Latest / Skin Anarchy / Q & A with board certified dermatologist and surgeon Dr. Natalia Spierings

Transcript

Q & A with board certified dermatologist and surgeon Dr. Natalia Spierings · Skin Anarchy

0:01
SPEAKER_00: The other little four has a ride.
0:05
SPEAKER_00: Only you can stand in their way.
0:07
SPEAKER_00: Journey across the end of the open world is sanctuary.
0:18
SPEAKER_00: Cross progression on the platform.
0:22
SPEAKER_00: Diablo 4.
0:23
SPEAKER_00: Available now.
0:24
SPEAKER_00: Rated and premature.
0:25
SPEAKER_00: Cap the banner or visit this episode's page to learn more.
0:33
SPEAKER_02: Then yeah.
0:34
SPEAKER_02: So, yeah.
0:36
SPEAKER_02: Hi guys, welcome back to Skincare Anarchy.
0:39
SPEAKER_02: This is Ecta, one of your hosts, and today I have an awesome guest.
0:44
SPEAKER_02: I'm so lucky she had time to do this.
0:46
SPEAKER_02: Um, Dr.
0:47
SPEAKER_02: Natalia Spearings.
0:49
SPEAKER_02: She's uh what I consider to be one of the best dramatologists I've found on Instagram and spoken to, but I'm gonna let her tell you guys like her background and Dr.
0:58
SPEAKER_02: Spearings, like just who you are, what you do, you know.
1:03
SPEAKER_03: Okay, so you can obviously edit this if it's too long.
1:05
SPEAKER_03: Um so my name is Natalia Spearings.
1:09
SPEAKER_03: Um, and um Dr.
1:11
SPEAKER_03: Spearings is my dad.
1:12
SPEAKER_03: So whenever someone calls me Dr.
1:14
SPEAKER_03: Spearings, I'm always like, who?
1:16
SPEAKER_03: Where?
1:16
SPEAKER_03: Yeah, but um anyway, so uh I always associate that.
1:20
SPEAKER_03: So I'm a dermatologist.
1:22
SPEAKER_03: Um in I live in London, um, and I trained in England.
1:25
SPEAKER_03: So though I sound like I should be from your country, Ekta, um I did live in Boston.
1:31
SPEAKER_03: Yeah, I lived on the East Coast for 13 years when I was a child.
1:35
SPEAKER_03: So that's where that explains it.
1:39
SPEAKER_03: Yeah, yeah.
1:39
SPEAKER_02: I was wondering when I first, I'm sorry, I didn't mean to interrupt, but like when you first spoke to me, I was like, she sounds American.
1:45
SPEAKER_02: Why does she sound American?
1:47
SPEAKER_03: Exactly.
1:47
SPEAKER_03: She sounds American.
1:48
SPEAKER_03: So and that I've lived in England for 20 years, yeah.
1:52
SPEAKER_03: Um, and I still sound very, very um East Coast.
1:56
SPEAKER_03: Yeah, so my parents still live in Boston.
1:58
SPEAKER_03: Um, so I do go to the States a couple times a year.
2:01
SPEAKER_03: I have a green card, so I am kind of say that, delete that.
2:05
SPEAKER_03: Um I do I do go to the States a couple times a year, and uh, but I have lived here most of my life.
2:11
SPEAKER_03: I'm originally from Holland, and that's where I lived when I was younger, and then after I left the states and went back to Holland, but then I came to sorry, I came to London for medical school, and I just stayed because you know when you become a doctor in a country, it's easier to stay in that country.
2:26
SPEAKER_02: Yeah, it's you trained there, you know, you're trained there.
2:29
SPEAKER_03: Yeah, you train there, you just stay in the country.
2:31
SPEAKER_03: So it wasn't like a conscious choice.
2:33
SPEAKER_03: I just had gone to kind of a British school in Holland, and they said to me, um, oh, why don't you apply to the UK?
2:40
SPEAKER_03: And I was like, Okay, and I'd never been to London before I came for my first medical school interviews.
2:45
SPEAKER_03: I just I really didn't know what I was doing.
2:46
SPEAKER_03: Yeah, so it was all a bit um crazy, but so sometimes I just make decisions without you know really having a load of thought behind them.
2:53
SPEAKER_03: When this is when I was younger, I don't really do it now.
2:56
SPEAKER_02: Um I do, I do yeah.
2:59
SPEAKER_03: Well, I try not to, but so maybe in my personal life I do.
3:02
SPEAKER_03: So, anyways, I basically moved to London for medical school, and I just I've stayed here ever since then.
3:07
SPEAKER_03: Okay, so I did all my medical training in London, then I did all my um we spent a lot more years being interns here than you guys do.
3:14
SPEAKER_03: Yeah, like four intern years before I became a resident.
3:20
SPEAKER_03: Okay, and then I did four we do four years of residency for dermatology here.
3:24
SPEAKER_03: Um, and then after residency, I did um a post like um post-residency, I guess.
3:31
SPEAKER_03: Like a fellowship.
3:32
SPEAKER_03: You won't be able to do that.
3:33
SPEAKER_03: I did a fellowship in micro Mo's micrographic surgery, which is skin cancer surgery for the head and neck.
3:38
SPEAKER_02: Oh wow, that's very impressive.
3:40
SPEAKER_02: That's that's awesome.
3:40
SPEAKER_03: Yeah, it was cool.
3:41
SPEAKER_03: It was cool.
3:42
SPEAKER_03: So and so basically I did that, and um sorry, it's like my throat.
3:48
SPEAKER_03: Um, so then after that, I basically started working as a consultant.
3:52
SPEAKER_03: So we call them we call ourselves consultants.
3:54
SPEAKER_02: Yes, please clarify that because I don't think most people understand that term, you know.
3:58
SPEAKER_03: So yeah, this is confusing.
4:00
SPEAKER_03: So in the UK, we're consultants, that's the same as a board certified dermatologist in the US, and what you guys would call an attending.
4:09
SPEAKER_02: Yes, okay, okay.
4:11
SPEAKER_03: Yeah, so I'm an attending, which is the same as a consultant, and the same as a board certified um dermatologist.
4:18
SPEAKER_03: So that's the term.
4:19
SPEAKER_03: So in England, anyone who's a board certified dermatologist will call themselves or refer to themselves as a consultant dermatologist.
4:26
SPEAKER_03: We will never refer to ourselves as cosmetic dermatologists, dermatology doctors, skin doctors.
4:32
SPEAKER_03: It's always gonna be consultant because that is like the official title.
4:36
SPEAKER_03: That is your distinction.
4:37
SPEAKER_02: That really is your distinction.
4:38
SPEAKER_02: So anyway, there's my story.
4:41
SPEAKER_02: So that's awesome.
4:42
SPEAKER_02: Like that's so important to understand too, because you're so I mean, I you're you know, it shows how you know progressed you are in your field.
4:50
SPEAKER_02: So it's really good to have someone like you and get your real opinion about things because right now I think everyone is a dermatologist.
4:59
SPEAKER_03: I see so many dermatologists on Instagram, and I'm like everyone's a dermatologist because it's not a protected title, so that's why putting board certified in front of it or consultant is really important.
5:09
SPEAKER_03: Um, in terms of like what my day job is, like, I'm not an Instagrammer, like that's not my day job, like just like you.
5:15
SPEAKER_03: This is this is like an extra thing you do as like an aside from your day job.
5:19
SPEAKER_03: So my day job is very, very clinical.
5:22
SPEAKER_03: I do six clinical days a week, so I see patients almost every day basically.
5:27
SPEAKER_02: That's a yeah, that's intense.
5:29
SPEAKER_02: That's a really hard it's intense, yeah.
5:31
SPEAKER_03: And I've been working like that since I became a consultant like 2016.
5:35
SPEAKER_03: So I'm a more than full-time clinical doctor.
5:39
SPEAKER_03: Um, so and I do spend a lot of time reading and doing research and things like that, but a lot of what I talk about comes from actual physical clinical experience.
5:49
SPEAKER_03: So, like last year I saw 6,000 patients.
5:51
SPEAKER_03: Yeah, you know, that's insane.
5:53
SPEAKER_02: That's so that's insane.
5:56
SPEAKER_03: That's insane.
5:57
SPEAKER_03: You're crazy, you're crazy.
5:58
SPEAKER_03: I just want to say, take a second.
5:59
SPEAKER_03: I'm crazy.
6:00
SPEAKER_03: But you know, as well as I know that in in the realm of surgery or in medicine, to be really um kind of to be top of your game, it's about experience.
6:09
SPEAKER_03: And you know, the the more experience you have, the more patients you get your hands on on a daily basis when it's like all the time, that makes you awesome.
6:19
SPEAKER_03: I'm not saying I'm awesome, no, but I'm trying to be awesome.
6:22
SPEAKER_02: But yeah, you're training, it's a trade at the end of the day sometimes, right?
6:26
SPEAKER_02: It's like you know, yeah.
