ZOE Science & Nutrition - Skin aging and acne: What you should do

Episode Date: August 31, 2023

As a listener to this show, you’ve probably heard of the gut microbiome. But did you know that your skin has its own microbiome?  Recent evidence suggests that these microbiomes are vital for our skin health. So, what should we do? Which foods make an impact?  And if we want our skin to look healthier, how about those collagen supplements that many of you have asked us about?  In today’s episode, our guest is Dr. Justine Kluk, a consultant dermatologist with a specialist interest in acne. Justine is a member of the British Association of Dermatologists, the Royal Society of Medicine, and the Royal College of Physicians.  ZOE’s Chief Scientist Dr. Sarah Berry also joins as a cohost to explore these ideas.  Download our FREE guide — Top 10 Tips to Live Healthier: https://zoe.com/freeguide Timecodes: 00:00 Intro 02:01 Quick Fire questions 03:52 What does skin do? 04:51 Why is the skin so important? 06:34 Is there a correlation between aging skin and health? 07:41 What is the skin microbiome? 11:46 Is exposure to the natural environment beneficial for children? 12:39 Can we change the skin microbiome? 13:32 Would an oral or topical probiotic help improve our skin microbiome 15:11 What can we do to help support the skin barrier? 15:39 Can overwashing/scrubbing disturb your skin? 16:40 Why does acne matter? 18:37 Is acne just found in teenagers? 19:12 What effect does menopause have on your skin? 20:36 What impact does diet have on acne? 22:14 Are diets with high glycemic content bad for acne? 23:01 What is happening to create the effects of acne? 24:23 Is there a connection between our gut health and skin health? 25:15 Practical advice for people with acne 28:16 Diet tips to help support healthy skin 29:51 How has the ZOE diet gone down in Jonathan and Justine's household? 32:54 How can the ZOE diet help with day-to-day cooking habits? 35:46 What causes skin aging? 37:44 What can we do to slow down skin aging? 39:55 Do collagen supplements work to keep your skin youthful? 41:52 How can retinol help your skin? 42:30 3 things that could help keep your skin young 43:31 Top nutrition skin myths 45:50 How important is it to apply sun protection? 46:36 How does stress impact our skin? 48:38 Questions for Jonathan 54:57 Summary & Outro Mentioned in today’s episode:  Mortality is written on the face from The Journals of Gerontology: Series A Too clean, or not too clean: the hygiene hypothesis and home hygiene from Clinical & Experimental Allergy Impact of outdoor nature-related activities on gut microbiota, fecal serotonin, and perceived stress in preschool children from Scientific Reports Justine shares more in-depth skincare and acne information at drjustinekluk.com and as @drjustinekluk on Instagram  Follow ZOE on Instagram.  Episode transcripts are available here. Is there a nutrition topic you’d like us to explore? Email us at [e-mail] and we’ll do our best to cover it. 

Welcome to ZOE, Science and Nutrition, where world-leading scientists explain how their research can improve your health. Today we discuss why your skin has a huge impact on your overall health, and learn how to slow skin aging and reduce acne. We'll give you plenty of practical tips. You'll learn how what you eat impacts your skin health and whether you really need those collagen supplements that so many of you have asked us about. Dr. Sarah Berry joins me as co-host today. Sarah is our chief scientist at Zoe and an associate professor at King's College London. Our guest is Dr Justine Cluck. Justine is a consultant dermatologist with a specialist interest in acne. She's a member of the British Association of Dermatologists, the Royal Society of Medicine and the Royal College of Physicians.

I'm excited for you to meet Justine, partly because so many of you have sent in questions about your skin health. And secondly, and also why I'm a bit nervous, because Justine is my wife. And I know Sarah is going to ask a lot of questions. I'll probably prefer she didn't. Wonderful. Well, I'm very excited to do this one. And I have to admit a little nervous. So great to see you. Great to be here. I'm even more nervous, so that makes you feel better. And poor Sarah stuck in the middle of us. I'm loving it. We can gang up on him, Justine. We always do.

I can get him back for like the last year of podcasts. All right, so I'm not feeling any more relaxed now. I'm going to try and take a little bit more of a backseat today. And so Sarah is actually going to start with a quickfire round of questions from our listeners. Yeah. So Justine, we start all of our podcasts with quickfire questions. The rules are you can say yes, no, or one line, only if you have to say one line. Okay. Okay. So there's six questions. First one is, can your skin tell you about the health of your whole body? Yes. Great. Does what I eat matter for my skin? Yes. Wow, that's good news for us at ZOE. Can dairy make acne worse? Yes, and we'll talk more about why and how much.

Great. Is it possible to reverse skin ageing? We can't reverse it, We can slow it down. Fabulous. Are collagen supplements a waste of money? It remains to be determined. Okay. That's allowed. Okay. I can simplify. Possibly. Probably. Now, the last question, you're allowed one to two lines. And what I want to know is what's the most unexpected thing you've discovered about skin through working with your patients? I think the impact, the really huge impact that having a skin condition can have on people's psychological and emotional well-being. I think that is something that really drives me to want to share with you guys and with your audience why it's so important that we pay

particular attention to our skin health. Amazing. So as I was preparing for today's podcast, I was thinking two things. So first, I was thinking I have to be really careful what I say today or I'm going to be in trouble for weeks. And the second is I actually thought back to Justine and my very first date. And I asked something really stupid, which for those of you who know me won't be very surprised, like, Justine, why did you decide to specialize in skin rather than all those much more interesting things you could do as a doctor? And Justine explained to me that I was an idiot

and that basically skin was the most interesting thing in the world. And so I thought actually that would be a brilliant place to start. Could you tell us what skin does and why it's so important for us all? And why you went on that second date as well, I think. I sometimes ask myself the same question now. Jonathan was sparkling and witting all the good things even back then, yes. So now just exposed to a bigger audience, which is annoying, but I thought it was just for me. Why do I think skin is the most interesting thing? On a personal note, I had acne myself as a teenager, as Jonathan knows. In fact, still do, still take treatment

for it. So for me, it's been a 30-year journey with a skin condition. So I think having had that experience and found it really difficult at times, I really want to prevent other people from going through the same. So I think one of the reasons why I think skin is so important is it's visible. And that can be a good thing. It also means it's accessible. So if we want to study the skin, we can access I think I can distill it into three points which is hard for me because I'm quite verbose but the first is that there's the skin barrier function which we'll come and talk about in a moment but the skin is our outer shield it's our first point of communication with the environment and so our skin does provide us with some vital functions, for example, regulating heat and water loss, protecting us from UV, from infection, from things we're exposed to around us. The second thing is, and you guys will be interested in this, is it's home to our skin microbiome. And we definitely will be talking about that, I hope. And the third thing, which

