Skin Cancer Surgeon: "Shocking Habits Causing Skin Cancer & Decreased Lifespan" | Teo Soleymani

Summary

In this informative podcast episode, renowned dermatologist Teo Soleymani joins host Dhru Purohit to discuss the complexities surrounding skin cancer and how lifestyle choices impact it. Soleymani shares unconventional insights into the role of sun exposure in skin cancer, challenges common perceptions about sunscreen, and offers practical advice on skin protection. He also delves into the controversial impact of seed oils on skin health, advocates for regular skin screenings, and highlights effective anti-aging treatments. Emphasizing a balanced approach, Soleymani combines scientific evidence with clinical experience to educate on maintaining healthy, youthful skin.

Highlights

• The importance of balanced sun exposure: Too little is bad for vitamin D levels, too much can increase cancer risk. ☀️
• Sunscreen should be used wisely; not all provide the same level of protection, and some might harm more than help. 🧴
• Interestingly, the study out of Sweden suggests sun avoidance could be as harmful as smoking due to low vitamin D. 🚫
• Genetics significantly influence skin cancer risks, often more than sun exposure itself. 📋
• The role of seed oils in inflammation: they may indirectly contribute to skin aging and deterioration. 🚫
• Regular skin checks are crucial for early detection of problems and are easy and painless. 👨‍⚕️
• Astaxanthin, vitamin C, and niacinamide are top antioxidants for skincare. 🥝
• Fraxel laser is highly recommended for reducing sun damage and may lower skin cancer risks. 🌟

Key Takeaways

• Sun exposure isn't all bad! Proper sun habits can benefit health, but don't forget the sunscreen. ☀️
• Some sunscreens might not be as protective as you think. Choose wisely! 🧴
• Genetics play a significant role in skin cancer risk, so know your family history. 🧬
• Regular skin cancer screenings are quick, non-invasive and can save lives.⏰
• Avoid excessive use of seed oils; they might increase inflammation and skin issues. 🛑
• Opt for natural forms of sun protection like clothing and shade over chemical sunscreens. 👒
• Maintain skin health with a balanced diet rich in antioxidants. 🥦
• Embrace a smart lifestyle that includes moderate sun exposure, regular screenings, and proactive skin care for healthier skin. 🌿

Overview

In this engaging conversation, Dhru Purohit hosts renowned dermatologist Teo Soleymani to explore some myths and truths about skin cancer. Dr. Soleymani challenges conventional wisdom on sun exposure and sunscreen usage. He emphasizes that while sun protection is vital, moderate, smart sun exposure is beneficial for vitamin D synthesis and overall health.

Dr. Soleymani provides unique insights into the misperceptions surrounding sunscreen while highlighting genetics as a crucial determinant of skin cancer. He introduces non-invasive measures like regular screenings as essential steps towards early detection and better outcomes in skin health management.

The discussion also covers lifestyle influences such as diet, particularly the impact of seed oils on skin health, and the significance of antioxidants in maintaining youthful skin. Through expert advice, Teo shares smarter ways to utilize sun exposure, choose appropriate skincare routines, and integrate effective skin treatments.

Chapters

• 00:00 - 05:00: Introduction and The Sun's Role in Skin Cancer The chapter introduces the topic of the sun and its role in skin cancer. It addresses the mixed messages around sun exposure prevalent on social media, emphasizing the caution advised by dermatologists. The narrative sets the context for understanding the sun's impact on skin health and its potential to cause early onset skin cancer, urging a careful consideration of sun exposure and protective measures.
• 05:01 - 10:30: Myths about Sun Protection In this chapter, the discussion centers on the myths surrounding sun protection. A traditional dermatologist tends to view the sun as highly detrimental, but the speaker offers a more moderate view, suggesting the sun is beneficial in moderation. There is a critique of the lack of evidence supporting some of the extreme warnings against sun exposure.
• 10:31 - 15:00: Sunscreen Effectiveness and Vitamin D The chapter challenges the common notion that avoiding the sun leads to a decreased risk of skin cancer related deaths. It suggests that there is no evidence supporting sun avoidance as a method for reducing lethal skin cancer incidences. It notes that while genetic and personal history factors are uncontrollable, dermatologists emphasize sun avoidance since it is an environmental factor that can be managed.
• 15:01 - 20:00: Traditional Societies and Sun Exposure In this chapter, the discussion revolves around the controversial views on sun exposure and its effects on skin, particularly within traditional societies. Experts debate the risks associated with UV rays, with some suggesting it is a significant concern while others, surprisingly, rate it lower despite the prevalent belief linking sun exposure to skin cancer. The chapter seems to challenge conventional wisdom by presenting unexpected perspectives on the role of sun exposure and skin health.
• 20:01 - 25:00: Diet and Inflammation in Skin Health This chapter discusses the relationship between diet, inflammation, and skin health, focusing on various forms of skin cancer. It highlights the complexities around the role of sun exposure in skin cancer and mentions common types such as basal cell carcinoma, squamous cell carcinoma, and melanoma. The chapter suggests that while sun protection is important, there is nuanced evidence regarding its impact on metastatic conditions.
• 25:01 - 35:00: Alcohol and Coffee's Impact on Skin This chapter discusses the impact of alcohol and coffee on the skin, focusing specifically on the occurrence of carcinoma in sun-protected skin. It emphasizes that the most lethal forms of skin cancer, such as squamous cell carcinoma, can develop without UV mutation signatures typically associated with sun damage. The chapter highlights that while sun exposure is a common factor, other elements contribute to skin cancer, making complete sun avoidance an ineffective sole preventive measure. The discussion reflects the complexity of skin health and the need for a broader understanding beyond sun exposure alone.
• 35:01 - 45:00: Evaluating Red Light Therapy and Other Treatments The chapter 'Evaluating Red Light Therapy and Other Treatments' explores the theme of skin cancer, particularly melanomas, which are noted as the most lethal form. Examples are given, including Bob Marley, who died of it, and Jimmy Carter, who survived despite it reaching his brain. The speaker, who appears to be a medical professional, mentions having a unique practice in Los Angeles where many of the patients, even young ones, have severe cases. It is highlighted that melanomas can occur on parts of the body not exposed to the sun.
• 45:01 - 55:00: Fraxel Laser and Genetic Screening This chapter discusses the occurrences of melanomas predominantly in men’s backs and women’s lower legs, attributing these occurrences to genetic factors and mutations. It emphasizes the hereditary and sporadic nature of these mutations and suggests a reduction of UV exposure to prevent additional mutations. Despite this, it acknowledges that many melanomas appear in areas that are not typically exposed to the sun, indicating these tumors do not have a 'sun signature'.
• 55:01 - 65:00: Lifestyle Changes for Better Skin Health This chapter emphasizes the importance of not feeling guilty about past sun exposure, such as a beach vacation years ago, in relation to current skin cancer diagnoses. A significant study from 1999 highlighted the impact of sunscreen use. It compared individuals who used sunscreen diligently to those who did not, examining the incidence of basal cell carcinoma, which is noted as the most common cancer globally. It asserts that one in four Americans is affected by this cancer.
• 65:01 - 73:00: Final Thoughts and Takeaways In this final chapter, the speaker reflects on the complexities related to sun exposure and public health advisories. Despite common warnings to avoid the sun, the speaker notes that there are no consistent differences in health outcomes between sun-exposing and sun-avoidant groups. This perplexing finding leads to a discussion on moderation and personal enjoyment. While extreme sun exposure and tanning practices are discouraged, moderate sun exposure without burning is deemed acceptable, as it contributes to feelings of well-being. The speaker concludes by emphasizing a balanced approach, suggesting that as long as one is careful not to burn, enjoying the sun is beneficial.