6:27
SPEAKER_02: So you have to get good at your trade.
6:29
SPEAKER_02: So yeah, you're absolutely right.
6:30
SPEAKER_02: I yeah, I understand, yeah.
6:32
SPEAKER_03: It's that whole like 10,000 hours to be like awesome at something.
6:35
SPEAKER_03: I remember I wrote that book.
6:36
SPEAKER_03: I mean, I think it's more than 10,000 hours, but so when I so when I talk about like you know, my clinical experience, I'm not talking about like once a week I see a couple patients.
6:45
SPEAKER_02: This is like massive amounts of day, yeah.
6:47
SPEAKER_03: You're like hammered all day, yeah.
6:50
SPEAKER_03: Yeah, and I think people forget that when they look at my Instagram posts or they you know criticize something I say or kind of question something, I'm like, you do realize that this comes from like a good couple years of seeing thousands of people with the same problem over and over again.
7:05
SPEAKER_03: Um, and so I don't just make stuff up, like it comes from somewhere.
7:09
SPEAKER_02: So it's so amazing to see someone with your enthusiasm and passion for this because I don't think people understand that like this is like you know, like I think science is like consuming, you know.
7:21
SPEAKER_02: I think I always thought I always felt like people never understood how consuming it can be.
7:26
SPEAKER_02: So like your schedule and you're going through it, it's like you're just you're driven to do this, you know what I mean?
7:32
SPEAKER_02: So I love seeing that because a lot of the dermatologists that I was telling you about earlier, like I don't see that with them, you know what I mean?
7:38
SPEAKER_02: They're not out there and really using their knowledge, and so I I just love that you're doing that.
7:43
SPEAKER_03: Um I like it too, but it is an obsession, it's like a proper this is a proper obsession.
7:49
SPEAKER_03: I'm I think you probably had that in your job too.
7:51
SPEAKER_03: I mean, it's a proper obsession.
7:53
SPEAKER_03: Um, and because you you need to be like there's no balance here, like you need to be obsessed about something to to really be able to understand it and be good at it.
8:00
SPEAKER_03: And I'm again, I'm not saying that I'm awesome or whatever.
8:03
SPEAKER_03: I'm just I'm trying to be there.
8:05
SPEAKER_04: Yeah, yeah.
8:06
SPEAKER_03: I know that the only road to get me to awesome is by just putting the time in and putting the work in, and that's basically fully immersing yourself.
8:15
SPEAKER_02: I mean, you brought up the research and how you're always up to date with research.
8:18
SPEAKER_02: I think that is such a key.
8:19
SPEAKER_02: Personally, I think I don't know why people don't do that more.
8:22
SPEAKER_02: I mean, you know, especially doctors.
8:24
SPEAKER_02: So I love that you said that because it's like you don't you're always upping your training, and that's so important, I think, right?
8:31
SPEAKER_03: So oh my god, totally.
8:32
SPEAKER_03: And it's part of our it's part of what we sign up for as like doctors.
8:36
SPEAKER_03: We have to stay up to date.
8:37
SPEAKER_03: I mean, I don't what's interesting about this though is that like I don't know about the latest like cosmetic skincare line that shows up, you know, in in some shop somewhere.
8:46
SPEAKER_03: I I because that that is not the kind of research I'm talking about.
8:48
SPEAKER_03: I don't go to like you know, CVS or Walgreens or whatever it is and look at the skincare every day.
8:53
SPEAKER_03: That's not what I do.
8:54
SPEAKER_03: But so I'm I'm talking about actual life.
8:55
SPEAKER_03: Real research, peer-reviewed journal articles.
8:58
SPEAKER_03: Like, yeah, real journal articles.
8:59
SPEAKER_03: Because that people are always like, Oh, have you not heard of you know skincare brand X?
9:02
SPEAKER_02: I'm like, uh no, yeah.
9:06
SPEAKER_03: I'm too busy actually learning something that's important.
9:09
SPEAKER_03: So sorry.
9:11
SPEAKER_02: No, I mean no, seriously though.
9:13
SPEAKER_02: I mean, that's so good that you're saying because here's the thing the idea here, in my opinion, I think, is to bring the science back to skin skin health, right?
9:21
SPEAKER_02: I mean, exactly that's what bothers me the most is like I I just look at people and I and I wonder, like, why don't you want to know the science?
9:29
SPEAKER_02: You know, so yeah, but why don't you question what you've been told?
9:32
SPEAKER_03: Because if it sounds dodgy, it probably is.
9:34
SPEAKER_02: Yeah, and it's like also like you're but here's my the with the science, it's like you're utilizing something scientific, so why don't you want to give it the credit of being science and then look into it and you know what I mean?
9:44
SPEAKER_02: That just it's so weird to me.
9:46
SPEAKER_04: So yeah, totally.
9:48
SPEAKER_02: Yeah, but anyway, so about okay, I'm gonna get to the question um that we got from our uh one of our listeners, and I'm so excited to ask you this because I actually had heard you on one of your lives on Instagram briefly touch on this.
10:02
SPEAKER_02: So when she asked about ceramides, this brought me back to that point that you made, or you were I think you were starting to hint that you had read something about ceramides and their um just how they work and how much how they're produced in the skin.
10:16
SPEAKER_02: So her question really was just what are ceramides and how do they work?
10:20
SPEAKER_02: Can we are we like affecting them at all, like their production and you know, just really wondering?
10:26
SPEAKER_02: Yeah, yeah.
10:26
SPEAKER_03: So this is like a super complicated area of dermatology that's not or of kind of um skin physiology that's not very well understood at the moment, anyway.
10:36
SPEAKER_03: But it's something that's been um looked into by a very small little group of people, purely almost completely from a financial perspective, because creating a new product that has ceramides in it, for example, um, is a multi-billion, literally billion-dollar industry.
10:56
SPEAKER_03: So the the knowledge we have about ceramides comes from this group of people.
11:01
SPEAKER_03: You know, whether or not that's good or bad, I'm not really gonna judge that, but that's where it's come from.
11:05
SPEAKER_03: So um, which immediately kind of you think, okay, well, right.
11:09
SPEAKER_03: Um let's look at that then.
11:12
SPEAKER_03: So um I have no doubt that the people who have done the research into ceramides are like truly they they care about skin.
11:23
SPEAKER_03: It's not just a financial motive because no, I don't think any doctor is is 100% like that.
11:28
SPEAKER_03: So yeah, there's always some ethics involved.
11:30
SPEAKER_03: Like you know, yeah, it comes from a good place of like we want to learn, we want science, and so on.
11:35
SPEAKER_03: So um the basic idea here is that what ceramides are, ceramides are a constituent of the lipid matrix that exists between the keratinocytes in the upper levels of the epidermis.
11:48
SPEAKER_03: So the top layer of the skin, you have your flattened carotinocytes, which are your flattened and um skin cells, which people call their your dead skin cells, though they're not dead.
11:58
SPEAKER_04: Yeah.
11:58
SPEAKER_03: Um, and that this the stratorcorneum or the very top of your skin is 20 to 30 cells deep, so it's not super thick.
12:05
SPEAKER_03: And then in between those flattened cells is your lipid layer or your lipid matrix.
12:10
SPEAKER_03: And the combination of the two things, so you have the keratinocytes, the cells in this lipid layer that creates your skin barrier.
12:18
SPEAKER_03: Yeah, and that that is your skin barrier.
12:21
SPEAKER_03: Um, so as a very fundamental concept, that's amazing.
12:25
SPEAKER_02: No, that's amazing.
12:25
SPEAKER_02: No, I mean it's just 20 to 30 layers thick.
12:28
SPEAKER_02: I didn't know that.
12:29
SPEAKER_03: Yeah, the cells, there's not it's not thick, and of course, it depends a little bit where you are in your body.
12:33
SPEAKER_03: So, like on your arms, um your skin, your epidermis can be slightly thicker on the face, or sorry, your stratum corneum is gonna be slightly thicker, on your face is gonna be thinner.
12:41
SPEAKER_03: But that's kind of if you think about the purpose of why it's there as a barrier, you're more likely to get something on your arm, for example, say, than on your face, perhaps.
12:53
SPEAKER_03: So, you know, I'm this is just I'm just making stuff up about you know why we're evolutionarily made to be a certain way.
13:00
SPEAKER_03: But so let's say it's 20, 20, 30 um of these pancake flat cells, and then they're sitting in this lipid layer.
13:07
SPEAKER_03: So you can kind of pick apart what's going on here.
13:10
SPEAKER_03: So the cells, the carotinocytes, are their own little world, and then the lipid layer is its own little world, and they're interconnected, but we're gonna look at them separately in the case of ceramides.
13:20
SPEAKER_03: Yeah, so this lipid layer is composed of cholesterol, ceramides, and fatty acids in a very specific ratio.
13:28
SPEAKER_03: So there's like 50% cholesterol, 15% fatty acids, and like 20% um uh or 25% ceramides, roughly.