I think is one of the reasons why I was really interested in becoming a dermatologist is our skin tells us a lot about what's going on inside our bodies and gives us clues about the health of our internal organ systems. And so one of the cool things about being a dermatologist is basically we're like super detectives. And so, you know, there are, I think, 3,000 different dermatological conditions. My colleagues might be listening to this and thinking, you know, there are, I think, 3,000 different dermatological

conditions. My colleagues might be listening to this and thinking, you know, there are actually 2,000. So if I'm over-inflating it, it's because I want to really represent dermatology here today. But, you know, 2,000 different ways of looking at red spots. So you have to be really good as a dermatologist at looking at patterns and looking for clues. And our skin does give us a sort of window into things that are happening inside. So that's why I think skin is interesting and why I will say it is the most important part of the body. But of course, it's connected to everything. So we can't think of it in isolation. Yeah, I think it's fascinating that it is like a window because I must say it's

something that I had never thought of before. And there was a study that someone had highlighted to me where they had twins and people were asked to age these twins according to their skin. Okay. And the twins that they aged as being older, according to their skin, actually went on to die and develop disease a lot sooner than the other twin just based on them detecting their age based on their skin. That really surprised me. That is really fascinating and I think maybe when we get into what are the factors that influence ageing you'll see that there may be some common things between what influences skin ageing and what influences ageing of our other organ systems and so you can't separate these things out and I think it's something that you guys have talked about on

the podcast quite a lot and I've certainly heard Tim say is that you can't separate these things out. And I think it's something that you guys have talked about on the podcast quite a lot. And I've certainly heard Tim say that we can't think of different parts of our bodies, different compartments separated from each other. It's something I talk about in my clinic quite a lot. All of this is connected. We haven't always understood how science is starting to plug gaps. So we understand now about the microbiome. We understand a lot more about hormones, but all of these bits are connected. And so you can't just think about trying to address one in isolation. You have to, of course, therefore will be factors that influence the health of multiple organ systems. So, yeah. Great. And you talked about the microbiome, which is one of Zoe's real areas of interest. And we talk a lot on our podcast about the gut

microbiome. So all of the trillions of bacteria that live inside our gut and impact our health. But I've recently started hearing about the skin microbiome. I know nothing about it. Jonathan probably does because he's probably heard you talk about it. But I wonder if you could tell listeners a little bit about what the skin microbiome is in the first place, what functions it has, what we do know and maybe what we still don't know about it. So I'll start with the last question, which is we know a lot less about it than we know about the gut microbiome, which might surprise people because I've said that the skin is so much more accessible. So you would think it's the obvious place to start investigations on the microbiome,

but that isn't the case. We know that we have all of these microbes living in our gut. We also have millions of microbes living on the surface of our skin. Something that I think is really fascinating is there's an argument always about what is the largest organ in the body and it's often said to be the skin. And so dermatologists take a lot of pride in that. I've actually recently learned that's not exactly true. For anyone who's interested, by weight, it's the musculoskeletal system. And by surface area, it's actually the lungs and the airways, the sort of gas exchanging surfaces are the largest. But what's really cool about the skin is if you were to kind of roll it out flat, it's two square meters. But there are millions of these appendages, so dips and divots in the surface of the skin because of our hair follicles and our sweat glands and our sebaceous glands, which are oil producing glands. And so actually the real surface area of our skin that our microbes can inhabit is 10 times that, at least 10 times that. So some say sort of 25 square meters.

So it's huge. So it's pretty big. A football pitch? Don't ask me. I'll have someone that's into football betting really fast. Maybe like a tennis court or something. It's definitely pretty big. A football pitch? Don't ask me. I'll have someone that's into football. Maybe like a tennis court or something. It's definitely getting big. So there are lots of them.

And there are good and bad ones. Something that's really interesting is a bit like Tim talks about, sort of there being these mini pharmacies, the microbes he compares them to mini pharmacies and the gut sending out signals to the rest of our body, the same is true of the microbes on our skin. And so they interact with our immune system. This is really important, particularly in early life. We should talk about the hygiene hypothesis, I think, which is the idea that we often think about small children, babies in particular, being vulnerable to infection,

and they are because their immune system is yet to mature and develop. So the theory in the past was that you should keep everything clean around small children so that you don't expose them to this risk of infection. And what we've learned is that, unfortunately, by not exposing kids to dirt and animals and all of this other stuff, we actually reduce the diversity of the microbes that live on their skin. And therefore, this affects the development of the immune system and actually increases the risk of people developing allergies and inflammatory skin disorders. And how do you do about letting your own children get really dirty in those first few years of life? I mean, Jonathan knows this is definitely a sort of do as I say, not as I do. And I think it's something actually that I've thought quite a lot about since having our

daughter who's now four, because, you know, I've trained in a hospital environment where sterility and cleanliness are king. And so that often gets translated into home life. So my family will laugh when they hear this, but they're like, you could eat off the floor in my home. I often say to my daughter, you can eat off the floor here, but nowhere else. But we know that this is not great for kids. And actually, there have been some recent studies showing that actually exposing children to the natural environment. So there is this scheme called Play and Grow where kids, I think there were two to five year olds, and they were sent to go and play with leaves and soil outside for a number of weeks. And what's amazing is the researchers found that the kids were less stressed and less angry. They had higher gut serotonin levels. They felt more connected to nature. So by that, they were more prepared to eat vegetables afterwards and were interested in the environment. And they had greater abundance and variety of microbes on their gut samples at the end of the study.