Skin Cancer Surgeon: "Shocking Habits Causing Skin Cancer & Decreased Lifespan" | Teo Soleymani Transcription

• 00:00 - 00:30 one of the first things we're going to go into is the sun okay help us understand the Sun and give it some context because the thing is on social media today depending on which dermatologist you follow and most of them would say we have to Beware of the sun we have to watch out for the sun the sun is out to kill us and if you're not careful you're going to end up with skin cancer super early talk to us about the Sun and give us a ranking on our system
• 00:30 - 01:00 from s to F why do dermatologists make a big stink about the sun yeah if you had a traditional dermatologist here they would put the sun on F in F category and I would probably put the sun maybe in a B I think it's good for you man I think too much is a problem but I think it's good for you and the reason we make a big stink and a lot of people won't talk to you about this but there is no evidence not a single shred of evidence
• 01:00 - 01:30 that sun avoidance will protect you from our most lethal forms of skin cancer in fact there is no evidence that avoiding the sun results in a decrease in skin cancer specific deaths the reason dermatologists and doctors make a big deal about that is I can't control your genetic predisposition I can't control your family history your personal history things that your genes are going to do so what I can control is environmental insults and that's that's
• 01:30 - 02:00 why we we make such a big stink about the sun because I can say okay I don't know what's going to happen to your skin but at least I can control an outside insult that's coming in that's too much UV so I wouldn't put it as an F though most of my colleagues would I'd probably put it as a you know a b you know it's crazy to hear you say that there's no evidence that's out there I say crazy in a way that's shocking to a lot of people that are listening that the sun in itself um is connected to well it is connected to skin cancer you wouldn't
• 02:00 - 02:30 deny that that a healthy usage of Sun is going to increase your risk of skin cancer is that how you'd say it so I'm going to I'm going to phrase it in a couple different ways there's many forms of skin cancer the three most common that we see in the world are basil cell carcinoma squa cell carcome and melanom it's what I've dedicated my career to treating as well as some of the rarer types there's no evidence that sun protection strict sun protection decreases your likelihood from dying from metastatic Mel or metastatic squ
• 02:30 - 03:00 missile carcinoma in fact the most lethal forms of these cancers arise in Sun protected skin the most lethal forms of SEL carcinomas don't even have the UV mutation signatures that we see in kind of more Garden variety sun damage skin cancers now it's not to say that sun doesn't cause them but there's so many other factors that don't go into that into that category that I think saying Sun avoidance means you will not get this is absolutely not true in fact most of my patients that succumb to these
• 03:00 - 03:30 diseases and I I have a very unique practice and I see the worst of the worst probably in Los Angeles most of my patients including my young patients that have very bad outcomes they're not Sun rated tumors so I don't want people they show up typically in the body I've heard you share this in other podcast they show up in the body that may not be getting a lot of sun 100% melan be examples yeah melanomas is are are historically been our most lethal form of skin cancer you know Bob Marley died of it Jimmy Carter famously survived it's it was in his brain the most common
• 03:30 - 04:00 place that they show up is the back of men and the lower legs of women why do you think that is there's there's genetic factors and genetic mutations that occur that partly are hereditary partly sporadic meaning they just they happen unfortunately luck of the draw um that's why a majority of these melanomas occur now we say okay don't go outside and get added mutations to your skin which is too much UV but we know in fact that these these bad Sun naive areas the the tumors are not they don't have a sun signature
• 04:00 - 04:30 so I don't want people to feel guilted that they went out in 1992 went to a beach vacation in Virginia Beach or something and that's the cause of their skin cancer in fact there was a very large study in 1999 published in one of our most incredible journals that looked at sunscreen versus no sunscreen use diligent sun protection versus none and the incidence the meaning the number of these cancers of Basil cell carcinoma which is our most common cancer in the world one in four Americans will get
• 04:30 - 05:00 this there was no difference between the groups so it scratched our head saying hey we we've been saying like avoid the sun like the plague you know dress like a beekeeper don't go out in the sun don't you know don't do this stuff but we couldn't we couldn't uh solve for this difference so there's a lot of factors that go into it now I'm not saying burn I'm not saying do the stuff you see online where people are tanning their parane in their butthole that's like not the thing to do but if you enjoy the Sun and you can do it without burning I think that's fine I think you feel good I think you said up so many
• 05:00 - 05:30 important things that are there the first one is that it's not that the sun doesn't play a role 100% it's that having all this sun protection in the traditional sense and we're going to break some of these down because there's a lot of different classifications some that are better than others but in the traditional sense of traditional sunscreen yeah there's no evidence that's out there that that is going to protect you from the most common skin cancers that are there
• 05:30 - 06:00 particular lifethreatening ones and is there a secondary factor that if you don't have enough high vitamin D levels which partly relates to the sun can also be influenced by supplementation that you are also at a higher risk for certain cancers that are out there so Sun avoidance is this true that sun avoidance could actually increase your risk if it leads to a situation where you have you know chronically low vitamin D levels is there any truth to that so so yes with an asteris not not
• 06:00 - 06:30 skin specifically because we know Sun avoidance will decrease the likelihood of some Garden variety skin cancers but there was a great study that came out of Sweden back in 2 maybe 16 17 that looked at over 20,000 women that avoid the Sun for risk of melanoma and they matched those women who had strict Sun avoidance to those who smoked a pack a day and those patients had the same cardiovascular
• 06:30 - 07:00 disease risk and the presumption was that the patients who avoided the sun had some biologic changes related to chronic low vitamin D and other factors that they couldn't measure in a test tube that equated to higher cardiovascular disease similar to pack aay smokers so there's a lot that the sun provides that I can't quantify but I can tell you you'll feel better you'll look better um so I I think Sun avoidance complete Sun avoidance a problem now if you know your family history Drew let's say you go outside and okay Mom had skin cancer dad had
• 07:00 - 07:30 skin cancer uncles had skin cancer then maybe your tolerance your ability your body's ability to heal after getting a lot of UV is lower genetically defined so maybe you take a little bit more protection but I think this blanket statement of you got to wear sunscreen every single day or you're going to die of skin cancer total nonsense so important yeah well that goes right into our second item that we have here to tiar rank and that is sunscreen and before we do it if you guys are new to us doing this tier ranking system we
• 07:30 - 08:00 have it broken down into the following categories s which is at the top which means Supreme and I'd probably even argue and You' probably agree that healthy use of the sun is probably one of the best sources of medicine that we have in our life morning sunlight and other things so could we bump it up from a b as long as you're being smart with it and bump it up to an S if you're being smart with it and not overdoing it I would put Sunmart as s for sure okay let's recategorize Sun smart if you're doing it the right way with all the
• 08:00 - 08:30 context that we have throw in all the recommendations from your friend Dr Andre hman morning sunlight it's going to be one of the best things for you if you're not burning if you're getting it in the right way S zero question and just so everybody knows burning is killing your skin so that's not what we want to do we're going to be coming back to that um so s is supreme we bumped up the sun the sun is happy it's shining down on us a is really good B is pretty good C is kind of neutral D is kind of bad and F is obviously the worst that's
• 08:30 - 09:00 there so you talked all about sunscreen traditional sunscreen there's a lot of different sunscreens that are out there some that I'm a fan of but traditional sunscreen it seems like the word is getting out to some people that it's a layered conversation it might be doing more bad than good what's your thoughts on the standard sunscreen that you see at every drugstore that's out there C at best at best at best okay got it C at best so why' you put it as a c and not a d or an F well we know that when people
• 09:00 - 09:30 use it it does provide benefits that outweigh the risks of blistering sunburns so it's it wants to do the right thing the problem is the way it's formulated the way people use it is not perfect so I can't give it a drf because their traditional sunscreens are intended to do their job they're intended to provide protection the biggest problem is the cosmetical industry has played a big role in making a lot of subpar chemicals that are you
• 09:30 - 10:00 know Panda sunscreen the second problem is most people don't even put on enough and the third the third factor is we know that other forms of sun protection shade shelter supplements actually have a better role at protecting your skin than sunscreen so if you pick the right there's a lot of asterisks to that if you pick the pick the right sunscreen if you use the right amount on your skin then it would be a you know b or a or I probably wouldn't put it as s but um but there's a lot of chemical sunscreens
• 10:00 - 10:30 that are um not great for the body there's a lot of em emerging or smoldering data suggesting they actually may be even delerious to certain hormone messaging sign signals and endocrine disruption and even some of the breakdown products are carcinogenic themselves so that's a huge problem number two is most people don't put on enough to get the SPF that's L written on the bottle itself so I don't know about you but I ever since I was a kid till almost adulthood I didn't know I had to put a shot glass where the sunscreen on you know I put a little bit on I assumed that was it like that's