13:39
SPEAKER_03: Yeah.
13:39
SPEAKER_03: So ceramides are uh um, or sorry, ceramides is a 50% component.
13:43
SPEAKER_03: Sorry, did not think about that.
13:45
SPEAKER_03: Um, so your your lipid layer, which is the kind of fundamental aspect of this barrier, yeah, is composed primarily of because it's 50% ceramides.
13:58
SPEAKER_03: Yeah, right.
13:59
SPEAKER_04: Yeah.
14:00
SPEAKER_03: Now these ceramides are a type of fat, if you will, like a cholesterol fatty acid type of fat with a specific structure.
14:06
SPEAKER_03: And there's lots of different types of ceramides.
14:09
SPEAKER_03: So there's like at least nine ceramide varieties have been identified in the lipid layer.
14:15
SPEAKER_03: Yeah, so there's there's like loads.
14:17
SPEAKER_03: So there's lots of ceramides.
14:19
SPEAKER_03: And what research has found is that, for example, as you age, some of the components of the lipid layer become less.
14:27
SPEAKER_03: Like, for example, you get you have less cholesterol in your lipid layer as you get older, which potentially accounts for why you get drier skin as you get older.
14:36
SPEAKER_03: We're talking like 70, 80, like old, older.
14:39
SPEAKER_02: Yeah, like really aged.
14:41
SPEAKER_03: Yeah, aged.
14:42
SPEAKER_03: Aged skin.
14:42
SPEAKER_03: Because aged skin is completely different from young skin in so many ways that it's just incredible.
14:48
SPEAKER_03: Um giant topic on its own.
14:51
SPEAKER_03: Yeah, I mean that is a giant topic.
14:53
SPEAKER_03: And you know, what the I can say that like because uh what I find totally fascinating about my day job is that I do tons of skin surgery in my day job.
15:01
SPEAKER_03: Yeah, as a side, like tons and tons, and I cut into facial skin all day long, like all day.
15:06
SPEAKER_03: You do the fun stuff all day.
15:08
SPEAKER_03: Yeah, yeah, so I get to do that fun stuff.
15:11
SPEAKER_03: So when I what always strikes me is so interesting, is when I have a patient who's like 20 and I have to remove something from their face, and then I have a patient who's 95.
15:20
SPEAKER_03: Yeah, literally literally within an application, right?
15:22
SPEAKER_03: Is it the elasticity?
15:23
SPEAKER_03: Yeah, yeah.
15:24
SPEAKER_03: Oh my god, it's not even it's just it's like every texture, the way the knife that sounds really horrible, the way the blade goes through the skin, the drag on the blade, and the way that the sutures go through the skin.
15:36
SPEAKER_03: I mean, every single aspect of when you operate on a skin that's 95 versus 20, it's just like uh dealing with like I don't know, different species.
15:45
SPEAKER_03: Yeah, like yeah, I know.
15:47
SPEAKER_03: Yeah, it's uh you probably have that because I mean when you like I don't know what kind of surgery you do, but when you do you know, there's a huge difference between like a 15-year-old and like a 90 year old.
15:56
SPEAKER_02: Everything, all the whole physics of it changes.
15:57
SPEAKER_02: It's it's everything, everything.
15:59
SPEAKER_03: Yeah, it's it's just I I have to use different sutures, I have to use different, you know, closure techniques, everything changes, and it's like this is an example of you know, this is how skin changes as you age, which is just fascinating.
16:10
SPEAKER_03: But anyway, we're moving on.
16:12
SPEAKER_03: Um so yeah, with the ceramides, getting back, uh I digress with the ceramides.
16:16
SPEAKER_03: Um, one thing also that's come to light is that in people with eczema, yeah, okay, they're I want you to I want you to tell everybody like well, tell us what is eczema in your if you were to do on it.
16:27
SPEAKER_03: Right, sorry.
16:28
SPEAKER_03: So eczema is um or dermatitis, which is also used interchangeably, is um inflammation of the skin due to disruption of the skin barrier, which leads to itchy red and sore dry skin.
16:41
SPEAKER_02: Okay.
16:42
SPEAKER_03: That's basically the underlying kind of definition.
16:44
SPEAKER_03: And then you can get into all the different causes and all the other issues, but that's basically what eczema is.
16:49
SPEAKER_03: So it's dry, itchy skin.
16:50
SPEAKER_03: So dry skin on its own is not eczema, it becomes eczemaus when it becomes inflamed red itchy.
16:58
SPEAKER_03: So when you start to scratch your dry skin and it starts to feel itchy, and then you start to break it to pieces, and then you see you know the the flaking and the tears, that's when you start getting kind of that's gotta be terrifying to like go through like I'm just imagining it as you're describing it.
17:13
SPEAKER_03: I'm like awful.
17:14
SPEAKER_03: Bad eczema is kind of um a massive life changer, so but it's totally manageable and treatable.
17:21
SPEAKER_03: Yeah, so um when I see kids like um I see teenagers like in the supermarket, it sounds so random, but like there was a checkout kid at a supermarket a few weeks ago, he had the worst eczema of his face on his face now.
17:33
SPEAKER_03: And I I was like, I went up to him and I was like, you know what?
17:36
SPEAKER_03: I'm so sorry, I'm I'm a dermatologist, I can help you.
17:38
SPEAKER_03: Yeah, oh my gosh.
17:40
SPEAKER_03: And he just looked at me like, what?
17:41
SPEAKER_03: I'm like, you have the worst eczema ever.
17:43
SPEAKER_03: Like you shouldn't even be working right now, you shouldn't be at home managing this.
17:46
SPEAKER_02: That's yeah, see, I'm so glad you did that.
17:49
SPEAKER_02: Because parents don't know.
17:50
SPEAKER_03: I feel like the parents wouldn't they didn't know then.
17:52
SPEAKER_03: They must have not known, right?
17:54
SPEAKER_03: Well, I don't know.
17:55
SPEAKER_03: I don't know if they actually I just don't know.
17:56
SPEAKER_03: They might a lot of um people don't think you can fix it because, like, oh, it's just a skin problem.
18:01
SPEAKER_03: They don't have any okay.
18:02
SPEAKER_03: Yeah, I'm so yeah, so I'm that kid now.
18:06
SPEAKER_03: Um, so but anyway, so with eczema, we know that or we think that there's a decrease in ceramides in the lipid layer of people with eczema, which may or may not be part of why they get it or have that problem.
18:22
SPEAKER_03: So these research is ongoing into eczema because we don't fully understand why certain people get bad eczema, especially children, and why others do not.
18:31
SPEAKER_03: So there's this idea that the ceramides within the um uh epidermis are lacking within starting corneum, which therefore means that the lipid layer doesn't form correctly, which therefore leads to problems with skin barrier formation and function, and then you have breakdown of the skin barrier, which then allows water to leave the skin, which then dehydrates the skin, and then it allows, you know, gets irritants to go into the skin, then you scratch, and then you, you know, there you go.
18:59
SPEAKER_03: Yeah.
19:00
SPEAKER_02: So that that's that's really like uh so ceramides really are integral to the structure of skin.
19:06
SPEAKER_02: I mean correct, absolutely, but they're only one, it's only one factor that you know it that's one thing.
19:13
SPEAKER_02: It's there's multiple things.
19:14
SPEAKER_02: Exactly.
19:15
SPEAKER_03: So exactly, exactly.
19:16
SPEAKER_03: It's one of many components of the skin barrier that many of which we don't really understand.
19:22
SPEAKER_02: So I think for me, like you know, just to kind of interject, I think it's so confusing to me how skincare companies are marketing these individual components of what works in a very biochemically complex way.
19:36
SPEAKER_02: I've never understood where that comes from and why it's propagated.
19:40
SPEAKER_02: Because it's like anyone I feel like who's had even general chemistry, we all understand.
19:44
SPEAKER_02: Like, you know what I mean?
19:45
SPEAKER_02: Like it's like chemistry, it's you need everything working together.
19:48
SPEAKER_02: So how does that work?
19:50
SPEAKER_02: Like, in your opinion, like what do you think is happening with these products that are like just seramide?
19:54
SPEAKER_02: Like, here you go, here's a bunch of ceramides, or it's you know, whatever.
19:58
SPEAKER_02: I don't know how they formulate it, but oh, I have no idea how they formulate it either.
20:02
SPEAKER_03: I I don't think it's super complicated.
20:03
SPEAKER_03: Uh I mean it's as in it's complicated, but it's not very scientifically complicated, if you get what I mean.
20:08
SPEAKER_03: Yeah.
20:09
SPEAKER_03: Because I think they they just kind of make things up.
20:11
SPEAKER_03: Um I you know, um, like these are like buzzwords, and so they're like trendy, you know, like hyaluronic acid.
20:17
SPEAKER_03: Oh my god, don't get me started.
20:19
SPEAKER_03: Um, but I mean hyaluronic acid is the same.