And when you were studying dermatology, were you taught anything about the microbiome at that point? No, I think the first time I heard the word microbiome was as a dermatology trainee. So I was already pretty advanced in my career. But it's relatively new, even in nutrition. It's only the last 10 years that we're talking about it. And Justine, something we often talk about is how can we change the microbiome in our gut to make us more healthy, given the link between the gut microbiome and health? Can you change your skin microbiome? So you talked about there's different bugs that are associated with different skin conditions. Can someone change their microbiome on their skin? And most importantly, does that then alleviate some of the symptoms

or conditions that you talked about? We're only really starting to get into it, Sarah. And I think often people would think that there's more real science here than there is because, I'm going to be cynical, but there's a commercial opportunity to sell skincare products that say they're going to balance your microbiome and supplements. Wow. Okay. So cream that you can put on that will change your microbiome. Yeah. So like a probiotic cream. Yeah. Creams containing probiotics. Really?

Yeah. So, I mean, this is not new. It's been, you know, for the last, I don't know, five plus years, they have these products out there. They say they can balance your microbiome, they contain probiotics, etc. But if you actually, you know, I think people might be surprised because if they are into skincare or beauty and have been into a skincare store, looked at the shelves, there are lots of products that have these claims now. But if you look at the science, actually, it's still in its infancy. And it's not nonsense that there are some studies where people have been given oral or topical probiotics. And there have been some favorable changes in reducing some of these pathogenics, some of these bad microbes that can take over but I think the sort of magic bullity type things that say you know a probiotic cream is going to balance everything I'd be a bit skeptical about those things still okay so I've got a question that I think a lot of listeners might be thinking or maybe I'm just crazy but we know that yogurt for example is a probiotic and it's going to be a lot cheaper than any of these creams what about slathering yogurt on your face i mean i get the smell i would this is good has anyone done that um i'm sure they have

i'm sure they have done i'm sure they have done i i don't know of any trial where people have put the yogurt on their skin but i think it goes back to you know dermatologists are used to telling people not to put toothpaste on their spots like there are things are designed for a specific purpose yeah okay. So eat your yogurt. And in terms of practical things that you could do to potentially support your skin barrier and reduce dysbiosis on the skin, these are things like, for example, using a gentle cleanser on the skin. So I like a cream or a gel cleanser for washing the face morning and evening. If we overwash our skin, we might disrupt the microbiome on the skin. If we use very harsh,

soapy cleansing products, we might disrupt the microbiome on the skin. Does it strip the microbiome if you use quite a tough, like I like one that really scrubs off everything that's got all grains in it and will that strip it or does it just reduce it can do in theory and I think we've got to remember that it is quite individual right so you know some people might say I use this you know exfoliating cleanser and actually that's fine for me I have no problems with it if it's fine for you and it's not disturbing your skin and you have no skin problems, it's probably okay. But the microbes on our skin like certain conditions. So if someone has an inflammatory skin condition and is thinking, how can I kind of support the good microbes on my skin?

I would say, think about this soap-free, gentle, creamy or gel cleanser. If your skin is inflamed, so in my acne clinic, for for example I tell people not to use those scrubs or exfoliating cleansers because if you think of an inflamed surface and then you're going to go and scrub something over the top of it you're going to increase inflammation in the area so that wouldn't be a good idea. I'd like to share something exciting. Back in March 2022 we started this podcast to uncover how the latest research can help us live longer and healthier lives. We've spoken to leading scientists around the world doing amazing research. And across hundreds of hours of conversations,

they've revealed key insights that can help you to improve your health. If you don't have hundreds of hours to spare, no need to worry. At the request of many of you, our team has created a guide that contains 10 of the most impactful discoveries from the podcast that you can apply to your life. And you can get it for free. Simply go to zoe.com slash free guide or click the link in the show notes and do let me know what you think of it. Okay, back to the show. I'd actually love to take that opportunity to move on to sort of two of the skin topics

where we had a huge number of questions from our Zoe listeners, which is acne and skin aging. And I'd actually love to start with acne. Maybe just start by telling us like, why does acne matter? So it's a big problem. Okay. Acne is the eighth most prevalent disease globally. So not the eighth most prevalent skin disease, the eighth most prevalent disease, you know, full stop.

So big problem. 9.4% of the population have acne. So just think like almost one in 10 people. That's a lot. Yeah, it is a lot. And it is the most common reason for people to come and see a dermatologist. It's associated with higher rates of depression and suicide. It's associated with scarring, which can become permanent in more people than you think. So maybe this is a kind of something that stays with people even after the inflammatory phase has gone. 90% of teenagers will have acne of some severity. So

if they're lucky, that will be very mild. They may just have a few blackheads and a couple of pimples. But for some people, it's very much more severe than that. And they have, you know, these deeper red swellings and cysts in the skin, and they're more likely to get the scars. And I always think it's quite cruel that the time at which people are most likely to develop acne is in puberty because of the rapid change in the hormones. And this is also where, you know, kids are so vulnerable because they are developing their social identity. They're trying to become more independent. They're navigating personal relationships. And they've got exams and all of this pressure that they didn't have when they were younger. And then they've got to contend with this very visible and painful skin condition. So I could keep going, Jonathan, but those are some of the reasons why I think. Is it just teenagers? Because I know that's actually not most of the people who see you. No. So for sure, it's much more common in the teenage years. And then acne is much more common

in males than females in the adolescent years and in the early 20s. But beyond sort of early to mid 20s, it is much more common in females. And so a rough sort of rule of thumb is that half of females in their 20s will have acne, a third of females in their 30s and a quarter of females in their 40s. Which is huge, isn't it? So half of all women in their 20s, still a third in their 30s. And what about menopause as well? We hear lots of people talk about getting spots around menopause. I'm at that perimenopausal phase and I've never had spots. I've been really fortunate, but I've started to notice I've got a few of my spots on my chest. I get a few here. And you hear anecdotally, a lot of women say during the perimenopause, suddenly acne returns and spots return. So just to reassure people, if we look at age alone, you are much less likely to develop acne for the first time or to continue having it in your 40s or 50s. So the chances of having acne do

decrease with time. However, at any time of hormonal shifts, you may be more vulnerable to having spots. So we do see it around the time of the menopause. We also see it around pregnancy. And of course, the classic time for having acne is during puberty. And is it more common than it used to be? Yeah, it is. And I think we haven't really always understood why acne has been becoming more common over the last few decades. But I think there are two leading thoughts at the moment. And the first is the adoption of the Western diet. And the second is increased stress levels. And could we talk a little bit about the impact that diet might have on acne? Because I know lots of my friends who are parents

