Latest / Rebellious Aging Podcast / Rebellious Aging: Skin
Transcript
- Speaker 1: Hi, I'm Dr. Robert Peterson. Speaker 2: Hi, I'm Mina. Speaker 1: And we're your co-hosts for the podcast Velious Aging Podcast. And today, this is episode four and we're going to be talking about skin. So skin is really important because that's what people see. And it's something that people worry about a lot and and skin ages and the aging of the skin is actually one of the things that we use to tell how old people are. So there's a lot of things going on in the aging of the skin. and we're gonna go into those right now. So Mina, what do you think? Speaker 2: Lots of layers, no pun intended, to this topic. And it's really, really interesting because young people, old people, like no matter the age, I feel like all of them are obsessed with skin health and they all want to talk about it. It's a very hot topic right now. So I think we should just kind of go over maybe the basic fundamentals of what we should know about skin as well as what it can tell us, as well as what we can do to take care of it. Speaker 1: Okay. So the skin, as you said, is layers, like an onion, like an ogre. and the outermost layer is called the epidermis. And the epidermis is the top layer of skin, and the epidermis is designed to interact with the outside world and to fall off. So your skin cells on the top are all constantly being rubbed and rubbing off. If they don't rub off, they accumulate and they get scaly, dry, flaky, and then they'll flake off. But typically in normal wear and tear, the the skin cells will just flake off by themselves. And so they're constantly being renewed. So the skin on the outside of your body right now, the outside, outside part, the epidermis, is relatively new. It's only a few months old. Whereas this the tissue underneath is more robust and that's designed. to stick around longer. but it's a good design because you're always bumping things, rubbing things, scratching things. And because the skin rejuvenates, that's why a shallow scrape will heal with no scar. If you get into the next layer down, which is the dermis, the dermal layer has the blood flow. That's the tissue that gives the nourishment to the epidermis and allows it to grow out. The dermal layer, th that doesn't turn over as much. but it does does contribute a lot to the skin. It it contributes the pigment to the skin, which helps protect us from the UV. And then it just kind of holds everything together. There's a a deeper layer. There's two layers of the dermis, there's the papillary dermis, which supports the epidermis and helps it grow. And then there's the reticular dermis, which is an underneath layer which kind of holds everything together. I see. So that's why if you get a cut, If you get a scrape, the skin doesn't open up. But if you get a cut, and if the cut goes through the epidermis, into the dermis and into the reticulodermis, because the reticulodermis is kind of holding everything together, the skin will separate actually if you cut through the the reticulodermis because it's it's holding everything together all the time and if you have a cut in it it it gaps apart. So the when we when we sew things back together. as plastic surgeons, we typically will close the deep layer, the the reticularmis together and take the tension off and bring it back together. And then that that kind of puts things back how they are and allows that epidermis then to grow over and have a minimal scar. If you don't then if the reticulodermis is divided, it will separate and you'll end up with a stretch mark or a widened scar. Speaker 2: So as a a plastic surgeon, skin is relevant to you in the sense that it has a lot of healing regenerative properties that you take advantage of for your procedures and your surgeries. That's why we do day after post ops and then everything like that for the follow-ups. And you want to make sure that your patient's skin is healing properly, right? Okay. Speaker 1: Yes, that's Speaker 2: There's also the cosmetic side of skin, I think. a lot of money to be made in the skin care, skin health, cosmetic beauty industry. so maybe we should talk about how this pertains to your practice as well as how it pertains to the rest of the world and, you know, how people view skin and beauty standards. Speaker 1: Sure. Well with aging, several things happen with the skin. The first is that you have deflation, you actually lose fat in your face. The fat compartments in the face will actually shrink, which is sort of unfortunate because every place else the fat gets bigger, but in the face the fat actually gets smaller. The second thing is that gravitationally you have you have pull on the face and it and it sags. The third thing is that you have muscle activity and that consistently over the you know over time is bending the skin in the same places. And because it's bending it all the time, it's sort of pimping it and folding it and causing wrinkles. And then the the last thing is that you have light based damage to the skin that causes pig pigmentary changes. Mm-hmm. And one of the things that was always interesting to me is that in in Asia, in in in order to show that somebody's older, they make pigmentary changes on their skin because the the Asian patients are less likely to get Wrinkles. Yes. Then Caucasian patients. but they do get dys chromia, they get discolorations and sunspots and