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Retinoids, Peptides and Injectables: A Dermatologist on What Works and What’s Overhyped · The LIVING Room Podcast | Inside The WNDR Lab

0:00
SPEAKER_00: Skin is a barrier organ.
0:01
SPEAKER_00: All it takes is to see one patient who has a severe burn or something that disrupts their skin barrier to see immediately how important our skin is as a barrier.
0:10
SPEAKER_00: There was an early observational study in Europe that showed people just living closer to a big highway versus farther away had worse skin quality in terms of brown spots and lines and wrinkles.
0:19
SPEAKER_00: Just think to yourself, whenever you're not washing your face at night, it's like getting in bed with your shoes on.
0:23
SPEAKER_00: The last time we had a sunscreen approved in the US, do you know when it was?
0:26
SPEAKER_00: 1999.
0:28
SPEAKER_00: It's pretty shocking in the dermatology community.
0:31
SPEAKER_00: Our skin cancer rate in the US is one in five, which I think is a lot.
0:34
SPEAKER_00: Because if you think of how many patients I see in a day, that means several of them are gonna get skin cancer.
0:38
SPEAKER_00: But in Australia, it is two in three.
0:42
SPEAKER_00: So they have a real public health challenge.
0:45
SPEAKER_02: Why are we taking skincare advice from them then?
0:47
SPEAKER_00: Because they've gotten so serious about sun protection.
0:50
SPEAKER_02: We've got a bit of a branding problem with SPF.
0:52
SPEAKER_02: I think if someone were to discover this as a product today and call it the best anti-aging skincare product of all time, then everyone would be using it every day.
1:05
SPEAKER_00: I think sunscreen needs the same PR that like Kale has had.
1:08
SPEAKER_00: Some people even get in a tanning bed to prepare for vacation.
1:12
SPEAKER_00: And we see more skin cancer in people who have those behaviors than people who actually get low levels of consistent sun exposure.
1:19
SPEAKER_00: As one of my medical school professors love to say, you better take care of your body like you might need it for 100 years.
1:24
SPEAKER_00: They just added one ingredient and followed subjects for 52 weeks.
1:28
SPEAKER_00: They had sequential imaging at defined time points.
1:31
SPEAKER_00: They were evaluated by an investigator, they reported their own self-assessment.
1:35
SPEAKER_00: And at the end of the year, every element of skin quality, texture, clarity, pigment improved by about 50%, which is a big improvement.
1:45
SPEAKER_00: We're used to seeing, you know, little percent improvements, you know, that most products of this eye cream will give you an 8% improvement.
1:51
SPEAKER_00: This 50%, and that ingredient was a good idea.
2:06
SPEAKER_02: Noelle, welcome.
2:08
SPEAKER_02: I'm so glad to be here.
2:09
SPEAKER_02: And congratulations.
2:10
SPEAKER_02: Thank you.
2:11
SPEAKER_02: I'm buzzing for you.
2:11
SPEAKER_00: Thank you.
2:12
SPEAKER_00: Our own little longevity and regeneration.
2:14
SPEAKER_02: Hey, do you have do you know the gender?
2:16
SPEAKER_00: Yes.
2:17
SPEAKER_00: Give you the insights who were having a boy.
2:19
SPEAKER_00: You know first.
2:20
SPEAKER_00: Yes.
2:21
SPEAKER_00: Have you already picked a name?
2:22
SPEAKER_00: We have not.
2:23
SPEAKER_02: Okay.
2:24
SPEAKER_02: Anyway, we're here to talk about skin.
2:26
SPEAKER_00: We are.
2:26
SPEAKER_02: And I think to start with, it would be really useful to give a little bit of background context because you sit at this interesting intersection between, you know, clinical practitioner, researcher, scientist.
2:38
SPEAKER_02: So why don't we start there?
2:40
SPEAKER_00: So skin, speaking of children, in a children's book, it would say, you know, we keep the outside out and the inside in.
2:45
SPEAKER_00: And that is true.
2:46
SPEAKER_00: Skin is a barrier organ.
2:47
SPEAKER_00: And all it takes is to see one patient who has a severe burn or something that disrupts their skin barrier to see immediately how important our skin is as a barrier, because someone with a severe burn can't control their water balance.
3:00
SPEAKER_00: They lose so much water through the skin, they get infections very readily.
3:03
SPEAKER_00: So when we're talking about healthy skin, one of the key functions is it's a robust barrier.
3:08
SPEAKER_00: So it helps us keep hydration in, helps us keep pathogens and infection out.
3:13
SPEAKER_00: Skin is also a biosensor.
3:15
SPEAKER_00: We don't have that many organs in our body that are.
3:17
SPEAKER_00: So we have so much immune activity in our skin.
3:20
SPEAKER_00: We have dendritic cells and longer hand cells, and they're constantly surveying for irritants, allergens, dangers.
3:26
SPEAKER_00: So a lot of immune activity in the skin, thermoregulation.
3:29
SPEAKER_00: I mean, you know, here you're putting all the members through their paces.
3:32
SPEAKER_00: And when people are exercising or their core temperature goes up in one of the saunas here, superficial blood vessels dilate to dissipate that heat.
3:40
SPEAKER_00: And then after exercise or heat exposure, perspiration evaporates and that cools the skin.
3:45
SPEAKER_00: So there's a lot of thermoregulation from the skin.
3:47
SPEAKER_00: And beyond that, it's a storage organ.
3:50
SPEAKER_00: We store fat, hydration, other important elements in our skin and pain sensitivity.
3:56
SPEAKER_00: You know, people who have neurologic injuries and can't sense pain get injured so readily.
4:00
SPEAKER_00: So our skin gives us really important feedback about pain.
4:03
SPEAKER_00: And then there's the issue of mate selection attractiveness.
4:06
SPEAKER_00: Our skin can convey things about our health or desirability in other ways.
4:11
SPEAKER_00: Lots have been written about that.
4:12
SPEAKER_00: So I think it's a fascinating organ.
4:14
SPEAKER_00: Maybe I'm biased, but it does a lot.
4:17
SPEAKER_02: So, but but take me back to that, the beginning of that journey.
4:21
SPEAKER_02: You know, how how did you pick that?
4:24
SPEAKER_02: Because everything kind of feels fascinating in biology, I would say.
4:28
SPEAKER_00: Well, in medical school, I really didn't think I'd become a dermatologist.
4:31
SPEAKER_00: I was really interested in surgery.
4:32
SPEAKER_00: I loved procedures, and I had a wonderful opportunity to work with a really incredible physician who specialized in collagen disorders.
4:40
SPEAKER_00: And I remember we were seeing a patient who was at Hopkins, and she's actually here from New York City, and she'd come down with this impossible to diagnose condition that had made her really sick very quickly.
4:51
SPEAKER_00: And I remember we were standing in the door looking into the room.
4:54
SPEAKER_00: We hadn't even gone in.
4:55
SPEAKER_00: And from the doorway, he diagnosed her because she had a little ridge under a blood vessel in her forearm.
5:01
SPEAKER_00: He could see the shadow.
5:02
SPEAKER_00: It's a condition called eosinophilic fasciitis.
5:04
SPEAKER_00: And if you know to look for that sign, it's a total unlock.
5:07
SPEAKER_00: And then she could be diagnosed and treated, and she went on to have a really fabulous life back here in New York City.
5:12
SPEAKER_00: But to me, as a physician, really interested in being able to look at someone and help them, dermatology has that immediacy.
5:20
SPEAKER_01: Yeah.
5:20
SPEAKER_00: You see it and you can interact with that information without a lot of fancy testing and delay and waiting for things to come back to the street.
5:28
SPEAKER_02: There's like a window into your health.
5:29
SPEAKER_00: Yeah.
5:30
SPEAKER_00: So I thought the physical diagnosis part was really fascinating.
5:33
SPEAKER_00: And then, you know, as I continued through my training, I've just grown to love more and more of the facets of what I do.
5:38
SPEAKER_00: So there's the medical piece, there's the aesthetic piece.
5:41
SPEAKER_00: And the work here we do with members on their skin, it relates to their performance and their self-perception.
5:47
SPEAKER_01: Yeah.
5:47
SPEAKER_00: And all the studies looking at quality of life in disease, skin disease and skin concerns are really outsized contributors to quality of life.
5:54
SPEAKER_02: Yeah.
5:54
SPEAKER_00: So I get to really feel like I help people, which is great.
5:57
SPEAKER_02: The thing that I want to kind of pull up pull on the thread with is that in the press, in the media, maybe I'm wrong here, but correct me if I am.
6:05
SPEAKER_02: That we're led to think primarily about skin as an aesthetic thing or like how we look.
6:12
SPEAKER_02: But as you've just described, there are so many different um indicators of our overall health.
6:19
SPEAKER_02: Can you maybe unpack that a little bit and help us understand why skin is so much more than how you look?
6:27
SPEAKER_00: Well, how you look can relate to your health, and sometimes it doesn't.
6:31
SPEAKER_00: What I mean by that is there's certain health conditions that manifest in the skin.
6:34
SPEAKER_00: If someone's liver isn't functioning properly, their skin can look yellow and jaundiced, right?
6:38
SPEAKER_00: On the flip side, someone with acne or another type of skin concern like that, it doesn't mean they're not healthy.
6:44
SPEAKER_00: So the skin can be a barometer for overall health.
6:47
SPEAKER_00: In other ways, some conditions are just skin limited.
6:50
SPEAKER_00: I think that the interest online right now in hyperfocusing on the skin and what we can do to the skin is just purely the visibility of it, right?
6:59
SPEAKER_00: I mean, people are very interested in showing before and afters.
7:02
SPEAKER_00: It's very catchy, especially with filters and editing.
7:04
SPEAKER_00: You can make these really, really catchy.
7:08
SPEAKER_00: But at the core, when I'm talking with members here and when I'm talking with our patients, I really want to make sure we're staying in a realm where we don't cause problems, where we keep the skin healthy because it serves so many more functions than just being attractive and looking glossy and smooth and appealing to people around us.
7:24
SPEAKER_00: It's actually doing a lot for our body.
7:25
SPEAKER_00: And some of what's coming through with what we find online information, some of it can be harmful to the skin.
7:33
SPEAKER_00: The high side is usually what's highlighted of all the things that can go right, but some things can go wrong if interventions are not well matched to you and your skin.
7:40
SPEAKER_00: So I care a lot about trying to help keep my patients from that and keep them on a path where they can see results and be feeling like what they're doing for their skin is worth their while.
7:49
SPEAKER_00: Does that make sense?
7:49
SPEAKER_02: It makes perfect sense.
7:50
SPEAKER_02: And I think there's so much carryover to the way that you conduct yourself and feel about yourself when you when you're looking good.
7:57
SPEAKER_02: So I'm not dismissing the value of that, but you know, as the largest organ of our body, there are just so many more functions that we can be or should be thinking about optimizing through skin.
8:10
SPEAKER_00: And looking at older individuals who sometimes have drier skin and an impaired skin barrier due to celebrating birthdays, as we call it, hormonal changes, medications.
8:19
SPEAKER_00: There have been some fascinating recent studies showing that repairing the skin barrier just with simple moisturizers and ingredients that are available to all of us actually can reduce systemic inflammation because of all the crosstalk between the skin and the circulating immune cells in the body.
8:33
SPEAKER_00: So it goes beyond, again, just looking good.
8:36
SPEAKER_00: I really care so much for our patients to be at their peak performance, and skin is a big part of that, or it can be.
8:42
SPEAKER_02: Can we talk first about the things that we know to work?
8:47
SPEAKER_02: And and as a second part of that question, can we categorize them in any uh if this is possible?
8:53
SPEAKER_02: Can we categorize them in order of importance or urgency?
8:57
SPEAKER_02: Because I think it's easy to get carried away with 10-step routines and that end up taking up so much of your time.
9:06
SPEAKER_02: And I think so much about what we're trying to do here, but that we all want to achieve is like how do we not suck the fun out of life and how do we not make people feel like they are failing because they're not doing everything that they see online.
9:20
SPEAKER_00: Right.
9:21
SPEAKER_00: Well, there's a new term recently coined that I think is great for some of this, which is called digital dermatosis.
9:26
SPEAKER_00: And digital dermatosis is when people are fed through an algorithm, just constant recommendations for products.
9:33
SPEAKER_00: They end up buying all these products and often can end up, when we look at their self-reported measurements of how they think their skin looks and how they feel about themselves, worse and worse.
9:43
SPEAKER_00: Because the more things you think are wrong and the harder you're trying to fix it, it actually can be sort of a negative spiral.
9:49
SPEAKER_00: So I think digital dermatosis is an interesting concept.
9:52
SPEAKER_00: And a lot of what you're doing here with Wonder is actually combating a lot of that noise and trying to bring it back to the science.
9:57
SPEAKER_00: So to answer your question about what we know works, some of that answer depends on what's our threshold for knowing.
10:03
SPEAKER_02: Yeah.
10:04
SPEAKER_00: So biopsy-proven studies are the gold standard, meaning you do something to the skin, you take a sample of the skin and you assess under a microscope.
10:12
SPEAKER_00: Not all changes visible under a microscope really register as meaningful changes in the skin, however.
10:16
SPEAKER_00: So you want to pair that with more objective measurements, be it imaging, surface measurements, subject to self-reported outcomes, investigator assessments.
10:27
SPEAKER_00: Not many things clear that bar.