of children that suffer from acne often will say oh Sarah what should they be eating and I can't tell them what they should be eating but I know that lots of people will go on elimination diets you know I must avoid all dairy or avoid gluten etc and you know when I was growing up acne was blamed on eating sugar and chocolate. I'm pleased you mentioned elimination diets we should come back to that in a moment because it's one of the most worrying things i see in clinic is people coming in and having read that various foods can contribute to acne and have taken that further and started excluding all sorts of things from their diet and are frankly

malnourished when they turn up in clinic and also have developed, I think, disordered eating as a result of, I think, misinterpreting information about food and acne. And especially for adolescents, that's such an important time to make sure that you're eating, you know, a wide variety of nutrients nutrients you know the the prevalence of iron deficiency anemia in adolescence is huge and so if people are avoiding certain foods that's a real problem correct and i think of you know my steps and so we have a 15 year old at home he'll be absolutely dying that he gets mentioned today but um dying of embarrassment that it's not excited excited but you know you they they have to sleep so much right in their

teenage years because they need all this you know conserving energy for growing so actually we do need to think about fueling ourselves properly and not restricting things particularly when there isn't sufficient evidence to to suggest it would be helpful so you know what what do we know we know that diets with high glycemic content are associated with increased severity of acne. And so can I just tell people what we mean by that? Please do. And I'm not a nutritionist, so I would rather you explain what it means. foods are typically high in really refined carbohydrates so white bread white pasta potatoes that kind of thing that cause a really rapid increase in blood sugar so you eat these kind of foods about 15 20 minutes later you've got this big peak in blood sugar and it also

stimulates lots of hormones like insulin and insulin like growth factor and so a little bit about acne so people understand how the sort of pathway is connected is that what basically underlies acne is an increase in oil production in the skin blockage of the pores where the oil is supposed to come out onto the surface of the skin by dead skin cells and then this creates a delicious feast for this particular bacteria see acne that feeds on this and this triggers inflammation. And underlying this is a particular group of hormones called androgens. Testosterone is the classic one, which increases the oil production and the pore clogging. And we can connect food to this because these sugary foods and these very refined carbs,

your blood sugar rises, then your insulin rises and insulin like growth factor rises, IGF-1, and this increases these androgen hormones. So it kind of, we can connect all the different dots along the pathway. Okay. You also talked about inflammation, which is something Jonathan particularly loves talking about. And I quite like talking about it with him. We know as well from our own ZOE predict research that the food that we eat is associated with our gut microbiome. That's also associated with lots of inflammatory factors. We also know if we consume really high glycemic index food, it actually initiates an inflammatory

response. Now, this is inside our blood. This is inside our gut. Would any of that be related to the kind of inflammation you're talking about that's going on at the level of the skin? The answer is yes, because there is a connection between our gut health and our skin health. We call this the gut-skin axis. And so for sure, the same sort of principles will apply. Sugar is the most important one. Dairy is one of them. People often will see an association with eating dairy and their skin getting worse, or certainly will have read about it from an acne perspective.

And there is some evidence now, mainly, there aren't any RCTs as far as some west, mainly observational studies showing that in western populations, dairy can aggravate acne, particularly milk, because this seems to have a greater impact on insulin than other things like cheese, potentially because of the whey contents or whey supplements can be problematic for acne sufferers as well. So the two areas of nutrition where there's been most research and evidence of their impact is dairy and the sugary stuff. So Justine, what would your practical advice be to help people with acne? Because there can be a lot of people listening to this who would love to know, okay, what can I do for myself? Or maybe they're thinking about their teenage children.

What would you say? I'd say the first thing is do go and get expert help if it's something that you're not able to manage yourself at home. I'm going to start with that because I think there is a big spectrum of severity with acne. There's very mild acne, which can be self-managed at home with some of the tips I'll give you in a second. But there are people who have much more severe acne.

It may be affecting their mental health. It may be causing scarring. And I think in that circumstance, please go get some support from your family physician, your GP or a dermatologist and do these other things on top of that. But I wouldn't want to delay people getting appropriate treatment. I think there are some skincare tips I would give, thinking about supporting the skin barrier and also, you know, in inverted commas, helping to balance the skin microbiome, but, you know, to create a healthy environment for the skin microbes that are beneficial to us, moisturizing the skin is important. So moisturizing the skin reinforces skin barrier function and it

makes the skin a happier, healthier place. If you have acne, people often avoid using moisturizer because they're worried about clogging their pores up more. Look for the words non-comedogenic on a package that means non-pore blocking. And that is something that you might find helpful. Vitamin A, retinol, retinoids. This group in topical form is really good for reducing pore clogging in the skin and can also reduce inflammation to a degree, more so for the prescription forms and the over-the-counter forms. But I think what is really important is choose one and incorporate it in your skin routine. So I would say cleanse your skin or tell your teenager if you're going to be relaying the information, cleanse your skin with a non-stripping product twice a day, moisturize the skin with a

non-comedogenic product twice a day, put a non-comedogenic sunscreen on in the morning and choose one active ingredient or one product with these active ingredients in to incorporate into your routine and introduce it slowly. Because again, you can sometimes do more harm than good if you're too aggressive and overzealous with these active ingredients. Try to combine too many of them together. Try to use too much too soon. I mean, I remember as a teenager being given a cream for acne and thinking this is the answer to all my problems and like squirting half the tube out and putting it on overnight. And of course, nothing happens immediately. And you think my acne is going to be gone tomorrow. And then you

wake up the next morning and you're like, you can't smile because your face is red and it's going to crack and it's really sore. And so, you know, I always say to my patients, you know, I'm glad you're excited about using this, but, you know, you do need to, you know, you do need to incorporate it gradually into the routine because you can actually end up doing more harm than good if you are, you know, not slow and steady. So, Justine, you've talked us through top tips of what you can apply to your skin and your understanding of nutrition and acne. So, if I could just summarise back from a practical perspective, based on what you said about nutrition, you're suggesting that foods at a high glycemic index are going to be a problem. So this is where this perception that, for example, sweets, chocolate might be bad, but also