yeah, sunspots and and that's the way that you can tell somebody's older. Yeah, Speaker 2: Interesting. Speaker 1: yeah. So so that is something that we see people for because you know, obviously a lot of our patients come in because they want to look better, they want to look younger, they want to look refreshed. And so we have to sort of combine things. We We can replenish the fat loss by doing fat grafting or fillers. We we we fix the sagging by tightening things and lifting them up and and if there's extra skin we take that away. Once skin is stretched, it really has a hard time unstretching. Yeah. elasticity is pretty much gone after your twenties. And so if if you want it to be tighter, we actually have to tailor it, we have to remove some skin. And then we We treat the wrinkles with tightening the skin and also with fillers and with with Botox, which we'll we'll get to a little bit later. And then for the dyschromia, the skin color changes. we either use medicine or we use a laser. although you know, then there's other things, chemical pills freezing, things like that. But typically right nowadays we use light based therapies. Speaker 2: So there's a lot of different solutions that people can come in to discuss based on what kind of concerns they have about their skin right, whether it be like the laxity you were talking about or the sun sun damage, like you said, the IPL therapy plays a big part in that too. but what about what they can do at home? Is there anything that they can be keeping up with in their skincare regimen or anything that they should be avoiding in their day to day life to help to mitigate those concerns? Speaker 1: Yeah, well the two biggies both both involve light. So about eighty percent of sun is of skin aging is felt to be due to sunlight and ultraviolet radiation. So the best thing that people can do is to avoid the ultraviolet radiation. And you can do that either with sun s sunscreens or with you know mechanical sunscreens, clothing, hats, sunglasses, things like that. Mm-hmm. And those are all really important. And again, in Asia, they're very, very conscientious about that. And and that's why you know Asian patients in in many places their skin is beautiful even as they age. And I was really surprised in Vietnam, even in the summer when it's quite hot. that people would completely cover every square inch of their body Speaker 2: Vigilant. Speaker 1: Yeah, to go outside and and take their, you know, their mopeds. and they'd be completely covered up. and it's it's sort of uncomfortable and it's it's not fun. I mean in in in America we like a healthy tan, but the healthy tan does age the skin. Mm-hmm. So avoiding the sun exposure is is really important. And so You say, well, what about vitamin D? Don't you get vitamin D from the sun? And the answer is yes, you do. So a good compromise would be to use sunscreen in places where you don't want wrinkles and then allow the sun to shine on your back or your, you know, arms or your legs, someplace where you have a bigger surface area and you can abs you know, still make the the the vitamin D. The second thing which is really, really amazing is the the retinoid compounds. So retinoid is is a whole family of compounds. So there's a whole bunch of different things that are basically all different flavors of vitamin A compounds. Speaker 2: Yes, it's a vitamin A derivative, right? Right. Okay. Speaker 1: Right. So retinoic acid is the you know, is the classic and and that that really works. That really works well. And that's that's the active ingredient. That's the thing that actually does it. The problem with vi with retinoic acid is that it's an acid. And if you put an acid on your skin, then it works because it's retinoic acid, it's a retinoid, it's a vitamin A driver. The problem is that because it's an acid, it's also drying and irritating. And can make your sun your skin sun sensitive as well. So at least here in Hawaii it's very, very hard for people to use retinoic acid or tretinoin, which is another name for it. Because it's too irritating. Speaker 2: Mm-hmm. There's so much sun here. Yeah. Yes. Speaker 1: So there are different different things that you can do. what we do is you know, the the product we use is is the red nuic acid combined with another molecule that kind of makes it less acidic. Mm-hmm. It's called a sterification and it's it's retinol, it's palmatate, and so the red noc acid is joined with the palmatic acid residue and that that calms it down. And the analogy that I like to use is that it's like taking orange flavored ice cream and adding vanilla ice cream and making a creamsicle where it's not quite so tart on the skin. but then the retinal cyspal metate will penetrate into the skin because it's not acidic and then inside the skin it's separated back out and the retinoic acid is freed inside the skin and and acts just fine but without irritating the top layer of the skin by being you know by being acidic. Then there are other formulations. So Retinoic acid is an acid, retinol is an aldehyde, retinol is an alcohol, and the aldehyde in the alcohol forms can be converted by the body into retinoic acid, but it's much slower and and you get a much slower dosing of it. So the good thing about that is that they're because they're much lower dose, they're safe and you can buy them in over the counter products. The bad thing is that they're not nearly as effective. And