10:29
SPEAKER_00: So one of them that's an oldie but a goodie, and dermatologists talk about it a lot, is tretinoin.
10:34
SPEAKER_02: Wait, what is it called tretinoin?
10:35
SPEAKER_02: Tretinoin.
10:36
SPEAKER_00: Tretinoin.
10:37
SPEAKER_02: Okay.
10:38
SPEAKER_00: It comes trippingly off the tongue.
10:39
SPEAKER_00: Tretinoin.
10:40
SPEAKER_00: So it used to be called retin A.
10:42
SPEAKER_00: That was the original brand name.
10:43
SPEAKER_00: And we have 50 years of data on this, right?
10:45
SPEAKER_00: So this is not something new, but it is all transretinoic acid.
10:50
SPEAKER_00: And it activates three receptors in the skin that are called RAR receptors.
10:55
SPEAKER_00: Alpha, beta, and gamma.
10:57
SPEAKER_00: And if you just look again online at information about retinoids, you'll see brands saying, well, ours is better and ours is more equivalent.
11:04
SPEAKER_00: Really, the bulk of the data relate to tretinoin, and over-the-counter products sometimes have extrapolations from those data.
11:12
SPEAKER_00: One of the exciting things in terms of accessibility of these products has been that a previously prescription form called adaplene, you may have heard it called differin, is now over-the-counter.
11:22
unknown: Right.
11:22
SPEAKER_00: So it used to be hundreds of dollars through prescription is now$12 of the drug story.
11:26
SPEAKER_02: What's it called over-the-counter?
11:27
SPEAKER_00: Adaplene.
11:28
SPEAKER_02: Adapoline.
11:29
SPEAKER_00: It's a little different though.
11:30
SPEAKER_00: It only activates two of the receptors, not three.
11:32
SPEAKER_02: Okay.
11:33
SPEAKER_00: Not a huge difference, but it's not identical.
11:35
SPEAKER_00: And I think where it can become tricky is if we look at the data on tretinoin, which are biopsy-proven data, that every aspect of photoaging improves.
11:44
SPEAKER_00: The thickness of the skin surface layers, the amount we're synthesizing new collagen, the amount our melanin granules, so that's hyperpigmentation, congregate or disperse, congestion down in our pores, atypical cells that can be precancerous, all of that looks better.
11:59
SPEAKER_00: But can we take some of these over-the-counter products that are not activating the receptors in the same way and make the same claims?
12:06
SPEAKER_00: Possibly not.
12:07
SPEAKER_00: But we see the phrase you use a lot, pulling of that thread of taking that big, robust set of data and saying our product kind of does that.
12:15
SPEAKER_02: Yeah, yeah, yeah.
12:17
SPEAKER_02: Am I right in saying then that there are some benefits to using some of these products that we don't see, but at a cellular level are happening.
12:29
SPEAKER_02: But as consumers, we can't test them.
12:31
SPEAKER_00: And I guess as your other question, I was saying, you know, what does it mean to know?
12:35
SPEAKER_00: Well, what does it mean to see?
12:36
SPEAKER_00: In what time frame?
12:38
SPEAKER_00: So an important area of learning that we've had about the skin recently has actually been related to perception.
12:43
SPEAKER_00: And there's a term circulating now called perception drift.
12:47
SPEAKER_00: I'm giving you all the new skin lingo that's happening.
12:50
SPEAKER_00: So perception drift is when we make a change.
12:51
SPEAKER_00: And you may see this also just in the training space, we know with members and your clients.
12:57
SPEAKER_00: Once we've made a change, it can be difficult to register that that change is sustained or is continuing to evolve.
13:03
SPEAKER_00: And to give a concrete example, we recently finished up as one of many sites of a phase three FTA approval clinical trial.
13:10
SPEAKER_00: And this was really controlled, right?
13:12
SPEAKER_00: We've got standardized three-dimensional imaging, we have investigator assessments, we have the subject self-assessment.
13:19
SPEAKER_00: Now, if we ignore the placebo controlled double blind part, because placebo enters into a whole other realm of what can happen.
13:25
SPEAKER_00: Just the open label part.
13:26
SPEAKER_00: So at the end, everyone got treatment.
13:28
SPEAKER_00: They knew they were getting treatment, I knew they were getting treatment.
13:31
SPEAKER_00: When we take that new baseline, where today you're getting treatment, I'm administering the treatment, let's get your imaging, your what we call PRO, patient report outcome, and my assessment.
13:40
SPEAKER_00: And we march that out over six months.
13:43
SPEAKER_00: Initially, all the subjects see the difference.
13:45
SPEAKER_00: And we objectively can see it because they're wireframes and three-dimensional data, really high-tech imaging.
13:51
SPEAKER_00: But as you then march out over the months, and it's extended out to six months, the imaging showed a sustained result.
13:58
SPEAKER_00: Investigators generally saw a sustained result.
14:00
SPEAKER_00: The subject gradually drifted back to what they thought was their baseline appearance.
14:05
SPEAKER_00: They could no longer see the result.
14:07
SPEAKER_00: So that's something I see happen with skincare, to take it back to your question, is it can take months for these products to work.
14:13
SPEAKER_02: Yeah.
14:14
SPEAKER_00: Even tretinoin, that gold standard ingredient, we're talking three to six months.
14:18
SPEAKER_00: So, how do we get people to stick through those initial months and appreciate the difference when it's not overnight?
14:25
SPEAKER_02: Well, we can apply that, I think, to nearly everything that we do that we know works, right?
14:29
SPEAKER_02: Consistency, adherence to the things that do actually work.
14:33
SPEAKER_02: And I think that's such a good point.
14:34
SPEAKER_02: There is this adaptation similar to like a hedonic adaptation when something good is happening consistently, you no longer see the good in it, right?
14:43
SPEAKER_02: You become you adapt to that being your new baseline.
14:46
SPEAKER_02: That's really interesting.
14:47
SPEAKER_00: Every day I have a patient say to me, Oh, I loved this initially, and then it stopped working.
14:51
SPEAKER_02: Yeah.
14:52
SPEAKER_00: So did it stop working or did you just adjust to the result that you achieved from it?
14:56
SPEAKER_02: Well, did you call that a dri something drift, perception drift?
14:59
SPEAKER_00: And I think as an industry with skincare, that's almost been capitalized on.
15:03
SPEAKER_00: If you think about brands, always a new launch, always a new ingredient, always a new claim.
15:07
SPEAKER_00: So you can catch people at that moment when they're saying, I don't see a difference anymore, it stopped working.
15:12
SPEAKER_00: Well, there's a new project.
15:13
SPEAKER_02: Try the new thing.
15:14
SPEAKER_00: Yeah.
15:15
SPEAKER_02: And are they are they often just repackaging the same thing?
15:20
SPEAKER_02: Or slightly different formulation, perhaps.
15:23
SPEAKER_00: Well, some of you know this world that we've discussed internally in terms of making recommendations for our members is that there aren't an infinite number of labs, there aren't an infinite number of ingredients.
15:32
SPEAKER_00: And whenever I hear a story of a brand saying, We went to the Amazon and found a berry, did you?
15:37
SPEAKER_00: Or was there a lab in New Jersey that offered this new ingredient up for your product?
15:41
SPEAKER_00: So not to say you never could go to the Amazon and find a new thing, but in general, there's a lot of common ground with skincare.
15:46
SPEAKER_00: You see a lot of the same ingredients across brands.
15:49
SPEAKER_00: So sometimes I give the analogy to patients if you know something's good for you, let's say, going back, for example, for retinol, fruit salad.
15:56
SPEAKER_00: Well, you can go to the farmer's market and you can cut it up and make a fruit salad, or you can go to some incredible, like Le Bristol in Paris that has the tiny little cubes of fruit and it's so gorgeous.
16:05
SPEAKER_00: It's fruit salad.
16:06
SPEAKER_00: Yeah.
16:06
SPEAKER_00: Either way.
16:07
SPEAKER_00: So some of these products have an experiential element.
16:10
SPEAKER_00: And if that's valuable to you to continue to use it because it is really elegant to use and it feels great and the packaging looks great, fine.
16:17
SPEAKER_00: But there also are simpler ways to get the ingredients or the food groups of a balanced regimen, which we can kind of go through how you'd construct that that are not that kind of fruit salad.
16:28
SPEAKER_02: Okay, one question there then.
16:30
SPEAKER_02: My observation is that within this field, there is a wild parity in price.
16:37
SPEAKER_02: And so you can have something that has similar ingredients on label, and they are one is 10x more expensive.
16:44
SPEAKER_02: Is there any difference?
16:48
SPEAKER_02: And I know we've spoken about this in the past, and I didn't really understand, but like stability of the ingredients matters, right?
16:54
SPEAKER_02: And so some of the like the products that we use, for example, are not cheap, right?
16:58
SPEAKER_02: And so there must be some rationale.
17:00
SPEAKER_02: But how does a a consumer pass through that to understand, you know, same ingredients, even like two products that are both very expensive, but one could be very good and one could just be hype or storytelling.
17:15
unknown: Yeah.
17:15
SPEAKER_00: I'm not sure there's one answer consistently across every brand because they do set their own pricing.
17:20
SPEAKER_00: Sure.
17:20
SPEAKER_00: Right?
17:20
SPEAKER_00: It's not independently validated that that reflects what they've spent.
17:23
SPEAKER_03: Yeah.
17:23
SPEAKER_00: With that being said, there are some products that because of the types of ingredients they've been able to combine into a stable formula, that takes a lot of testing.
17:32
SPEAKER_01: Yeah.
17:33
SPEAKER_00: One of the things we saw a lot during the pandemic era where people were at home more doing a lot of skincare, is there was a rise in what I would call elemental products.
17:42
SPEAKER_00: Here's a one ingredient this and a one ingredient that and a one ingredient this, and you could mix them at home, was the idea.
17:48
SPEAKER_00: Those can be less costly to produce because when a lab is making something and looking at stability, there's not much to test.
17:55
SPEAKER_00: It's like a salad bar.
17:56
SPEAKER_00: You're just putting different ingredients out, right?
17:58
SPEAKER_00: You're not combining them in any way.
18:00
SPEAKER_00: A difficulty can be that I see in clinical practice is that we are not cosmetic chemists.
18:04
SPEAKER_02: Yeah.
18:05
SPEAKER_00: And anyone who is not is not going to have that deep well of knowledge of how to combine things.
18:10
SPEAKER_00: So especially in 2020, 2021, I would see people coming in with chemical burns from products they'd mixed at home, with really reactive, bumpy rashes from it, skin barrier disruption.
18:22
SPEAKER_00: So not to say those products can't be beneficial.
18:25
SPEAKER_00: And it can be a very cost-effective way to add an ingredient to your regimen.
18:29
SPEAKER_00: But sometimes the products that have been composed with a lot of ingredients do require extra testing to really make them shelf stable and active so that you can take that off the shelf six months later and still have activity.
18:44
SPEAKER_00: In the US right now, we don't have a lot of oversight with labeling as compared to places like Europe.
18:50
SPEAKER_00: So another issue is you can include what's called a sprinkle level of an ingredient.
18:54
SPEAKER_02: Right.
18:54
SPEAKER_02: Then it goes on the label, but there's not another active ingredient.
18:57
unknown: Right.
18:57
SPEAKER_00: So you're not really getting a meaningful benefit from it, but it's in there.
19:01
SPEAKER_02: Same with the supplement industry.
19:03
SPEAKER_00: Yeah.
19:03
SPEAKER_00: Yeah.
19:03
SPEAKER_00: There's a lot of parallels there.
19:04
SPEAKER_00: So it can be really difficult for consumers to evaluate how to choose a product.
19:10
SPEAKER_02: Yeah.
19:10
SPEAKER_00: And I think right now we're also in a phase because of all the newness that's being pushed out constantly, where we're getting into that paradox of choice.
19:18
SPEAKER_02: Yeah.
19:19
SPEAKER_00: You know, the famous jam experiment, I referenced to patients about their own bathroom counter a lot.
19:24
SPEAKER_00: So there was a group of psychologists who put six jams out at a supermarket.
19:28
SPEAKER_00: And then they went back and put 24 out.
19:30
SPEAKER_00: And they found when there were 24 sitting out on the table, many more people came to look, but many few people, many fewer people purchased it.
19:37
SPEAKER_00: Because it was just overwhelming.
19:39
SPEAKER_00: And that's what I see with my patients is they'll go to a setting that sells skincare and it's the 24 jam scenario.
19:44
SPEAKER_00: They're drawn in, they want to see it, but in the end, like, I don't even know where to begin.
19:48
SPEAKER_01: Yeah.
19:48
SPEAKER_00: So a lot of what I try to do for my patients and our members is get back to the six jams, make this a little more streamlined so that we can be intentional and then have consistency with that approach.
19:58
SPEAKER_02: Okay, Noel, tell me what your six jams are.
20:00
SPEAKER_00: Well, a lot of things are my jam, but we can start with six.
20:03
SPEAKER_02: Okay.
20:03
SPEAKER_00: One is cleansing.
20:04
SPEAKER_02: Yeah.
20:05
SPEAKER_00: And I'm amazed with my patients, even with members here, that's sometimes not a consistent part of people's regimen.
20:11
SPEAKER_00: And this ties in a lot to work that your other scientists on our scientific council are doing around the exposome.