20:22
SPEAKER_03: I mean, hyaluronic acid is is part of your dermis.
20:24
SPEAKER_03: The idea that you can apply it topically and it would do anything at all to your skin is just lunacy, it's completely crazy.
20:31
SPEAKER_03: Um you know, and that's massively trendy.
20:34
SPEAKER_03: So ceramides are also part of this trendy thing.
20:37
SPEAKER_03: You know, I know skincare companies just want to make money.
20:39
SPEAKER_03: I mean, that's really what it comes down to.
20:41
SPEAKER_03: Um, I I associate a lot with like new, like I relate it to like nutritional stuff.
20:45
SPEAKER_02: Yeah.
20:46
SPEAKER_03: Um, you know, if these buds, you know, people write like, oh, um, I don't know, has uh antioxidants in it.
20:52
SPEAKER_02: Oh, yeah, yeah, yeah.
20:53
SPEAKER_02: Like those little, like it's almost like an opinion piece, like people write.
20:58
SPEAKER_03: Yeah, yeah, yeah.
20:59
SPEAKER_03: Like, I mean, and but it's used as it's just a marketing tool and it's used to sell stuff.
21:03
SPEAKER_03: You know, I don't I just just like with food, um, you know, everyone writes preservative free on all their foods because then people buy it more.
21:10
SPEAKER_02: Well, I mean, I think that's so important though, right?
21:12
SPEAKER_02: Because I it's cool that you're actually looking at the skincare industry as really just an industry.
21:17
SPEAKER_02: That's so important.
21:17
SPEAKER_02: Yeah, that's so important.
21:18
SPEAKER_03: Yeah, yeah.
21:20
SPEAKER_03: And I try to kind of get that uh message across in my Instagram and stuff, which gets me in loads of trouble because basically what I'm saying is that it's all just marketing BS, all marketing, and um, it's all marketing, and all these products are just marketing crap.
21:32
SPEAKER_03: Um, and that gets me in loads of trouble because a lot of people make their living off of this.
21:38
SPEAKER_02: Yes, you know, they make money, I've heard that too.
21:41
SPEAKER_02: Yeah, I've heard that people are making a lot of money.
21:44
SPEAKER_03: People make a lot of money by um, you know, being on YouTube and being like, let me review this cleanser.
21:50
SPEAKER_03: I'm gonna tell you why this cleanser is better than this cleanser.
21:52
SPEAKER_03: You know, people make a living off of this.
21:54
SPEAKER_03: And uh what I'm saying is that who gives a crap?
21:56
SPEAKER_03: Just use any cleanser because they're all bloody the same.
21:58
SPEAKER_02: Yeah, yeah.
22:00
SPEAKER_02: That's what is so important because uh yeah, and people are making a lot of money too.
22:04
SPEAKER_02: These are there's the new term skin fluencer, you know what I mean?
22:07
SPEAKER_02: I I've heard I've seen that everywhere.
22:09
SPEAKER_02: Skinfluencer, I don't understand what that is.
22:11
SPEAKER_03: I don't want to, I mean, and so it was funny because someone actually made a comment on my Instagram saying, you know, you're a doctor, you're not an influencer.
22:18
SPEAKER_03: I'm like, correct, right?
22:19
SPEAKER_03: As if that was you're getting the better, the better option here.
22:22
SPEAKER_03: Yeah, I'm like, I don't I don't want to be influenced.
22:24
SPEAKER_02: You are being benefited in this situation, yeah.
22:27
SPEAKER_02: So what?
22:28
SPEAKER_03: That's a crazy, crazy observation.
22:30
SPEAKER_03: I was like, thanks for the compliment.
22:31
SPEAKER_03: Um, but no, so I mean that's the thing is the minute I say something like that, like for example, I've recently gotten um in trouble on Instagram for saying that all moisturizer brands are the same, yeah.
22:42
SPEAKER_03: Again, and oh my god, the backlash was huge.
22:45
SPEAKER_03: And I was just like, Well, I mean, someone tell me how they're not the same.
22:50
SPEAKER_02: Yeah, you know, it's the experience though, Dr.
22:53
SPEAKER_02: Spearings.
22:54
SPEAKER_02: Natalia, I'm sorry, Natalia.
22:56
SPEAKER_02: I don't want you to be closer to that.
22:58
SPEAKER_02: Um, no, but like seriously, it's the it's the experience.
23:01
SPEAKER_02: That's what's good.
23:02
SPEAKER_02: That's the buzzword.
23:03
SPEAKER_02: I mean, I use the buzzword, I use that word, you know what I mean?
23:06
SPEAKER_02: Like, people are literally saying it's the experience of rubbing this on my face that makes me feel like I've done something, you know.
23:13
SPEAKER_03: Yeah, and that's fine, and I don't mind, but then don't pretend that your um$80 moisturizer that's giving you that experience is any better than the one that costs two dollars.
23:21
SPEAKER_03: Yeah, because it's not because the product itself is no different.
23:24
SPEAKER_02: I just think it's so I think you okay, honestly, I think you're getting a lot of backlash, and I think I've been trying to do it too because I really believe you about the Vaseline thing.
23:33
SPEAKER_02: I think when you say Vaseline to people, they don't like that it's like two dollars.
23:37
SPEAKER_02: I really that's like my personal theory.
23:39
SPEAKER_03: Like, can I just yeah, no one likes it that it's two dollars because it's like yes, but I've spent hundreds of dollars on my skincare, you can't tell me that this is gonna be just as good.
23:46
SPEAKER_03: And like, well, actually, it is because it your your$200 moisturizer is basically made of vaseline.
23:54
SPEAKER_02: Oh my god, yeah, but no, like getting back online, so ceramides, like, okay, so basically ceramides are they're there, they're a huge part of our skin, um, and there's a lot of them, so yeah, can continue, which you think is yeah.
24:10
SPEAKER_03: So so right, so the then the idea came that okay, so if we have people with bad eczema and they have a ceramide deficiency, can we put ceramides onto their skin and therefore correct that and help their eczema get better more quickly without the use of, for example, steroids.
24:30
SPEAKER_04: Right, right.
24:31
SPEAKER_03: So, can we correct the underlying pathophysiological problem, one of which is a lack of the specific ceramide?
24:38
SPEAKER_03: Right, okay, which is a very noble concept.
24:41
SPEAKER_03: Yeah.
24:42
SPEAKER_03: And I think, yes, great.
24:43
SPEAKER_03: We're gonna look for um causation and we're gonna look for treating the actual underlying problem and not the symptom, because that's what we do with steroids often.
24:53
SPEAKER_03: Yeah, we do with symptoms.
24:54
SPEAKER_03: So I that's very noble, and I think it's great.
24:57
SPEAKER_03: However, that concept has been taken away from that very niche area and now planted into cosmetic skincare in general.
25:08
SPEAKER_03: And the message now is everyone needs to use ceramides because ceramides are good for your skin.
25:13
SPEAKER_02: Yeah, yeah.
25:15
SPEAKER_03: And that is a problem because that's not true.
25:17
SPEAKER_02: Yeah.
25:18
SPEAKER_03: Okay.
25:19
SPEAKER_03: So if you have normal skin, and that means you don't have eczema or eczema, using a ceramide-based moisturizer is probably or it potentially is not harmful, but it's definitely not going to be anything different than a normal moisturizer.
25:34
SPEAKER_04: Yeah, yeah.
25:36
SPEAKER_03: So, in the sense that can it be harmful?
25:38
SPEAKER_03: Yes, it can, because now we have further studies showing that if you then put the wrong ratio of ceramides on a skin with another problem, yeah, okay, yeah, then you're going to shut off your own body's production of their own its own natural ceramides.
25:57
SPEAKER_03: Or you're gonna kind of disorganize it, if that makes sense.
26:01
SPEAKER_03: Because you're yeah, yeah, because your body makes ceramides in order to um, you know, make this lipid layer.
26:07
SPEAKER_03: So, and obviously these eczema patients have a problem where they don't make a certain ceramide, which is part of the problem.
26:13
SPEAKER_03: So, if you have a natural, your your skin is if you have normal skin and your skin is functioning very well and it's doing what it needs to do, potentially if you load on, say, ceramide number three in your moisturizer, you are then causing your you're putting a lot of ceramide three on, which means that your skin's not gonna form its lipid layer properly because you're gonna have an unbalanced ceramide ratio.
26:37
SPEAKER_03: Yeah.
26:38
SPEAKER_03: Does that make sense?
26:39
SPEAKER_03: Yeah, absolutely.
26:40
SPEAKER_02: Negative feedback.
26:41
SPEAKER_02: Yeah, yeah.
26:41
SPEAKER_03: Yeah, exactly.
26:42
SPEAKER_03: Negative feedback.
26:43
SPEAKER_03: And then suddenly you you may cause more problems.
26:46
SPEAKER_03: Now that's not been 100% validated in the literature because no one's really started, no one's really properly field.