That's why you can buy them over the counter. one of the problems with Retin A is that in in high doses, like if you take it as a pill, if you take if you take it as Accutane for acne, something like that, it can cause birth defects. Speaker 2: Yes, that's one of the big complications that come with acutine, right? Right. They have to make you sign a waiver that states that you aren't trying to get pregnant. It could cause birth defects, things like that. Yeah. so there are like drawbacks, right, to these prescription. You have to make sure that you do your research and that that prescription is a good fit for you, basically. Speaker 1: That's right. Yeah. So accutane's not for everybody, but it is it is, you know, is really good for for acne. And and retinoic acid, similarly, people are concerned about the potential for birth defects with retinoic acid. we don't really have strong evidence one way or another. It it doesn't seem it to be nearly as teratogenic causing birth effects as accutaneous, but but just for caution, you would want to avoid retinoic acid if you were pregnant or thinking about becoming pregnant. Speaker 2: if I were to start using a tretinoin, I have like acne, I wanna shrink my pores, I wanna control my sebum production, which is all true, how should I go about applying it? And do you have any tips or advice? Speaker 1: Well the the best thing to do is to start with a low dose because there's a thing called a retinoid effect. When you give a lot of retinoic acid or retinol of some kind, one of the retinoids, at at the beginning there can be a irritation from it because the skin can be too dry or too irritated. but your skin sort of adapts and accommodates to it as with time. And so with time you can increase the dose. but start off a l with a low dose and in fact if it's still irritating even with a low dose, then do it every other day initially. So what we typically do is we start people on, you know, every other day with a low dose. Then when they're tolerating that, then they go up to every day. If they're tolerating that, then we go up to twice a day. If they tolerate that, then we go to a higher dose then work our way up. And And that way you avoid the irritation and the retinoid effect. Now the problem is that if you you know, you go on vacation for two weeks and you forget your your retinoid and you come home, guess what? You're kinda starting over. Yes, exactly. So you you have to build back up again. Speaker 2: That's why they say not to stop. Even if you're seeing some like peeling or like irritation and things like that. Speaker 1: yeah, if you stop you kinda have to start over. better than stopping is probably just to back off a little bit. Right. Speaker 2: Probably. Speaker 1: And and if you back off then then general it'll it'll be okay. Speaker 2: And you should be wearing SPF all all the time, but especially with prescription strength retinol like treadnoin. Speaker 1: Yeah, so there's it's there there's sort of two separate things. One is you're you're using the SPF just because you're trying to avoid ongoing UV sun damage. and then also the the the sun does cause exacerbation of the irritation that you get with the retinoids. So so yeah, you want to use a a sunscreen. Now y the the The main thing on sunscreens isn't so much the SPF, you know, anything above fifteen or thirty or whatever is is fine. The main thing is reapplying. Because if you put sunscreen on and it's SPF a hundred, you know, it's it's a really great sunscreen, but it washes off after a couple hours. Then after a couple hours your SPF is zero. because it's washed off. Mm-hmm. And so the key is to reapply it and and and make sure you put on enough. The one of the problems is that especially the really high grade sunscreens are kind of expensive. And so people want to economize with them. Yes. And use it sparingly and Speaker 2: Yeah. Speaker 1: well and if you use it sparingly then it doesn't work as well and it's easier to wash off. So that's why Yes, I said in Asia they don't rely on sunscreen products. They just flat out cover things with clothing. Mm-hmm. And and you don't have to you don't have to wonder if it's working or not. Yes. If it's covered, it's covered. If it's not, it's not. Mhm. Speaker 2: And if I like to tan or if I wanna have a tanned look, do you suggest just completely foregoing the tan, the foregoing the sun? What do you think about like I mean there's tanning beds. I I I don't think that that's good for your skin either. Speaker 1: Well, it's that's a really good question because from the skin standpoint, there's no question. It's easy. No UV ever. Yes. You know, keep that UV away from me. It's it's causing it's causing activation of met matrix metalloproteins, it's causing your you know irritation, it's causing sunburn, it's causing wrinkles. So keep that sun away. On the other hand, for your mental well well being. Sometimes a little sunlight feels nice and it helps you feel better. Yes. And you know, and if you wanna lie in the sun, you have to balance it. Right. Speaker 2: Right. Speaker 1: Right. There's that it's bad for your skin but good for your brain or your, you know, psyche and and maybe your social life, you have to you have to balance all those things out and and find what's right for you. there's real risks of sun exposure and you can get later on you can get skin cancer from sun exposure, which would