20:18
SPEAKER_00: The exposome refers to all the factors to which we're exposed.
20:21
SPEAKER_00: And if you think of our skin as that largest organ, it's getting everything.
20:24
SPEAKER_02: Yeah.
20:25
SPEAKER_00: It's getting airborne pollution, blue light from our screens, of course, UV, hot, cold, et cetera.
20:32
SPEAKER_00: And pollution specifically is showing to be pretty significant when it comes to inflammatory skin diseases and actually skin aging.
20:39
SPEAKER_02: The pollutants in the air.
20:40
SPEAKER_00: Yes.
20:40
SPEAKER_00: Those particulate pollutants in the air.
20:42
SPEAKER_00: So there was an early observational study in Europe that showed people just living closer to a big highway versus farther away had worse skin quality in terms of brown spots and lines and wrinkles.
20:52
SPEAKER_00: So I generally say to my patients when we're going through their regimen, you know, are you washing your face at night?
20:57
SPEAKER_00: And some of them are like, exhausted.
20:59
SPEAKER_00: I am not.
21:00
SPEAKER_00: And so I said, just think to yourself, whenever you're not washing your face at night, it's like getting in bed with your shoes on.
21:05
SPEAKER_01: Yeah.
21:06
SPEAKER_00: You're just taking the whole day, put the whole day into bed with you.
21:08
SPEAKER_00: So it's a simple thing, but because pollution is sticky, just washing your face and removing it at the end of the day is actually very beneficial.
21:15
SPEAKER_02: And just use a cleanser for that.
21:16
SPEAKER_02: And then do you cleanse again in the morning?
21:19
SPEAKER_00: I do.
21:20
SPEAKER_00: But if you're not using anything too active overnight, if I had to choose, then the nighttime would be my priority.
21:25
SPEAKER_00: Okay.
21:26
SPEAKER_00: Right.
21:26
SPEAKER_00: If someone says it's not realistic, I'm not going to do it twice.
21:28
SPEAKER_02: Yeah.
21:29
SPEAKER_00: But if we're using active ingredients, I we have members like that.
21:32
SPEAKER_00: But we work on this incrementally, like any habit.
21:34
SPEAKER_00: Yeah.
21:35
SPEAKER_00: I do try to encourage patients to pair this with brushing your teeth because that's something you usually do in the morning and evening.
21:41
SPEAKER_00: So if you can just get into that habit, that can be really helpful.
21:45
SPEAKER_02: Yeah.
21:46
SPEAKER_02: And that is consistency.
21:47
SPEAKER_02: I I it took me a long time to consistently approach skincare with anything.
21:53
SPEAKER_00: I feel like I'm part of your journey on that.
21:54
SPEAKER_00: I'm just gonna put myself in there.
21:55
SPEAKER_00: Yeah.
21:55
SPEAKER_02: You really are.
21:56
SPEAKER_02: I am and I'm being consistent now.
21:57
SPEAKER_00: Yeah.
21:58
SPEAKER_02: But I think actually part of that is because.
22:00
SPEAKER_02: I'm getting older, right?
22:01
SPEAKER_02: And I think when you're in your 20s, 30s, it feels less important because you get away with it.
22:07
SPEAKER_02: Right.
22:08
SPEAKER_02: Anyway, let's not divert because I want to know what the second jam is.
22:10
SPEAKER_00: Step one was cleansing.
22:11
SPEAKER_00: Yeah.
22:12
SPEAKER_00: So our second jam would be daytime.
22:14
SPEAKER_00: We want to think about defense.
22:16
SPEAKER_00: That's the paradigm.
22:17
SPEAKER_00: So if I were to pick one type of product for daytime before sunscreen, which we'll get to and let it have its own moment, some kind of antioxidant.
22:25
SPEAKER_01: Okay.
22:25
SPEAKER_00: And an antioxidant, you know, we talk about this dietarily, right?
22:29
SPEAKER_00: You can get vitamin C from your oranges.
22:31
SPEAKER_00: There are many antioxidants in dark berries.
22:33
SPEAKER_00: There's, you know, an infinite number almost in diet.
22:36
SPEAKER_00: But topically, we think that they can do two things.
22:39
SPEAKER_00: One is they can help form a line of defense against reactive oxygen species.
22:44
SPEAKER_00: And those are things that, you know, they generate free radicals in the skin and downstream can impact skin aging and skin cancer or skin irritation, inflammation.
22:53
SPEAKER_00: And the pollutants generally generate those reactive oxygen species, UV light does.
22:58
SPEAKER_00: We think even blue light from screens.
23:01
SPEAKER_00: So something in the daytime, yeah.
23:03
SPEAKER_00: And I don't want to sound fear-mongery about that.
23:05
SPEAKER_00: It's not like our screens are gonna do us in, but in the same way that ophthalmologists worry about our eyes, dermatologists worry about our skin.
23:11
SPEAKER_00: An easy trick that I encourage my patients to do is just turn down the blue light or activate night mode on your cell phone and your desktop.
23:18
SPEAKER_02: Night mode is a game changer.
23:20
SPEAKER_02: It's a winner.
23:22
SPEAKER_00: Nice warm light.
23:22
SPEAKER_00: Yeah.
23:23
SPEAKER_00: But it's something so easy.
23:24
SPEAKER_00: And once you do it, you get very used to it.
23:26
SPEAKER_00: So I think that can help reduce some of that exposure.
23:28
SPEAKER_00: But in the daytime, a simple moisturizer serum, something with an antioxidant is a great thing to do.
23:34
SPEAKER_02: Is that this could be completely wrong, what you would call barrier functions?
23:39
SPEAKER_00: A little bit different.
23:40
SPEAKER_00: I mean, they're connected in the sense that both can have downstream effects with inflammation, et cetera.
23:45
SPEAKER_00: But an antioxidant is something in that vitamin C category or a polyphenol.
23:50
SPEAKER_02: What would that be like a serum or a cream or it could be, and we can we can go deep into this.
23:54
SPEAKER_00: The big difference with serum and cream is the main type of water versus oil ingredient.
24:00
SPEAKER_00: So serums we often think about being more water-based and they absorb quickly.
24:03
SPEAKER_00: Creams often have a lotion-y feel.
24:06
SPEAKER_00: And as I mentioned before, kind of the food groups with your skincare and thinking about, you know, how do you have a balanced assortment?
24:12
SPEAKER_00: In areas like New York or DC, where I practice, we don't have the same weather all year long.
24:16
SPEAKER_01: Yeah.
24:17
SPEAKER_00: So that's why it's hard to have one regimen that you stick to all year long.
24:20
SPEAKER_00: So having a water-based product, and that could be a serum, often includes ingredients that bind water to the skin.
24:27
SPEAKER_00: So humectants, like hyaluronic acid is a big one or glycerin.
24:31
SPEAKER_00: Whereas moisturizers have the primary function of sealing in hydration.
24:35
SPEAKER_00: So if you're living in a humid climate, like summertime in New York or DC, you may not need hydration added.
24:41
SPEAKER_00: You've got water in the air.
24:42
SPEAKER_00: It's humid.
24:43
SPEAKER_00: When people go to the beach on vacation, they say their skin looks great.
24:45
SPEAKER_00: A lot of times that's humidity.
24:47
SPEAKER_00: You can just maybe get away with a moisturizer.
24:49
SPEAKER_00: But you know, we had this really rough winter, like the snow creeped.
24:53
SPEAKER_00: It was really quite terrible.
24:55
SPEAKER_00: And the air was so dry and so cold.
24:57
SPEAKER_00: So I had patients coming and saying, My moisturizer is not working.
25:00
SPEAKER_02: Well, it's why you would use the water-based.
25:02
SPEAKER_00: Yeah.
25:02
SPEAKER_00: Then you put a water-based product underneath and then seal it in, it works much better.
25:05
SPEAKER_00: So that I'd say is kind of the third jam is depending on your skin type and the season, you may need a balance of hydration and moisture.
25:13
SPEAKER_01: Yeah.
25:14
SPEAKER_00: And men and women can differ widely in this.
25:17
SPEAKER_00: Men have thicker skin, men have more oil production.
25:20
SPEAKER_00: And women in the prime of life going through hormonal changes can have a big shift in how well their skin holds on to hydration.
25:27
SPEAKER_00: So it's something that may evolve over the course of your life and with the seasons, but being thoughtful about, you know, is it super humid or is it really dry out and how do I adapt my skincare would sort of be jam number three.
25:40
SPEAKER_02: Okay.
25:40
SPEAKER_00: Okay.
25:41
SPEAKER_02: Jam four.
25:42
SPEAKER_00: Jam four is going to be sunscreen.
25:44
SPEAKER_02: Now before we move on to that, I think we may want to asterisk that.
25:47
SPEAKER_02: Because how do I how do we test for the like how do we know?
25:51
SPEAKER_02: So, so I'm the, you know, going through these seasonal changes.
25:55
SPEAKER_02: Like, how do I know for me, you know, a difference in gender, difference in seasonality, age, whether I should be using the oil-based, uh the water-based or the cream, at what point do I change?
26:10
SPEAKER_02: Is there are there tests that we can be doing at home?
26:14
SPEAKER_00: Well, I think it relates in a sense to how we've structured our skin testing for members here.
26:19
SPEAKER_00: Now that is hyper-personalized.
26:20
SPEAKER_00: We're collecting a lot of data and we're following those data points over time.
26:24
SPEAKER_00: But at home, there are really simple things that we can do that are free and easy.
26:30
SPEAKER_00: So one of the first things I recommend to patients is when you're starting a new regimen.
26:34
SPEAKER_00: Okay, like I'm resetting, it's spring, I'm gonna commit to this, I'm gonna do three steps.
26:38
SPEAKER_00: Take a good photo of your skin.
26:40
SPEAKER_00: Get into some good natural light.
26:42
SPEAKER_00: Smartphones now have such good cameras.
26:44
SPEAKER_00: Take a good high-resolution photo, maybe from the side to front and the other side.
26:47
SPEAKER_02: Yeah.
26:48
SPEAKER_00: Take a photo a month later.
26:50
SPEAKER_00: Yeah, and look at it.
26:51
SPEAKER_00: Now, I've had patients put these photos into Chat GPT and get like full assessments.
26:55
SPEAKER_00: I'm not suggesting you necessarily do that.
26:57
SPEAKER_00: Just look at it.
26:57
SPEAKER_01: Yeah.
26:58
SPEAKER_00: You'll know if you think your skin looks better or not.
27:01
SPEAKER_00: And that's something that is really easy and can help ground what you're doing a little bit in do I see a difference?
27:07
SPEAKER_01: Yeah.
27:08
SPEAKER_00: Another thing that can be helpful is just wash your face in the morning and put nothing on.
27:12
SPEAKER_00: Just walk around for 30 minutes or an hour.
27:15
SPEAKER_00: Do you feel dry and tight?
27:16
SPEAKER_00: Does your skin look oily?
27:18
SPEAKER_00: Does your skin feel comfortable?
27:19
SPEAKER_00: Are there certain areas of your face that feel like, oh, I just want to put something on, other feels normal?
27:24
SPEAKER_00: That can be helpful because that exercise may be very different in July than January.
27:28
SPEAKER_00: And that can give you a gauge.
27:30
SPEAKER_00: Because if you really feel dry and tight, well, you probably need some hydration.
27:33
SPEAKER_02: Yeah, yeah.
27:33
SPEAKER_00: If you feel oily, well, I probably don't need a lot of moisturizer.
27:36
SPEAKER_00: Right.
27:37
SPEAKER_00: So these are free and easy things at home that can help you kind of level set with where you are in your skin.
27:42
SPEAKER_02: Let's talk about Jam 4 because this is an interesting topic.
27:48
SPEAKER_02: Because if I were to go online and try to even understand the efficacy of SPF, I'm I'm certainly shown lots of evidence for using it, but then there's a lot of fear-mongering as well now with you know ingredients and um dosage and you know how often you should be using it.
28:10
SPEAKER_02: I now use it because of you every single day.
28:13
SPEAKER_00: Because of me.
28:14
SPEAKER_00: Yeah.
28:14
SPEAKER_00: Warms my heart.
28:15
SPEAKER_00: Yeah.
28:16
SPEAKER_02: So unpack that for me because you're super bullish on it.
28:20
SPEAKER_02: I think most great skin scientists are, right?
28:24
SPEAKER_00: Well, I think there are a few ways that we can look at this.
28:26
SPEAKER_00: And first, I never want to dismiss people's concerns over things.
28:31
SPEAKER_00: I think one of the reasons there can be a disconnect in shared decision making when it comes to our health, is where a patient or a member feels, you know, I have a concern, I really do.
28:41
SPEAKER_00: And it's just dismissed.
28:42
SPEAKER_00: No, it's fine.
28:42
SPEAKER_00: No, don't worry about it.
28:43
SPEAKER_00: So I never want to take that approach.
28:45
SPEAKER_00: I always want to talk with my patients about help me understand what worries you about this.
28:50
SPEAKER_00: A lot of what I hear day to day, because I have in DC patients who are very analytical and they consume a lot of information and want to understand how best to interpret it.
29:00
SPEAKER_00: I sometimes give the analogy about real-world use versus some of these testing scenarios that get, as you said, kind of fear-mongery online.
29:10
SPEAKER_00: It's like if you tested a seatbelt in a car.
29:12
SPEAKER_00: We test it going down the street, we test it in a collision.