therefore, perhaps people should be reducing the amount of these refined carbohydrates. So for example, the white bread, the white rice, the pasta, the potatoes, and any other kind of rapid carbohydrates that increase blood sugar. And would you say that that would be a good diet tip that we could also give people? Yes. And I think one of the things you said in this podcast before that I think is really helpful and practical is even if you do nothing else you can just switch having your white bread white rice or white pasta with wholemeal versions of that you don't have to change your lifestyle or any of the other things that you do that's a sort of simple switch that you could make as a starter for 10 or add protein healthy proteins or healthy fibers or fibers healthy you can add healthy proteins or healthy fibers or all five is healthy you can add healthy proteins fiber or some healthy fats as well which will kind of reduce that blood sugar response yeah exactly and

i would also say just life is about balance and it is okay to have treats and i wouldn't want the take-home message for anyone you know to be that you know if they're at a restaurant on their birthday they can't have the pasta as it's served or they can't have a pudding that night. It's okay to do that as long as that is the treat and not the norm, I would say. Okay. So while we're talking about food, I'd quite like to quiz you a little bit about Jonathan. So Jonathan is obviously incredibly well-behaved in everything he does. So my perception is that Jonathan follows the Zoe recommendations to a T. So I'm not even convinced that he would go and have his birthday cake at a restaurant if it didn't score high on the Zoe score. Have you noticed his diet change since he started the whole Zoe program?

And also, I'd be curious to know how yours has changed so I'd say Jonathan's diet changed before the Zoe program a little bit and I'm sure this is why he you know went on to to form Zoe Jonathan's talked a bit about you know having had issues with his gut in the past etc I hope you don't mind me saying that Jonathan and so had already started making some changes to the way he ate before we even met but you know he does live it at home and I think actually after you know a couple of years of being told you know the what was our life like after I did Zoe and before you did Zoe we actually we have now I want to know what Justine was going to say. The fact that she's thinking twice about how to say it. I was going to say, you know, it's a sort of mind field here.

I think we have a sort of, you know, there are lots of jobs we share in the house. We both work, we both have young children. And the sort of split is normally I prepare the food during the week and Jonathan does it on the weekends. That's how we do it. Justine, I have seen on your Instagram account, the pictures you've been posting of your meals. They look incredibly healthy. They all look like they would score above 80 at Zoe, but most importantly, they look really tasty.

So this is sort of part of, thank you, Sarah. This is kind of part of the evolution. So Jonathan was kind of the early adopter and he was doing Zoe and I would be preparing the food during the week. And I think it would be fair to say we were having the same thing on repeat every week because I'm time poor. I've never had very much confidence in my ability to cook. My mum is an amazing cook and somehow I think I always felt

overwhelmed. It seemed like quite a lot to do and didn't get into it. So after a couple of years of having the same foods on repeat every single week, the same five things on rotation, and Jonathan saying, be really nice if we could have, you know, a bit more, a few more plants or what have you. I then did Zoe myself last year, and I was really excited about it. You know, I am a science geek and I love the idea of, you know, putting on the CGM, seeing what was happening to my blood sugar in real time. I had some shockers, things that I was eating that I thought were really good for me, caused massive blood sugar spikes. I loved doing this sort of at-home poop test and all of that, the sort of science experiment at home bit. But having then, you know, these results that arrived that were personalised to me, I was then much more invested in actually making some changes. So it felt less

like Jonathan nagging me to do things because, you know, it was good for him or he thought it was healthy for us as a family. Jonathan nag? Never. I don't know who you would be talking about. Sounds so implausible. So, you know, I kind of felt like, you know, this was something that I could get on board with as well. And then I think the biggest surprise to me was actually getting into cooking because this was something I was like a can't cook, won't cook person. And I've worked out for myself that there are a lot of things I can do even without the app now. So I know that if I just have a load

of beans, canned beans, red kidney beans, pinto beans, cannellini beans, or what have you in the cupboard, I have some chopped tomatoes and I have an onion, you know, in the fridge somewhere. If I have these staples, I can basically do a bunch of stuff, you know, I can always feed us. And how much have you changed your diet? Quite a lot, actually. I would say lots. Yeah, quite a lot, actually. I think that... What I love, by the way, is that I said all of this stuff for the previous couple of years, having obviously taken part in the early studies and getting my results. And Justin's like, whatever, just going to ignore you because obviously I say all sorts of stuff all the time that might not always be right. And it was only when you actually did Zoya yourself and got your own results and guidance, right, that that made the shift. It was really interesting that then it was like for you you it wasn't just your husband nagging at you and actually i wasn't expecting justine to

change very much i think you had a very clear view that you knew what was good for you and what was healthy and just having that justine has really changed her diet which is great for me because it means the whole family's diet has shifted dramatically as a result i think there's something very convincing about seeing your own data absolutely Absolutely. I think that's really what it boils down to. That and for me also, the fact that preparing food doesn't have to be as difficult as you think it is and incorporating, you know, if you have, as I say, a few of the staples in your cupboard at home, you can do this with very little effort and time. And I know because I have a four-year-old and I run a clinic and I have a very demanding husband. Jonathan demanding no way. My only frustration

is now Justin has to take a photo. He's changing the topic talking about how demanding Jonathan is. So I say my only frustration now is because Justin does most of the cooking now so she has much more than she did before because she's really got into it out of this, which again was not at all like an expected byproduct. We've learned to eat a lot of things. I think we would never eat any sort of bean ever, right? That's sort of like you eat baked beans when you're a child. And I think there's no doubt there's been a sort of shift. And what's interesting, I think, I'm fascinated by is

you eat some of these things first i mean i don't even i don't like this very much i'm eating this because it tells me that it's healthy and what is really interesting is you know if you can stick with that for a month it's like your whole taste buds change don't you find and suddenly you start to think actually this is really nice and it's almost like you're somehow shrugging off a lot of whatever you're you've been learning from this ultra processed food and maybe your microbes are changing a bit with it. But your taste buds change. So like with salt, for example, which we're over consuming in the UK and it's a big problem how much we're consuming,

but you become desensitized to it. And so they say that you've got to gradually wean yourself off it and your taste buds will then start to appreciate it more. I'm really conscious of time and I think it would be great to talk about a topic that I'm really interested in, which is as a 46-year-old woman, I, myself and all my friends are interested in skin aging. And so you said in the quickfire questions, we can't reverse signs of aging, but we might be able to slow it down. There may be some people listening to this, scientists who say we can reverse ageing, but I think let's talk about some of the practical things that we know for sure at this point can slow things down.