be which would be not good. But you know, a certain amount is probably you know, it's probably fine. Mm-hmm. but as I said, you you're balancing what the skin wants versus, you know, what your brain wants and and Speaker 2: Tells you to do Speaker 1: sun. Yeah, right. the sunlight probably helps to balance your microbiome and things like that too. So there it's it's it's probably best you know, moderation in all things. Yes. Speaker 2: Yes. And you mentioned matrix metalloprotein. Can you tell me what that is? Speaker 1: Yeah. Yeah, those are enzymes that are in the skin and as we said in the in the skin there's the the collagen and the you know the top layer of the epidermis and then then in the lower levels you have collagen last and you have you know all this mesh that's holding everything together and that's a matrix of fibers, fibrils that that that are it's a mesh together. And there are enzymes that actually chop it up. And they're called matrix metallic proteins because they use metal it's just like anything. I'm sure they have some good thing that they do that's that's that's undoubtedly a good purpose for allowing things to move through the tissue when they need to, but but by and large, yeah, they're bad. They they cause wrinkles, they cause you know, aging of the skin. Yes. And they're activated by tobacco and sunlight and and so that's why you know, somebody who smokes, you can kinda tell by looking at them by looking at their skin. Mm-hmm. You know, from a from a distance, you can tell that they smoke because it's really it's really hard on the skin. That plus the fact that the nicotine causes vasal constriction. So the skin's not getting as much blood flow as it would want to get. the but yeah those metric alloy proteins are are part of what causes skin to age. Speaker 2: And then so to avoid that we just don't smoke. Speaker 1: Yeah. so again smoking, you know, if you ask the lungs, you ask the blood vessels, you ask the Speaker 2: I think we can agree that smoking cumulatively is just not what we're supposed to be doing for our bodies. Yep. and then third is the senescent fibroblasts. Elaborate. Speaker 1: Yeah. Speaker 2: What does that mean? Speaker 1: Yeah, so this is really interesting. it turns out that aging is really complicated and it it it's self-perpetuating. That when the cells get old, they stop multiplying, you know, they they don't need to make new cells because they've already sort of filled up all the space. The the cells when they get old, the cells themselves, when they get old, they enter into what's called the SAS piece, an essence associated phenotype. and the and the s and it's secretory phenotype. That's what the second S is for. And what happens is they don't just sit there and just age gracefully. They actually start to produce factors that are deleterious and cause and cause other cells to age more and they cause what's called a pro-inflammatory. Speaker 2: Yes, you've mentioned that in some other episodes, right? The aging cells can affect other healthy cells, causing them to age. Speaker 1: Right. And that that so that senescent phenotype of having the pro inflammatory mediators where the cells put, you know, out things that are actually not that useful, and and deleterious, that's called inflammaging by some people. And And so that's actually gonna be a really, really super important target for treatments in the future because we're starting to get a handle on how to take care of that, and we understand now what's happening, we understand that there's an inflammatory component component to it, but in addition, there are medications that are being developed that will allow the body to clear out. Those they're called zombie cells. They're cells that aren't really doing anything useful. Yes. But they're hanging around and they're and and releasing releasing inflammatory mediators. And if you could you know, sort of get rid of those cells, then that would decrease the amount of inflammation and that would be that would be useful. Mm-hmm. Mm-hmm. Bob Peterson: Yeah, so they cause aging. And this is this is actually really interesting because what happens is When you have glucose circulating in the body, the glucose attaches on to the collagen fibers and and a lot of other things. And then it'll actually hook two collagen fibers together and and sort of weld them together. And the higher the glucose, the more that that happens. So that's a really good argument in favor of glucose control. and and also avoiding spikes in the glucose. So eating refined sugars and you know highly processed foods that are rapidly absorbed and cause glucose spikes increases the amount of the the glycation end products and those end products cause the collagen to hook together and stiffen and th it's impossible for the body to break down that that connection. So the collagen is locked together and becomes more brittle and and we can't undo it. So what so when you say the collagen is welded together, what does that mean for us? We lose that collagen essentially? Well it's that the collagen normally ha has a bunch of fibers and they're you know, they're flowing together. When they're hooked together, imagine if you put some glue in your hair It was gluing the hair together instead of being flowing and soft and wavy, it would be clumped together. And that's what happens with the collagen fibers. They're supposed to be, you know, flowing