29:15
SPEAKER_00: If you drop a car out of an airplane and say, well, the seatbelt didn't work, the crash test dummy split in two, that's not a scenario we'd really expect to ever see in the real world.
29:25
SPEAKER_00: So a lot of what's happened with the ingredient data on sunscreen is taking one ingredient, feeding it to animals at a very high dose, and saying, well, there's this site finding in a rat.
29:37
SPEAKER_00: One of the things that has been recently kind of pinging online, and because there's a lot of talk around fertility and infertility in our country and in the world, is sperm quality and sunscreen.
29:46
SPEAKER_00: But those studies literally add sunscreen to the petri dish.
29:49
SPEAKER_00: So I sort of say to patients, unless you're mixing sunscreen in the mix, I don't think that that's a real world example.
29:55
SPEAKER_01: Yeah.
29:56
SPEAKER_00: But it's something that can become a really quick headline and catches your attention really quickly.
30:01
SPEAKER_00: So I look a lot at what's being done in Europe and in Australia and in Asia with sunscreen because the last time we had a sunscreen approved in the US, do you know when it was?
30:10
SPEAKER_00: To reference, may he rest in peace, Prince.
30:12
SPEAKER_00: It's 1999.
30:14
SPEAKER_00: It's 1999.
30:16
SPEAKER_00: It's pretty shocking in the dermatology community.
30:19
SPEAKER_00: You know, dermatologists feel really strongly about this.
30:22
SPEAKER_00: Well, it's sort of a long story, but they FDA issued some guidance, and then there was a stay on that guidance that sort of halted innovation.
30:29
SPEAKER_00: There's been a sunscreen innovation act that's gone into effect to try to correct this.
30:34
SPEAKER_00: And there is a new sunscreen that is in the shoot for approval that's been in Europe and Asia for a long time.
30:40
SPEAKER_00: It's called Tinosaurb S.
30:41
SPEAKER_00: It has a lot of UVA protection.
30:43
SPEAKER_00: It's very lightweight, it's very stable.
30:45
SPEAKER_00: We're very excited.
30:46
SPEAKER_02: Is that this one?
30:47
SPEAKER_00: Yeah.
30:48
SPEAKER_00: Oh, I brought you one from Korea.
30:49
SPEAKER_00: I'll have to read the label and see if that one has it.
30:51
SPEAKER_00: Some cups of man.
30:54
SPEAKER_00: I do.
30:55
SPEAKER_00: This is the gift that keeps on giving.
30:56
SPEAKER_00: Champagne is a temporary joy.
30:58
SPEAKER_00: So does this have approved for sale in the US?
31:03
SPEAKER_00: So we're permitted to import this.
31:04
SPEAKER_00: So this only has US approved ingredients.
31:06
SPEAKER_00: But if you look, for instance, Japan, there's a famous Biore sunscreen.
31:09
SPEAKER_00: Tinosaur Bass is the big ingredient in that.
31:11
SPEAKER_00: Thanks for watching.
31:12
SPEAKER_00: So from you're welcome.
31:13
SPEAKER_00: You're welcome.
31:14
SPEAKER_00: I'm visiting you in your house to bring something.
31:16
SPEAKER_00: So that I think may be the beginning of a good era for us in the US, because without new ingredients in such a long time, I think that has added to some of the confusion.
31:25
SPEAKER_02: Yeah.
31:26
SPEAKER_00: FDA uses a term called GRASE, generally recognized as safe and effective.
31:31
SPEAKER_00: They currently classify mineral sunscreens, meaning sunscreens that have zinc and titanium as GRASE, which is why the European sunscreens you see coming through are generally mineral, because they can get approved quite quickly.
31:42
SPEAKER_02: Oh, I see.
31:43
SPEAKER_00: The class of chemical sunscreens is generally not deemed by FDA as unsafe, but they say they want more information.
31:50
SPEAKER_00: I like to look, though, at other countries that have more filters approved.
31:53
SPEAKER_00: And Australia is a great example because our skin cancer rate in the US is one in five.
31:58
SPEAKER_00: Is that right?
31:59
SPEAKER_02: It's one in five.
32:00
SPEAKER_00: Which I think is a lot.
32:01
SPEAKER_00: Because if you think of how many patients I see in a day, that means several of them are going to get skin cancer.
32:05
SPEAKER_00: But in Australia, it is two in three.
32:09
SPEAKER_00: So they have a real public health.
32:11
SPEAKER_02: Why are we taking skincare advice from them then?
32:14
SPEAKER_00: Because they've gotten so serious about sun protection.
32:16
SPEAKER_00: They have a combination of difficult things.
32:18
SPEAKER_00: So they have a lot of people with European genetics that may be prone and a big whole nose on layer.
32:23
SPEAKER_02: Yeah.
32:23
SPEAKER_02: Oh, of course.
32:24
SPEAKER_00: So the reason I look to Australia is they've really wrapped their arms around this and said this is a threat to our population's health.
32:30
SPEAKER_01: Yeah.
32:31
SPEAKER_00: And so they've been really intense about how do we create better sunscreens, better guidance around sunscreens.
32:38
SPEAKER_00: And we could, as a little parenthesis, just talk about their guidance for sunscreen because it's something I bring up every day in my practice.
32:44
SPEAKER_01: Yeah.
32:45
SPEAKER_00: So here in the US, there's often the recommendation of just wear your sunscreen, wear it every day.
32:51
SPEAKER_00: Now, for some people, that works well.
32:52
SPEAKER_00: And I'm thrilled that you've been doing that.
32:54
SPEAKER_00: But I see a lot of people, and I've had these conversations with our members, where that just is not part of what they're used to doing.
33:00
SPEAKER_00: It's not something they want to do.
33:02
SPEAKER_00: So Australia's taken another level of nuance on this.
33:05
SPEAKER_00: And they say, check the UV index.
33:07
SPEAKER_00: So today, I've been doing this.
33:09
SPEAKER_00: Yes, did you see what today is in New York?
33:10
SPEAKER_02: It's low, isn't it?
33:11
SPEAKER_02: Six.
33:12
SPEAKER_02: Is it six?
33:12
SPEAKER_02: So that's moderate.
33:14
SPEAKER_00: Yes, moderate.
33:15
SPEAKER_00: So Australia is three and above, put on your sunscreen.
33:19
SPEAKER_00: And I've found a lot better what we call adherence to sunscreen, meaning people more willing to do it if they feel like they're basing it on data.
33:26
SPEAKER_00: So with my patients, I'm like, you're gonna check the temperature, you're gonna see if it's gonna rain, scroll down and see that UV index.
33:31
SPEAKER_00: If it's going to be three or higher, put on sunscreen.
33:34
SPEAKER_00: The exception Australia makes is if it's below three, but you're gonna be on the water, on snow, a reflective surface.
33:41
SPEAKER_00: But I think that's a great way to look at it because you know, if it's a UV index of one in the middle of winter, you didn't wear your sunscreen, probably.
33:48
SPEAKER_02: So I visited my mom in Melbourne recently in January, and she lives there, and the UV index was like 12.
33:58
SPEAKER_02: 12 or 13.
34:00
SPEAKER_02: How high does it go up to?
34:02
SPEAKER_00: I mean, I think you're pretty much at the top there.
34:03
SPEAKER_00: It's pretty much crazy.
34:05
SPEAKER_00: You're almost on the surface of the sun, I think, at that point.
34:08
SPEAKER_02: I I was I was like burning a little bit, even with even with suncream on.
34:13
SPEAKER_00: Yeah.
34:14
SPEAKER_02: I go like a I'm British, I go like a purple shade.
34:17
SPEAKER_02: It's not great.
34:18
SPEAKER_00: It's your body telling you to stop.
34:19
SPEAKER_00: Yes, it's a helpful mechanism in a way.
34:21
SPEAKER_00: But um, I do think, you know, they've again taken this so seriously.
34:24
SPEAKER_00: And I don't know about your mom's experience there, but in general, you know, the availability of sunscreen in public places, essentially.
34:29
SPEAKER_00: Everywhere.
34:29
SPEAKER_02: Like every bar, every restaurant, it's all free at all times.
34:33
SPEAKER_00: Yeah.
34:33
SPEAKER_02: I mean, I think it's helpful for someone who's so forgetful.
34:37
SPEAKER_00: And to return to your original question about safety, they're dealing with a really real risk to their population.
34:42
SPEAKER_00: I mean, that is melanoma.
34:44
SPEAKER_00: Yeah, a huge number.
34:45
SPEAKER_00: So I think the safety data also are something that each of us is going to interpret based on our perceived personal risk.
34:52
SPEAKER_00: So you look at a place like Australia, if you're much more likely to get skin cancer than not, you're probably going to put on some sense.
34:57
SPEAKER_02: I think we've got a bit of a branding problem with SPF.
35:00
SPEAKER_02: I think, you know, if if someone were to discover this as a product today and call it the best anti-aging skincare product of all time, which it is, probably, right?
35:14
SPEAKER_02: Then it everyone would be using it every day.
35:17
SPEAKER_00: I think sunscreen needs the same PR that like kale has had.
35:20
SPEAKER_00: You know, like someone needs to blow it up, like it's really appealing.
35:23
SPEAKER_02: It's a quinoa revolution.
35:26
SPEAKER_00: Very much a quinoa revolution.
35:27
SPEAKER_00: And sometimes they ask patients, you know, to think about if I were to say, okay, there's a product I have, all you need to do is add one thing.
35:35
SPEAKER_00: That's all I'm asking, one thing for a year.
35:38
SPEAKER_00: And a study was done and published in dermatologic surgery, which is one of our big journals in dermatology, where they just added one ingredient and followed subjects for 52 weeks.
35:47
SPEAKER_00: They had sequential imaging at defined time points.
35:50
SPEAKER_00: They were evaluated by an investigator, they reported their own self-assessment.
35:54
SPEAKER_00: And at the end of the year, every element of skin quality, texture, clarity, pigment improved by about 50%, which is a big improvement.
36:05
SPEAKER_00: We're used to seeing, you know, little percent improvements, you know, that most products of this eye cream will give you an 8% improvement, this 50%.
36:12
SPEAKER_00: And that ingredient was sunscreen.
36:14
SPEAKER_00: And when I frame it that way, that this is not just about preventing sunburn, which of course is important.
36:19
SPEAKER_00: This also is about shielding your skin to give it a chance to repair because the skin is a reparative organ, like the liver.
36:26
SPEAKER_00: Again, we don't have many biosensors, we don't have many reparative organs.
36:29
SPEAKER_00: Skin just keeps winning, can do all these things.
36:31
SPEAKER_00: But it needs a little help and sunscreen can do that.
36:34
SPEAKER_00: So even if someone feels like their risk of skin cancer is remote, doesn't feel that scary to them.
36:40
SPEAKER_00: What about something that just helps your skin look significantly better in every way after a year?
36:45
SPEAKER_02: Why do you think that people don't wear sunscreen?
36:49
SPEAKER_02: Like, why would what's the argument against?
36:50
SPEAKER_02: I mean, is it just to do with like getting a good bit of color, maybe?
36:54
SPEAKER_00: Well, I think sometimes it's just the experience of it.
36:57
SPEAKER_00: You know, if you wear a sunscreen, it gets in your eyes and it stings and you're at work and you're slowly crying all day, you're probably not gonna want to wear sunscreen.
37:04
SPEAKER_00: If you put it on and you look really shiny or you look really How do you know why I do at work?
37:09
SPEAKER_00: I'm sure the tears are hard earned here, not from your sunscreen.
37:13
SPEAKER_00: But one of the things that can be challenging, you know, in a city like DC or in New York, where we have patients and members of all different skin tones, is the messaging around mineral sunscreen as being G R A-S E.
37:25
SPEAKER_00: Like, oh, FTA says it's totally fine.
37:28
SPEAKER_00: Not every skin tone can really wear mineral sunscreen.
37:31
SPEAKER_00: That is the truth.
37:31
SPEAKER_00: It is a physical protectant.
37:33
SPEAKER_00: While some absorb, some sits on the surface.
37:35
SPEAKER_00: And if you have a deep skin tone, if you have richly pigmented skin, it can look gray or purpley or ashy.
37:42
SPEAKER_00: And that for some people, like don't they don't want to walk around?
37:45
SPEAKER_02: When you put that the mineral script sunscreen on, it can make you look that way.
37:49
SPEAKER_00: Because you're getting the zinc and the titanium on the surface.
37:51
SPEAKER_00: I mean, zinc is what's in diaper cream and stuff, right?
37:53
SPEAKER_00: It's white, there's some opacity to it.
37:55
SPEAKER_00: So I think to be inclusive of all skin tones, we also shouldn't be over limiting and say, well, you know, just mineral sunscreen.
38:03
SPEAKER_00: Chemical sunscreens seem work great and they can be much more cosmetically elegant, as the term goes, for people with deeper skin tones.
38:10
SPEAKER_02: One in five is frightening.
38:13
SPEAKER_02: It is one in five people in the US will develop skin cancer.
38:17
SPEAKER_00: And some of it goes back to what you were discussing earlier, you know, that you work on so much with members is consistency.
38:23
SPEAKER_03: Yeah.
38:23
SPEAKER_00: We think the worst thing for our skin and skin cancer risk is what's called binge tanning.
