forget any. Yeah. Yeah, these are the bread and butter, right? These are things that have solutions, that you're not necessarily hearing from your regular dermatologist that a functional medicine approach, integrated medicine approach can really help solve. And sometimes it takes a minute to figure it out, to unpack it, to be a detective. But it's worth going into that route.

Starting point is 00:32:18 And sometimes it does mean modifying your life a little bit. Like sometimes you can eat gluten, sometimes you can't eat dairy. Sometimes you have to fix your gut. Sometimes there's things you have to do. It takes work, which is why I think so many people don't do it too. Yeah. But the other alternative is just to be miserable.

Starting point is 00:32:32 Exactly. I don't know, for sure, for sure, yeah. I had quite an amazing patient. I'll just tell you quickly who had psoriotic arthritis, which is like an advanced form of psoriasis that affects the joints. So hard. And it's a tough condition. And at Cleveland Clinic, we did a study where we took our patients in our center for

Starting point is 00:32:48 functional medicine. We're treated by the functional medicine doctors who had psoriasis or rheumatolythitis, comparing it to the rheumatology patients in the rheumatology department, which is rated number one in the world for rheumatology at Cleveland Clinic. So these people know what they're doing. They were really good. And the trainer in the, and the fellow looked at our data. We didn't analyze the data.

Starting point is 00:33:08 They looked at our data. They used all their traditional rating scales that they have in medicine for rheumatology. And we did better across the board in outcomes. We're using functional medicine, not using drugs, them using all the drugs. Like doing the usual things, like looking at their gut. The gut health, nutrition, yeah, everything, elimination diet, the usual stuff. And it was like, I think it was shocking to them, but it was like obvious to me. I had a patient who was a psoric arthritis patient who had multiple other issues.

Starting point is 00:33:36 She had pre-diabetes, she had migraine, she had depression, she had irritable bowel, she had reflux, and obviously psoriasis and arthritis. And she was taking Stellara, which is a very expensive immune suppressing drug, and she was taking a bunch of other drugs from all, like her neurologist and her psychiatrist and her gastronologist and her endocrinologist for her diabetes and her prediabetes and her migraines in her. And they're all like, these are the best. doctors in the world and they are giving them the best treatments for their, but they're all treating

Starting point is 00:34:04 like a blind man in the elephant. And I'm like, what is the common denominator in this patient? It's inflammation. All these migraines are inflammation, prediabetes inflammation, irritable bowel's inflammation, reflux inflammation, joint pain's inflammation. I just surrises and skin inflammation. And I said, look, I don't, uh, she has severe bloating and severe, like, reflux and all these symptoms. I think you have Cbo, which is bacterial overgrowth in the gun. I think you probably also have fungal overgrowth, given how many antibiotics of steroids you've been on. And so I basically gave her an unabsorbed antibiotic for phaxamine,

Starting point is 00:34:37 and I gave her in any fungal, not typical treatments for psoriasis. No. And I gave her some probiotics and vitamin D and fish oil, and probably a little zinc or something, and not a lot. And I put her off gluten, dairy, sugar, processed food. I basically put her on my 10-day detox diet, which essentially is an elimination diet,

Starting point is 00:34:56 I think it's sort of all the potential triggers for short term. She came back six weeks later and she said, I'm better. Like, I have no psoriasis, no arthritis. I stopped all my meds. I said, I didn't tell you to stop your meds. She said, well, I know, but I felt better. No migraines. No pre-diabetes.

Starting point is 00:35:11 She lost 20 pounds. No more reflux. No more irritable bowel. And no more depression. And depression is also inflammation, right, in the brain. And so I was like, this is, this is an example of a way that, you know, traditional medicine misses the boat. Like, they just kind of don't understand. how to think about the problem,

Starting point is 00:35:30 and that by using these other sort of filters to see the same symptoms and the same diseases, we see a different set of issues that are going on. And it's almost like we put on special glasses, like you put on infrared or night vision glasses, and you go, like, oh, I see what's going on. And then she, you know, she, but this is not, people say, oh, it's an anecdote or whatever.

Starting point is 00:35:50 And I'm like, yeah, I've done this for 30 years, and I can tell you there's hundreds and hundreds and thousands of patients across the spectrum of different diseases that have responded this way. And not everybody responds to everything. And sometimes it's a puzzle. And like I had a patient with the eczema, I couldn't get better.

Starting point is 00:36:05 And then I figured out it was mercury. But it's just, it's really about being persistent. So if you're listening out there and you have these issues, don't give up. There's a way forward. You might have to change your lifestyle, but it works. Let's get into, let's get into aging. What's happening in terms of like skin as we age?

Starting point is 00:36:22 Like, what goes wrong and how do we, how do we improve? Because you see some people like, who look like 100 when they're four. and people who are like 90 who look amazing. So yeah, there's different things happening at the different layers of our skin, and I'll just like briefly touch on it. So, you know, the top layer of the epidermis, as we get older, our cellular turnover gets more sluggish.