26:54
SPEAKER_02: I think I feel like most of derma, like the dermatology papers I usually find.
26:58
SPEAKER_02: I feel I feel like that do you feel like that on your profession like your sector, like it's just a budding field?
27:03
SPEAKER_02: Because there's like really no, I I've never found like really concrete stuff that's like, you know, like no, and yeah, exactly.
27:11
SPEAKER_03: And all the all the sample sizes are always really small.
27:14
SPEAKER_03: Yeah, like yeah, yeah, everything's always like a really small study.
27:17
SPEAKER_03: But the and they all come from like very specific centers in like Korea, or like there's a lot of stuff coming out of like um Korea that Koreans, for instance, um, Korea, but the um the thing is core the the the study of the uh the corneocyte, so um that's a field like corneobiology that's basically only been accepted as kind of its own area since like around 2010.
27:40
SPEAKER_03: Yeah, that's so that and you know we're in medicine is like 10 to 20 years behind you know what happens in real life in research.
27:47
SPEAKER_03: So this is all a very new area, but of course the skincare industry has kind of pounced on this word ceramides, and it's like, okay, yeah, let's pump this into everything because you can even buy, I think from I don't know, Clarence or something.
28:00
SPEAKER_03: They sell a little tub of capsules, and in the capsule is just as apparently it's pure ceramide.
28:07
SPEAKER_03: Oh wow, yeah, I know, yeah.
28:09
SPEAKER_03: Uh-huh.
28:09
SPEAKER_03: And I saw I saw that and I was like, all right, that loads of sense.
28:12
SPEAKER_03: I'm pretty, I don't want to slide off one company, but I think it was Clarence who did that.
28:16
SPEAKER_03: Um, and they have so a lot of companies sell these like ceramide capsules and you know ceramides, and just coming off of this idea, um, to be that okay, so there was a cream made by these people who did this research in eczema.
28:32
SPEAKER_03: Um, and the cream was called Epicarum or Epicerum, like Epi Epi, and then C I M.
28:39
SPEAKER_03: Yeah, and it it was licensed by the FDA as a medical device, right?
28:44
SPEAKER_04: Oh wow.
28:45
SPEAKER_03: So it's only available on prescription.
28:47
SPEAKER_03: Now, I think 100 mils of it, like a very small, like three and a half ounces of it, is like$250.
28:54
SPEAKER_03: Yeah.
28:54
SPEAKER_03: Yeah, it's really expensive.
28:56
SPEAKER_03: It's on prescription only.
28:58
SPEAKER_02: Pretty much it's unattainable.
28:59
SPEAKER_03: Like unattainable, yeah.
29:02
SPEAKER_03: And they did some, in order to get FDA approval, they did a number of studies to show that when children with eczema used um epicarum or whatever versus placebo, they had an improvement under eczema without needing to use steroids.
29:15
SPEAKER_03: Now, we do know that eczema will generally improve if you use a moisturizer just across the board.
29:22
SPEAKER_03: Um, and I don't I can't recall what the placebo was, whether it was nothing.
29:26
SPEAKER_03: I think it was nothing because you can't you can't use another moisturizer because that wouldn't make much sense um in terms of an FDA approval study.
29:33
SPEAKER_03: So, but basically, so that was how it got licensed.
29:37
SPEAKER_03: Now, this cream was super expensive, and then a company like um like CeraVee, yeah, then decided to make a similar cream, which is what CeraVee is, hence the name, you know, Cera.
29:51
SPEAKER_03: I just put that in there.
29:51
SPEAKER_03: Yeah, CeraVee.
29:53
SPEAKER_03: Yeah, so their entire, yeah, no, there you go.
29:55
SPEAKER_03: Their entire range of cream is based on the concept of this physiological kind of molar ratio of ceramines to cholesterol to fatty acids, and therefore CeraVee is like the this product that is a competitor for this very expensive prescription product.
30:13
SPEAKER_03: Now, Epicarum is um patented, I think, that that um exact, like you know, uh yeah, like the exact name, the exact yeah the the composition of it, like the ingredients.
30:25
SPEAKER_03: Oh, the formula you mean.
30:26
SPEAKER_03: Okay, okay.
30:26
SPEAKER_03: The formula, sorry, that's what I meant.
30:27
SPEAKER_03: The formula is patented.
30:29
SPEAKER_03: So Cera V couldn't copy the same formula, um, but they did something similar, whatever, uh, ceramides, something or other in there.
30:37
SPEAKER_03: And so that's the idea.
30:39
SPEAKER_03: Now, what's interesting is that, of course, when this started to happen, um, dermatologists in the United States were like, why are we gonna prescribe this super expensive cream when probably using you know a Vaseline type cream that we already use super cheap, that will probably do the same.
30:53
SPEAKER_03: So, two people did studies and they did very interesting studies where they um looked at the treatment of eczema and compared outcomes of epicarum versus like a standard moisturizer.
31:05
SPEAKER_03: Interesting, and I think also vehicle control, though again, it's hard to vehicle control this.
31:10
SPEAKER_03: And both studies were pretty decently done and found that there was no difference in outcome.
31:15
SPEAKER_02: Wow.
31:16
SPEAKER_03: So, and I presented those papers at them.
31:19
SPEAKER_03: I was I was I was asked to do a talk a few years ago for a bunch of um primary care doctors about eczema, and it was paid for by the company that owns Ceree.
31:29
SPEAKER_03: Oh wow, La Roche, uh, sorry, which is L'Oreal.
31:34
SPEAKER_03: And I did this talk, and I had asked them in advance, I was like, Can I say anything I want?
31:39
SPEAKER_03: And they're like, Yeah, yeah, this was like 2017.
31:41
SPEAKER_03: And I was like, All right, then no one checked my my presentation in advance, and um I basically said, Okay, this is how serum minds are meant to work.
31:48
SPEAKER_03: And everyone, oh, interesting, interesting.
31:50
SPEAKER_03: And then I was like, knocked everybody out of buying their product, yeah, yeah.
31:54
SPEAKER_03: And I was like, but actually, because they all got like Cera V goodie bags at the end, you know, and samples of locations.
31:59
SPEAKER_03: Yeah, and at the end, I was like, actually, there's no two studies to show that makes no difference, so you can probably just prescribe what you're self-rescribing.
32:05
SPEAKER_03: Yeah, yeah, yeah.
32:06
SPEAKER_03: And needless to say, they've never invited me back.
32:10
SPEAKER_03: Well, I think you made your mark though.
32:12
SPEAKER_03: You made your mark, yeah.
32:14
SPEAKER_03: But I don't do come drug company sponsored uh talks anymore, so I stopped doing them about two years ago.
32:20
SPEAKER_03: Um so I will not speak for industry ever.
32:22
SPEAKER_03: I love that.
32:23
SPEAKER_03: I love that.
32:24
SPEAKER_03: Yeah, but I think and for skincare um companies, L'Oreal's not a pharmaceutical company, but I will not uh speak for any or be paid by um any drug company, so I will always be paying for my own trips to conferences.
32:36
SPEAKER_02: Oh my god, you are such a breath of fresh air in the medical field, dude.
32:41
SPEAKER_02: Like you don't even understand.
32:42
SPEAKER_01: I am surrounded by idiots and oh my there's a school in northern Virginia that's making college better.
32:48
SPEAKER_01: They offer over a hundred certificate and degree programs.
32:51
SPEAKER_01: They make tuition affordable and manageable through smaller payments over time, they make online learning accessible and enjoyable, and across six campuses, you can learn great careers like nursing, cybersecurity, skilled trades, and more.
33:03
SPEAKER_01: Northern Virginia Community College.
33:05
SPEAKER_01: It's the affordable, achievable, flexible, doable, possible, and credible college.
33:09
SPEAKER_01: Nova.
33:10
SPEAKER_01: We make college better.
33:11
SPEAKER_01: Apply now at boldynova.com.
33:14
SPEAKER_03: And the amount of samples they give us, I mean, because you can have like drug samples is one thing, like to give you actual drug samples.
33:21
SPEAKER_03: Here they don't really do that, but the amount of skincare samples, like, I mean, we have literally closets full of it in the hospital.
33:28
SPEAKER_03: Closets full of CeraVee and Bioderma and Laverage MSA and Endelios and QV and every Sun Sense and every brand, we just closets full of it.
33:37
SPEAKER_03: And I I have stopped about again, about two or three years ago, I stopped giving patient samples because I was like, you know what?
33:43
SPEAKER_03: I don't want to, it's not my job to sell these products.
33:46
SPEAKER_02: Yeah, it's not.
33:47
SPEAKER_02: And you can't put your name behind something at all.
33:49
SPEAKER_02: Like it's and like today, like doctors are they get blamed for everything.
33:53
SPEAKER_02: So, like, you can't put your name on something that it's in even hinting that you're you know what I mean, promoting something because then we get the brunt of it, basically.
34:03
SPEAKER_02: Yeah, no, totally in trouble.