38:28
SPEAKER_00: So people may be on good behavior, maybe they're not outside too much and they're wearing lots of sunscreen, and then they go on vacation and it's gone wild.
38:38
SPEAKER_00: Right?
38:38
SPEAKER_00: They get big sunburns, they want to be out in the sun.
38:41
SPEAKER_00: Some people even get in a tanning bed to prepare for vacation.
38:44
SPEAKER_00: And we see more skin cancer in people who have those behaviors than people who actually get low levels of consistent sun exposure.
38:51
SPEAKER_02: Is that right?
38:53
SPEAKER_02: And I suspect that's most people.
38:56
SPEAKER_00: I think it's become a much more prevalent thing because people sort of know it's not good for them.
39:00
SPEAKER_00: So, you know, most of the time I'm not gonna do it because then I'm a bit of a few.
39:03
SPEAKER_02: If I do this once, I'm gonna be fine.
39:04
SPEAKER_00: It's exactly analogous.
39:07
SPEAKER_02: When you are talking about these cases, this the one in five people, is it always like kind of an acute response?
39:15
SPEAKER_02: So, what I mean by that is if I were to go on holiday tomorrow, I haven't seen much sun because of this extremely long winter, I just binge tan, and then I I come back here, I burnt a little bit, but I seemingly recover.
39:32
SPEAKER_02: Is the cancer developing immediately, or is it something that in two years' time, five years' time, could come back to haunt me?
39:39
SPEAKER_00: It's like many things with our health, an intersection of genetics and environment.
39:43
SPEAKER_00: You know, two people could have the same behavior and one end up with that diagnosis because the genetic piece plays a role.
39:50
SPEAKER_00: However, we can't control the genetic piece.
39:52
SPEAKER_00: So all we can control is our environment.
39:54
SPEAKER_00: And those exposures that are high risk, like tanning bed use, binge tanning, sunburn.
39:59
SPEAKER_00: It's not that we see an enormous immediate change in terms of getting a skin cancer.
40:03
SPEAKER_00: With that being said, if you biopsy a spot on someone's skin and they're just back from the Caribbean and they've had a sunburn, it often looks more atypical.
40:10
SPEAKER_02: Sure.
40:11
SPEAKER_00: It's more that slow burn that over time you're accumulating DNA damage.
40:15
SPEAKER_00: Now, our immune system does a great job, you know, back to that original set of functions for the skin.
40:20
SPEAKER_00: We know that because people who have a suppressed immune system from organ transplantation, they have so much skin cancer because they don't have the benefit of that immune surveillance getting rid of damaged cells.
40:29
SPEAKER_00: So again, I don't want to scare people.
40:31
SPEAKER_00: It's not that you go to the beach and, oh, here comes the skin cancer, let's just wait 10 years.
40:35
SPEAKER_00: But your cumulative choices add up in the skin.
40:38
SPEAKER_00: And ingredients like jam number two, antioxidants, can actually help enhance the body's own DNA repair mechanisms.
40:45
SPEAKER_00: No product should be making a claim that it repairs DNA.
40:48
SPEAKER_01: Yeah.
40:48
SPEAKER_00: And FGA's taking action on some of those products, but we can enhance the way our body can naturally do that.
40:53
SPEAKER_00: So if you get a sunburn, when you come back from vacation, really upping your antioxidant game topically may be able to help to some degree.
41:01
SPEAKER_02: That's useful to know.
41:04
SPEAKER_02: Okay.
41:06
SPEAKER_02: Clear on the clear on the SPF.
41:08
SPEAKER_00: Yeah, I think the other key pillar of using SPF effectively is how much you use.
41:14
SPEAKER_00: So when someone says I use sunscreen, I usually follow up with how do you use sunscreen?
41:18
SPEAKER_01: Yeah.
41:19
SPEAKER_00: Because women sometimes will see it in their makeup and think that's sufficient.
41:23
SPEAKER_00: If you're not wearing heavy coverage makeup, there is no way you're getting enough sun protection from makeup.
41:28
SPEAKER_00: I generally recommend for people who are starting to commit to this, like, I really want to take care of my skin, I'm going to do it.
41:34
SPEAKER_00: Get a little half teaspoon measure, see how much sunscreen that is.
41:38
SPEAKER_00: And put it on your face and neck.
41:39
SPEAKER_00: It's probably a lot more than you've been applying.
41:41
SPEAKER_00: And that's partly why I really prefer lightweight sunscreens, like the one I just gave you.
41:45
SPEAKER_00: It is so light.
41:46
SPEAKER_00: So you can use more of it.
41:47
SPEAKER_00: You know, thicker products, people tend to use less.
41:49
SPEAKER_02: Yes.
41:50
SPEAKER_02: Yeah.
41:50
SPEAKER_00: And studies vary on the efficacy if you underapply, but some studies show that the SPF can drop to as much as the square root of the labeled value.
41:58
SPEAKER_00: So a 50 could become a seven really quickly if you're just like dabbing it on.
42:02
SPEAKER_00: And one of the things Australia does well is they're very directive about here's how much to apply.
42:07
SPEAKER_00: For instance, with spray sunscreens, they say if you're doing your whole body, you're applying it for like a minute.
42:12
SPEAKER_00: I mean, can you imagine continuously spraying for a minute?
42:14
SPEAKER_00: First off, your sunscreen's probably empty.
42:16
SPEAKER_02: Yeah.
42:16
SPEAKER_00: But second, like it's really damp.
42:18
SPEAKER_02: Well, one thing I noticed out there was there was even in the stores, you couldn't buy anything less than like 30.
42:25
SPEAKER_02: I mean it was like 50 on every bar and reference factor 50.
42:29
SPEAKER_00: That's their baseline recommendation.
42:30
SPEAKER_00: So it differs from the US.
42:31
SPEAKER_00: The American Academy of Dermatology recommends broad spectrum sunscreen of SPF 30 or higher.
42:36
SPEAKER_00: In Australia, it's 50.
42:38
SPEAKER_00: Now the difference isn't vast.
42:40
SPEAKER_00: We think that SPF 30 blocks about 95% of UV, whereas SPF 50 blocks 98%.
42:46
SPEAKER_02: What's the number?
42:46
SPEAKER_02: What does the number actually mean?
42:48
SPEAKER_00: It relates to how these products are tested.
42:50
SPEAKER_00: So if I were to put you, which we would never do, but put you in front of a light designed to give you a sunburn.
42:55
SPEAKER_01: I'm here for it.
42:56
SPEAKER_00: And then we apply, you're ready.
42:58
SPEAKER_00: You're contributing your body to science.
42:59
SPEAKER_00: It's inspiring.
43:00
SPEAKER_00: And then we put a sunscreen on.
43:02
SPEAKER_00: The SPF relates to how much longer you can stay under that UV before you get a burn.
43:07
SPEAKER_00: So if it's one minute and then we put on a sunscreen and you last 30 minutes, that's SPF 30.
43:12
SPEAKER_00: But an important element of that is they're applying it thickly.
43:16
SPEAKER_00: So when I have patients say, I'm gonna get a powder, an SPF powder, well, you better look like you dipped your face in flour if you think you're getting that protection.
43:23
SPEAKER_00: A little dusting is not the way that these products are tested and labeled.
43:28
SPEAKER_02: It strikes me then that the sprays are probably not as useful as the creams.
43:33
SPEAKER_00: I think sometimes for ease of application, people like them, but I say to my patients, your skin has to be wet.
43:38
SPEAKER_02: Yeah.
43:39
SPEAKER_00: So people generally don't like that for their face.
43:41
SPEAKER_00: It tends to be more for the body.
43:43
SPEAKER_02: Hey, is there a chance that people are overdoing this?
43:46
SPEAKER_02: You know, I I know you know there's so there is so much of an upside to getting sun exposure, certainly for this vitamin D, but also for like our cognition and our energy levels.
43:59
SPEAKER_02: I I suspect the amount we need is a lot lower than people think.
44:02
SPEAKER_02: But is there a risk that we're putting on too much sunscreen?
44:06
SPEAKER_00: Well, some studies have looked at the impact of daily use sunscreen on vitamin D levels.
44:10
SPEAKER_00: So the British Journal of Dermatology had one study like this, and we didn't see a meaningful decrease.
44:15
unknown: Okay.
44:15
SPEAKER_00: With that being said, I never want people to feel scared to enjoy their life.
44:19
SPEAKER_01: Yeah.
44:19
SPEAKER_00: Like today is a gorgeous day in New York City.
44:21
SPEAKER_00: I love seeing people out walking around.
44:23
SPEAKER_00: We shouldn't be scared and just living inside.
44:26
SPEAKER_00: However, I think vitamin D is really important to skin health.
44:29
SPEAKER_00: And sometimes when I see patients who are on the other side of that spectrum, maybe they've had a skin cancer or a loved one has had a skin cancer that was a terrible experience.
44:37
SPEAKER_00: They're so sun avoidant.
44:39
SPEAKER_01: Yeah.
44:39
SPEAKER_00: And I check vitamin D routinely in patients who are either extremely sun avoidant or who have had a skin cancer.
44:45
SPEAKER_00: And the reason I check if you've had a skin cancer, what your vitamin D level may be, is we sh have seen in many studies that vitamin D levels in that healthy range, especially kind of close to 50, which is above what we consider the bare minimum here in the US, have better prognosis if you have skin cancer.
45:00
SPEAKER_00: So what's not helpful is to get a skin cancer and then move into a windowless room never to be seen again.
45:05
SPEAKER_02: But I'm sure it happens that you know people are very avoidant after something as frightening as that.
45:10
SPEAKER_00: Yeah.
45:11
SPEAKER_00: And so vitamin D, I consider, you know, both as a vitamin and as a hormone a really beneficial thing in the skin.
45:15
SPEAKER_00: And we shouldn't be scared of the sun.
45:17
SPEAKER_00: But sunburn is DNA damage.
45:20
SPEAKER_00: So we want to avoid it.
45:21
SPEAKER_02: Huh.
45:22
SPEAKER_02: Okay.
45:23
SPEAKER_02: Very clear.
45:24
SPEAKER_02: Love that.
45:25
SPEAKER_02: What's jam five?
45:27
SPEAKER_00: So I think that by that point we're moving into nighttime.
45:29
SPEAKER_00: Okay.
45:30
SPEAKER_00: And part of why I say that is I hesitate to recommend any regimen that's steps and steps and steps.
45:34
SPEAKER_00: I think the likelihood of continuing is low.
45:37
SPEAKER_00: And you start losing that clear association between what you're doing and what you're seeing as a result.
45:43
SPEAKER_00: So when we get to nighttime, we want to think about repair.
45:46
SPEAKER_00: So daytime is defense, nighttime is repair.
45:49
SPEAKER_00: So we can sort of repeat jam one because I would like someone to cleanse.
45:53
SPEAKER_00: But five would be something that helps with the skin's natural reparative processes.
45:58
SPEAKER_00: Now we spoke about tretinoin at the outset.
46:00
SPEAKER_00: It's very much proven by science to be helpful.
46:03
SPEAKER_00: The difficulty is sometimes it's hard to tolerate.
46:05
SPEAKER_00: And what I mean by that is people can get what's called a retinoid dermatitis.
46:09
SPEAKER_00: So it's like an eczema.
46:10
SPEAKER_00: You get red, you get peely.
46:12
SPEAKER_00: That is too much because we know that inflammation in a chronic state is not great for our skin.
46:18
SPEAKER_00: So I try to find products like that for my patients that are below the inflammatory threshold.
46:23
SPEAKER_00: So over-the-counter retinoids, we have retinol.
46:26
SPEAKER_00: There's one we use here a lot at Wonder retinyl retinoate, which is a form of a retinoid.
46:31
SPEAKER_00: There's retinal spelled with an A and not an O.
46:35
SPEAKER_00: These have more conversion steps in the skin to become retinoic acid.
46:38
SPEAKER_00: So they're more tolerable.
46:40
SPEAKER_00: And depending on your skin's sensitivity, it might be better to use something gentler that you can use with consistency than to bomb your skin with tretinoin twice a month and then have to recover.
46:50
SPEAKER_02: What would be an example of something gentler?
46:53
SPEAKER_00: Well, in general, the really mild retinol, so there's something called a retinol ester that have a lot of conversion steps to become retinoic acid and activate the receptor, are very gentle.
47:03
SPEAKER_01: Okay.
47:03
SPEAKER_00: With that being said, there's some cases where they're not suitable.
47:06
SPEAKER_00: For instance, in pregnancy, we don't recommend them because the oral cousin of topical retinoids, we know is not a great thing in pregnancy.
47:13
SPEAKER_00: It's a vitamin A derivative.
47:15
SPEAKER_00: All of these are.
47:16
SPEAKER_00: And fat-soluble vitamins, you know, we have to be careful not to overdo those in pregnancy.
47:19
SPEAKER_00: So there are now some peptides, topically, we're not talking about injective peptides here.
47:24
SPEAKER_00: So topical peptides that have some benefits that appear to be not the same as a retinoid, but you're in the same playing field.
47:32
SPEAKER_02: Yeah.
47:32
SPEAKER_00: So one that we sometimes recommend here to members is Matrixal.
47:36
SPEAKER_00: That's been around a long time.
47:37
SPEAKER_00: We see that in the wound healing literature, having quite robust data actually in how it helps the skin architecture.
47:42
SPEAKER_00: And then oligoptide 1, sometimes called EGF, can have some of the same effects of helping thicken the upper layers of the skin and improve skin cell differentiation.