• 10:30 - 11:00 what my parents told me you know so C because I think it's well- intended it's trying to do good but it's not a be or and a because there's better forms and the stuff out there a lot of it's crap man a lot of it's not great well said well you brought up a really important point before we get into some of the super controversial things that are related to the skin including seed oils and antioxidants alcohol those are all coming up so stay tuned but you brought up an important point which is that you
• 11:00 - 11:30 know for as long as human beings have lived and you look at some of these more traditional societies that are used to a lot of sun on a regular basis Societies in maybe some of the Aboriginal Societies in Australia places in Africa like where I'm from in Kenya India uh you know they'll often use um physical barriers right and I'll have you explain what that is as a way to protect from being out in the sun which sometimes
• 11:30 - 12:00 they have to be because they're working outside during the day they're doing other things in America it's always funny when you see somebody working outside uh or being outside for a little while like let's say you see we're here in Santa Monica recording you see a jogger and it's hot outside they'll take take off all the clothes that they possibly can and they'll be in the sun on a regular basis in other countries you'll see that actually almost their entire body is covered often with very breathable clothing
• 12:00 - 12:30 users they are sueme to sunscreen 100% so in every single St and I will I will paint this an even a simpler um image you literally cannot burn if you're in the shade like you cannot burn if you're in the shade but you can burn if you put on sunscreen if you're out long enough you don't put on enough it washes off it wears off you sweat it off so just that concept to grasp you literally cannot burn if
• 12:30 - 13:00 you're in this shade whether you're outside for 24 hours or 2 hours we know in every single study that's looked head-to-head at physical barriers so clothing hats shade shelter versus topical products meaning sunscreens uh the physical barriers have outperformed every single study compared to the topical sunscreens in protecting you against sun damage sunburns and downstream effect so we know you know you can see actually you bring up Kenya
• 13:00 - 13:30 is a good great place that you know they are worldclass marathon runners and you see these guys training for marathons running and they're running with clothing and you assume you're scratching your head you're like well he doesn't look like somebody that can burn easily and it's hot why the heck is he covered up because they know eventually the sun will win it's like it's a glowing star that's thousands and thousands of degrees our skin is not meant to to do that you put a car outside and it rusts after 50 years imagine our soft skin right but we know that physical barriers one will always
• 13:30 - 14:00 provide the same SPF protection so it doesn't change as the day goes on unlike topical sunscreens where you get a change as it washes off a change as the chemical structure changes with related to UV exposure and we know that you can layer you can provide protection you don't get absorption of physical barriers like hats and shade and shelter so if I were to pick one and I do this all the time I personally tend to prefer physical barriers over sunscreen I'm a SK cancer surgeon I just I don't wear
• 14:00 - 14:30 sunscreen that often I don't like it if I can avoid it if I need to or I'm going to be outside where I know I'm going to burn I will wear it I'm not saying don't use it but for me shade and shelter and hats and SPF clothing provide much better protection for me so I tend to use that so if we had to rank that here and I have that in the form of uh hat and sunglasses but that obviously means just any form of shade there's even now clothing brands that are out there that are really trying to tell you that these are lightweight things that you can use during running where would you rank that on our tiered system over here if the
• 14:30 - 15:00 Sun is an S I'd put that as an a as an a as an a for sure there's no downsides it's only going to be upsides it's easy to use yeah 100% the only downsides are honestly just you know cost you got to find some form of shade and then um you know if it's hot some people don't like you know SPF clothing or hats or things like that but honestly the downside is very minimal compared to topical sunscreens and their questionable changes that can occur um in fact there's actually an interesting thing that you bring up in that a lot of
• 15:00 - 15:30 patients a lot of people communities populations indigenous populations in Central America and Africa and South America take forms of sun protection that we learn from there's a group of indigenous people that live along the Amazon River in Brazil and um uh most mostly in Brazil and they tend to go on Expeditions on the river for fishing and we found that they consume a fern before they go on these 3-day
• 15:30 - 16:00 fishing Expeditions they eat like this plant and we couldn't figure out why until somebody studied it and they found that when they ate this plant they burned less when they were outside they didn't have topical sunscreens the way we have at you know our local drugstore they had physical clothing barriers and this plant and they found that this there's a fern called polypodium that they consume and when they consume it it increases the time they can spend in the sun before their skin burns so just learning from population and why they do things a certain way can just you know
• 16:00 - 16:30 also open our eyes to other options I think unfortunately sunscreens have been shoved down our throat but they're there are also other great options and greater options out there that's amazing and we'll come back to that F uh because I know you know a lot more about it um one other question that I have for you so take somebody like yourself yeah you have more of a olive skin complexion your family is background is from like Middle East area um and you know my family's ethnic uh background is from India and I'm also a little bit darker
• 16:30 - 17:00 than you you know how does your skin color play a role with how you think about being mindful about the Sun but also about how much sun you need to be healthy yeah totally great question actually funny you say that my dad still doesn't understand what I do for a living you know I I say I'm a skin cancer surgeon he's like where did the cancer come from I'm like the skin he's like yeah but what organ to the skin like that he's you know he's my dad's tan he's all my whole I mean he loves that he's like what's a skin cancer
• 17:00 - 17:30 surgeon you know so I think you bring up a good point I generally speaking it's an SPF somewhere between 5 to 10 you're just your native skin type if you're a little bit darker you can get a higher equivalent SPF equivalent I know I can tolerate an hour out in midday Sun without turning red or burning it's very different than a northern European skin type we call it we Define them by Fitzpatrick types in my family there's very little skin cancer I'm ethnically Armenian but traditionally Armenians are
• 17:30 - 18:00 blond haired blue eyes they're of the caucus mountain region so somewhere in my genetics there's a little bit of predisposition from our ancestry but there's some protection in the more Middle Eastern blend that I have I have olive skin you're absolutely right so I know my personal risk for skin cancer is lower than somebody from Northern Ireland my form of sun protection primarily is more for premature aging related to Sun then it is skin cancer
• 18:00 - 18:30 now I'm not I'm not saying I'm immune to it by all means I just know that my my risk factor is a little bit less so my desire to protect myself from the Sun now at this age is primarily to prevent premature aging I know I need some sun I feel better I perform better I sleep better I can focus more when I get normal sunlight so I know I try to get 20 30 minutes in a day unprotected and typically in the morning yeah typically in the morning I'll go for run in the morning or late afternoon when I get
• 18:30 - 19:00 home I'll play with the kids outside and I don't have any form of protection on I know my skin doesn't turn red I don't burn so I know my threshold if you you know Drew you could probably go outside and tell me you can be out in an hour and a half and your skin really won't turn red that's your Skin's tolerance now that doesn't mitigate premature aging you know you still if you really want to prevent UV related changes that collect over time then you take some form of sun protection but in terms of your skin health risk you have a higher
• 19:00 - 19:30 tolerance than even myself per se um so I think just knowing you know individualized medicine we talk about this all the time and what does that mean is just knowing your body's specific capabilities and and incapabilities you know I have I have patients who ironically my highest burden skin cancer patients are ones that avoid the sun like are defly avoidant they are not in the Sun the last time they were in the sun was 20 years ago but they're on their 30th skin skin cancer so those are things that go
• 19:30 - 20:00 back to what we were talking about and that there's a huge genetic component to that to it that we ignore as dermatologist we say where sunscreen nothing will happen well I don't know about that well I'm glad you brought up the premature aging because obviously a lot of people listening today for sure they want to be smart about Sun so that they can and smart about their skin so that they can avoid skin cancer and obviously the next best thing is catching it early yeah 100% so most of our conversation moving forward from here is is not going to be just on that
• 20:00 - 20:30 e even if you care about those things you also still care about and probably your main priority is premature aging a lot of people who listen this podcast are 40 years old plus and their 50s 60s 70s and Beyond and they're thinking about how do they maintain a healthy level of skin so something that you mentioned which is that look the more time you spend in the Sun that will prematurely age your skin there's no way getting around that is that ACC absolutely okay absolutely so it's