Starting point is 00:36:40 It slows down. So that contributes to just kind of more dull on even skin. And I think of that phrase like smooth as a baby's butt, because literally like babies, their skin cell turnover is every two weeks. As adults, it's every four weeks. But then like I said, as we get older, it just becomes more sluggish. So that's what creates like the buildup of dry. skin and like uneven skin tone. So there's that. And then, you know, we have our melanocytes,

Starting point is 00:37:03 which sit at the base of our epidermis, and these are the cells that produce pigment. And their activity just becomes more like unpredictable, like some just poop out. They're like, I'm just going to like release all this pigment. And we get like more sunspots and like uneven pigmentation as we get older as well. And then we're also, you know, producing lipids. And we have sebaceous glands that are living in the dermis, but then they get released into the epidermis. And lipid are also responsible, like I mentioned earlier, for keeping our skin hydrated, keeping our skin intact. So as we get older, we get more dry skin. And then below the epidermis, we have the dermis. And probably the biggest component is collagen, which sits in the dermis. And I mean,

Starting point is 00:37:43 there's other components, elastin, hyeronic acid, or what we call glycosamine and glycans, which are these sugar molecules like hyarronic acid that sort of like live between the collagen fibers and support the collagen and elastin. And as we get older, we get breakdown of collagen, we get more disorganized collagen and elastin, and that contributes to wrinkles that we see. And that's a natural part of aging, but there are certainly things that accelerate that, which we can talk about. Below the dermis is the subdermis or the subcutaneous fat, which, you know, as we get older, fat decreases as well. And then below that is bone. As we get older, like our bone, our bone starts resorping and like, yeah, yeah, we have decreased bone structure.

Starting point is 00:38:23 So, like I think of it like a mattress, you know, like the mattress cover is. like our epidermis, and then the springs are like your dermis, and then the actual bed frame is your bone structure that's supporting everything. And so we need all of that to look like a very appealing bed. From your perspective, given what you know with functional integrated dermatology, how do you think about skin differently with aging? How do you help people take care of their skin differently with nutrition,

Starting point is 00:38:49 lifestyle, hormones, gut, supplements, and skin care? Because top of those stuff does matter. It does matter. Yeah, if you were to ask a conventional dermatologist, there, you know, there are a lot of things that we have so much evidence for, decades of evidence topically that can help your skin, whether it's retinoids, sun protection. There's other things like vitamin C, like topical antioxidants. Yeah. But there are also things that we can do internally that really help our cellular activity repair the cells. And like you mentioned, nutrition, stress, sleep, other like environmental, like stressors.

Starting point is 00:39:26 I mean, we know that UV is huge, but whether it's pollution or like other endocrine disrupting chemicals, these all come together and then also just being sedentary too. These all just come together and accelerate aging. Oh, sorry, I forgot to mention cigarette smoke. I mean, a lot of people I feel like are not smoking cigarettes as much these days. People still do, but cigarette smoke is huge. Yeah, very common there. But yeah, cigarettes and alcohol definitely just create more inflammation.

Starting point is 00:39:52 Okay, cigarettes, I think people understand if you smoke, you look kind of haggard. and you get wrinkles fast, and if you want to wrinkle and age quickly, definitely smoke. But alcohol, I don't think people know. Can you talk about alcohol and skin? Yeah, alcohol can accelerate skin aging. So our bodies are exposed to a variety of different toxins, but our liver, thankfully, is there to help stop or to help just kind of decrease that toxic burden. But when that burden accumulates, if our liver is stressed or distracted by things like alcohol or potentially other medications, then that toxic burden can increase and increase stress on our cells, what we call like oxidative stress. And that causes cells to not function as well.

Starting point is 00:40:33 So when it comes to collagen, we're not building collagen. Inflammation from oxidative stress can also break down collagen more quickly without. So Nicholas Perricone was right, oxidative stress and inflammation are key to skin breakdown in age and now. Yeah. Yeah. So you mentioned collagen a few times. People hear about collagen and they take collagen supplements. Is that a thing? Like, is there data on it? Is it just window dressing? Like, what is actually going on with the whole industry? Because, you know, people think, oh, I'm taking collagen. I'm getting collagen. Is that actually happening? I know. It's not a straightforward answer. I would say overall, yes, I think that there's enough data to support collagen consumption. But, you know, a lot of the data that

Starting point is 00:41:18 is pretty compelling, is industry-backed. So you kind of have to take that with a grain of salt. Anecdotally, I do see a lot of improvement of patients who do take collagen peptides. And yeah, just because you take collagen peptides doesn't mean that that collagen goes to your skin. It's more so that the collagen peptides can send signals to help your body build better collagen. But I also advise patients, I'd rather you also get better sleep, get sun protection, decrease the stress in your life. strength train. I would rather, like, have that all dialed in before you're incorporating collagen peptides. I don't think it's like the easy switch to just add collagen peptides. To eat crap and be stressed and not sleep and just take a bunch of collagen supplements and think

Starting point is 00:42:00 you're fine. Yeah, exactly. But the short answer is, yes, I do think that. I'm on team collagen. Okay, great. Amazing. I think that's helpful. I think I've always wondered because I, you know, I think they're good in the gut and they can be a gut, but I always wonder, do they get really absorbed and used properly? But the other thing is sort of, we didn't really get into. yet was sort of the sun. Yes. You know, I think UV radiation. And then, you know, when you get a sun burn, that's because the sun's creating oxidative

Starting point is 00:42:29 stress and inflammation and damaging the skin. And that's why you get it sunburn. And that creates lasting damage. How does that work? And what happens in the mitochondria in the skin? Because we didn't really talk about mitochondria, which are basically little energy powerhouses in the cells. But they are also key.