47:52
SPEAKER_00: Yeah.
47:52
SPEAKER_00: And those are really non-irritating.
47:54
SPEAKER_02: Can we can we just double-click on this catch all term of peptides for a moment?
47:59
SPEAKER_02: Because this is like the Wild West out there.
48:02
SPEAKER_02: When it comes to to skin, you know, there are two I think that people are talking about.
48:08
SPEAKER_02: And one is a GHK and the other is melanotan, I think.
48:14
SPEAKER_02: Um neither of which I can see any compelling human data for.
48:18
SPEAKER_02: Yeah.
48:19
SPEAKER_02: And and some kind of obvious risks for what where do you stand on those?
48:23
SPEAKER_00: So I think the first one you're referencing is the copper peptide, right?
48:26
SPEAKER_00: That we've seen in topical skin formulations for a long time.
48:29
SPEAKER_00: It's having a moment, I think, because there's such interest in peptides.
48:34
SPEAKER_00: I just saw an article come out where someone was saying, you know, if you really look at all the data of copper peptides, it's better than anything else we've got.
48:41
SPEAKER_00: Well, again, we need to look at how real world those data are.
48:45
SPEAKER_00: So similar to some of the sunscreen studies, we're like, this is how you'd actually use it.
48:48
SPEAKER_00: Some of the data are in a petri dish, which is very hard to extrapolate to real world outcomes.
48:53
SPEAKER_00: Yeah.
48:53
SPEAKER_00: And most of the data that are real world are just have someone have what we call a washout, which is like, if I said to you, no moisturizer, no cleansing, we're gonna make your skin look as unhappy as it can for two weeks.
49:05
SPEAKER_00: Then we're gonna give you something.
49:07
SPEAKER_01: Yeah.
49:07
SPEAKER_00: And you're gonna put it on and see what it does.
49:09
SPEAKER_00: Almost any intervention is favorable at that point.
49:13
SPEAKER_00: So that's why it's such a commonly used skincare testing strategy for commercial studies, because we could put improved this by this amount.
49:21
SPEAKER_00: Yeah, because we're starting at a baseline that is kind of as low as you go.
49:24
SPEAKER_00: And then we're adding something.
49:25
SPEAKER_00: So those kinds of studies are very difficult.
49:27
SPEAKER_00: When I talk with patients and they're saying, My time is my most precious resource.
49:31
SPEAKER_00: Yeah.
49:31
SPEAKER_00: Should I spend my time on this?
49:33
SPEAKER_00: Not to mention spend your money on it.
49:35
SPEAKER_00: It would be really nice to have comparators.
49:37
SPEAKER_00: Yeah.
49:37
SPEAKER_00: Right?
49:37
SPEAKER_00: How does this work compared to something we know works?
49:40
SPEAKER_00: A lot of things work a little, but to make informed decisions as a consumer, you want to know what works better.
49:45
SPEAKER_02: Yeah, what's giving me most of the things that we're doing?
49:46
SPEAKER_00: Those data are really lacking.
49:48
SPEAKER_00: Yeah.
49:48
SPEAKER_00: So it's not to say that topically I think copper peptide is dangerous.
49:52
SPEAKER_00: I just can't recommend it with the level of strength of conviction that I can some of the things like vitamin C or retinoids where we have better data.
49:59
SPEAKER_02: Yeah.
50:00
SPEAKER_02: We always use this term, I overuse it, major in the majors first.
50:04
SPEAKER_02: Yeah.
50:04
SPEAKER_02: Right.
50:04
SPEAKER_02: And I think we've got some good solutions, techniques for the things that it's already claiming to solve for.
50:12
SPEAKER_02: And so if we if you have one, they're both claiming the same thing and one has much more data for not only efficacy but safety, we should always pick that one.
50:21
SPEAKER_00: And if someone's already doing all the basics and they want to add one more thing, sure, try it.
50:25
SPEAKER_00: But sort of be scientific.
50:26
SPEAKER_00: Add that one thing and see what you think is happening.
50:28
SPEAKER_00: Now, melanotan I put in a little different category.
50:31
SPEAKER_01: Okay.
50:32
SPEAKER_00: Because we are concerned when you think about skin cancer, they're what we call keratinocyte carcinomas.
50:38
SPEAKER_00: And those are things like basal cell and squamous cell cancer.
50:40
SPEAKER_00: They originate from the keratinocyte and then melanocytic cancer.
50:44
SPEAKER_00: So the melanocyte, that's melanoma.
50:46
SPEAKER_00: Melanoma is one of the scariest diagnoses we have in medicine.
50:50
SPEAKER_00: You know, when else can something less than a millimeter thick kill you?
50:54
SPEAKER_00: Yeah.
50:55
SPEAKER_00: It's a really scary cancer.
50:56
SPEAKER_00: Dermatologists are so vigilant with our patients about that.
50:59
SPEAKER_00: So something that's stimulating melanocytes, if you have an unfortunate genetic risk, that could be a second hit that's really dangerous.
51:07
SPEAKER_00: So that worries me.
51:08
SPEAKER_02: I didn't know.
51:10
SPEAKER_02: This is the frightening thing, is that there are people with very big platforms promoting the use of something that could be extra life-threatening for people over time.
51:20
SPEAKER_02: We don't know that for sure, but we don't know that it works for sure, right?
51:23
SPEAKER_02: We don't know that it's we certainly don't know that it's safe.
51:27
SPEAKER_00: Yeah.
51:27
SPEAKER_00: And I think that in this current moment, it can be so eye-catching to see some of these before and afters or these hooks of like, here's what no one wants you to know.
51:35
SPEAKER_02: Yeah.
51:35
SPEAKER_00: You know, but in the field of dermatology, I will say the things that really work, it's not that no one wants you to know.
51:40
SPEAKER_00: Like you're gonna know if something really works.
51:42
SPEAKER_00: I think an example of that, not that I'm saying everyone should do this, but Botox.
51:46
SPEAKER_01: Yeah.
51:46
SPEAKER_00: Right.
51:46
SPEAKER_00: There was a husband and wife in Canada.
51:48
SPEAKER_00: He's a dermatologist, she was an ophthalmologist.
51:50
SPEAKER_00: She was using it to treat spasms of the eye muscles.
51:53
SPEAKER_00: And patients in the waiting room were seeing these other patients like you look so good.
51:57
SPEAKER_00: That spread like wildfire.
51:59
SPEAKER_00: That's not gonna be a secret for long.
52:01
SPEAKER_00: It's now the most commonly performed cosmetic procedure worldwide.
52:04
SPEAKER_01: Yeah.
52:04
SPEAKER_00: So I generally say to patients, if someone's giving you the hook, here's what no one wants you to know.
52:08
SPEAKER_02: Yeah.
52:10
SPEAKER_00: I don't think that any great secret is a very good thing.
52:13
SPEAKER_00: There's always a red flag.
52:14
SPEAKER_00: Yeah.
52:16
SPEAKER_02: Crazy.
52:17
SPEAKER_02: It's kind of scary though, because we I think it's something we all want, right?
52:23
SPEAKER_02: Like we all want to look our best.
52:25
SPEAKER_01: Yeah.
52:26
SPEAKER_02: And so when a path of least resistance is presented and it feels very attainable, and you're, you know, feeling low and confidence, or you know, you you're starting to notice the effects of aging, like that's kind of uh an easy hook.
52:43
SPEAKER_00: And for a lot of this, I think part of what's compelling is that thread of plausibility.
52:48
SPEAKER_00: Yeah.
52:48
SPEAKER_00: There's a little plausibility there.
52:49
SPEAKER_00: I think some of the things that don't take off, it just sounds so outlandish that people think, yeah, my sales resistance is going up.
52:56
SPEAKER_00: I'm not gonna listen to that.
52:57
SPEAKER_00: But where there's plausibility, that's harder.
52:59
SPEAKER_00: And I think one of the stories we could go into that's very current right now would be topical estrogen for this.
53:05
SPEAKER_00: I don't know, you and I may have a different algorithm.
53:07
SPEAKER_00: So this may not be reaching you, but it's really out there for women in the prime of life.
53:12
SPEAKER_02: Yeah.
53:12
SPEAKER_00: Is that something you've heard members asked about a little bit?
53:15
SPEAKER_02: Yeah, I I that's not part of my algorithm.
53:18
SPEAKER_02: It's mostly dogs.
53:19
SPEAKER_02: I love that algorithm.
53:20
SPEAKER_00: You should scroll mine and then we'll reset it.
53:22
SPEAKER_00: I'd like to have just dogs.
53:24
SPEAKER_00: But when we think about this, you know, again, the threat of plausibility.
53:27
SPEAKER_00: Well, we know that with systemic hormone therapy, there are improvements in skin barrier function and skin quality.
53:33
SPEAKER_00: So if you take someone who's estrogen deficient, they're going through the menopausal transition, they're postmenopausal, there are studies looking at replenishing estrogen levels.
53:42
SPEAKER_00: Of course, progesterone and other hormones are at play, but specifically estrogen, skin seems to do better.
53:46
SPEAKER_00: People who felt so dry and they were having issues, you know, it seems to be helpful.
53:52
SPEAKER_00: A difficulty is how much you can extrapolate that to topical use.
53:55
SPEAKER_00: And we have a big issue with that in general here in the US because of paucity of data.
53:59
SPEAKER_00: So, for instance, in pregnancy, the recommendations are if you could eat it, you can apply it topically.
54:04
SPEAKER_00: It's a pretty crude measurement, right?
54:06
SPEAKER_00: Because you're not getting that much absorption of anything applied topically, but that's sort of how we extrapolate.
54:10
SPEAKER_00: And when it comes to topical estrogens, there are some amazing stories online that circulate of people, you know, I know someone who used this forever and they look great.
54:19
SPEAKER_00: And I have colleagues who have, you know, certain patients they say have used this, they look great.
54:23
SPEAKER_00: But they are also likely, as you would say, majoring in the majors, right?
54:26
SPEAKER_00: People who care to only add this one ingredient, what else could I do?
54:30
SPEAKER_00: Are likely not doing nothing else for their skin.
54:32
SPEAKER_00: So that's a hard real world confounder.
54:35
SPEAKER_00: When we look at the science, there is a wide variety of what we see with this.
54:40
SPEAKER_00: Online, the message is very positive, generally.
54:43
SPEAKER_00: Look what it can do for you.
54:44
SPEAKER_00: And compounding pharmacies are selling it directly to patients.
54:46
SPEAKER_00: But there are biopsy-proven studies, which I'm amazed they could recruit for this, looking at the crow's feed area, which the eye area is the thinnest skin on the body.
54:54
SPEAKER_00: Like everyone would pretty much beyond a certain age, like their eye area to look better.
54:58
SPEAKER_00: And a lot of the metrics in this study looked worse.
55:01
SPEAKER_00: What we think may emerge from this is that there may be differences in how photo-aged and non-photoaged skin respondents.
55:07
SPEAKER_00: So there have been studies looking at non-sunexposed skin on the hip versus sun exposed on the forearm or face.
55:12
SPEAKER_02: Right.
55:12
SPEAKER_02: Yeah.
55:13
SPEAKER_00: There seems to be a lot of difference there.
55:14
SPEAKER_02: Same product, different location.
55:17
SPEAKER_00: But what people want is like the prime real estate to look better and it's sun exposed.
55:20
SPEAKER_02: Money shot.
55:21
unknown: Yes.
55:22
SPEAKER_02: Yeah.
55:22
SPEAKER_00: So it's tricky that we don't have a clear sense that it works.
55:27
SPEAKER_00: It could make things worse.
55:28
SPEAKER_00: It could make things better.
55:29
SPEAKER_00: The studies that are collecting subject self-assessment, a lot of them show no difference.
55:35
SPEAKER_00: Yeah.
55:35
SPEAKER_00: The subject, the studies that are open label where you know you're getting it, there's no placebo, sometimes are loosely positive, but placebo-based studies often are.
55:42
SPEAKER_02: Yep.
55:43
SPEAKER_02: Yep.
55:43
SPEAKER_00: From my background in college and biology and research, some of the biopsy-proven studies I don't interpret as positively as some interpret those headlines because my background in studying what we call fibrotic disease, where the skin gets hard, right?
55:57
SPEAKER_00: We have conditions like scleroderma.
55:59
SPEAKER_00: It's a devastating disease.
56:01
SPEAKER_00: We all have this balance of collagen synthesis and degradation.
56:04
SPEAKER_00: And when you see cosmetically marketed products, more collagen production, less degradation.
56:09
SPEAKER_00: Well, beyond a certain point, actually, that's not positive.
56:12
SPEAKER_00: And one of the main markers that's been studied in estrogen and some of these other cosmetic newcomers to the market is something called MMP1, matrix metallic proteinase one.
56:22
SPEAKER_00: So it breaks down some of the extracellular matrix, which is an important function.
56:25
SPEAKER_00: It's like housekeeping for ourselves.
56:26
SPEAKER_01: Yeah.
56:27
SPEAKER_00: That's a target of autoimmunity in these fibrotic skin diseases like scleroderma.
56:31
SPEAKER_00: So it's not all positive, of like, I think it gets marketed of we'll just tip the balance.
56:36
SPEAKER_00: But I think it remains to be seen how we could individualize this.
56:39
SPEAKER_01: Yeah.