• 20:30 - 21:00 something to know about because I think sometimes you know we put a little bit of criticism on traditional Dermatology there's probably you know Wellness is a wide spectrum too there's some individuals inside of there that are like you're not going to age at all from being out in the sun and you you just can see it with your own eyes your friends that even eat healthy that are avoiding seed oils and this and that they're spending a lot of time in the sun they're going to be getting age skin if they're overdoing it and not taking corrective measures which we'll be
• 21:00 - 21:30 talking about some of those corrective measures totally everybody's going to age Mother Nature father time will always win if nobody's living finite right the question is are you aging at your natural predetermined biologic clock or chronologic clock or are you accelerating by things that you're doing and the example I give this I you know I show my kids this all the time we put we take a grape and we put it in the sun we you put one grape out all day it'll start to shrivel by the end of the day if you take a grape and you give it 20 minutes a sun it won't shrivel for about
• 21:30 - 22:00 a week or two but it'll eventually shrivel right so the same premise exists the sun protection or UV protection and we talk about the Sun but the sun's you know a whole spectrum of wavelength of light the predominant ones that we are are a problem is in the UV region both from a skin cancer standpoint and an aging standpoint and when we talk about aging it's UV related breakdown of collagen and elastin which is the what gives our skin it's elasticity its suppleness its volume it's its look Sun
• 22:00 - 22:30 avoidance plays a much more direct predictable role for premature aging than it does the cancer side so if you are somebody that wants to maintain the skin that you had as a baby which I'm not sure why you'd want to do that but if you wanted perfectly Flawless skin for the rest of your life then you would take much more sun protective measures we know that that Association or that that correlation is very linear now that being said there are things
• 22:30 - 23:00 that you can do to mitigate sun and sun damage that you've had in the past so it's not like oh you know the stuff you did in your teens and 20s and 30s that's it if you you're going to you're going to be a shriveled raisin in your 40s and 50s it's not the case but just like and no offense to anybody who's a vegan or doesn't believe in like leather or whatnot you but when you take hide and you leave it in the sun it turns into tan wrinkled leather same thing as our skin right so if you are aesthetically conscious then your desire for sun
• 23:00 - 23:30 protection may be more than somebody who's not sure sure with also understanding the holistic aspect of Health which is if you go to overboard which a little that in Angeles are you missing other downsides related to the benefits and the healing aspects of the mood you know other cancers that you might be avoiding cardiovascular health like you mentioned I know it's still a hot debated area but I tend to be Pro uh if we overdo it and
• 23:30 - 24:00 we completely avoid the sun you're probably going to have a lot of other downsides in your life absolutely there's so patients who who are in the hospital they look pale they look ghastly they're they're ill and when you look at people who avoid the sun strictly in big cities New York City Los Angeles Chicago Etc they have a similar appearance and one cohort of patients are not sick another cohort of patients
• 24:00 - 24:30 are sick but your body has a very keen ability to tell you hey something's a little off and I'm not saying tanning means you're healthy but there's a reason when when you come back from vacation you have a little bit of a vacation glow it's your body has rested it's tend to calm down usually we get a little bit more sun exposure and things like that when we're on vacation especially summertime vacation the problem with that is being able to measure that and no doc will be able to measure your exposure to Sun and say hey
• 24:30 - 25:00 Drew you're healthier because you're you know getting some sunlight yeah important Point okay let's get into some of the controversial things that are out there I hinted at this a little bit earlier but one of probably the most controversial things in health right now is the topic of seed oils you have institutions like Harvard University saying that not only are seed oils uh not bad for you but they're not pro pro-inflammatory they're not uh things that are going to increase
• 25:00 - 25:30 chronic disease risk uh places like toughs and their nutrition school that are out there everybody has different thoughts I've shared my own thoughts I've shared my own bias I tend to not feel great when I'm having a lot of seed oils and I'm exposed to I know the I'm not cooking with seed oils so if I ever have them it's going to be in eating out which obviously tends to be higher calories you know a lot more ingredients that are inside of that but tell tell us about seed oils and their relationship
• 25:30 - 26:00 to skin premature aging how do you look at it and where would you rank them on our tiered system what's below F can I put it can I put it below F the so so many things to talk about in this and a lot of the institutions have outside funding that affects their studies unfortunately institutions are not immune to bias we see this all the time also just and this is anecdotal but almost every single person will agree with this when you go to Europe you can
• 26:00 - 26:30 eat the stuff that you cannot eat in the states five days a week and you feel fine the amount of industrialized product in our Foods is is Monumental in the states it's a it's a huge problem I tend to be in the camp that think seed oils should not be in our diet seed oils are pro-inflammatory I notice and we see this when you eliminate this in skin conditions that are inflammatory psoriasis eczema there improves we actually put patients on
• 26:30 - 27:00 anti-inflammatory diets we did this up at Stanford I do it in my practice when you when you get rid of inflammatory foods including seed oils you can get an improvement in actual quantifiable skin disease I have psoriasis myself every time I have a junk diet for a couple weeks my psoriasis flares and it's reproducible so I know it's it's not just a one-off I can consistently make it flare with my diet and and improve it now will it go away no but it's one less added drug or medicine that I need to use to cure something that I'm trying to
• 27:00 - 27:30 cure so seed oil there's a huge connection between the skin and the gut and the microbiome and the immune system immense connection we're only just now U unveiling it we know that the gut microbiome plays an important role in our Skin's immune response the organisms in our gut that metabolize the food release metabolic byproducts kind of like the exhaust of your car right it emits emits essentially invisible
• 27:30 - 28:00 gases that are byproducts of your combustion engine those microorganisms food breakdown byproducts modulate and affect our Skin's immune system so when our microbiome and our gut is metabolizing things that it normally doesn't like to metabolize or cannot tolerate metabolizing very well you see immune disregulation in the skin and that acutely leads to common things like rashes eczema flares um different you
• 28:00 - 28:30 know you know itchy red red changes in the skin but long term I do think there's a lot of data that will come out in the next 10 years that shows you pro-inflammatory foods like seed oils lead to premature aging and lead to skin cancer we're only now at the tip of the iceberg and elucidating that in a lab fascinating fascinating so you know just to make sure we add this to the context there's a wide variety of seed oils 100% 100% universally I've heard from most people and I feel this myself with my
• 28:30 - 29:00 own immune system I feel like my throat is often my Achilles heel so the first thing I see is that the worst form of seed oils and I'd like to get your thoughts on this are going to be deep fried oils is that your yeah do you agree with that yeah hydrogenated soybean oils and safflower oils and canola oils especially the hydrogenated versions they tend to be a big problem they're not meant to be consumed right you know and on the side of it and obviously there's a lot of things in
• 29:00 - 29:30 between you're going to eat out sometimes I'm going to eat out sometimes a lot of restaurants they haven't gotten the memo a lot of restaurants have True Food Kitchen does a great job parakeet does a great job sweet green does a great job you know it's now people are waking up to the fact that consumers want this so shout out to those restaurants but you're not going to you know be obsessing over the fact that hey you just ordered a nice piece of grilled salmon with some side of veggies you're eating out with your wife your kids you guys are having a good time they used a
• 29:30 - 30:00 little bit of canola oil it's not a big deal cuz it's not the base of your diet is that accurate look I have the saying moderation is key even moderation itself right so no I have three kids trying to stop seed oils and and their diet entirely is impossible it but can we avoid it we cook mostly at home I can avoid it if we're going out and I don't know what's in it well I lose sleep over it not really but if it becomes their meal three days a week seven three three times a day seven days a week a week then we got a problem yeah right that's
• 30:00 - 30:30 I think fundamentally all of medicine is that way you know I think patients with diabetes if they have a slice of cake one time will it will it destroy their body no but we know that over time over many years The Chronic sugar increases in the insulin that's pumped out as a result will lead to Downstream product uh Downstream problems but we know diabetes just like skin cancer just like anything else is it not is usually not an one time you did it and that's the end of it unlike
• 30:30 - 31:00 you know heart attacks and things like that but um I I'm fine with it I try to avoid them but in the US it's intertwined in literally everything I mean it's it's in everything I don't know if you saw but one of the major chains that made an announcement uh you know a few like a month ago that they're going seed oil free when it came to their fries it was a burger place called steak and Shack or something like that then a bunch of people found out that the fries that they order are precooked in and it's not a knock on them it's just
• 31:00 - 31:30 just goes to what you were saying we're just sort of whether you're trying to avoid seed oils or not even things with microplastics and phalates and bisol they're so intertwined in our food system it's going to take a few years for us to really figure out better options but at least the awareness is there so people can choose uh so that companies can start looking for better supply chain process for sure man and you see this awareness is key and number one is just awareness of a problem that you didn't know existed whether it's