fibers, but they get they get stiff. And that makes the skin brittle. If the skin's brittle and you bend it, guess what? You get a wrinkle. Wrinkles. Because you've you've pleated in a crease in that brittle collagen that's And it's not there to support it. And it's not really to to you know wave around. So sunlight actually doesn't affect that very much. It's pretty much a product just of your glucose. And it's a direct it's a direct effect of glucose concentration. That it's not an enzymatic process or anything like that. It's just that the the glucose sticks onto the fiber and then it sticks onto another fiber and they're stuck together. So we should be avoiding trying to avoid blood sugar spikes. That's the best way to do that. How should I how how would I go about doing that? Well, again, try and re avoid refined sugars and and highly processed foods and and if you do eat dinner and then have a dessert, if you go for a walk right away. I've heard of I have heard about that, going for a walk, like a good like ten minute walk after meals. Yeah. Yeah. That's good because that that helps to blunt the speak the spike in the glucose because you have to use up some of the glucose to to move and so yeah, walking around after after dinner is actually good. That's why I feel better doing that. Yeah. I never knew that there was any merit to that. Yeah. And then moving on to diagnostic silence or the overlooked as we call it. Yeah. Well the the problem here is that i if a light skinned person gets a dark spot. Yes then you say, my god, there's a new dark spot and you're light skinned, so that could be cancer. But if a dark skinned person gets a new dark spot, first of all it's it's not as noticeable. And second of all, it's everybody goes, well, you know, you have dark skin, you're protected, your melanin keeps you from getting skin cancer, so you know, it's probably nothing. Which is a common misconception, right? Yeah. So it is true that lighter skinned people get skin cancer much more frequently than darker skinned people, but because it's uncommon in dark skinned people, it can be overlooked. And if it's overlooked, it can advance. Right. And so the the statistics show that actually, although darker skinned people get skin cancers less often, they're often more advanced because they're not detected as early or they're not as suspected as much because the melanin does provide a certain amount of of protection. Yes. Yeah, that too. Yeah. we also should talk about the estrogen withdrawal because the estrogen withdrawal at menopause is also something that activates the th those matrix metalloproteins. And and so you you lose about a 30% of your facial collagen within five years after menopause. that's a lot. 30%? Yeah, that's really a lot. So in our hormone episode we talked a little bit about you know estrogen replacement therapy and and why earlier is is better. And again it's one of those big trade-offs, you know the estrogen is certainly good for many things and then there are some small risks So say the two you have to balance. Mm-hmm. Exactly. Well, maybe we should delve into then some surprising facts. I think not everybody, maybe not even our viewers, know about. and to start off, strong, fact number one is that time is not wrinkling your face. the sun is. That's absolutely true. So even as you age, there can be little to do with how it affects your skin. Whereas in the sun and UV damage, right? Is a big driving force behind, you know, the way we look old and our skin health and integrity as we get older and it's just a product of sun damage. Yeah, that's right. And and that's why places that don't get sun, the skin's actually usually a lot better, and they've done they've done twin studies where one twin had a lot of sun exposure and the other identical twin had much less sun exposure. And the identical twin without the sun exposure will oftentimes look about a dozen years younger. And that's why people in northern climates where they get little sun exposure and cover up a lot, their skin tends to age less. Mm-hmm. You know. So about ninety percent of visible skin changes are attributed to UV, right? Exposure and stun damage. Yeah. there's gonna be a little bit from just repetitive motion. Yeah. You're still gonna get prolize feature or something like that a little bit. Unless you get Botox. Yes, unless you get Botox. Mm-hmm. Okay, and then fact number two is that the best anti aging product costs twelve dollars and requires a prescription. This is gonna ruffle a lot of feathers within the beauty industry, I think, because If you're telling me that I can go and get a prescription for this twelve dollar medication and have great skin com comparable to that of a a hundred dollar product over the counter. yeah, better. Really? Yeah. So this is what we talked about earlier with retinoids. Yeah, over the counter products have retinol and retinol in them. And that's good. That's a good start. But as I said, they're over the counter. Yes. And since they're over the counter, it's not so strong. So if you really want something that's gonna work, nothing beats retinoic acid or the retinal cyspalmitate, ret a stronger retinoid. And the tritinoin's out in generic, it's inexpensive. and that's a retinolic acid type of product, it's a retinoid. And and it's a strong one. but as we talked about, i it also makes your skin more sun sensitive. You have to be careful