56:39
SPEAKER_00: And it's so much of what is great about Wonder Labs is you're really looking at for this specific person, how hyper-personal can we be with our recommendations.
56:47
SPEAKER_00: So I'd like to see that happen with topical estrogen, where we start to have less of a broad stroke.
56:51
SPEAKER_00: It's like, oh, everyone order a cream online and see what happens.
56:54
SPEAKER_00: Maybe we can be more targeted and figure out who would most benefit.
56:57
SPEAKER_02: It's such a challenge, not just in this as a domain, but just overall for optimizing our health, because what works for me doesn't necessarily work for you.
57:06
SPEAKER_02: Are there are there any other um real red flags going on within your field?
57:12
SPEAKER_02: Are there any other things like buzzwords or products or tools that you're like, this is just mostly noise?
57:19
SPEAKER_00: Well, I think there's in this moment of being able to clear the bar to get people's attention, there's a lot of overcalling.
57:27
SPEAKER_00: So maybe in a slightly more nuanced description, what you're saying is not insane.
57:32
SPEAKER_00: But by the time you take it to this really exaggerated level, we've lost the plot.
57:36
SPEAKER_01: Yeah.
57:36
SPEAKER_00: An example of that recently was a study that came out that I've discussed with some of our members about nicotinamide, which is a form of vitamin B3 and skin cancer prevention.
57:45
SPEAKER_00: So what got pulled from this study was a headline: a simple multivitamin.
57:49
SPEAKER_01: Yeah.
57:50
SPEAKER_00: Or a simple single vitamin is the key, and you're not going to get skin cancer.
57:54
SPEAKER_00: And wouldn't we all like to hear that we take a supplement, we're not going to get skin cancer?
57:57
SPEAKER_00: In fact, we were recently, my husband and I were at this lovely hotel on the beach.
58:02
SPEAKER_00: I walk up by the pool and I see people drinking alcohol, some of whom also vaping, getting a tan, but with IV drips hanging.
58:09
SPEAKER_01: Yeah.
58:10
SPEAKER_00: And I'm like, out of curiosity, I'm like, what's in the IV?
58:13
SPEAKER_00: And a lot of it was vitamin B3.
58:14
SPEAKER_00: And this place was touting.
58:16
SPEAKER_00: You know, it's going to prevent your getting skin cancer.
58:17
SPEAKER_00: So, like this theory of antidote.
58:19
SPEAKER_00: Like I can be here frying myself with a cocktail, possibly vaping, but I have an IV.
58:24
SPEAKER_03: Yeah.
58:24
SPEAKER_00: I don't think that's an appropriate conclusion from that study.
58:26
SPEAKER_00: And one of the key issues, there have been prior studies, but this one is more robust than some we've had in recent years, is it was retrospective.
58:34
SPEAKER_01: Yeah.
58:35
SPEAKER_00: So it was in the Veterans Affairs that's in the VA hospitals and it looked at medical records, seeing who'd been on this vitamin for six months or more.
58:43
SPEAKER_00: Any physician who's worked or trained in a hospital knows you see a patient, you're like, oh, are you still on this?
58:48
SPEAKER_00: They're like, I stopped that 10 years ago.
58:50
SPEAKER_00: It's wildly inaccurate, unfortunately, which is we could do a whole episode on that.
58:54
SPEAKER_00: But to say that that's an accurate way of knowing who really took this vitamin for six months or longer, it's just in their medical record.
59:02
SPEAKER_00: They didn't even talk with this.
59:03
SPEAKER_00: It's just a chart review.
59:04
SPEAKER_00: So I think there are so many problems.
59:07
SPEAKER_00: This wasn't a self-report.
59:08
SPEAKER_00: This was a just looking in your record.
59:09
SPEAKER_00: Like if I open your medical record and see, oh, he reported starting nicotinamide last year.
59:14
SPEAKER_00: Yeah.
59:14
SPEAKER_00: And it's not off his record.
59:15
SPEAKER_00: So we'll log him as someone who's taken it six months or longer.
59:18
SPEAKER_00: So, in, you know, not to minimize that there's no impact from that study, but it did show that people who'd had previous skin cancers may have done better.
59:26
SPEAKER_00: But there's so many confounders.
59:27
SPEAKER_00: Maybe they'd made overall changes with their life.
59:29
SPEAKER_00: Maybe it wasn't just the nicotinamide, maybe they'd done other things like optimizing their health in various ways, seeing a dermatologist consistently catching things at the precancerous level.
59:39
SPEAKER_00: So again, I think when that becomes the ivy drip by the pool, I think we have lost the plot.
59:44
SPEAKER_02: Yeah.
59:44
SPEAKER_02: I think this is kind of the whole purpose of this as a bigger project.
59:48
SPEAKER_02: And the reason why, you know, this certainly the podcast exists, but the business in general is we we need to try and remove that middle ground where, you know, we in the in the lab and in academia, we find these promising markers or trends within our research.
1:00:06
SPEAKER_02: And then someone takes that and runs with it.
1:00:08
SPEAKER_02: And then the next thing you see in the press is like, take this supplement because we found this.
1:00:13
SPEAKER_02: And that's what's so misleading for us.
1:00:15
SPEAKER_02: And so I think going back to the source is what we should be trying to do with every single headline that we're seeing is like we we need to understand A, does this actually work?
1:00:25
SPEAKER_02: And then B, figure out, does this actually work for me?
1:00:27
SPEAKER_02: Which is another big step.
1:00:29
SPEAKER_00: Yeah.
1:00:29
SPEAKER_00: And try to assess the risk and benefit balance.
1:00:31
SPEAKER_02: Yes.
1:00:32
SPEAKER_00: Some of these interventions I worry less about because it's not going to harm someone.
1:00:35
SPEAKER_00: Hanging an IV by the pool, actually, like that does sort of worry me just as a concept.
1:00:40
SPEAKER_00: But if you think about other a lot of devices now, like red light masks, like people have different views on them.
1:00:46
SPEAKER_00: Some people like them, some people think they do nothing for the skin.
1:00:49
SPEAKER_00: If you're not using a form that's going to harm your eyes, it's probably not harmful.
1:00:53
SPEAKER_00: It's just you're spending your time and your money.
1:00:55
SPEAKER_00: So I feel differently about something like that that may have some benefit for certain people that we can't yet predict.
1:01:01
SPEAKER_00: Like, are you the person who benefits from this or not?
1:01:03
SPEAKER_00: It's a low risk intervention.
1:01:05
SPEAKER_00: I get more concerned with some of the, you know, injected peptides and other things that are happening where we can't as clearly articulate risk and benefit because it's not as studied.
1:01:15
SPEAKER_02: Yeah.
1:01:15
SPEAKER_02: Yeah.
1:01:15
SPEAKER_02: And that is what that is one of my major hopes from what we do is as we can scale and make this kind of technology and tools and testing more affordable, we can figure out if it works for us.
1:01:26
SPEAKER_02: Yeah.
1:01:27
SPEAKER_02: I mean, red light's a great example.
1:01:28
SPEAKER_02: Red light, the efficacy of red light is dose dependent based on your skin tone and heritage, right?
1:01:33
SPEAKER_02: So it might not be doing anything or it might be doing harm.
1:01:37
SPEAKER_02: Well, you may have ordered a device that's a dud.
1:01:39
SPEAKER_00: Like it's just we don't have enough specificity with these devices.
1:01:42
SPEAKER_00: Like maybe your neighbor got one that's better.
1:01:44
SPEAKER_00: Yeah.
1:01:44
SPEAKER_00: And it's working better somehow.
1:01:46
SPEAKER_00: Um, I think also just the marketing of all this is so upside driven.
1:01:51
SPEAKER_00: So again, what makes my antennae go up, in addition to that phrase, here's what no one wants you to know.
1:01:55
SPEAKER_00: Yeah.
1:01:55
SPEAKER_00: It's, you know, when something is all good.
1:01:58
SPEAKER_03: Yeah.
1:01:58
SPEAKER_00: All good.
1:01:59
SPEAKER_00: Like I can look at you right now and be like, I see a lethal threat to your life in your glass of water.
1:02:05
SPEAKER_00: Because if you drink too much water and you it disrupt your whole electrolyte balance, you could die.
1:02:10
SPEAKER_01: Yeah.
1:02:10
SPEAKER_00: But that's a crazy thing to say because small to moderate to even large water consumptions, totally fine.
1:02:15
SPEAKER_01: Yeah.
1:02:16
SPEAKER_00: So I think that this all upside marketing should be a red flag to people.
1:02:20
SPEAKER_00: And I've seen patients in recently, unfortunately, who've been injected with non-approved in the US substances like PDRN, which people call salmon sperm, things like um platelet-drive growth factor, PGGF, and they've had disfiguring complications.
1:02:36
SPEAKER_00: And what's so sad to me, independent of how difficult it is to help them, because we don't have a roadmap for treating these complications, and the fact that whoever treated them has now abandoned them with this problem, is also that they were so hopeful that actually the lack of approval was cool.
1:02:51
SPEAKER_00: Right.
1:02:52
SPEAKER_00: Because it means it's new and it's cutting edge.
1:02:54
SPEAKER_00: Unfortunately, you know, as someone who participates as an investigator in these phase three studies, it takes a lot of work to establish risk.
1:03:01
SPEAKER_00: And risk is important because, as one of my medical school professors love to say, you better take care of your body like you might need it for a hundred years.
1:03:08
SPEAKER_00: And I really live by that for my patients.
1:03:11
SPEAKER_02: I love that.
1:03:12
SPEAKER_00: Yeah.
1:03:13
SPEAKER_02: I'll probably steal that and now use that in other podcasts moving forward.
1:03:17
SPEAKER_02: Can I ask you a question that I've been thinking about recently?
1:03:20
SPEAKER_02: And that is why do some people age better than others in their skin?
1:03:27
SPEAKER_02: And and I want to add, that's not based on their like wrinkles or like skin tone.
1:03:34
SPEAKER_02: Just some people just look like better for their age.
1:03:38
SPEAKER_02: And I can't figure out why that is.
1:03:40
SPEAKER_00: So apart from mom and dad, which is a piece of it, right?
1:03:43
SPEAKER_00: Genetics plays a big role in how we age intrinsically.
1:03:46
SPEAKER_00: And I should explain by intrinsic aging, I mean if you and I stayed, turned these lights off for the podcast and stayed in this dark room for 20 years, we would still age.
1:03:54
SPEAKER_00: Not from sun damage, but skin might become more lax, we might get more wrinkles, hair might turn gray.
1:03:59
SPEAKER_00: Some of that is a biological quack that's happening from the inside.
1:04:02
SPEAKER_00: And we can discuss there are a few things we think help modulate intrinsic aging.
1:04:05
SPEAKER_02: Drive you mad within two days.
1:04:07
SPEAKER_00: We'd read all these books, we'd have a good time.
1:04:09
SPEAKER_00: But extrinsic aging, the exposome we talked about before, all these factors that drive that is something where we can modify more readily with products, procedures, et cetera.
1:04:20
SPEAKER_00: And when we think about perceived age, we have some good science around this.
1:04:24
SPEAKER_00: So the combination of intrinsic and extrinsic aging results in where we are today.
1:04:29
SPEAKER_00: And if you take subjects and show them a picture of a face and just say how old is this person, it's a quick, immediate perception of age.
1:04:36
SPEAKER_00: And studies that look at this and then modify slightly features of the photographs show that, well, when everything is happening, you've got lines and wrinkles and shadows and brown spots and red spots.
1:04:46
SPEAKER_00: Okay, that is probably the face that will look the most aged.
1:04:49
SPEAKER_00: But beyond that, I think it's fascinating as someone who talks about this every day with patients.
1:04:53
SPEAKER_00: It's not lines and wrinkles.
1:04:55
SPEAKER_00: It's generally drawing the perception of age.
1:04:57
SPEAKER_00: It's evenness of skin tone, light reflection from the skin.
1:05:01
SPEAKER_00: These hallmarks of what you said earlier are signs of health.
1:05:05
SPEAKER_00: So in skin quality research, we're pretty formalized about it.
1:05:08
SPEAKER_00: We talk about mechanical, visual, and topographical elements.
1:05:12
SPEAKER_00: Mechanical is the firmness of the skin, the bounce back.
1:05:14
SPEAKER_00: In Asia, they call it jello skin, the goal that your skin can just move and withstand creasing and bounce back.
1:05:21
SPEAKER_00: Visual is red, brown, that kind of discoloration, also light reflection.
1:05:26
SPEAKER_00: And then topographic is pores, fine lines, deeper shadows.
1:05:31
SPEAKER_00: So when taken all together, they all contribute, but leading the way for looking healthy and looking young is actually just even light reflective skin.
1:05:40
SPEAKER_00: And I sometimes give the example to patients of like, I think we all know maybe a yoga instructor who's like in their 70s and they look great.
1:05:46
SPEAKER_00: And it's not that they have no lines and wrinkles, but there's something radiant about them.
1:05:50
SPEAKER_00: And so I'm much more focused on that kind of optimization than on ironing everything out.
1:05:55
SPEAKER_02: Some people just grow into that as well, don't you think?
1:05:58
SPEAKER_02: Like some people are born to be like, They're best looking at like 60.
1:06:03
SPEAKER_00: Yeah, may we all be so lucky?
1:06:04
SPEAKER_00: Yeah, I know.