Starting point is 00:42:48 to skin health. And can you kind of tie that together or how all that connects? UV radiation is probably the number one extrinsic factor that contributes to skin aging. So beauty from the outside in, but also sun from the outside in. Sun, inside out and outside in. Yeah. I mean, yeah, we know genetics plays a role and all these other things, sleep, stress, nutrition, exercise, these all play a role. But we, but by far, and smoking too, but by far it's, it's UV radiation. And, you know, and, you know, and, Yes, as you mentioned, it increases oxidative stress in our cells. Basically, it's causing like a localized stress response within our cells and it's causing DNA damage. And, you know, it's all fine because if you're healthy, we have the DNA repair mechanisms in place that go in and like repair that DNA. We have like the antioxidants that can fight those free radicals, those unstable molecules from oxidative stress. And, you know, we can repair and heal from that. But with enough hits, your body's like, okay, like, we've done enough. And that's why you see those consequences of just proliferation. longed and like just chronic sun exposure come out later in life because it's like your body has

Starting point is 00:43:52 already done so much to try to combat that that it just comes out later in life. And so when you have this oxidative stress within your cells from UV radiation, it affects the function of the organelles and namely mitochondria. I mean, as we age, mitochondrial function does decline. But, but stressors like UV, UV radiation definitely accelerates the mitochondrial dysfunction within the cell. So when your powerhouse of the cell, the mitochondria, aren't working as well, then that cell itself will create more oxidative stress to your body. And, like, your body just has a harder time, like, fighting it. Like, it's almost winning. And then, so when your cells aren't working well in the skin, you get more collagen breakdown, like those are, like the fibroblast, which are the cells

Starting point is 00:44:37 that make your collagen. Yeah, it don't work well. And then, yeah, it just continues. And then, like, your epidermis, the keratinocytes, the top layer of your scale, there, I mean, our skin's a dynamic, living, breathing, organ. We think the skin's just there to make you look good. But no, it's doing so much. Our cells are constantly regenerating. We're building things. So when you have that mitochondrial dysfunction,

Starting point is 00:44:58 which in addition to UV radiation could be from a bunch of other things. But when you have that, then, yeah, that's where you can see a lot of cellular aging and then skin aging from that. Something people don't really talk about is, you know, skin health related to mitochondrial health and how much energy it takes to have healthy skin, As we age, you said, the mitochondria become more injured and damaged just because of aging itself, because of insulin resistance, because of generalizing inflammation in the body, because of sun damage, because of poor diets, because of all these reasons that we accelerate mitochondrial injury.

Starting point is 00:45:28 And it doesn't just affect the energy in the cells in our tissues and organs, but in our brain, but also our skin. And I think some people don't really realize. And that I want to love you to talk about this process of sort of how do we take care of our mitochondria and how do we think about like the repair, regeneration renewal of mitochondria. There's a concept in medicine called autophagy, which means cellular cleanup, essentially means self-eating. Like at night when we sleep, our bodies will gobble up with lysosomes, all these old parts and recycle them. But also the mitochondria have a process like that too called mitophagy.

Starting point is 00:46:03 So can you talk about mitophagy and skin and how that all connects and how accumulating damaged mitochondria, at least some more skin aging, and how to use mitophagy to. to help clear and fix that for healthy skin aging? Yeah, there's, and there's multiple ways to address mitophagy. So yes, mitophagy is what you said. It helps clear out that kind of the damage mitochondria, the mitochondria that aren't functioning, because they're really just like taking up space

Starting point is 00:46:28 and then the cells aren't working as well. So to optimize mitophagy, we want to decrease the stress in the cell, the oxidative stress in the cell. So doing things like, you know, decreasing processed foods, those can, you know, add to the stress in the cell, decrease UV radiation. And that's a whole another topic because I know the sun is important to. Vitamin D. Vitamin D. But there's a way to do it responsibly. But yes, but minimizing like chronic UV exposure. So there's that. There's

Starting point is 00:46:58 nutrition. Actually, you know, sleeping adequately. Sleep is when we're doing so much repair. not only, you know, within our skin cells, but like our whole body, so so important. And then stress, minimizing stress, stress contributes to more oxidative stress literally within our cells. So minimizing that. I know we've talked about strength training. When it comes to exercising, we know it's nourishing ourselves like with the circulation, but it's also, you know, improving things like insulin sensitivity. And when you have just all these other markers functioning better than unless, and you have less inflammation, your mitochondria are going to work better. So by minimizing all these things. And also increases the number and the function of mitochondria exercise. Oh, yeah,

Starting point is 00:47:47 definitely. Yeah, yeah, I know. Exercise I think is like so amazing for mitochondria. And, and there's also supplements that you can take too. Like it's, we live in a toxic world. So it's hard to, to really combat all of these stressors with our bodies. I mean, yes, we do have. You need the foundations, but supplements, You have the foundation, but supplements do help. And things that are anti-inflammatory are helpful. I mentioned, you know, we talked about omega-3s for a while. And then, you know, vitamin D supplementation can also help with that oxidative stress too, actually. And, and then I'm also a fan of things like uralithin A, where it really does target mitophagy directly. And you can get some endogenous uralithin A. Like, you know, it's a byproduct of like things like walnuts and pomegranates from your gut. But, but I do think that oral. supplementation can definitely benefit everyone because it's like only 40% of people can actually create their own, like urolithin A. And your allithin A, we know, helps with mitophagy within your cells. And, I mean, there's oral versions, there's topical versions, but that's something

Starting point is 00:48:54 that I would certainly consider. I would also consider things like, you know, just polyphenols, whether it's through foods or through supplements. You know, there's decent data with DGG, which is from green tea, as well as like cocoa flavanols. And then I mentioned carotenoids earlier, which include things like astazanthin and beta carotene. These all help kind of reduce that oxidative stress burden within yourselves, which then will in turn help with mitophagin. Well, ashthantin is something that's in salmon because it's from the algae. Yes. And it's like with the salmon eat that makes them orange.