about it if you're thinking about eating you know, having a baby. So there is mixed blessing. But it certainly does work better. Yes. efficacy wise, if I wanted to put my savings towards something that will work, yeah. You would recommend to me prescription treadnoin, first and foremost. Yeah, yeah. Well it it works a whole lot better than The expensive over the counter products. Yeah, because you can buy twelve of those expensive products and still not be seeing the same amount of change as you would with just the one product, right? Because they're care retained. Yeah, I mean that they're over the counter for a reason because they're they're not strong. Mm-hmm. they're guaranteed to not cause too much trouble and also not cause too much effect. Mm-hmm. I see. Okay. And then for our third fact. Is that your fingernails keep an exact biological receipt of your health? Yeah. So this is kind of cumulative into our skin and nails, maybe even a little bit of hair. Yeah. You know, it all ties together. But how can you read fingernails? Well the the the the nails grow, They grow about a millimeter a a day. So over the course of a month they'll go a centimeter, you know, something like that. And and if there's an issue it it will grow out like tree rings and you'll see it. And then conversely if you have a problem, if you have a fungus infection in your nail, it takes forever to fix it because it has to, you know, has to grow out new you know, new nail that doesn't have the spores in it. If the spores get into the new nail, then it perpetuates. Yes. So takes a long time, it takes like a year of treatment for treating, you know, fungus in the nails. Wow. And you said that it can also reveal some underlying health conditions, right? Like severe illnesses or, you know, infections, We generally don't use it for that, but it it does. keep track of all of those things. And you know, forensic forensic anthropologists can look at a nail and can read a lot from it, huh? They can read a tremendous amount. That's a more sophisticated analysis than we generally do. But the the underlying fact is that the nails, you know, grow out slowly and that they will keep a record of, you know, what what has happened. Interesting. We're not that far off from trees. Yeah. Right. Okay. And then moving on, our darker skin tones face a deadlier skin cancer threat due to medical biases. Yeah, that's right. It's what we talked about earlier that that you know people if you have a brown spot on a darker skin person say, Well it's you know, it's probably not a cancer. But you should still maintain you know, a high vigilance and make sure that you you treat it appropriately and And don't overlook it just because it's a dark spot on a dark skinned person. So you would recommend everyone to get regular skin checks. Yeah. Yeah. With their dermatologist or primary care provider. Absolutely. Mm-hmm. And then also tying into that is that skin rejuvenation has officially shifted from cosmic to synolytic. Yeah, that's what you talked about with the zombie cells before that that SASP, the secretory phenotype of senescence. Yeah, stenescence associated secretary phenotype. That the the zombie cells are causing inflammation and they're affecting the other cells near them and then also cells far away. So if we can apply medications that will quiet them down. or I actually a lot they're looking to just kill off. but at at the very least quiet them down then that would make a A huge difference in of inflammation, yeah. Yes, inflammation you were referring to it as also right. Right. Okay. Well now we can go ahead and move on to some of the inconvenient truths, lifestyle audits, all encompassing. So one of the inconvenient truths that we discussed I think a little bit earlier was that Topical collagen creams are a scientific scab. Yeah. So we're being conned. Well if you believe that collagen is gonna get into your skin, yeah, I guess you are. Because the thing is, i it is true that your skin loses collagen with age, and as we just talked about with menopause, you'll lose thirty percent of your skin collagen within five years. So it seems like, okay, I'm gonna lose collagen if I just rub some collagen on top of the skin, then that would be good. Yes. Well it's you know it's not a bad moisturizer, but it's it's a really expensive moisturizer. And the collagen molecule is too big. So it's not going to penetrate deep down and it's just going to kind of sit there. Yeah, and that's what I mean the skin is designed to keep out big molecules. And you don't want little molecules getting in because all kinds of bad things would get in. So the skin's job is to keep stuff out. And collagen's a big molecule. If you can't keep collagen out, you're never gonna have a prayer keeping out little smaller things. Yes. But it is true that if you chop collagen up into little pieces and you eat them, that then your body will have the pieces, the Lego blocks that it needs to make new collagen. And that's called hydrolyzed collagen it it does seem to help improve the collagen. So rubbing it on doesn't seem to work too well, but eating it actually does seem to help. So then that's I've seen it in like the form supplement pill as well as like a powder that people can add to like their smoothies or coffees and things like that. That's exactly right. Okay. Good to know that that's more effective than topical. Yeah. The fillers and