• 31:30 - 32:00 something in medicine like awareness of cancer awareness of high blood pressure awareness of skin disease awareness is the first thing when you're blind to a lot of things that's going on you take things for granted or you don't know and you can continue about your day I think as we try to recorrect the course I I think we we'll make an improvement in our kids life I grew up in the era of fruit rollups and gushers and the stuff that now we're like how the heck could we give this to our kids but that's what I ate in the '90s we didn't know any better you know and um we're okay now I mean I
• 32:00 - 32:30 don't know what the future holds but we're it's not that like you know we're all dying and dropping dead so I think I think fear mongering is a problem but we do know that inflammatory foods particularly seed oils disrupt both the gut microbiome and disrupt immune homeostasis that's the biggest problem that we will see what what the long-term Downstream effects are in modulating our body's immune balance it our immune system cannot tolerate something that's
• 32:30 - 33:00 where a lot of disease comes from even skin cancer we know patients who have a weakened immune system have a 65,000 per increase in skin cancer risk so it's not just the sun it's not just the diet but it's the Myriad of all the things playing together besides uh just to touch on that besides medications that people might be on that lower their immune system because they're fighting one thing and they're lowering their immune system um what are other things that dramatically you know lower
• 33:00 - 33:30 people's immune system that they would be 65,000 more susceptible to skin cancer yes number one thing by far are are obviously medications that are immunosuppressors and and illnesses that are um immune I don't want to say immunosuppressive illnesses but immune deficient illnesses for example you know the most common one that we think of is you know HIV okay you know and there's other condition autoimmune conditions you lupus things like that that affect or modulate your immune system have some
• 33:30 - 34:00 weakening of immune surveillance right because your body in in case of autoimmune disease is so busy dealing with auto fighting what is normal as much resources yeah with autoimmune diseases basically our body doesn't know what is bad and what is normal so it fights the wrong thing that's all autoimmune disease is is it m mistakes self or it mistakes normal for for bad and and it fights that so medications Auto diseases immune immuno deficient States things like that but I do think
• 34:00 - 34:30 that I do think our diet has a huge role in IM implicating immune weakness or some sort of relative immune deficiency and that's that's what a lot of people who are so so strict about you know seed oil avoidance and uh holistic diets and things like that are touching upon without knowing that that's what they're alluding to is that chronic disease we we think is an immune problem it's a metabolic and immune problem whether
• 34:30 - 35:00 it's diabetes whether it's cancer cancer all organ system cancers it's thought to be a metabolic and an immune system problem which is why actually the Nobel Prize in 2018 was given to the drugs that unleash the immune system to fight cancer and so now we're just understanding that the question the big question which I don't have the answer to and I don't know if anybody does is how can you modulate your immune system through lifestyle and diet and we have little ideas we have thoughts of certain supplements you know the actually the
• 35:00 - 35:30 Indian diet the herbs and supplements that are used in Indian cooking are one of the most potent ways that you can modulate your immune system for the better but we're now just understanding diet lifestyle you know environment and ways to improve our immune system that's not just go to the doctor get this pill go to the doctor get this injection type yeah well said amazing uh so I plac it there for you because we didn't have lower than a f but You' put seed oils as a frequent usage which even if you are
• 35:30 - 36:00 even I'm sometimes a little bit confused by the science that'ss out there because I'll have people on the podcast that say no like when you look at it you know in these studies we haven't seen the inflammation I say look there may be a lot of confusing things that are out there about seed oils but I think the simplistic aspect is you can easily avoid them at home yeah and you don't have to cook in beef Tallow if you're worried about excessive saturated fat diet you can cook with avocado oil y
• 36:00 - 36:30 olive oil right there's plenty of options that are there and traditionally seed oils come with processed food excess calories so that's a great reason to avoid those because you're not going to be overeating and packing on you know extra weight from eating too much processed foods 100% right so easily an F on okay great you know I want to go back to something that you mentioned before you said when you see patients in the hospital who have been bedridden and are dealing with something yeah you know
• 36:30 - 37:00 these patients they're not getting Sun their immune system is down a bunch of things and it's natural to see these patients and they often look as I've had in my own family people that might look a lot paler than they normally would be they look sick and you look at people that are super Sun avoidant they almost have a very similar skin complexion I know some of those people I'm not going to mention any names yeah yeah on the flip side is it fair for me to say that when some somebody is tanning you know when you go to
• 37:00 - 37:30 places uh where you see people who have been probably tanning since like the 70s 80s and they have very beat up leather skin that's also another extreme version man right and I think mostly people have gotten the memo they're not into tanning but just so that we hear from you I think I have tanning here on here somewhere if you had to rank tanning somewhere on our tier system where would you rank it intentional tanning
• 37:30 - 38:00 intentional tanning traditional lather up you're trying to get dark you've been doing it for years i' put that as an F as an F as an F intentional tanning I'd put that as an F intentional tanning yeah it's one thing to be out in the sun and get darker like I if I spend two or three days out midday and I'm like out in the sun for like two hours I will be maybe like like one shade darker than I am right now like I'll tan pretty quickly that's different than this intentional tanning typically people who
• 38:00 - 38:30 are very lightskinned who feel like they want that European look always and they're overdoing it yep it's always we always want what we don't have you know in Asian societies the cast always wants fairer skin because it relates to you know higher Social stature and royalty in fair skinned individuals they always want that you know Mediterranean Olive glow so we're always chasing things that we you know we can't have but the Palm Springs Florida um retirement Comm imunity look is a big no no your body is
• 38:30 - 39:00 struggling your skin is struggling don't do that you're eventually going to be my patient um but I think n your body's natural ability to produce color because you're doing things normally without the intention of burning to a crisper tanning I think is fine I think all you know tanning beds intentional tanning F there's no reason to do it absolutely no reason what about another one that people ask about sometimes and that's coffee they're wondering does that have anything to do and specifically in the CATE category of premature aging you'll
• 39:00 - 39:30 hear some ideas on social media I'm sure people have seen the reals oh coffee will dry you out it's this it's going to make your skin look like that and then some people talk about how coffee is literally the highest source of Co of polyphenols in a lot of people's diets it's unfortunate but that's what it is yeah and that there's a lot of benefits to having coffee so where would you rank coffee on our list and why would you put it there probably put it as a c as a c
• 39:30 - 40:00 okay as a c there are Pros to Coffee there are some questionable cons to coffee I'll tell you what we know from the science so coffee majority of the time we drink it for the caffeine content not the flavor um some people drink the decaf for the flavor but generally most of the Americans in the world drink it for its you know cognitive boosting it wakes you up the caffeine is great I love coffee I drink a ton of it myself and as I drink more of it as more kids I have the the thing that we know about caffeine is caffeine is a mild diuretic
• 40:00 - 40:30 and a Vaso constrictor so at higher doses tends to constrict the tiny vessels that feed skin the tiny vessels that feed certain parts of our body it's also a diuretic but very mildly which means it makes you peel a little bit more which in theory could dehydrate you it's not enough for us to see in most people and the amount that they consume a really big gradient difference in skin in hydration status so the the premise
• 40:30 - 41:00 that coffee dries you out or makes your skin a little bit more dry is not really the case now some people are sensitive to caffeine metabolic byproducts so what their body does in compensation is actually will produce more oil in response and I'm one of those people and I see this all the time is after you know by midday caffeine consumption will increase the amount of oil I put out so how will you notice that like your SK my Skin's Oiler yeah my forehead's shinier my nose is shin and it tends to be more of a compensatory response um than
• 41:00 - 41:30 anything we know that they used to be thought that caffeine would make people flush a little bit more or make their rosacea worse or make their acne worse and that we've actually figured out it's not the coffee itself but it's the temperature of the beverage so iced coffees caffeine tablets if you're into that stuff um don't do the same thing so if you tend to have rosacea that kind of redness that flushes in the sun with emotions and beverage and spicy foods it's not the coffee it's the temperature of the coffee you're drinking I think in my personal opinion I'd probably actually put coffee a little
• 41:30 - 42:00 bit higher than a c maybe a b because of all the good things that it has okay it gets a little bit ofm it gets a little bit of a bump is the more I think about this but just like with anything overdoing it's a problem right so if you're having 1,200 milligrams of caffeine a day from coffee consumption it's not going to be good for you it's not going to be good for your nervous system not going to be for good for your kidney filtration system not going to be good for your skin if you're having a a relatively normal amount normal is a range in the in the world anywhere from you know 100 to 400 milligrams a day which is usually like a cup or two yeah