Perhaps we could start by talking about what actually causes skin ageing so we know what potentially we can avoid, and then some great tips from you on how we can actually slow it down as well. Hi, I have a small favour to ask. We want this podcast to reach as many people as possible as we continue our mission to improve the health of millions. And watching this show grow is what motivates the whole team at Zoe to keep up the really hard work of creating new episodes each week. So right now, if you could share a link to the show with one friend

who would benefit from today's information, it would mean a great deal to me. Thank you. Okay, sure. So I think when we think about skin aging, we divide it into sort of two categories. There's intrinsic aging. So this is the passing of time, so chronological aging and genetics. And I think a lot of people would expect that those have the greatest influence on how our skin ages. So you mean, for example, if your mum's or father's skin aged well, you might think, well, that's fine. I'm going to have great skin as well. So, yes, correct.

And also that you might expect that someone who is 70 looks older than someone who is 60. Okay. So there's also this sort of chronological age. Then we have the second category, which are extrinsic influences on aging. Meaning? So meaning things that impact our skin from the environment, so environmental exposures. And actually the most influential of these is sun exposure, and we call that photoaging. And people will probably be amazed to hear that 80% of visible skin aging is attributable to sun exposure.

80%. So if I had, which I didn't, unfortunately, stayed out of the sun, put sun cream on religiously up until now and I've only just started wearing sun cream since I've been watching you on Instagram talk about how important it was if I'd have slathered myself in sun cream up until now could my skin look could you look even more youthful than you do already could I look like my 20 year old self I mean possibly so the you know the evidence is that sun protective behaviours, and part of that is sunscreen.

Part of it is also staying out of the sun between 12 and 2 when the sun is directly overhead, wearing a hat, covering up in the sun. So sunscreen is part of the armamentarium, but it's not everything. But yes, the answer is that protecting your skin in the sun so it's not sunscreen is part of the armamentarium but it's not everything but yes the answer is that protecting your skin in the sun can for sure slow signs of aging and i think this is quite empowering because we can all do this it's in our control exactly it's not very difficult i remember justin and i went on this amazing holiday to japan early in our relationship

when i was trying to convince her to stay with me. And we saw all these women there, right, of all ages, basically with umbrellas. And it's not raining. It's like a sunny day. And so you see like this huge focus there on managing skin exposure. And Justine was like, this is part of why they all look so incredibly young, isn't there? And actually, that reminds me of something, you know, that's also very interesting is that how we age. So, you know, the manifestations of aging may be slightly different actually in different populations as well. So in more sort of European populations, wrinkling may be the predominant thing. And in Asia, so you were talking about Japan, brown marks or brown spots, dark spots, whatever you want to call them,

these pigment changes may be the predominant hallmark of aging. But sometimes people wonder what we mean when we say skin aging. What are we talking about? And we're basically talking about the skin becoming drier over time. We lose more moisture through our skin. We lose collagen, this sort of protein in our skin that makes it firm and reduction in collagen causes the skin to wrinkle more and to sag more. And then the other thing that we get is these dark or brown spots on the skin. And so lots of people I know are taking collagen supplements on the belief that they will enable their skin to stay younger, look more youthful. Do they work?

The jury really is still out, Sarah. Am I recommending these in my clinic? No, is the answer. Are there other doctors recommending them? Yes. People might want to know what we're talking about when we say collagen supplements. This is sort of collagen that people take in, I guess, capsule form. They're broken down into peptides absorbed in the intestine. It has been proven that they do find their way into the bloodstream about an hour after they've been eaten, and then they accumulate in the skin. And the idea is that they trigger increased collagen production in the skin, which makes the skin firmer, that they may trigger elastin in the skin, which is this other protein that makes the skin more springyy and also improve hydration in the skin. And there have been some studies that show favorable effects when people have taken collagen supplements. There's others that show less of a benefit. The difficulty with interpreting the data is that a lot of the studies are sponsored by companies who make supplements so they have an interest in

presenting the data in a way that would show you know that there's a favorable effect and a question I always have is we know that we tend to absorb these nutrients better when we get them in food so do we really need to take a collagen supplement couldn't we be thinking more about you know the Mediterranean diet and getting these nutrients in our food? So before going and shelling out a lot of money on collagen supplements, because that's the other thing, the studies have shown that the effects don't last when you stop taking the collagen supplements. So this is something that if you were deciding that you were going to take on board, you'd have to keep on doing that. It could end up being

awfully expensive. So why don't we think about the inexpensive, easily accessible things that we can do that have lots more evidence behind them? And that's the sunscreen. Retinol. Retinol comes from vitamin A and it's available in topical form for improving signs of skin aging, something you put on your skin in the evenings usually because it can make the skin a bit more sensitive to the sun. And that can boost collagen production in the skin, making the skin firmer and can also help with reducing the appearance of some of these brown marks that appear on the skin as well. So that would be something that's real, is it? Because I remember when I first met you, I'm like, this is all potions, isn't it? Isn't everything that you put on your skin is all fake? That's real. I often say there are three things if you want to think

about skin aging that you can incorporate into your daily routine. And sunscreen is number one. Number two is using retinol at night. And for anyone who's listening to this, you may be pregnant or trying to get pregnant. That's not the time to use retinol. It shouldn't be used at that point in life. And the third thing is thinking about antioxidants that you can apply to the skin. And vitamin C is the most studied one. So we know that if you apply vitamin C to your skin in topical form, that this increases collagen synthesis. It helps to boost your own collagen production.

It helps to reduce dark marks on the skin. So we make fewer of these. And it also protects us from inflammation on the skin so we make make fewer of these and it also protects us from inflammation in the skin as well so so vitamin c topical vitamin c is important and there are other antioxidants so things like resveratrol coenzyme q10 so you know there are antioxidants that are important but but basically these three groups, antioxidants, sunscreen, and retinol are the key things. And I wonder if I could ask you two top nutrition skin myths that I have seen doing the rounds on social media. They might not be myths, so you're the person to ask. One is that polyphenols are our own natural sunscreen.