Starting point is 00:49:29 They mix it orange, right, right. I know some people. It's like carrots. It's like the same thing. I know there's this trend with young people that's called like tan maxing and they like are consuming all these like carrots and dastas, anthonyth and stuff like so they could like look like.

Starting point is 00:49:41 I did that once. I wasn't intentionally. I said carrot juice was good for me. So way back when I was drinking carriage juice every day and I was like, wow, I'm like orange. It's crazy. I want to double click on your own looking at. For people listening, it's what we call a postbiotic.

Starting point is 00:49:57 So when you eat certain compounds, and these are polyphenols, it can be pomegranate, green tea, granberry, walnuts, whatever, your bacteria, if you have the right bacteria, will process that and create metabolites. And some of those metabolites have beneficial effects. So, you know, people don't understand that probably a third or half of the metabolites in their bloodstream are from their gut microbiome. They're not made by your cells. They're made by these bacteria that are producing all these molecules. And when you have bad bugs, they're producing bad crap.

Starting point is 00:50:28 And they're producing, when they have good bugs, they're producing these beneficial things. And so your lettonase, like you said, most people don't have microbiome because I mean, I give talks. And I'm like, who here has never taken an antibiotic? I remember a thousand people like, nobody will raise their hand. We're like, I think once somebody raised their hand out of a thousand people like, oh, I didn't ever drink antibiotics. I feel like it's not very common. I mean, all of all of us that had an antibiotic, we kind of kill off the bugs.

Starting point is 00:50:51 And so it's really important to help to support that, those bugs. But also, like, you can actually take a supplement and your lymphina supplement. And it's something that actually I use every day, mostly from a metabolic function, from a brain function, from a muscle function, from my top of it. I don't think about it for my skin so much, but now I do.

Starting point is 00:51:16 And I think there's a lot of data on it. And one of the things it also does seems to do is reduce inflammation. So it can reduce CRP. It helps with all these benefits. So I think it's one of those supplements that has a lot of research. And I think, you know, this is literally millions and millions at all of research on this, which is not typical for most products.

Starting point is 00:51:34 So I think I'm impressed by it. It's in publishing journal of the American Medical Association, major journals. It's not like in some supplement journals somewhere. It's this good science. So I think this phenomenon of taking care of your mitochondria as a concept is really important. Like, you're only as healthy as your mitochondria. And when you age, your mitochondria decline and function declines. And a lot of the things that we know for healthy aging, whether it's, you know, overnight,

Starting point is 00:52:01 12 to 14 hour fast or whether it's exercise or whether it's like your lyrin A. These are all things that help your mitochondria function better. So I think it's so important. And like with your lithin A too, there's, I learned that you have to be cautious too with which products have your lithin A. Like there's really just like that one like mitopure that has the like the properly studied amount or like the accurate amount of uralithinae because like if you look at some other brands, they've been studied like with third party testing where it doesn't actually

Starting point is 00:52:31 show like the adequate. Yeah, the dose, the dose. Yeah, if you take one milligram of aspirin, it's not going to do anything. I agree. I have been a big fan of timeline nutrition and might appear for a long time. I've taken it for a long time. I think that's why they're one of the sponsors of my show. And I think it needs to be transparent about it. I think, you know, yes, they're sponsoring the podcast, but also like I looked at the science and you have. And it makes sense. And it's is valid science and it's impressive compared to a lot of other products people take. Yeah. It's impressive.

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Starting point is 00:54:43 If you want to try it, go to peaklife.com slash hymen and get 15% off for life. That's P-I-Q-U-E-Life.com slash hymen. When someone has skin aging, is there a way to kind of reverse it or is it, or is it a damage already done. There's definitely ways to modify your cellular function. I don't know if you're going to be 100% you know reversible, but like, you know, if somebody comes in their 70, we're not going to make them look like they're 25. But there are certainly, I know, I know, right? I'm 66. I was hoping for a miracle here. I definitely think that we can for sure optimize cellular function, you know, regardless of how old you are. And one of the things that sort of ties a little bit into

Starting point is 00:55:27 and I'm wondering if it ties into this mitochondria is this exercise. And you said that muscle building is one of the best ways. It's a non-skin care intervention for healthier skin and midlife. And I don't really understand how string training would affect the skin. Can you kind of unpack that for? I know. Yeah. I'm basing that off of there is a study that was really interesting.

Starting point is 00:55:47 It was a small study. It was like 60 or so participants. They were women in their kind of midlife age range. And they compared them doing aerobic. exercise to strength training. And they both showed improvement with like hydration and barrier function in the skin. But they actually, and they, they were measuring, you know, different layers of the skin. The, the participants who were, who were strength training actually had a thicker dermis, you know, so dermis is where our collagen sits. And I think that it makes sense, you know,

Starting point is 00:56:21 when you are, you know, when you're strength training, and I've heard you talk about this before, you're increasing insulin sensitivity, and then that kind of takes a load off of your cells. You're decreasing inflammation as well. Your mitochondria are optimally functioning. And when your cells in the dermis are affected by that, they're going to work better. They're going to build more collagen. So I, to me, it makes sense. I would like to see more studies, but I do really appreciate that. I'm kind of on my face, obviously, I've had a lot of sun damage. But I noticed like I'm 66, and I look at my skin, the elasticity. My body, it don't really have a lot of skin aging.

Starting point is 00:57:02 I notice it a little bit thinner in some ways, but, you know, I've been eating well my whole life. I've been, you know, exercising my whole life. I've been trying to, I mean, stress is about the thing, but, you know, I've been taking, you know, basic nutritional supplements. And I'm just, like, kind of amazed at, you know, what, what you can do if you actually take care of yourself and you do the right things. And it's something I think.