• 42:00 - 42:30 a cup or two though in the US our food system is wild and that we hybrid make the beans you know Starbucks beans are are engineered to produce more caffeine than any other Bean but that's oh interesting yeah that's a totally different story it's funny because I recently went to Japan side note and over there on the menu they'll literally write do you want American coffee and parenthesis it'll say weak are you serious or do you want Japanese coffee which is assumed to be strong and it actually is very part of that is also too they like their coffee very pure we're having these
• 42:30 - 43:00 crazy fucos where you have all sorts of sugar and other things it's almost like three beverages in one yep yep yep and with the sugar with the amount of liquid and everything else that's probably adds to it as well 100% but I think if you're having the normal amount of coffee and if you're having relatively good quality coffee without like the you know Dunkin Donuts 70 scoops of sugar in there um the polyphenols the antioxidants that come with it are a good thing I tend to drink my coffee black cuz I'm it's on a mission it's going to do its thing it's going to wake me up and get me going um
• 43:00 - 43:30 I think I would put it as a be I don't think it has any dilar effects on the skin that we should be concerned about that's awesome I'm an Americano guy I do usually even just a single shot in the morning adding a little bit of Honey which I know people think it's crazy but I I like a little bit of honey I'm talking about a quarter of a teaspoon nothing wrong with it makes me feel great you know you mentioned something which is antioxidants yeah let's talk about that you know we're kind of switching back and forth in this conversation between [Music]
• 43:30 - 44:00 your and but people who have skin cancer yeah right so we all want to know how to protect ourselves because from my understanding skin cancer is growing every year is that right y yep yeah the only cancer that's still increasing in incidence it's the only cancer that's increasing in incidence every year on year every year on year and there's there's so many things to talk about on that you bring up you know antioxidants and toac track and I know I think I'm jumping around even more than you are
• 44:00 - 44:30 spray sunscreens I would put as an F oh wow spray sunscreens you know the stuff you buy at you know regular drugstore that you see in the spray ball F by far okay got it I think sunscreens as an umbrella I'd probably put as a c as C but that includ F by far that includes even like the healthier sunscreens inside of there so the the the mineral pure mineral safe you know those are safe those are I I put those as an a sprays put as an F so collectively will come as a see but spray well I don't
• 44:30 - 45:00 have an icon for a spray but if we did and you're watching on YouTube just know that that's going to be an F yeah 100% why is that there's two reasons one you never get enough coverage that you you see as the SPF label on the bottle that's number one sprays tend to be chemical sunscreens which the chemical ingredients are now being shown to be endocrine disruptors and also some of their breakdown products are carcinogens and number three the majority of the spray sunscreens use a propellant and the propellants tend to be Benzene
• 45:00 - 45:30 derivatives so you're inhaling Benzene as well as a lot of these chemical sunscreens there's been many class action lawsuits for spray sunscreens because of the consequences to them even if the even if the sunscreen is not um chemical it's a mineral your inhalational hazards for minerals as a spray is a problem so just avoid the sprays alt together and you see a lot of people especially use them on kids yeah yeah easy oh it's easy kids don't like
• 45:30 - 46:00 sunscreen being put on it's easier to just spray them but I can imagine kids are a lot more susceptible to these things so for suncreen does that also mean avoiding the there are a lot of mineral based sunscreens that now are getting into the spray category yeah should you still avoid those I tend to avoid them number number for two reasons number one you don't know what the propellant is that gets the spray out is it compressed air or is it a actual propellant that tends to be in the Benzene category and nobody in their right mind should be breathing in Benzene as a way to protect another
• 46:00 - 46:30 organ and number two in in inhalation of micronized minerals zinc and titanium can have consequences longterm in the in the lungs you got to remember we're telling people to use sunscreen for 40 50 60 years of their life it the problem won't be the one-time use the problem will be the daily use over 40 years yeah that's where we it's it's so hard to gather that type of data and and and we I we digress a little bit but I just want to explain how mineral versus
• 46:30 - 47:00 chemical sunscreens work because it when you know that kind of makes you a little bit more concerned as a consumer mineral sunscreens tend to act as a shield think of a metal shield on the skin and they tend to bounce off um UV rays and and sometimes they absorb them and they just hold them on the surface of the skin right that's why a lot of people don't like them because they're like oh it doesn't my skin looks white yeah but because it's a shi it exactly it acts as
• 47:00 - 47:30 a cast or a shield chemical sunscreens the way they work is they have to absorb the energy of the UV undergo a chemical transformation in your skin and then release that UV energy as heat so every the way chemical sunscreens work is they they are undergoing chemical reactions biologically on your skin big question is this normal is this not is this safe long term 40 Years of using this is a problem and I tend to be on the side of no chemical sunscreens I
• 47:30 - 48:00 I don't recommend it I don't carry it in my practice typically people use it because they're like oh great it Blends into my skin exactly exactly in the 80s and 90s sunscreen um was PR predominantly the white you know 1980s lifeguard nose chalky zinc zinc oxide right the problem is you can't wear makeup over that very easily it goes on cakey it goes on gritty you look like you have sandpaper on your face so cosmical companies said okay how can we make a different form of chemical tend to be organic or or phenol-based
• 48:00 - 48:30 chemicals that will go on smoothly so that people who want to wear makeup on top won't see this gritty chalkiness and that's how chemical sunscreens came to be wow the problem is it's now after you know 20 30 years of data we're saying the stuff we claimed in the fda's 1999 study is generally recognized is safe and effective is no longer safe and effective true yeah and sunscreens are an interesting thing they're actually drugs they're controlled by the FDA they're considered over-the-counter drugs so you
• 48:30 - 49:00 can't just make yourself a sunscreen it's a controlled substance the FDA has to approve it you have to show that it does the things that it does in very very elegant studies so the original manuscript that defined all the stuff we saw in you know Myrtle Beach and Florida and you know all the Palm Springs and everything that you saw copper tone and a banana boat and sunbum and stuff that you saw in stores were defined in 1999 in the original manuscript and the there was 19 or 20 chemicals in that list now I think 12 of them are considered not
• 49:00 - 49:30 safe wow in fact two of them are pulled out of the out of all the European Union because we know that when they break down in the skin they're the breakdown product benzo phenon is a well-known carcinogen yeah so crazy it's like you're putting this on to protect from cancer and and we're doing all this other yeah yeah exactly that's nuts that's nuts uh but antioxidants you were talking about yes yes I was saying we're going to be switching back and forth in this conversation between skin preven uh skin prevention like healthy aging how
• 49:30 - 50:00 to prevent you know premature aging and then also skin protection cancer avoidance and everything because obviously we have you here so you know just for the audience that's following along we're going to switch back and forth because these things are often related to each other so I'm bringing up antioxidants right we have a bowl full of raspberries and berries here that I want you to rank and kind of piggybacking off of coffee does uh us going out of our way to include a healthy amount of antioxidants in our diet does that help
• 50:00 - 50:30 out in protecting our skin s s s you're gonna put that as s I'm gonna put that as s what are your favorite forms and why do you put it as an S great question so my favorite forms for antioxidants I tend to like a few specific ones I tend to like vitamin C it's a huge one in skin topical and like through food topical and food yeah and oral it can be oral supplementation and it can be both as a topical form as a topical form the simplest study that you
• 50:30 - 51:00 can do is take an apple cut it in half put a little bit of orange juice on one side or a crushed up vitamin C tablet and leave the other side untouched leave it out for a day see what happens this un the untreated side turns brown the treated side stays nice and crisp and healthy same concept on your skin when you apply it topically it's a great form of protection from environmental pollutants when we consume it it's obviously an amazing antioxidant internally it's also the most essential thing that your body needs to produce collagen without vitamin C you cannot
• 51:00 - 51:30 make collagen doesn't matter whether you take supplements you eat all the protein you want in the world without vitamin C your teeth will fall out your hair will fall out everything will fall out I actually see probably twice or three times a year patients with scurvy and how do they end up getting it in this modern day and age great question I saw it in New York City I see it here very restrictive diets and Lifestyles and and religious beliefs okay got it got it so it's not somebody who's like on the carnivore diet it's somebody who maybe has um just somehow ended up you've
• 51:30 - 52:00 something you know we've seen it patients in patients with carnivore diets okay they have very restrictive diets that avoid all sources of vitamin C and then other people who are food avoidant for other personal or religious beliefs usually I see this in patient you know and it's very rare but you still see it couple times a year in the big cities is um people who have a very specific white diet they're only eating rice and white bread or they're only eating you know potatoes and and starches and they have no form of