1:06:05
SPEAKER_02: What a result.
1:06:06
SPEAKER_02: So I want to ask you three more questions.
1:06:11
SPEAKER_02: One is where do you see this playing out over the next 10 years or so?
1:06:17
SPEAKER_02: Because things seem to be moving so quickly in every area of longevity science, health science.
1:06:23
SPEAKER_02: What are the things that you're excited about that that talk about those threads, the things that we're seeing promise in, but when uh they're not quite ready for prime time?
1:06:32
SPEAKER_00: So I think I'd put that in a few categories.
1:06:33
SPEAKER_00: So one is actually I think there's a big push right now towards streamlining.
1:06:38
SPEAKER_00: I think there's a lot of overwhelm out there when it comes to products, procedures, et cetera.
1:06:42
SPEAKER_00: And so to round out our jams, jam six would be like a little moisturizer at night.
1:06:46
SPEAKER_00: If you think about quite literally the six jams, you could have a little tray of your skincare or a little drawer.
1:06:51
SPEAKER_00: And one of the things I often recommend, again, free and easy to do at home, is take out all your products and put them on your counter and look at them.
1:06:59
SPEAKER_00: There is a cosmetic graveyard lurking in so many people's, yes.
1:07:03
SPEAKER_00: And you've got stuff then that's expired, it's everything's half used.
1:07:06
SPEAKER_00: So really resetting with a smaller number of things you're actually gonna use.
1:07:10
SPEAKER_00: So in general, I'm excited about development of products that can do more with less, right?
1:07:14
SPEAKER_00: Like we've talked about this.
1:07:15
SPEAKER_00: Like, could you have a daily multivitamin for your skin topically?
1:07:18
SPEAKER_00: How much could you get into one product and streamline how much people have to do to see a result?
1:07:22
SPEAKER_00: So I think from a formulation standpoint, that's gonna be interesting.
1:07:26
SPEAKER_00: From a treatment standpoint, there's some interesting new developments in part because we can finally think about intrinsic aging, not just extrinsic.
1:07:34
SPEAKER_00: So here in the US, we had approved almost three years ago something called a skin booster.
1:07:39
SPEAKER_00: They've been in Europe and Asia and Brazil and Canada for some time.
1:07:42
SPEAKER_00: It's an injected hydrator.
1:07:45
SPEAKER_00: So this is not a filler, this is not Botox, this is a skin quality treatment.
1:07:49
SPEAKER_00: And one of the proteins in the skin that changes a lot as we age is called aquaporine three.
1:07:54
SPEAKER_00: It's almost like plumbing between the cells because it's pulling hydration into the cells.
1:07:59
SPEAKER_00: And we also think it then plays a role in how your skin cells differentiate.
1:08:02
SPEAKER_01: Sure.
1:08:02
SPEAKER_00: So what we've seen with these products is when we replenish hydration in skin that has lost the robust ability to make hydration, which happens as we age.
1:08:11
SPEAKER_00: And for women in the menopausal transition happens pretty abruptly, we actually see better functioning of these aquaporens.
1:08:17
SPEAKER_00: It revs some of these internal systems up.
1:08:20
SPEAKER_00: And so I don't mean that skin boosters itself are the thing I'm most excited about, although I use them a lot in my practice.
1:08:25
SPEAKER_00: My patients love them.
1:08:25
SPEAKER_00: It's that idea that we're becoming more connected on a cellular level to the why of what we're doing.
1:08:31
SPEAKER_01: Yeah.
1:08:31
SPEAKER_00: When I listened to your podcast episode on nutrition, I loved that phrase that we're renting weight loss with the GLP ones.
1:08:38
SPEAKER_01: Yeah.
1:08:38
SPEAKER_00: I think some of our cosmetic treatments, broad strokes, are kind of renting better skin.
1:08:43
SPEAKER_00: You know, someone can get Botox and look better for a couple of months, but if we're not thinking about the bigger picture in five, 10, 15, 20 years, we're really going to see it.
1:08:51
SPEAKER_00: So I think I'm excited about those things that really are addressing anatomy and physiology and not just renting better looking skin for a couple of months.
1:08:59
SPEAKER_02: If you could have unlimited funds, I like to ask everyone this unlimited funds, um, unlimited resources and support to answer an unanswered question within your field, what would it be?
1:09:13
SPEAKER_00: I think what we can do to slow the arc of aging in a more personalized way.
1:09:18
SPEAKER_00: Because right now our recommendations tend to be kind of repetitive.
1:09:22
SPEAKER_00: And there have been settings, like in London, there was a place that opened that was doing a buckle swab, getting your cells and saying, we're going to personalize your skincare.
1:09:30
SPEAKER_00: In the end, people were getting the jams with the cleanser, the antioxidant, the moisturizer, the sunscreen, the peptide or retinoid.
1:09:37
SPEAKER_00: So we know now that we can do things to lessen precancerous biomarkers in the skin, as an example.
1:09:43
SPEAKER_00: We can use gentle, what are called, fractionated lasers.
1:09:46
SPEAKER_00: We turn over a fraction of the skin.
1:09:48
SPEAKER_00: Cosmetically, people love them because their skin looks more even and smooth, but we're actually reducing precancerous damage.
1:09:54
SPEAKER_00: And clinical studies show a lower rate of those keratinocyte skin cancers, basal cell and squamous cell, from getting these lasers.
1:10:00
SPEAKER_00: But what if we knew that certain people could benefit outsized from that?
1:10:04
SPEAKER_00: Because all of this is an investment of time and of resources.
1:10:07
SPEAKER_00: So if I knew that you are someone where that intervention is really going to move the needle compared to someone else, that would be a great way to further personalize it.
1:10:15
SPEAKER_00: So I think these kinds of questions of even with our existing armamentarium of treatments, how do we give you what you need is something that Wonder Labs is really working on.
1:10:24
SPEAKER_00: That's why I'm excited to be part of this.
1:10:26
SPEAKER_00: We're just not there yet.
1:10:28
SPEAKER_00: And so when I see ads and things of like, we're going to customize and send you this thing, I know what they're sending, but the mail, it's the stuff we recommend for everybody.
1:10:36
SPEAKER_00: But I think we're getting to a place where with better data, with better ways we can follow changes over time, we will be able to make this truly personalized.
1:10:45
SPEAKER_02: Yeah, it's exciting.
1:10:46
SPEAKER_02: I agree.
1:10:47
SPEAKER_02: That's the thing I'm most excited about.
1:10:49
SPEAKER_02: Agency.
1:10:50
SPEAKER_00: Yeah.
1:10:50
SPEAKER_02: You know, being able to get a higher return on our time and effort and a better result.
1:10:55
SPEAKER_02: That's what we all want, really, right?
1:10:57
SPEAKER_02: We want to be able to get a better result in less time.
1:10:59
SPEAKER_01: Yeah.
1:11:00
SPEAKER_02: Okay.
1:11:01
SPEAKER_02: Final question for you.
1:11:04
SPEAKER_02: If you were to know everything that you know right now, but you got to start all over again with your skincare at 20 years old.
1:11:12
SPEAKER_02: What would you change?
1:11:14
SPEAKER_00: Well, 20-old me was already pretty into skincare, I must say, I've always loved it.
1:11:17
SPEAKER_00: But I'm going to think back.
1:11:19
SPEAKER_00: I think one is, and I see this actually with tweens and things who come in as patients.
1:11:24
SPEAKER_00: Yeah.
1:11:24
SPEAKER_00: They are tween.
1:11:26
SPEAKER_00: A tween is like you're not quite a teen, you're 12.
1:11:29
SPEAKER_00: You're 11.
1:11:29
SPEAKER_00: And I mean, you may have seen there's been a huge rise in skincare consumption in that age group.
1:11:33
SPEAKER_00: So Sephora is just brimming with 12-year-olds right now wanting to buy skincare.
1:11:39
SPEAKER_00: I think becoming intentional, you know, viewing skincare like nutrition in a sense.
1:11:44
SPEAKER_00: You want to think about the food groups.
1:11:46
SPEAKER_00: It doesn't mean every day has to be perfect, but are we getting, you know, our protein and our greens and our hydration?
1:11:51
SPEAKER_00: You know, are we getting our antioxidant and our sunscreen and our moisture?
1:11:55
SPEAKER_00: And starting at that stage with that mindset, I think would have been helpful to me or to anyone who's just interested in skin and starts getting all this different stuff.
1:12:04
SPEAKER_00: Because it's unclear that all of it makes a difference and you can then end up just with a mishmash of things that may or may not even sit well together.
1:12:13
SPEAKER_00: And I think there's a nice change that's happened since I was a teenager where some of the things that were being done, we don't do as much anymore.
1:12:21
SPEAKER_00: Like I know that you're scientists who work on microbiome are very into this, but you know, we used to give people antibiotics for acne all the time.
1:12:27
SPEAKER_00: I have quite quit that a long time ago.
1:12:30
SPEAKER_00: So there are things, you know, that 15-year-old me was existing in a time where understanding of skin was different.
1:12:35
SPEAKER_00: So if I were 15 now, really trying to edit down the inputs I'm receiving about my skin.
1:12:42
SPEAKER_00: Yeah.
1:12:42
SPEAKER_00: So maybe not just anyone online who wants to talk about skin becomes a source of information for me, looking for trusted experts and then paring it down.
1:12:51
SPEAKER_00: So being consistent with sunscreen, majoring in the majors from a young age, trying not to burn all of the above.
1:12:58
SPEAKER_02: Okay.
1:12:59
SPEAKER_02: I'm gonna add one bolt on to that, as I often do.
1:13:03
SPEAKER_02: On the flip side of that, for our parents, you know, for people like in their 70s, 80s, beyond, um, who still, of course, have an ambition to look and feel and perform their best as they as they should.
1:13:15
SPEAKER_02: And what there are so many things that we can be doing for our physiology that we can improve a lot of these metrics of aging.
1:13:22
SPEAKER_02: Does that apply to skin as well?
1:13:24
SPEAKER_02: I assume, yes.
1:13:26
SPEAKER_00: Yes.
1:13:26
SPEAKER_00: And I think there can sometimes be more complexity in taking care of older people because sometimes there are underlying medical conditions that have emerged.
1:13:34
SPEAKER_01: Yeah.
1:13:34
SPEAKER_00: So, for instance, cholesterol-lowering medications, they lower cholesterol in your blood.
1:13:39
SPEAKER_00: They're commonly taken in this country by people who are in their 70s and 80s.
1:13:42
SPEAKER_00: They really impact the skin barrier and the lipids of the skin barrier.
1:13:45
SPEAKER_00: So we can see dry skin, eczema, all of this.
1:13:48
SPEAKER_00: So when someone's older, getting a really good history of what's happening underneath it all, how that might impact their skin is important.
1:13:55
SPEAKER_00: And I think we're learning that glycemic index, which I know you talk about a lot, makes a big difference for certain conditions that can happen at any age, like acne, but especially conditions as we age, we think about inflammaging and these advanced like glycation endpoints.
1:14:10
SPEAKER_00: So that is something that becomes more of a conversation when someone's 75 than when they're 15.
1:14:15
SPEAKER_01: Yeah.
1:14:15
SPEAKER_00: But I like that now we have some more information to be able to be a bit more comprehensive and holistic.
1:14:20
SPEAKER_00: Instead of just are using sunscreen and moisturizer, we can tailor it to the things that are of biggest concern to them.
1:14:26
SPEAKER_00: I mean, I'm amazed even with glycemic index, you know, patients who end up tracking their blood sugar, how different their skin can become quickly.
1:14:33
SPEAKER_00: I mean, all of this is still emerging as an area of understanding.
1:14:36
SPEAKER_00: But I think there's a lot that's going to come from that.
1:14:38
SPEAKER_02: Yeah, the next five to ten years are gonna be pretty fascinating.
1:14:40
SPEAKER_00: Yeah.
1:14:41
SPEAKER_02: Hey Noelle, every day is the school day when I sit down and talk to you, and I really appreciate you coming in.
1:14:47
SPEAKER_00: Oh my gosh, it's more fast.
1:14:48
SPEAKER_02: Where where can people find out more about you?
1:14:51
SPEAKER_02: Also, maybe we should put a little pack together about the the stages of jams for people, which we could add into the show notes.
1:14:59
SPEAKER_00: And I have all the studies I reference I can share in the show notes.
1:15:02
SPEAKER_00: We can let people look for themselves.
1:15:04
SPEAKER_00: I think that's also helpful is for people to feel like there's not this gatekeeping of I think so.
1:15:08
SPEAKER_00: Well, I have a lot of training in this, so you should listen.
1:15:10
SPEAKER_00: Like, you know, look for yourself.
1:15:11
SPEAKER_00: There are a lot of good primary sources that we can.
1:15:14
SPEAKER_02: I would love that.
1:15:14
SPEAKER_02: That would be really helpful.
1:15:15
SPEAKER_02: And now you've said it on a live recording, so you have to.
1:15:17
SPEAKER_00: Yeah, I will do it.
1:15:18
SPEAKER_02: Thank you for coming.
1:15:19
SPEAKER_00: So good to be with you, and I'm so glad that you're wearing your sunscreen.
1:15:22
SPEAKER_00: My heart is happy.
1:15:23
SPEAKER_02: Good.
1:15:23
SPEAKER_02: I will continue.
1:15:24
SPEAKER_00: Yes.