34:05
SPEAKER_02: We have to deal with all that.
34:06
SPEAKER_03: Totally, yeah.
34:07
SPEAKER_03: And in in England, um, you know, it's it's also a problem here.
34:11
SPEAKER_03: And what I can't stand is when doctors promote um brands on social media, it really pisses me off.
34:17
SPEAKER_03: Um because I'm like, it's one thing for a skin influencer or like a beauty journalist or a facialist to promote a brand, because they make money off that.
34:26
SPEAKER_03: That's fine.
34:27
SPEAKER_03: As doctors, we don't, this is not how we make money.
34:29
SPEAKER_03: We make money by seeing patients and doing our jobs.
34:31
SPEAKER_03: I agree.
34:32
SPEAKER_03: I don't make money selling skincare.
34:33
SPEAKER_02: No, I just honestly know you're you're so 100% on that.
34:37
SPEAKER_02: And I, you know what?
34:38
SPEAKER_02: Um I did I was doing that and I was like, you know what?
34:41
SPEAKER_02: This is time for me.
34:42
SPEAKER_02: It's because of you.
34:43
SPEAKER_02: When I talk to you, I was like, what is yeah, like this is garbage, man.
34:47
SPEAKER_02: Like, what am I, you know what I mean?
34:49
SPEAKER_02: Like, it made me really think about skincare, to be honest.
34:52
SPEAKER_02: Like, I'm not even like like I feel like as a as a scientist or you know, in from a science perspective, I never put in that much thought about like dude, this is actual dermatology that they're like molesting, and like you know what I mean?
35:04
SPEAKER_02: Like, it's really bad.
35:06
SPEAKER_02: It's really bad.
35:07
SPEAKER_02: So yeah, it's really bad.
35:09
SPEAKER_03: So, yeah, so ceramides.
35:11
SPEAKER_03: Um so the I guess the point of it is I guess the question that your listener had asked is should she or he even be bothered to buy a ceramide-based product?
35:23
SPEAKER_03: That's basically the question.
35:24
SPEAKER_02: Yeah, that's the question, yes.
35:26
SPEAKER_03: Yeah, and and I would say if you like it, go for it, but you don't don't worry about whether or not your cream has ceramide in it or not, because it really doesn't matter.
35:33
SPEAKER_03: Yeah, so and I would probably say, you know, I mean, it it doesn't to be honest, I think the risk of it being having a negative impact on skin is so low, because most people don't have most the majority of people have normal skin.
35:48
SPEAKER_03: So um I would say the risk of it having a negative impact is so low, you know, it doesn't really matter if you like the Ceree or sorry, ceramide-based, you know, moisturizer or whatever, just go for it.
36:00
SPEAKER_03: But it's not magic in any way.
36:04
SPEAKER_03: So yeah, yeah.
36:05
SPEAKER_02: No, I and I'm glad that you gave a simple answer to that because I think that it's it's just everywhere.
36:12
SPEAKER_02: And I love that she had asked this question, and this was our first question because it's so huge.
36:17
SPEAKER_02: I mean, and I think it's a huge topic, and I like I think I think you covered it so nicely, and I I I have no idea, you know.
36:26
SPEAKER_02: I get a lot of questions, I'll I'll be honest, you know, on Instagram, and I really don't know like how to answer them, and I can't imagine like I I'm sure you get like tons, you know what I mean?
36:38
SPEAKER_02: Like just what do you tell people at one point?
36:41
SPEAKER_02: So, yeah, hopefully this answers that person's question.
36:45
SPEAKER_02: Um, but really my other I didn't really have any other questions.
36:48
SPEAKER_02: I mean, that was my main thing, like, with for me too, because ceramides to me I think are so interesting in terms of their signaling and what I've read.
36:57
SPEAKER_03: So yeah, I'm gonna write a post.
37:01
SPEAKER_03: I've been avoiding writing a post about ceramides because it is very confusing.
37:05
SPEAKER_03: Yeah, and you know, you have a limited amount of characters to to write something, you know, useful.
37:10
SPEAKER_03: So it's something that I've kind of actively stayed away from writing about, but I I think I'll have to know.
37:15
SPEAKER_02: So if you were if you were like to okay, I this is such a hard question to ask after everything you told us, but if you were to recommend anything for anything to do like as a routine for your skin, like what do you think everyone should do just for normal skin health?
37:32
SPEAKER_02: Is there anything?
37:33
SPEAKER_03: I mean, you don't if there's nothing, then that's fine too, but you know, I mean, this sounds really uh crazy, but I think if you have normal skin um and there's nothing wrong with your skin and you're quite happy with it, then doing nothing is fine.
37:45
SPEAKER_02: Okay, yeah.
37:46
SPEAKER_02: Um like don't just it's good.
37:48
SPEAKER_03: Don't yeah, don't touch it.
37:50
SPEAKER_03: You know, if it ain't broke, don't fix it.
37:51
SPEAKER_03: So you know, if I mean I have I've like my one of my best friends, um she has like totally beautiful skin, and she's her mother, she always used she always tells me that her and her mother have only ever used Nivea soft as a moisturizer forever.
38:05
SPEAKER_03: Oh wow, like she's she's 35 and she's never used a serum, an acid, uh retinoid or anything.
38:14
SPEAKER_03: Um, and she just she's like, why?
38:15
SPEAKER_03: I just use Nivea soft.
38:16
SPEAKER_03: Yeah, like literally Nivea in the white.
38:19
SPEAKER_02: Wow, that's so cool.
38:20
SPEAKER_02: That's like it reminds me of like the cold cream, like Pond's cold cream.
38:24
SPEAKER_03: It's it's like cold cream because and then um so this is my friend Soby.
38:27
SPEAKER_03: She's uh she's an AE consultant, she's an A and E um board, what board said by an emergency room doctor, and she's just like she doesn't understand, she doesn't understand my job at all.
38:36
SPEAKER_03: She doesn't understand dermatology.
38:38
SPEAKER_03: She's like, I don't why do people bother with just I just use like Nivea?
38:41
SPEAKER_03: Yeah, and it's you know, there's loads of people like her.
38:44
SPEAKER_02: Yeah, it's like almost a ritual.
38:46
SPEAKER_02: I feel like um, you know, it used to be right, kind of ritualistic, like your mom did it, your grandmother, like you do the same thing.
38:52
SPEAKER_03: Yeah, yeah.
38:52
SPEAKER_03: Like at night, you see your mom putting on her Nivea moisturizer from the blue container or whatever.
38:57
SPEAKER_02: My mom usually wants cold cream, so like yeah, you know, yeah.
39:01
SPEAKER_03: I mean, I I have it too with that.
39:02
SPEAKER_03: So, but like or a bottle of a thing of it, but yeah, but you see your mom like applying stuff when you're young, and it's kind of you the smell of it's quite classical, like the you know the Nibia smell quite like Yeah, it's memories, and it brings back like memories of like your your mom putting on her face cream, you know.
39:18
SPEAKER_03: So that it's and the thing is, um, and that's pretty much like 40 years ago, or maybe four years ago isn't long enough, but we didn't have actives, yeah.
39:29
SPEAKER_03: There were no serums, there's no 10-step Korean skincare, there were no sheet masks and eye creams and you know, whatever.
39:36
SPEAKER_03: Maybe not 40 years ago, maybe 50 years ago, and like women looked good.
39:40
SPEAKER_03: Yeah, they age very gracefully, you know.
39:43
SPEAKER_02: Yeah, yeah, yeah.
39:45
SPEAKER_03: Before Botox and before filler, like, and then on the flip side of it, like I don't know what you watch on TV, but I watch a lot of um The Real Housewives.
39:54
SPEAKER_02: Yeah, I've I've done like a lot, yeah.
39:57
SPEAKER_03: So I'm like a Real Housewives watcher now, especially since like lockdown when I had like not a lot else going on.
40:03
SPEAKER_03: So um it's incredible to see their skin.
40:07
SPEAKER_03: So these women, um, so many some some of some of them have lovely skin, but a good number of them have um major skin problems.
40:15
SPEAKER_03: Oh wow, and it's like and because I uh this is what I watch when I watch TV.
40:19
SPEAKER_03: What do you mean by major skin problems?
40:21
SPEAKER_03: Like actual like bad pigmentation, um bad uh kind of roughness of the skin.
40:29
SPEAKER_03: One of them, while housewives, this is from like 2017, she has really bad pigmentation.
40:34
SPEAKER_03: And because you see her without makeup on, I'm like, wowzers, we can so fix that.
40:38
SPEAKER_03: So even now, with um, you know, these women are super wealthy, they have access to everything, they still don't get it right, you know.
40:46
SPEAKER_02: Yeah, that's I mean, you know, money can't fix everything, you know.
40:50
SPEAKER_02: Yeah, so it's still you know, it's it's like yeah, the science isn't there, so it's not there.
40:54
SPEAKER_02: We can't, you know, just do whatever.