• 52:00 - 52:30 vitamin C and they come in their gums are bleeding they have what we call cork screw hairs or the hairs are starting to twist and bleed into the skin oh wow yeah and you're like hey have a little orange or have a vitamin C they they correct so that's my number one if I go to pick one antioxidant probably be vitamin C there's two close next ones the next one I like asz anthon I think it's an under talked about antioxidant that it's not common in the Derm world we don't know why but it's really common in the wellness and functional world there's a lot of good data showing it
• 52:30 - 53:00 has really good antioxidant properties you usually find it in things like micro Aly Krill shrimp salmon um but we actually have done several studies in skin and it shows that it improves skin appearance objectively by 30% elasticity hydration status fine lines and wrinkles um signs of aging and it's an easy supplement that can be consumed you can have it in your diet you can take it as a supplement so I love asz anthan um and another anti oxidant that I absolutely love and these are isolated forms you
• 53:00 - 53:30 know not like you you get a myriad of compounds when you eat blueberries or pomegranat or raspberries but isolated antioxidants I love nicotinamide or niacinamide and it's a B vitamin derivative that has been shown as an antioxidant to allow your skin to correct DNA damage from the Sun and this has been shown both in laboratory studies animal studies and human studies in fact there was a landmark study that just supplemented patients only with nicotinamide which is a B3 derivative
• 53:30 - 54:00 nothing else and their cancer risk dropped by 30% wow their skin cancer risk it's and how are they taking it as a supplement a supplement okay got it yeah th milligrams a day or 500 twice a day and is it true that I've seen like skin products that have it now in it those work topical products so it they they help improve complexion they help improve redness from the same It's probably hard to get that same do yeah yeah and and the correction the DNA correction that is needed is from the inside out so the oral supplements but you know we know patients who eat the
• 54:00 - 54:30 full rainbow diet the antioxidant diet the anti-inflammatory diet they have a reduced risk of skin disease they have improved skin tolerance immune tolerance of the skin we know that their their inflammatory things like eczema and psoriasis tends to improve so antioxidants s you cannot go wrong nobody will ever say Hey you ate too many good foods you know I love it I love it all right we got it on S all right I want to give a little shout out to project that you're involved in yeah you actually have your own supplement
• 54:30 - 55:00 that's there I always first of all I love any entrepreneurs that are out there that are creating you know evidence-based products things that can help people that can work so I have no problem giving a little plug but I also I want you to rank it so tell us what we're ranking and what the product is yeah I I I'm biased so I this is a product called Sun powder it's the first daily drinkable skin care supplement it's the first supplement of its kind to protect and repair your skin from the inside out I describe it and the
• 55:00 - 55:30 simplest way to describe it is think of it as ag1 for your skin got it and I'm biased I will rank it as an S but I will tell you why I rank it as an S because any other dermatologist and you're going to see some dermatologists in the near future talk about this across the United States would rank it as an S as well for several reasons number one there's nothing out there like it there it's the most comprehensive package uh for skin Health that's taken once a day as a powder that's mixed into water it originally came from a necessity for our skin cancer patients we we had a
• 55:30 - 56:00 high-risk Clinic when I did my training at Stamford that had patients with innumerable skin Cancers and I had I ran a high-risk Clinic over at UCLA where I was a professor and we looked at ways that we can protect patients skin that was not just tell them to wear sunscreen because God knows these patients were avoidant of the Sun and they would still get numerous skin Cancers and some of them you know disfiguring cosmetically or functionally so we looked for a way to reduce their
• 56:00 - 56:30 risk and in doing so we also looked for a away well if we're doing that how else can we improve the quality and appearance and the health of your skin so I partnered with my colleague um over from Harvard he's a cosmetic dermatologist who practices in Miami and his patients are a little bit different than mine you know 80% of my patients are skin cancer patients and probably 20% are Cosmetic in regular his are 100% cosmetic so he had a need for keeping PE patients skin healthy and making sure
• 56:30 - 57:00 whatever they did would maintain you know if you do all these amazing things for your skin you spend all this money you you get a beautiful youthful complexion you go back out in Miami Beach in a week you're going to get all that stuff come back and you're like what did I do so we formulated a product called Sun powder that has eight clinically studied ingredients in the doses that was studied in the published journals that not only protect you from sunburns it reduces the likelihood of you getting a burn while outside meaning it increases the time you can spend
• 57:00 - 57:30 outside before your skin turns red now it's it's not a replacement to sunscreen I want to make that clear but it works in addition it's an internal form of protection it helps reduce your skin cancer risk so we published that data and looked at over 500 patients who had two or more skin cancers in the past and when they took the active ingredient uh for a year which is nicotinamide at 1,000 um their skin cancer risk reduced by up to 30% the ingredient that helped reduce
• 57:30 - 58:00 sunburn risk is this Fern from the Amazon rainforest called polypodium and when consumed and we're running a clinical trial right now in my practice and another clinical trial in Miami when consumed Shields your skin from turning red from too much UV exposure so I can take it surf go out and swim do all the things that I do and it allows me to be in the sun longer before my skin says hey hey like I'm starting to burn take it easy how or how much before you go
• 58:00 - 58:30 out and surf do you take it yeah right I I usually take it about two hours before it's it's in my morning mix I'll mix it in my smoothie drink it and then I go ironically the times that I need sun protection the most are the times that I can't apply right I'm either in the water I'm I'm hiking I forgot to bring it I'm skiing you know I just don't think of you know I I shouldn't say this I I don't think to apply or reapply when I'm out on on mountain and I've gotten some of my worst sunburns when I'm skiing I ironically um and then there's other ingredients we put a full dose of aanin in there there's bioactive
• 58:30 - 59:00 collagen peptides with vitamin C you know there's hyaluronic acid which is the stuff com common cosmetic fillers are made of it hydrates the skin um there's biotin there's a lot of great ingredients in one single scoop so it was a lot of work in the making originally dedicated to our patients and we said there's nothing there besides telling patients avoid the sun wear sunscreen and see you later buddy so we said why don't we find out a way to improve the skin it's been an awesome Venture amazing well we'll put the link to in the show
• 59:00 - 59:30 notes but for people listening on audio where can they find it yeah sunpower.com powder there's a Tik Tok called drink Sun powder and it's the the social media handles show skin Cancers and lasers and Ed there's a lot of skin education it's not a a page about selling supplements I think the supplement world is very saturated but there's amazing data that's evident based in all the ingredients in this amazing awesome
• 59:30 - 60:00 congratulations uh on that note you know you were talking about some of the content you guys feature one of the things that you're big on yeah and that you like to tell people is when it comes to protecting our skin from potential problems later on it's important to get screenings done yeah so that's the next thing that I want you to tier Rank and talk a little bit about the how and the wise yeah for especially my
• 60:00 - 60:30 audience including myself I don't think you know I'm 42 turning 43 this year amazing man thank you brother good dermatologist um and I have like some moles that are like the bottom of my neck over here and like uh every so often when I'm swimming or I'm hanging out with my wife somewhere somebody might say usually somebody older is like you know you should really get those things checked out and I have AAL bias and I'm like yeah yeah I'll get them checked out at some
• 60:30 - 61:00 point in time but I'm also generally feeling like i'mm I'm not too worried about it but at the same time too like I don't want to end up in some situation where I have to deal with skin cancer and I could have detected could have detected it a lot earlier right and I had up in your office so what are the dos and don'ts and where do you rank uh screening and let's put it at different feel free to contextualize it based on either ages or risk profile like you mentioned one of the top things that
• 61:00 - 61:30 will increase your risk profile for skin cancer is if you've already had a parent or family member who has been diagnosed with some form of skin skin cancer can you talk about that yeah so to to take a you know a bird's eye view of of that statement in the US we tend to be more reactionary to our health care than than proactive and that's across all Specialties we tend not to see the doctor until there's something that needs to be treated as opposed to seeing the provider for preventative or
• 61:30 - 62:00 screening measures and that's not just skin it's every organ system I love skin screenings because it's probably the least invasive screening of any body system possible so I I put screenings as an A and I I'll tell you why if you go see your regular Primary Care Dock and they're going to see how you're doing you're going to get a blood draw just to see your basic lab functions I don't even poke you when you come to the office I just see your skin it takes
• 62:00 - 62:30 five minutes for me to examine maybe maybe a couple minutes less couple minutes more for me to examine every square inch of your skin and it's just by looking and we are trained to know what should be there what shouldn't be there it's not like getting a colonoscopy you know we're we're getting to the age where we need to do things like colonoscopies and that heaven heaven knows that's much more invasive and that's a simple screening you know you know smokers and their CT scans for their lungs so it's the least invasive