Starting point is 00:57:25 It's good to start early, but also you can start any age and slow the process down. And I'm curious, like, from your perspective, like, what are the highest value interventions for people listening? Like, what are the things that, you know, for skin longevity? Like, what are the highest target intervention? So, yeah, I know we want to talk about what we can do from the inside out, but I do have to say, sun protection is probably the biggest thing you can do. The sunblock. Yeah, sunscreen.

Starting point is 00:57:55 And like when you're outside, you know, try to minimize the time you're in, you're outside during like those peak UB hours, which is like between 10 a.m and 2 p.m. wearing some protective clothing, hats. Those all play a role. Now, like I see, you need UB blocking clothes or? You don't need it. But like, but sunscreen's not 100% going to block out all your UBRAs. But can you get a like sun damage through your clothes? Oh, yeah, yeah, yeah.

Starting point is 00:58:24 UB can still penetrate clothes. It's still a form of protection, but UPF material does a much better job at, like, blocking out UV rays. So just some things to consider. And I know that we, you know, also I just want to take into consideration the fact that the sun is really important too, right? Like for vitamin D, absorption, metabolism, as well as like circadian rhythm regulation. Yeah, for light in your eyes. Definitely, like getting that sun early in the morning.

Starting point is 00:58:50 But I think that you can still do all those things. You can go outside, wear sunscreen. Don't try to bake outside for prolonged periods of time. That's where we see a lot of the skin cancer. And, you know, with melanoma, it's for people who have that intermittent prolonged exposure. So it's interesting. When you go to the Bahamas for a holiday, you know, lay on the beach all day for seven days. Exactly.

Starting point is 00:59:15 For men, the most common location for melanoma is the back. And for women, it's the legs. But those aren't areas that are seeing the sun every day. but for like those intermittent bursts of sun exposure like going to the Bahamas and you're just getting like burned on your back, that plays a bigger role with melanoma development. Whereas the non-melanoma skin cancer is like basal carcinoma or squamous cell carcinoma. Those are from just like chronic daily sun exposure that just build up over time. But all of that can contribute to skin cancer development as well as accelerated age. But not all melanomas are skin sun exposure related. Are they or are they? Well, yeah, you're right. Not all because we can see melanoma between the toes. We could see. anal melanoma. That's what I mean, yeah. So there's other components, too. And what's interesting, too, we have studies to show that low vitamin D can make melanoma, like can put you at higher risk for melanoma, which is kind of ironic, right? Because we say stay out of the sun, you know,

Starting point is 01:00:07 to prevent melanoma. So it's about finding that healthy balance. Vitamin D is important for melanoma prevention, too. And, you know, we always talk about supplementation and trying to get vitamin indeed through food, but like I said, you can still go outside, just got to do it responsibly. But I'm sorry, to answer your question, the highest impact is sun protection. It is. And it's, I mean, we have studies to show that it plays the biggest role, probably about 80 percent, and when it comes to skin aging. There's genetics, but then, you know, there's other factors too. So smoking, we talked about, thankfully, you know, I think people aren't smoking as much. People still do smoke, of course, but that's huge. Like when they look at identical

Starting point is 01:00:45 twin studies and like they see the twin who's out in the sun and smokes drastic difference. So that. And then when we talk about nutrition, so sugar can accelerate aging. I've heard you talk about advanced glycation end products or AGEEs. This is when sugar, you know, when you have more sugar that can bind to your collagen fibers and that can make your collagen more brittle and like break down more easily and like not remodel as well. So sugar is huge. And then of course if you have insulin resistance from sugar, that's going to create more inflammation and further aggravate, you know, collagen breakdown. Try to, like, minimize processed foods as well, but most of our data is with sugar. And then when it comes to what to add, we touched on this briefly,

Starting point is 01:01:26 but just like nutrient dense foods, foods full of polyphenols. I just say like just colorful foods, you know, like vitamin C, your citrus, your bell pepper, like the berries, just things that full of polyphenols is important. And then, yeah, and we talked about coroninoids too, whether it's, and also lycopene, beta-carotene, as well as acesanthin. And then sleep is huge. We do have some good data to show that poor sleep, circadian rhythm disruption, that can all accelerate aging. Stress is huge, and stress is like harder to quantify just because, you know, like what is stress? Like, we all deal with so much stress. So, but, you know, just a matter of incorporating stress, decreasing modalities into your life. And then exercise, we have data to show

Starting point is 01:02:16 that that helps with skin, collagen production. Those put, and yeah, minimizing pollution. I would say those are like the biggest levers with sun protection being the biggest one. And then we also have a ton of evidence when if you just put it in a vacuum. Like if it's just, if you're just focusing on skin, topical retinoids, we have decades of studies to show the impact of topical retinoids for skin health. It's got vitamin A derivative. Vitamin A derivative. Yeah.

Starting point is 01:02:42 So the most popular example is retinol, which can get over the counter. Then there's a prescription retinoid, which is trinotin. The brand name is retinae. Those are the most common forms. There's retinal. Retinaldehyde, there's tazeract to seretine adapylene. There's a lot. But anyways, there's a lot of studies to show that that really helps with collagen remodeling.

Starting point is 01:02:58 And then topical antioxidants, vitamin C being the most studied example shows. So after sunscreen, we like retinoids and vitamin C. So put vitamin C and retinoids on your skin. Correct. Yeah. vitamin C in the morning because that works alongside sunscreen to help with, like, the oxidative stress from the sun as well as pollution, and then retin noise at night to really contribute to that repair process when you're sleeping.