40:56
SPEAKER_02: So yeah, so it's it's such interesting, actually.
40:59
SPEAKER_02: No, it is, it is, and I'm I'm actually glad you brought that up because I was um asking my co-host Fraheen in the last podcast about this show.
41:07
SPEAKER_02: I don't know if you've seen it on Netflix.
41:08
SPEAKER_02: I think you guys have a different Netflix than us, but like it's like a show by nurse Jamie, who was like a oh skin decision, yes, and that um plastic surgeon.
41:19
SPEAKER_02: And I was wondering what do you think about that one?
41:20
SPEAKER_02: What do you do you like it?
41:22
SPEAKER_02: I haven't, you know what?
41:23
SPEAKER_02: I haven't watched it.
41:24
SPEAKER_02: I can't bring myself to watch it.
41:25
SPEAKER_02: You need to watch it and let me know what you think because I love it.
41:29
SPEAKER_02: I'm not gonna lie to you.
41:30
SPEAKER_02: I love it.
41:30
SPEAKER_02: I think it's so good.
41:32
SPEAKER_02: Because they've got the plastic surgery side, you know what I mean?
41:34
SPEAKER_02: So I'm just curious what you're gonna think.
41:37
SPEAKER_03: I like the plastic surgery has not a problem, but I'm worried about seeing what that nurse Jamie gets up to in terms of.
41:42
SPEAKER_02: Yeah, they're cringing with all her lasers.
41:46
SPEAKER_03: Um is that she is she a laser nurse?
41:48
SPEAKER_03: Yeah, is that what she does?
41:50
SPEAKER_03: Oh, okay.
41:51
SPEAKER_03: I know she has a skincare line, which I already put.
41:53
SPEAKER_02: Yeah, she has a skincare line and she has those tools.
41:55
SPEAKER_02: Like she blew up because she has those like derma rollers and like those little it's basically a derma roller, but she just keeps making tools for skincare to like I don't know, I guess.
42:05
SPEAKER_02: I think the claim was the whole lymphatic drainage thing.
42:08
SPEAKER_02: That's what I understood from that.
42:09
SPEAKER_03: Oh my god.
42:10
SPEAKER_03: You know what?
42:10
SPEAKER_03: Yes, I did a live on myself yesterday.
42:12
SPEAKER_03: I did one with Caroline uh Lebouchera on Saturday, and um I both times I had to talk about manual lymphatic drainage.
42:20
SPEAKER_02: What did you well can you let okay?
42:22
SPEAKER_02: Let's can you do like a recap, a brief recap of that?
42:25
SPEAKER_02: Because yeah, yeah, yeah, yeah.
42:27
SPEAKER_03: Because again, the question we I got was um, is it a real thing?
42:30
SPEAKER_03: Yeah, is it though?
42:32
SPEAKER_03: I'm curious.
42:34
SPEAKER_03: It is it is in medicine.
42:36
SPEAKER_03: So manual like okay, so where this comes from is um so I trained at St.
42:40
SPEAKER_03: George's Hospital in London, which is a lymphedema center.
42:43
SPEAKER_03: Yeah.
42:43
SPEAKER_03: Okay.
42:44
SPEAKER_03: So and lymphedema is swelling um or excess lymph fluid in the tissue due to whatever underlying cause, whether it's a genetic problem with your lymphatics, or you are are morbidly obese and you have problems with your lymphatic drainage, or you've had like surgery where you've had your lymph nodes removed, for example, from breast cancer surgery and so on.
43:05
SPEAKER_03: So then you get lymphatic problems, right?
43:07
SPEAKER_03: Yeah, and lymph, as you know, but I'll just explain it, lymph is lymph is the fluid that's released into the tissue from blood flow.
43:15
SPEAKER_03: So it's all the waste products, and that fluid gathers in your subcutaneous tissue, and then it goes or in your tissues and it goes back up into your blood circulation, and your lymph vessels are the the transport mechanism for that fluid for the lymph, right?
43:30
SPEAKER_03: Yeah, so as you know, and there are a whole network of them all over your body, and they're connected in some way to your vascular system.
43:38
SPEAKER_03: I think.
43:39
SPEAKER_02: Yeah, not connected, it's it's a garage into the vascular system, like it's yes, yes, there you go.
43:46
SPEAKER_03: So um a lymphedema is like um edema, swelling, due to lymphatic over having too much lymphatic fluid um for whatever underlying reason.
43:56
SPEAKER_03: And St.
43:57
SPEAKER_03: George's is one of the lymphedema centers um in the country and because prof Mortimer um is uh Peter Mortimer is like the ster consultant dermatologist who's awesome and he's one of the like the founding fathers of the treatment of lymphedema and he is now retired but he set up a center and I he I trained with him and so I know a lot about lymphedema so it's like really at the center of it then this research then I like yeah yeah and he's he's one of the four you know leading specialists of lymphedema research in the country in the world or whatever.
44:25
SPEAKER_03: So I know a lot about lymphedema.
44:27
SPEAKER_03: Yeah and I saw patients yeah with really severe lymphedema um and basically what manual lymphatic drainage is is literally is what it says it is so it's manually kind of forcing the fluid into the cyst vascular system so it goes back it leaves the tissue and it can be done through strenuous massage it can be done through bandaging it can be done through stationary cycling if it's in your legs um so all of this stuff is manual lymphatic drainage so forcing the lymph fluid out of the tissue and back into the circulation that's what it there's conditions like something there's a weird condition weird or an unusual condition called Morbihan syndrome where you get problems with your lymphatics in your face right and you can get damaged lymphatics in the skin in the facial skin due to severe rosacea for example so there's very unusual conditions like that and we you we've seen I've seen because I worked in a center that you know was I was very fortunate to have you got to see the real cases about to see all this weird stuff.
45:31
SPEAKER_03: Yeah so that is we had a whole team of nurse specialists who were specialists the lymphedema nurses and their job was manual lymphatic drainage right wow really actually yeah to like help people you know live be able to walk yeah I mean because if you I can if I showed you some pictures of stuff you'd be all obviously horrified like you can get um over too much lymph loot in your legs and you can't walk because your huge yep just like breast cancer women with the arms it's very swollen yeah they get it breast cancer like they those patients really get it like bad so it's it's like I can't imagine on the face I'm sitting here imagining all this on the face and I'm like oh my god your skin must be so stretched you know what I mean like it's just it's yeah yeah it's pretty it's pretty bad so does it do they work then because I know like no okay so that so yeah so that the the the reason I explained that was just to explain that manual lymphatic drainage is a thing but not for a beautician yeah like this is a medical thing like it's not like uh a thing you go to a spa for and so all this nonsense where you use like jade rollers all that crap on someone's face like you know oh this is where you're it's manual lymphatic drainage for the no one has you don't have collections of lymphluid in your face yeah and I think that's important please elaborate on that because that's so yeah so I mean people you don't you don't get swelling in your face unless there's something wrong with you.
46:56
SPEAKER_03: Well you know you know the women that always say like well my under my chin I'm like I'm just swollen in this area you know what I mean so like that's facts yeah yeah yeah but like you know it's not really no this is great yeah yeah but it's not it's not why would it be if if you had lymph collection or edema of your chin I'd be like wow there's nothing wrong with you like we need to get some medicine you know there's a medical concern here and like same with people like bags in the eyes and like that's also generally not fluid unless you are retaining a lot of fluid because you've eaten like a super high salt diet that that can happen it's really unusual but that can happen if you overdose on salt the next day you'll wake up and you might feel like your under eyes are puffy but that lasts for like 12 hours and it goes it's like your your lymphatic drainage will kick in and we'll do it on its own that's physiological and like that's physiological because you've overdosed on salt your kidneys haven't had time to deal with it so you're not you're you know you're basically retaining more fluid like if you feel bloated or kind of puffy after you've eaten a really high salt meal like around your tummy or whatever that's that's just that's physiological but so that that is an aside but generally speaking like a normal face like you don't go to a spa to get your face or please drain my face my please drain my face if this if that's happening then you need to see a doctor like pronto okay so so okay so jade rollers and all that okay it's all crap then it's like it's crap right oh god yeah total crap like come on guys I feel like I feel like I honestly I love how much you know but I it it's like it makes me question like why do we even still have skincare like I know but it's like the jade roller thing I think is hilarious.
48:41
SPEAKER_03: Yeah well I'm just like people people are buying they're paying money for like a piece of stone on a like a little wheelie thing.
48:48
SPEAKER_02: Well you know they're claiming the stone does something too let's be like that's the craziest part the stone like it's conduction or something I don't know something like that.
48:58
SPEAKER_02: That sounds highly evidence based it's yeah yeah you know like I mean that's what I you know I read that in passing somewhere so God knows what the story is at this point but yeah no I mean I'm glad that okay so jade rollers do nothing you can use Vaseline everything you know Vaseline is all you need um is there anything else like any skincare well I don't even want to say that no not skincare any skin health thing or can I don't know anything that you want to would want to tell somebody that just came in.