Is that correct? Because I've seen this as headlines. Just eat loads of polyphenols. You don't need to apply sunscreen. I would say? Because I've seen this as headlines, just eat loads of polyphenols, you don't need to apply sunscreen. I would say, why don't you do both? Okay, so I think we're not yet in a position where we can say that there is something that you eat that is going to protect your skin well enough so that you don't need to rely on sensible sun protection behaviours, staying in the shade, wearing a hat, covering up. If you are someone who doesn't like using sunscreen, there are other things that you can do. I personally

am very comfortable putting sunscreen on exposed sites and I wouldn't rely on these oral polyphenols. But it's not total nonsense in that there is theory there. So for example, if you think about a carotenoid like lycopene may have some photoprotective effects. Omega-3 might have some photoprotective effects. But I definitely am not swapping my sunscreen for those. Okay, great. The other thing that I've seen in lots of headlines is intravenous antioxidant vitamin drips.

It will make you look 10 years and feel, but make you look 10 years and feel but make you look 10 years younger and this is a growing craze i think amongst a niche community and for those of you listening justine is shaking her head ever more vehemently as sarah is saying this i'm just not even going to talk about yeah no i i don't believe in those okay so i often use the word nutribollocks to talk about nonsense when it comes to nutrition and what you're saying is intravenous antioxidant drips to make your skin 10 years younger is neutropollux. But polyphenols as a potential sunscreen isn't advisable, but there is some science behind why it might be photoprotective. I may have even sounded much more strong on the polyphenols of sun protection than I intended to. What I'm saying is I wouldn't dismiss it, keep an eye on the space, but for sure we're not at a position yet where I would say swap your sunscreen for that. And the antioxidant drips, I'm always prepared. When you work in science or in medicine, you have to keep an open mind because things change. I'm prepared to be convinced that those are a good idea, but I'm not at the moment. And I have to ask a follow-up question because it impacts my life.

How important is it, in fact, that you apply sun protection? It is important. Okay. And I think we've talked about skin aging here, but there are other things, like your risk of skin cancer increases with age and with cumulative UV exposure. With sunburns, that increases your risk of skin cancer, not least because also they're uncomfortable at the time. So protecting your skin in the sun is more than preventing your skin looking older earlier. It's also about reducing risk of things like skin cancer. So just before we run out of time, I mean, we've talked a lot about food, we've talked a lot about skincare routines we talked a lot about skincare routines.

Is there anything else that a listener can do that can really affect the health of their skin? Yeah, so absolutely. Stress is mega and sleep. And so actually in the clinic, when I counsel people about how we're going to manage their skin condition, I would start with genes and hormones. And then we talk about skincare habits. We talk about the food we eat. We talk about stress and sleep. These are sort of the key things we touch on. Something that I think people might be really interested to know is, I mentioned earlier about people with acne having higher rates of depression and suicide. Did you know that some of our stress hormones, so thinking about this brain and skin connection,

some of our stress hormones actually get released in the sebum, the oil from our oil producing glands in the skin and literally bathe the surface of our skin. So the connection... We are like bathed physically in stress when we're stressed. Correct. So there is definitely a really strong connection between the brain and the skin in ways that people might not expect. Yeah, it's really interesting because I've always thought of the skin as just this inert outer layer, like we started, you know, when we started talking. But talking to you now and obviously, you know, having listened to lots of your Instagram posts, it's fascinating how it is a living part of us. Yeah, absolutely. And we've got this community of all these bugs living on us as well. So

it is very much a sort of reactive, dynamic organ. And there's so much more we're still going to learn about it. But I hope know, I hope I've convinced you. Oh, absolutely. People often think about, you know, going back to Jonathan's original point about how when he met me, he wondered why I wasn't, you know, a kidney physician or something like this. And, you know, skin is absolutely fascinating. And there's, as I say, so much more we're learning about it. So I hope I've convinced everyone else of the same. I wouldn't be allowed home if I didn't say yes, so I'm sold. You're not allowed to answer any other way.

Amazing. Thank you very much, Justine. I'm going to try and do a little summary and I really have to get this one right. Yeah. So Jonathan, before you do your summary, I'm not going to do the summary, but before you do your summary, I have been subjected to a year of quickfire questions from you. Justine has been subjected to about six years of quickfire questions. So we have some quickfire questions for you. We have five questions. Oh, no, I wasn't prepped for this at all.

That's very unfair. Okay, go on, Sarah. Five questions each. Okay. The fifth question is going to be tough. Each of our fifth questions is tough, so you get two points. So you can get a maximum of 12 points. All right.

I'm very competitive, so I'm heading for the 12. If you don't get 10 out of 12, there is going to be a forfeit. Oh, dear. So the forfeit is if you don't get 10 out of 12, you will either have to drink a Diet Coke. Right. Or you'll have to eat a McDonald's. And we're going to let your son, Zach, decide which of those you're going to have to do. Oh, I can't do either of those.

So I better score 10. Okay. Pressure is on. So I'm going to go first. Now, my questions are going to test just how much you listen to me. Okay. And how much you've listened to the podcast. Okay.

Okay. Wow. Ready? Yes. Okay. This is a controversial one I'm going to start with. Are all ultra processed foods bad for you? No, if you use the NOVA classification.

Well done. Should we all be taking omega-3 supplements? No, because you can also get it through diet. Okay, great. Does diet improve menopause symptoms? Yes. Okay. Who do you prefer doing podcasts with, Tim or me? That's like choosing between your parents. I love them both equally. Oh, Jonathan, damn it. I think I should take a point away for that. Tim's not here. I prefer you, Sarah. Just in case I only get nine points, I really don't want to have to eat at McDonald's. Yeah, I would have deducted point away for that. Tim's not here. I prefer you, Sarah. I want to get, just in case I want to get nine points.

I really don't want to have to eat at McDonald's. Yeah, I would have deducted a point for that. Okay, now this is the challenge. This is the two point question. Okay. All right. Now it's quite tough, but I've talked about this so often on our podcast. Okay.