Starting point is 01:03:22 I need to up my game here because I've been focusing on, you know, my exercise and diet. And skin care, I'm like, you know, I'm a guy. I don't really care. I mean, if you want to, like, for overall longevity, you've got to do all the exercise and diet. Like, that's going to be better for overall. I'm curious about like, you know, I don't want my skin to age faster than it needs to. And these sounds like simple things, like the vitamin C and retinitis. And you can do the retinol over the counter.

Starting point is 01:03:47 You do retinal over the counter. That's strong enough. Yeah. For a lot of people it is. And the thing is, it's just slower acting. Tretanoin is faster acting. Retinal has to get converted. It has to go through a couple stages before it gets converted to Tretanoin.

Starting point is 01:04:01 So Tretnawan works faster. It has a higher irritation potential so people who have sensitive skin or adjusts or out, we do recommend something like a retinol. Yeah, and I would say we have the most evidence behind that. I know timeline has their topical, like you could do topical uralitha, which we do some studies to show that that can help with wrinkle reduction as well as increasing hydration and barrier repair in the skin. And so, yeah, something else to think about, too. There's some supportive ingredients in those products, like there's topical niacinamide. We do have some nice data with topical niacinamide for barrier repair and wrinkles too, as well as, you know, things like

Starting point is 01:04:39 hytheronic acids, ceramides. These are like a nice hydrating ingredients. Great. And it's a good list. It's a good list of how to get healthy. Now, people are talking about, I just kind of briefly want to kind of dive into this, but people are talking about a lot of these sort of newer therapies where there's exosomes, peptides, growth factors, NAD products, red light therapy. Can you kind of, is it hype, is it science? Like what What's the 80-20 on this stuff? Yeah, I know. People talk about those a lot.

Starting point is 01:05:06 I would say, don't do that unless you're already doing sunscreen, retinoids, vitamin C. But yes, growth. And lifestyle. And all the lifestyle things that we talked about. But, yeah, I just talk about peptides because so many people, that word is just so popular, mainly because of the injectable peptides. But because the injectable peptides have become so popular, topical peptides has just gaining so much more buzz. But they've been around for decades, too.

Starting point is 01:05:31 And there are a bunch of different types. of topical peptides. Some are better than others, but in general, I am definitely a fan. I think it's so easy to incorporate peptides into your routine. There's a lot of moisturizers that incorporate it, a lot of serums that already have it. There's even some and some sunscreens. But basically, they send signals to yourselves to build more collagen, or they send signals to your cells to increase hydration. So definitely all about peptides. Like topically or like injectable? Topically. Because like GHKC was a thing, a lot of women are eating for their skin. Right, right. Is that like legit? I'm sure it helps. But.

Starting point is 01:06:03 as of now, we don't have the evidence or like the safety measures in place to fully recommend it. Yeah. So I'll say that. But we do have topical GHCU, the topical copper peptides, which we definitely have good evidence for. I mean, not as good as retinoids for sure, but that helps with collagen recycling and rebuilding. So incorporating copper peptides is wonderful into your routine, as well as some other, like, hydrating peptides and collagen building peptides. And there's also like neuromodulating peptides. So some people like to call it like Botox in a bottle because, you know, Botox essentially like paralyzes your muscle so you're not creating the those deeper contractions, super mild form of that with these neuropeptides for people who are like Botox averse. It doesn't compare to Botox. But anyways, so that's peptides. Depending on the pepides, you could do a lot of different functions in the skin. Then there's growth factors you mentioned. Growth factors are also signaling molecules that I think we do have some pretty decent evidence for. Growth factors are pretty large molecules. So just because you're putting growth factors on your skin does not necessarily mean it's penetrating the skin and doing its thing. So I would say you

Starting point is 01:07:08 have to make sure you get the right growth factors. Not all of them are equal. But I do like them. And then there's PDRN, which has gained a lot of buzz because of the whole K-Beauty, Korean beauty, kind of. What is PDRN? So PDRN stands for polydeoxy ribonucleotide. And it's derived from salmon sperm. Okay. And most of the data is with PDRN injections into the skin. We know that it helps with collagen remodeling when it gets into the dermal layer. It helps with wound healing, topical PDRN. We have some evidence for its efficacy, but doesn't compare as much to the injectables. But I like it. I think it's a wonderful ingredient to have in your moisturizer. So, and we're seeing more of that. Salmon spurn. Salmon spurn. Sammon spurs. Samin spacials is what we're

Starting point is 01:07:51 calling it. What about things like exosomes and stem cells? Like people are injecting those in their face topically. Once again, it's one of those areas where it's a little bit controversial because we do still need more safety data. I think it's still kind of the Wild Wild West with that. There are a lot of products out there that have topical exosomes in them. And they are lovely and they seem to work. But whether or not the exosomes are doing anything or what exactly they're doing, it's hard to say. Because it's so hard to stabilize exosomes at room temperature. Like they need to be like frozen at a negative temperature. I wonder about these creams or. Yeah. And also it's like what exosomes are the best, like umbilical cord exosomes or like mesenchol exosomes from bone marrow or like fat, fat cells. Yeah, there's different kinds.

Starting point is 01:08:36 And that kind of goes along with stem cells too, you know, which ones are the best. So I think we still have more to come with that. But I think it's promising. I know you've been a dermatologist for a long time. I can't tell how old you are. I want to know your skin routine. Okay. Wait, wait, should I have you guess how old I am?