49:28
SPEAKER_03: Yeah I mean I would say that um looking after your general health is very important um I guess but I think more specifically the number one thing that all of us can do to keep our skin looking good as we get older is just staying out of the sun yes I mean I know this is like the beating a dead horse saying this but it's like and I'm not saying wear sunscreen every day.
49:49
SPEAKER_03: Yeah I'm saying actively avoid sun exposure so which is not the same so how do you what do what do you do like I'm just gonna honestly like how do you actively avoid like the wrong amount of sun exposure you know what I mean like yeah so I I live in a country that doesn't have much sunshine so for me that's relatively straightforward I I'm not OCD about this like it's mildly sunny today it's about 18 degrees Celsius um I went to the gym this morning I walked back I did not wear a hat it's partially cloudy it's maybe a little bit sunny I wore sunglasses didn't wear sunscreen walked for maybe 30 minutes outside um I didn't freak out I'm good I don't mind yeah what I what I mean is more like um if you go on holiday if you go on vacation and you're gonna be on a cruise ship you know that's where wide brimmed hats big sunglasses you know get that don't let your face sit outside in the sun or like roast that is yeah don't roast I mean I would tell your whole body tell you not to roast your whole body but people are gonna get a tan or want a tan or whatever.
50:54
SPEAKER_03: But I I would say if we're and we're gonna talk about if we're talking about facial skin aesthetics only so we're not talking about skin cancer that's a whole new topic.
51:01
SPEAKER_03: We're just talking about keeping your skin looking good.
51:04
SPEAKER_03: Right um and this this is for people of all races and all skin types actively avoiding sun exposure on your face neck and perhaps your hands is the best way to keep your skin looking good as you get older.
51:21
SPEAKER_02: So wear long sleeves then as much as you can or gloves.
51:25
SPEAKER_03: No um I mean yeah with the body like yes I would still say if we're gonna talk aesthetics only then yeah keeping your arm skin covered will keep your arm skin looking good because I have a lot of women who come to me in their 50s and even their 40s and say you know can you fix the pigmentation on my arms?
51:44
SPEAKER_03: Yeah and I'm like well not really um you know just try not to let it get any worse now by not actively exposing yourself to the sun.
51:53
SPEAKER_03: It's easy to say you live in don't you live in Florida?
51:55
SPEAKER_02: No I moved I was in Florida I'm in New York now but yeah like Florida everyone's always outside like literally every all day people are just outside in Florida.
52:05
SPEAKER_03: So yeah and like I don't live in a climate like that so I mean I do go to Dubai every month.
52:10
SPEAKER_03: Well I did so I do but even in Dubai I don't go outside which I know sounds crazy but um so I don't live in a climate where I'm outside all the time um so it's har it's easy for me to say I didn't vote the sun because I don't live in this problem.
52:22
SPEAKER_03: Yeah but I guess if you live in somewhere like Florida and you want to be outside you know that this is where that the wide brim hats the special hats that also cover your ears and your neck you know those stupid looking oh wow I forgot all about those you had to bring that back.
52:36
SPEAKER_03: Yeah no the the mullet hat oh those are so awkward but innecess you know but like because like um like my friend Caroline in Dubai she swims every day outside now as part of her exercise so she's like wearing like a mullet hat to cover her back of her neck and everything because it's like well um you know that's how people get um skin cancers in the back of their neck they get them on their ears you know the you have to put skin right so it's like everywhere anywhere you have skin yeah you you have the wrist yeah so hair is very protective hair is protective well that's okay so you know I feel like this is for another day but I'm okay so there's a whole hair care thing you know that I've crushed oh yeah hair is a whole new subject and then I will go down that road with you but like no okay so basically stay out of the sun as much as you know you need to don't just don't be excessive is what you're saying.
53:27
SPEAKER_03: Yeah and then if you're gonna wear sunscreen well like I write on Instagram all the time like sunscreen is not enough like you can't just slap on sunscreen and then put your face outside like doesn't sunscreen we know that sunscreen doesn't protect people from from from photo damage it's just not good enough no matter yes no matter what the SPF not none of that matters.
53:46
SPEAKER_03: No to because people don't apply it correctly so unless you put it on correctly which is 2.5 mil which is half a teaspoon on your whole face which is a crap load of sunscreen that's a lot you're you're generally gonna rub it off wipe it off it's just you cannot rely on it it should be your third your third line so your first line is active avoidance your second line is covering up like big hat sunglasses da da da and your third line is gonna be your SPF 50.
54:12
SPEAKER_03: Wow it's because people look at it the other way around yeah so they it's like skin if I have the if I have the you know sunscreen on I'm good everything's good I can be out in the sun you know yeah and it's it's it's the opposite so I'm I always try to say no sunscreen is not enough and then I get a lot of people saying yeah but what do you mean I shouldn't wear sunscreen I'm like no that's not what I'm saying.
54:29
SPEAKER_03: I'm just saying that it's not you gonna it shouldn't be your first step.
54:32
SPEAKER_03: Your first step is how am I going to avoid this and how am I going to stay out of the sun and how am I going to wear my hats and is it going to look cool with my outfit.
54:39
SPEAKER_02: Right.
54:40
SPEAKER_02: Right.
54:40
SPEAKER_02: No I mean I'm so glad that no but like I didn't know that at all and I think most of us don't because we we're always told that you know even as a kid you always put on sunscreen you know but it's like yeah I didn't I didn't know that it's not protective.
54:54
SPEAKER_02: So I I mean is it well I mean it is protective to a point.
54:58
SPEAKER_02: Yeah yeah to a point I should have yeah I should have worded that better.
55:01
SPEAKER_02: But yeah exactly I didn't know that I thought it was truly something that um you know it was it was just more defense I guess than I but not to sound really cynical but why is it that we think sunscreen's so amazing I think for me okay I think it's because you get that layer on top of your skin and I think there's some conditioning there with me where it's like if I've got a layer something on me then I'm I'm safe it's like hiding the blanket mentality you know what I mean like yeah yeah and I think but I think that the the the underlying issue is that the skincare industry makes us believe it is yes yes because sunscreen is a huge market.
55:41
SPEAKER_02: It's a huge market yeah and and this is a huge market.
55:44
SPEAKER_02: It's a multi billion dollar market.
55:46
SPEAKER_02: I'd love to see some of that going to you know actual doctors and research you know that'd be great.
55:51
SPEAKER_03: Yeah so for me but for me to go around saying sunscreen is your third line that that puts a dent into the uh profit margin of the sunscreen industry because like oh hold on a second you know um no no no everyone has to wear sunscreen every day and reapply it every two to three hours forever yeah that's a huge that's a huge amount it's like a full bottle I think like like you had brought this up when we did our live too like it's a giant amount it's a giant amount and it's great for a company selling sunscreen.
56:19
SPEAKER_03: Yeah you're right it's that you have to use more of this buy more of it and here it's only$25 a bottle so but you have to have it because otherwise you'll get old and get skin cancer.
56:30
SPEAKER_03: You know there's a lot of the fear mongering with it and actually you know what the sky they should be saying is listen get your hat ik avoid exposure da da and then put the sunscreen on you know also right but like educating almost in a way like educating but of course that takes away from their bottom line I mean I'm very cynical about this but I I you know business is business.
56:49
SPEAKER_02: Yeah yeah no but it's important to know this though you know and like it really is because yeah I'm not gonna lie I think all of us are sold on sunscreen that's a it's like a solid sell it's been like that for you know decades now so yeah totally it's a solid thank you so much Natalia for for doing this you're amazing and I always have so many questions for you thank you thank you for having this was amazing and so informative but um I'll let if you have time I would love to have you on again that would be amazing yes okay awesome um the listeners I know are gonna love you so thank you so much and I will talk to you next time yep definitely thanks have a great day bye Extra Hey guys so I hope you love that episode please make sure to hit subscribe if you're tuning in to us on any podcast platform we are available on so many different platforms so wherever it is that you're tuning in just go hit subscribe you will be immediately notified when we publish new episodes this way you're able to tune in to amazing insights from experts brand founders industry leaders authors all the wonderful people that we host and that's very important for me because I love to hear from you guys and really understand what you love and what you want to hear more of.
58:09
SPEAKER_02: Also make sure to give us a follow on all of our social media outlets we're available on Instagram TikTok X you name it we're there.
58:17
SPEAKER_02: We also have a blog on Medium so if you're a reader and you love medium blogs check us out on Medium.
58:22
SPEAKER_02: We publish some really great articles on there that do deeper dives than just what's available on the podcast and it's really a great place for all of you science geeks out there that want to learn a little bit more.
58:33
SPEAKER_02: We go above and beyond with our research and making sure we're bringing you information that you usually probably won't hear about in other outlets.
58:39
SPEAKER_02: So check us out leave us a comment leave us a review and we'll be back next time with another episode.
58:44
SPEAKER_02: Thank you.