Okay. So what percentage of energy is not absorbed when you eat nuts? Ooh, that's really hard. For people listening, this means by what percentage, back-a-pack labelling, overestimating the energy content. Is it like a third? I think it's about a third. Oh, my goodness.

Well done. That's six out of six. You see, I always listen to you. Now we're over to Justine. All right, I'm more scared about this one, I have to admit. You don't have to be scared. Actually, I'm testing your truthfulness here because I know the answer to some of these questions.

So I'm going to be interested in other people's. Sounds like that's really hard. You have to help me keep counting. So number one is going to be, is acne more common in males or females? I know at least for adults, it's more common with women. Okay. Yeah, that's correct. But you said for adolescents, it's more common in men earlier.

So exactly. So over the age of 25, more common in females and in adolescents, in males. Well done. I can't tell you, by the the way how nervous i am right now so i've had years of your quick fire questions i realize it's a lot easier to ask them than to have to answer them i have more sympathy now with all my guests okay so question two is what is the minimum spf i would consider um buying for a sunscreen product that we keep at home? 500. No, that was a joke. 50. So I would say 30 or higher. Justine says that. Shall we let him have that point? No, because the reality is she says that,

but we never buy one that doesn't say 50 on it. So I feel like that's... Okay, hold on. It's yes or no. You're now explaining your answer. I think we can accept 50. Okay, we'll allow that. The answer is 30, though. And the next question is, which meal or food do you most associate with happy times?

And I know the answer. Gelato, ice cream. Okay, I thought that was what he was going to say. So for context, for people who don't know jonathan family have been going to a particular place in italy in the summers for i'll say i was going to say centuries but yeah yeah he's been he's been good excellent skincare skincare yeah and i know that jonathan one of jonathan's big passions in life is gelato and this is something that tim might say it's a heritable trait this is something that uh that my stepson has definitely inherited. My next question was, what is the Zoe-inspired meal that

I've made that you've most enjoyed? This is question four. Yeah. I think that the one I have most enjoyed is when we actually had Will Bolswicz, who many people on the podcast know, and Sharon, who's our head of marketing round for dinner. And they're both vegan. And you made this sort of bean stew, which was absolutely fantastic. And if you had said to me 10 years ago that I would have eaten like a vegan bean stew and said that it was amazing, I'd have been like, what? But like, where's the steak? So that would be my favorite and the only person who didn't enjoy that meal was my stepson who said where's the steak where's the meat yeah exactly okay um so i've got one more question you've got

one more question this can be the one that is the bonus question but he's doing fine so he's not going to get a forfeit unfortunately unfortunately. Damn it. Okay, I was going to say Star Wars or Princess Bride. Oh, that is so tricky. I'm going to really divide the audience this year. I feel like that's really like being asked to choose your favourite child. So this was one that we, when Sarah said we're going to do some quickfire questions, and by the way, you can see I'm obviously not used to the quickfire questions because they've taken a bit longer to answer.

However, we had to have a consultation at the dinner table last night. So Jonathan was out last night. So the family sat around the table and this was the question that we chose together. I think I'm ultimately going to go Star Wars, but I mean, I could, I'm going to go Star Wars. Will Zach still talk to me? I mean, I don't know. I think he will. Well done, Jonathan. You've scored 12 out of 12. You do not have to eat McDonald's and you do not have to have a diet cake.

Wonderful, which will keep my skin looking healthy for longer. Let me do a quick summary of today's session where we covered a lot of stuff. I think the first thing we said is that skin is really important. You know, it's not just this impermeable barrier. We now know it has its own microbiome of these millions of bacteria. And interestingly, lots of skin conditions that we have actually link to sort of individual sort of bad bugs in that context. We talked about acne, which is one of the big topics that our members wanted to talk about. Apparently, half of women in their 20s and still a third of women in their 30s have acne.

So it's not just something that you go through as a teenager, that it can have really life-changing impact. You talk about people even committing suicide, which is really terrible. Interestingly, there is some evidence that food can have an influence and specifically dairy and sort of food causing these big high blood sugar spikes can be an issue. But there is also a danger of people going to this, like cutting all their diet out. And that's even worse. So to sort of be cautious as one approaches that, that we had some great sort of practical tips. So gentle cleanser, don't strip your skin, moisturizer you can do if you have acne. And none of these devices that are sort of scraping at your face. And

Justin described, you know, using her fingertips, which I can tell you is indeed how she does this. Then we talked about anti-aging. So Sarah wants to know how to continue to look 30 forever which i think is definitely why i keep coming on the podcast because you keep saying nice things and what justine said is actually sun exposure is 80 of your skin aging so really isn't about your genes it's about things that are under your control so that means sunscreen and just not being in the sun you know like all the time is really important. But there are some real things that you can do. And you mentioned retinol and an antioxidant like vitamin C, both of which I refuse to do because it's too much effort, but I know that Justine does religiously. And then finally, we talked about sort of what else can you do. So firstly, bin those collagen supplements,

bin all these other supplements. In terms of the amount of money, this isn't worth it. And a lot of it, I think there's very little evidence. On the other hand, interestingly, stress can have this huge impact. So if there's things you can do that reduce stress, it really can affect your skin. And amazingly, apparently, if you are really stressed, you're actually bathing your skin in it, which I'd never heard before. It's slightly terrifying because I get stressed quite often in this idea that you're sort of soaked in it marinating it is is amazing but also sleep and even just going into nature might be able to do something for all of you who are listening to this working from home therefore is to like keep listening to the podcast but walk out into nature and improve your skin sarah and justine thank you so much thank you that was fun enjoyed it me That was fun. Enjoyed it. Me too. Thanks for having me. Oh, it was a real pleasure. And I've got through it without anything too disastrous. So I'm pretty happy. Sarah, you obviously didn't know the right questions to ask. Thank you all. Bye bye.

Pleasure. Thank you, Justine and Sarah for joining me on Zoe Science and Nutrition today. If you want to understand how to support your body with the best foods for your skin and your gut health, then you may want to try Zoe's personalized nutrition program. You can learn more and get 10% off by going to joinzoe.com slash podcast. As always, I'm your host, Jonathan Wolfe. Zoe Science and Nutrition is produced by Yellow Hewings Martin, Richard Willen, and Alex Jones. See you next time.