laser treatments, things like that actually can build collagen in the skin as well. Mm-hmm. I've heard that as well. I knew the laser, but only recently did I understand that filler, HA filler can also do that. That's right. That's insane. Wow. Yeah. Okay. So another inconvenient truth is that thirty to fifty percent of fungal nails have zero fungus. So what's on my nail? What is It's not fungus. If you look at the nail and it's thickened and it's y yellow and it's kind of fallen apart, you think, my god, that must be fungus. And it might be. It often is. But it might not be. It might just be that the nail is old it has some other exposure. And so if you're gonna treat with an antifungal, it's really prudent to get w what they call KOH potassium hydroxide prep to look and see if there's actual fungus in the nail before you get because the antifungals are annoying and you have to take them for a whole year. Really? So yeah, you don't want to you don't want to commit to that if you don't really need to yes. Yeah. Mm-hmm. And then another inconvenient truth is that high doses of biotin can dangerously mask a heart attack. Yeah. Yeah. So that's another nail nail issue that some people take biotin. For brittle nails, which is fine. But the problem is that if you're having a heart attack and you're taking a high dose of biotin, the biotin will make it so that the test that they do for proponent test, and the biotin can give you a false reading, basically. That you can have a reading that would tell them, my god, you're having a heart attack, we better, you know, put you in the SU or whatever. but but with if you're taking a lot of biotin, the reading may come back normal. And and then, you know, it would it would probably come back higher later on, but you you you don't want to delay it. Mm-hmm. So the regular suggested serving amount of biotin should be fine. Yeah. Yeah. Right. Just not if you're doubling the dose and tripling and okay Okay, and last but not least, is that the elderly use the least sunscreen despite having the highest risk. Yeah. Yeah. So I think probably part of it is that sunscreen's expensive. Mm-hmm. It's annoying. people are yeah, you have a lot of other stuff that they're taking care of. they may be putting on makeup, which actually might serve just as well as a sunscreen. Just covering a little bit more of the surface area that it would be exposed right to the sun. Yeah. And then I think probably mostly it's just you know, the inconvenience and then also to some extent probably a well I'm old already and so can't fix this, might as well just let it be. Exactly. And the the sun the sun damage isn't gonna have us long to to make a skin cancer 'cause I'm not gonna be around that much longer. Yeah. But sunscreen's good for everybody. Everybody should be wearing sunscreen. Yeah. Okay. And then so let's go over what I would think is what I should have if I could only have four products on my shelf. Yep. you've put me onto tretinoin. So for sure I want to start a tritinoin. I wanna see how it's gonna help my skin health, how it's gonna help my acneic problems, sebum control, as well as tretinoin is mainly for cellular turnover, right? Yeah, it does that right. In turning over skin cells so that the healthiest cells are more frequent than what it would take naturally without retinoin. Yeah, sort of. That the tritinoin is as I said, it's like a retinoic acid. And and vitamin A is like vitamin D. It's it probably should be called hormone A. It's actually it's kind of like a steroid hormone. It's it goes to the nucleus, it changes the way that the cells express the proteins in the body It causes the dermis and the epidermis to differentiate properly and you know does a lot of good things. if you think about it in terms of vitamin A deficiency that you know in the old days people had in vitamin deficiencies because of their diet or you know, the sea voyages or whatever. And vitamin A deficiency is called pellagra. And it causes you know problems in the skin and the hair and stuff like that. And the sun is it sort of inactivates the vitamin A in your skin. So if you have a lot of sun exposure, the sun is breaking down the vitamin A in your skin. So your skin may be vitamin A deficient, even if you the rest of your body isn't, because the vitamin A in your skin is being broken down. So if you just put some vitamin A back into the skin. the skin will be happy and healthy. and it's just it's probably just fixing a deficiency. Mm-hmm. that's probably the more or less the main way that it works. Mm-hmm. And when you're using an active ingredient like tretinoin, you should also always be using a sunscreen no matter what. no matter what. Yeah. But especially if you're using an active ingredient and but even if you're not too because the the the the good thing is that the tretanoon's gonna undo some of the sun damage that you're gonna be getting because it's restoring the vitamin A that you've lost from the the sun exposure. and all the better if you're using a sunscreen too. And then for my morning routine I do use a vitamin C right now. I've been told it protects against free radicals, brightening. There's a lot of things that it does. Can you elaborate a little bit? Yeah. So vitamin C is good. It downregulates the melanin production. Mm-hmm. So it it makes your skin lighter, makes you less likely to get brown spot. It is an antioxidant. it brightens