Starting point is 01:08:55 I kind of would say like maybe late 30s. Yeah, I'm 43. Yeah. So that I'll take that. Thank you. But yeah. So, you know, I mentioned the. the topical skincare regimen. I definitely for a while have been incorporating sunscreen. I didn't

Starting point is 01:09:10 for most of my 20s. And it wasn't until I started Durham residency where I was like, oh, okay, I guess I should do this. So I do sunscreen. I do some type of retinoid at night. By the way, you can't use a retinoid when you're pregnant. And then I do vitamin C in the morning. But I do. I use serums and moisturizers that incorporate peptides and or growth factors. I do use a product with PDRN and copper peptides. I use a serum that has a neuromodulating peptide to help soften my lines. Do these things stack you just put one on after the other? So, okay.

Starting point is 01:09:45 So it's so funny because I hate overwhelming people because there's so much noise out there in the skincare world. So what I tell people is really the foundational skincare regimen is a cleanser. It's like washing your face is important too. It's kind of underrated like the buildup of pollution. Like all that. stuff during the day? Like that accelerates skin aging. Those are, those are, those creates oxidative stress on your skin. So washing your face is so important. And then moisturizing because, once again,

Starting point is 01:10:13 because of the elements, our skin barrier is disrupted. Our carotinocytes are working hard to repair the barrier. And like if there's stress on our skin, it needs help. So moisturizers are important and then sunscreen. So those are the three minimal things to do. And then after that, a retinine and vitamin C. And then if that's well established, then you can incorporate another serum that might have like peptides or growth factors. And then like just find a good moisturizer that has all the fun things that has growth factors and peptides too. Yeah, that's good. I mean, just kind of a brief aside, because I think it's an issue for for me, I think about this, which is what's in the skincare products besides the active ingredients and are those harmful? And I had a patient once who

Starting point is 01:10:54 used sunblock all the time. When I checked her urine, she had extremely, high levels of paraben, which is a plastic, like a petrochemical toxin that they use in these compounds. So are you fixing one thing and hurting another thing? And how do you manage that? And what do you think of the Skin Deep database from Environmental Working Group that kind of grades skincare products based on levels of toxins in them? I respect the fact that something like this exists out there. I do take it with a grain of salt because the data that's in the EWG database is from studies where there are usually like insanely almost impractical doses, insanely high amounts of these products or ingredients that are used on like animal models. And we can see issues in animal

Starting point is 01:11:41 models, or whether it's endocrine disrupting issues, potentially cancer, you know, and it's, it's hard to extrapolate that to human data for a lot of these things, for things like paribins and even like some of these chemical sunscreens too. And so I think like theoretically it seems scary. Like, oh my God, when it's given an insanely high doses to animals, like we should not do that. We shouldn't use it as humans. But I wouldn't, you know, if people have been using a lot of these products,

Starting point is 01:12:13 I wouldn't freak out. Like, just because somebody has a bunch of parabens in their urine, the question is, okay, but what exactly, like, what is, how is that manifesting in their skin? I mean, my philosophy, and maybe this is right or wrong, I don't know, but if you wouldn't eat it, don't put it on your skin, because everything you put on your skin gets absorbed through your skin. Okay. So I have something to say to that. I have something to say to that because our skin is, honestly, our skin does serve as a great barrier. Like, it's one of the functions of the skin is to protect our body from like the outside elements, from pathogens, from irritants and all those things. So there is an element of really good barrier protection on the skin. But the other thing I want to add, too, is that not necessarily everything you eat is good for your. skin. This is true. Like lemon. Like lemon will destroy your skin. Really? Yeah. Lemon eating juice, lemon juice. Lemon can, yeah, lemon can cause like irritation from the acids in the skin. I mean, we have stomach acids that can that can deal with that. Putting lemon on your skin or eating

Starting point is 01:13:08 lemon. So eating lemon is good. Oh, eating lemon on your skin is not good. I wouldn't do that. Yeah, yeah. Fair enough. Fair enough. Fair enough. So, but yes. You want to put chili peppers on your face. Right. Exactly. Exactly. But no, but I, I do appreciate you saying that. Like, we have to be, you know, if we can eat it, then, you know, it's potentially safe for our skin. But I also want people to know that our skin is there to protect us too. And like a lot of these things usually just penetrate through the epidermis, not really getting into our vascular. Of course, there's things that get into our vascular as well.

Starting point is 01:13:40 But our skin, I would give it more credit. It really does do a good job at keeping a lot of the things out. I'll say that. But yes, there are definitely things that can get absorbed that aren't. I mean, because I always wonder about it. Because as a doctor, I'm like, when you someone comes in the emergency, from their heart attack, you put nitric glycerin paste on their chest. Yeah, there's topical estrogen.

Starting point is 01:13:58 Topical hormones. You've got, you know, all these topical drugs that we deliver through the skin, whether it's fentanyl patches or, like, it's a known thing. It is a known thing, yes. So, like, it's not like they don't get through. No, for sure. And there's certain vehicles that deliver these things more effectively than others. So it's a matter of, like, what the product is.

Starting point is 01:14:20 But, yeah, no, for sure. Like, things definitely can get absorbed through the skin. So if you have a choice between something it doesn't have a lot of bad industrial ingredients in it versus something that does, would you choose the one that doesn't or you don't care? Of course I would want to look at the safety data behind it too, but I would try to minimize like anything that has this like toxic burden to the skin for sure. Yeah. Okay, good. I think you're right. It's probably not enough data.