the skin a little bit by down regulating the melanin production. Mm-hmm. So it's Vitamin C also is is sort of good for your skin. there are a lot of products that sort of combine vitamin C with a peeling to allow it to to penetrate a little bit better. Vitamin C is is water soluble and so it's gonna stay on the top of your skin and vitamin A, the red noic acid, is a fat soluble, so it penetrates into the skin a little bit better. And you should always be using some type of moisturizer, I've been told to, right? if you do have oily skin, your your sebum production is gonna be higher if you strip it all the time and you keep taking off all the oil, just washing your face and not reapplying a kind of moisturizer. So I also put ceramoid moisturizer on the shelf too. Yeah, yeah. So ceramoid's a good moisturizer. it's a long chain molecule that holds water on the skin. Because it's negatively charged and holds the water on. Mm-hmm. Okay. That sounds like a good lineup. you want to put on an SPF every day and then just be aware of the the fact that the UV can go through the windows and clouds and stuff. And you can get a sunburn even if it's cloudy. It doesn't stop the UV. Mm-hmm. Now but and and you did ask a question about tanning beds if you didn't want to tan. And the The the you know father of modern dermatology is a guy named Fitzpatrick, he was in at Harvard. Yes. And he once said that the tanning bed industry should pay him a royalty because he said that there's UVA and UVB. UVB is a stronger UVB and that causes a lot more sunburns. And UVA within tanning beds. So in theory, if you go in a tanning bed and get tan, That will stimulate the melanocytes, it will cause melanin production, it'll make you tan. And that should help keep out the which is a dangerous one, and should make your skin healthier. So a tanning bed in that sense is probably a little bit healthy and might help keep you from getting skin cancer. Might. And will age your skin as well. So if you are going to get a tan, that's probably not a bad way to do it. I think that the the the self-tanning lotions are probably even better. Interesting. And I always thought that they should make they should make sunscreen so that it looks like a tan. Mm-hmm. So that first of all it looks like a tan, and then second of all Then you know if it's still there. Yes. Because one of the problems with sunscreen is that sunscreens are designed to disappear. Yes. So you don't see Yes. If you see they're makeup. Mm-hmm. You know, they're not sunscreen. But if they disappear How can you tell? Then it's really hard to know if it's still on. Yes. And then you don't know it's still on, then it's probably washed off and you're probably not getting as much sun protection as you thought you were. Uh-huh. You wouldn't know to reapply. Yeah, and you wouldn't know to reapply. So so maybe I should invent a a sunscreen that you can see. Absolutely. Actually there is there there is one. I'm too late. there's a really good there's a really, really good sunscreen that is a micronized titanium sunscreen. And if you look at somebody with a UV camera, you can see If the sunscreen's still on. Yeah. which is a little bit outside the realm of what people normally do, but but it actually it's an interesting idea that you can see 'cause you're trying to block the UV. So in with a with a UV camera you can look at it and you can see if the person looks dark, that means the sunscreen's there. because it's blocking the UV. Yes. and if it's light then that means they missed a spot or you know, they they need to reapply. Mm-hmm. And then the ten minute walk that we were talking about to blunt the glucose spike after meals. Absolutely. We should all be doing that. If you can. you know, in in Europe and places where people go out to eat and walk there. Yes. And frequently they'll have dinner and then walk home. Mm-hmm. In America we tend to walk back out to the car. Exactly. Sit in the car while we drive home. But I mean that's one of the charming things about yeah, an urban atmosphere where people can walk to restaurants and then then stroll back afterwards. And I think that that is helpful if possible. Yeah, that it ties into skin health that much. Yeah. As for our self audits, right? There are things that people can be doing. Taking to their dermatologist making that appointment to get checked yearly for melanomas and other skin concerns and things like that. They should be doing this at least once a year. Right. there was a dermatologist that I love named Norm Goldstein and used to say, Examine your birthday suit on your birthday. interesting. Yeah. Great. It was a really it was a great suggestion. That on your birthday, you know, look in the mirror and check every place you can see. And If there's anything that looks suspicious, get it get a check done. Mm-hmm. Mm-hmm. Yeah. Great. Okay. Well, I have a lot of new advice now. I'm gonna be taking inventory of my skincare routine too. So thank you so much for elaborating on all of those skin health, skin concerns for us, Dr. Peterson. Yeah. And if you wanna read more about it, you know, the the Rebellious Aging Guide book. A lot of material there. A lot of good material. A lot of good stuff. It's got some pictures and then we'll try and get a LM video presentations that will that will give some pictures of this as well. Okay. That sounds good. Thank you so much. Okay, see you next time.