Starting point is 01:14:45 Like what happens when you put all these things on? But like just like at a high level, like I wonder if anybody's in the studies to see if you put this stuff on your skin and measure the blood levels or urine level. of these compounds. Has anybody done that work? Yeah. I mean, I think that some of it has been looked at, too. Like, we do see higher absorption with chemical sunscreens and our bloodstream. Does it better use mineral sunscreen? So, yeah, I mean, if that sort of freaks you out, then yes, I would use mineral sunscreen. The FDA kind of puts that in the category of generally recognized as safe, whereas the chemical sunscreen is not in that category, mainly because you do have extensive systemic absorption with it, whether or not that's the state. Whether or not

Starting point is 01:15:23 does anything is just still up for a debate. Wait, are you saying that the FDA says that these chemical sunscreens are not generally recognize as safe? That's right. Wow. But there's a new one that just came out this past year that is, it's a BEMT, Parcel Shield, it's another name for it. That is, it's a chemical sunscreen that is lumped with generally recognized as safe.

Starting point is 01:15:42 But yeah, no, we need some work with the chemical sunscreen. But I have to tell people, they're still effective. They're still overall safe. We don't have the human data to show that it does anything. thing, but it does absorb more into your bloodstream. This is such a great conversation. Are you up for a few rapid-fire questions? Let's do it.

Starting point is 01:16:00 Okay. So what's the biggest driver of premature skin aging? UV radiation. Sun, okay. Yeah, the sun. Can you take age skin and actually improve it or not? Yes, you can. There's hope.

Starting point is 01:16:09 There's hope. What matters more for skin health? Is it in longevity? Skin care or exercise? It depends on what your goals are. If you want to live longer, I would say exercise. If you want your skin to look smooth and wrinkle-free skin care. How about mitochondria?

Starting point is 01:16:22 how important they're going to scale. Oh, yeah. Mitochondria, oh, at least a nine. At least a nine. Because there's a lot of other factors that also contribute to aging, too. It's not just mitochondria. We need...

Starting point is 01:16:34 And Yerlythane is the data there or not? Your lithonase, yeah, I would say we have really good data with uralithinae. Amazing, okay. And then what's the most overrated anti-aging skincare trend? Okay, so there's like products that are called... What TikTok trend should people be like,

Starting point is 01:16:49 wait. There's a couple of things. Like, a lot of people are into, like, beef tallow, and they think that that protects their skin from the sun, it's, no, it does not. It's an okay moisturizer, but it's not anything miraculous. We have a lot better moisturizers out there. Be fat on your skin, not a thing. Yeah, it's fine. I don't really use coconut oil. It's like... Coconut oil can be helpful. It is comedogenic, so be careful if you're acne-prone, but beef tallow is also

Starting point is 01:17:12 comedic as well. But people think it's like a miracle cure, and it's not... Amazing. Okay. Wow. Well, thank you so much for your insight. your work, your advocacy, because there aren't enough, I would say, integrated functional dermatologists out there. Yeah. They really aren't. And I had the privilege of learning from some of the OG ones, you know, back in the day. And I think that, you know, if you're listening to this, you know, there's really two issues.

Starting point is 01:17:38 One is healthy skin aging and two is skin conditions. And there's a lot to do about both of them. Yeah. And hopefully, you know, we can really help people to understand what they can do. Tell us where people can learn more about you, find you, learn about your work. I am very active on social media. My handle is Dr.dominaDR.m-M-A-M-I-N-A on Instagram, TikTok, and YouTube. I have a website, Dr.mabina.com.

Starting point is 01:18:02 And if you're also interested in prescription skin care, I'm a co-founder with other derms for a prescription skincare service called DermClick. Amazing, Derm-Cliq. All right. Well, so good to meet you and having you on the podcast and thanks for your work. Thank you so much for having me. Hey, everybody. It's Dr. Mark here. I'm so excited to share that my new book is officially available for pre-order today.

Starting point is 01:18:20 after more than 30 years of practicing medicine and caring for tens of thousands of patients, I've written the book that brings everything together that I've learned about helping people get healthy and stay healthy as they age. It's called 100. What to do today to live 100 healthy years is a whole body guide to living 100 healthy years. It's grounded in a new understanding of how our body's work. It's the new map of the body. And inside, I walk you through the seven core systems that drive your health from your gut

Starting point is 01:18:47 and hormones to how your cells make energy that help. and help you understand the signals your body's been sending you all along. Now, a lot of what's in the book, I learned the hard way through my own body. When I got sick, the medicine that I trained in did not have any of the answers I needed. So I had to go look for them myself. And that search became my life's work. This book brings together decades of my learning from my patients, from the scientific research and scouring that, from the things I got wrong and the things I had to rethink along the way.

Starting point is 01:19:16 I don't want you to have to struggle the way I did to find those answers. So much of our health is shaped by what happens outside your doctor's office. And I want you to feel confident knowing how to care for yourself every day. I put so much of myself into this book. And I'm really excited to finally share it with you. It's really my life's work. It's my capstone of my career that I put everything I know. It's finally available for order today, pre-order, everywhere booked your soul.

Starting point is 01:19:38 Go get a copy. Please support me. And this is my life's work. So I think you're going to love it. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions.

Starting point is 01:19:53 Don't forget to rate, review, and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am chief medical officer. This podcast represents my opinions and my guest's opinions. Neither myself nor the podcast endorses the views or statements of my guests.

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Starting point is 01:20:49 trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public, so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening. When it comes to supplements, you only want the best for your body, the kind with the highest quality, cleanest, and most potent ingredients you can get. That's exactly what you'll find at my supplement store where I've hand-selected each and every product to meet the most rigorous standards for safety, purity, and effectiveness. These are the only supplements I recommend to my patients, and they're also what I use myself. Whether you want to optimize longevity or reduce

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The Dr. Hyman Show - Why Your Skin Isn’t Healing: The Gut, Hormone & Inflammation Connection

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