• 62:30 - 63:00 screening of all body systems to detect cancer and things that shouldn't be there so why not do it you know once a year is all you need for pretty much everybody and maybe even every other year if you have absolutely no family history and you have you know no personal history and your Skin's doing fine maybe even every other year but it's a five minute check any particular age where you recommend that people I yeah I tend to like well it depends on family history like we talked about if you have a very very strong family history of melanoma I tend to recommend at the beginning of puberty moles change with puberty particularly progesterone
• 63:00 - 63:30 hormones so as you go through puberty you will make new moles your moles will change and that's something that a good dermatologist should be able to survey if you don't have a family history or personal history melanoma or any other form of skin cancer then I think in you know after puberty adulthood somewhere around 18 once a year is just an easy way uh to upkeep and monitor your skin and what what I like about screenings is just like any cancer in the body whether it's breast prostate lung colon skin
• 63:30 - 64:00 anything else early detection dictates better outcomes so when you catch Things Early it doesn't matter whether it's a a melanoma or a lung cancer or a prostate or breast cancer the earlier you catch it the more likely you're going to cure it right so we make a a big stink about oh I went to the dermatologist they biopsied something small on my nose I tend to see the consequence of the things that haven't been done now I'm taking off an entire nose I'm taking off an entire ear or worse yet we're talking about this thing is now in the neck or in the lungs or you know cats out the
• 64:00 - 64:30 bag so I love screenings ironically you bring up screenings tomorrow I'll be screening um all the firefighters that were implicated in the Pasadena Altadena fires W for just a screening exam these guys there's over you know 250 firefighters we're going to see tomorrow and these guys have an occupational hazard and many of them don't know that and it's such an easy thing that I can do that I can set this up at the fire academy and Screen them there no other organ system will allow you to do that you know you have to go to the doctor's
• 64:30 - 65:00 office you have to get a blood draw you know even screening for diabetes you have to get a poke to see what your blood sugar is here I can I can go to the patient I can tell them about hey you're outside fighting fires you're keeping us safe and healthy the Palisades Malibu you guys are outside all the time here's a hazard here's something that you guys should watch out for and let me just take a look at your skin yeah greatest thing we catch something worst thing I wasted five minutes of your time right right any dos and don'ts for people who are like okay well I can't go to my regular doctor
• 65:00 - 65:30 because they're not trained in this I have to go and find a dermatologist are they looking for anything special no I think I think any good medical dermatologist in this day and age should be able to screen you unfortunately in a lot of big cities things have migrated more towards cosmetics and uh cosmetic Dermatology so you tend if you're looking for a screening any good medical dermatologist should be able to do that unfortunately that you're right there is a little bit of a gatekeeping meaning our some often times there's a wait that's several months for some providers
• 65:30 - 66:00 and if you need to see something urgent see your primary dock at least first um as opposed to waiting six months for something that could be a problem but if you have no concerns and you're just going in for a screening any good dermatologist should be able to do that okay great all right we're gonna pop into a few other areas I want to talk about and then we're going to chat about a bunch of treatments that people have questions about does this work is it harmful what's the best because now we're starting to get into the part of the conversation where we know about the
• 66:00 - 66:30 important about being Sunsmart yeah we know about the importance about being Sunsmart we know about physical barriers being Supreme yeah and how we can rely on those minimizing you know sunscreen use for especially sunscreen misuse and the harmful sunscreens that are out there relying more on the mineral ones but not the spray ones that are out there we've talked about the importance of screening and avoiding tanning uh Sun powder and the role that that can play in a healthy diet as well too uh coffee
• 66:30 - 67:00 uh so a few more things we want to touch on and then we want to go into you know some of the treatments that are out there that are the common ones anytime I tell somebody like I mentioned to my sisters that you're coming on they're like oh my gosh can you ask them this this and this this absolutely man this is the fun stuff not that it's only women that are asking about it men are super into their skin as well too totally so a couple more items that we want to touch on and then we'll get into these uh uh restorative regenerative therapy Keys tools techniques practices all right alcohol let's talk about that for a second what do you want to say
• 67:00 - 67:30 about alcohol and the skin and where would you rank it on our tiered system F an f f okay F that doesn't mean I don't consume it okay got it but it's an F there's no amount of alcohol that's good for you no amount that being said it is something that's socially consumed and to an extent overc consumed but from a skin stand point and a biology standpoint it's a toxin right an alcohol itself is broken down into a metabolite
• 67:30 - 68:00 called acetal dhide which is what creates a lot of the problems in the skin so first alcohol tends to be a mild diuretic which is why when you start to drink you feel like you got to go to the bathroom more or you know you know at the bar you're like oh I started to pee and there there there it goes it's because there's actually an a diuretic effect so number one tends to dry you out and that becomes a problem especially the next day because we tend to wake up and our body's trying to overcompensate by holding on to the water we peed out so
• 68:00 - 68:30 you wake up with puffy eyes that hangover look there's an actual biologic change related to the alcohol that was consumed in your skin that makes you look like which is The Hangover look as a result we tend to overcompensate for that dryness by producing more sebum so more oil more likelihood for breakouts um our skin isn't that happy as a result of the secondary changes that occur from alcohol's mild diuretic property so that's number one which is why you always look funny or you have puffy bags
• 68:30 - 69:00 under your eyes is the fluid shifts that occur from alcohol consumption number two the acetal diet is a is a toxin and some populations particularly Asians have no ability to break down the acetal theide so it collects In Their Skin there's this thing we you know incorrectly call the Asian glow and there's a reason for that the acetal dhide actually accumulates and and dilates blood vessels in the skin there used to be what was thought as you know the sailor's nose or the drinker's nose in which patients would
• 69:00 - 69:30 have really big vessels on the nose and the nose was growing um you know the pores were growing the nose itself was growing too much and they thought that that was due to too much alcohol consumption we now know it's mostly due to a condition called rosacea or rinofima as a result of rosacea but there's some truth to that alcohol and acetal ahid accumulate and dial vasodilate The Skin So you looked flushed you looked redder you can even get that like surprised or shocked look when you're drinking and your face is flushed and that's because your body
• 69:30 - 70:00 doesn't like the metabolite so there's no good amount of alcohol that is saf or healthy for your skin we know it's a consequence during surgery and procedures it makes you bleed more it slows down wound healing so if you're undergoing any sort of cosmetic surgery reconstructive surgery or even a cosmetic procedure we avoid alcohol because of its blood thinning properties and bruising properties so there's a lot of problems with alcohol and not very many good benefits now do I enjoy a glass of wine or a cocktail I do do I try to avoid it I do I think
• 70:00 - 70:30 if I pick my alcohols I tend to pick ones that at least come with some theorized benefit which tend to be the red wines and things like that um but I for skin I put as an F I heard you say on another podcast that in particular grain-based alcohols are the ones that you are most worried about people overc consuming yeah yeah grain-based alcohols for for several reasons one the volume we tend to consume is a problem and number two tends to be inflammatory so so grain-based alcohols will cause an
• 70:30 - 71:00 inflammatory shift in our diet and in our Skin's immune response we know that it flares certain uh skin diseases you know eczema sasis will get worse when patients are constantly consuming grain-based alcohols um and then we it basically acts as a seed seed oil equivalent I I tend not to like them um so that's like a whiskey a barley yeah or yeah yeah beers you know beers um certain vodka certain whiskies colored
• 71:00 - 71:30 whiskies you know they tend to be very inflammatory and you see both the acute problems and the downstream problems people with certain gluten intolerances um and gluten intolerance has become this unfortunate catchall in the US everybody who eats a pizza and gets an upset stomach says they're gluten intolerant but true gluten intolerance like celiac disease um these grain alcohols wreak havoc on the immune system system so I tend to avoid them okay let's get into some of these
• 71:30 - 72:00 restorative yeah modalities yes the fun stuff that are out there the fun stuff all right one of the ones that is a spectrum but it's gotten a lot of attention over the last few years is the spectrum of red light therapy yeah so let's talk about it I have a red light mask here just as an easy icon talk about it and then rank it on our on our tier b b yeah okay great maybe an a maybe an a maybe an a maybe depending we have to see a little bit more data it
• 72:00 - 72:30 was five years ago a d to most dermatologists yeah and data started to come out more and more and randomized trials have come out more and more and it bumped it up from a b a c to a b there's some benefit the problem is it's such a broad spectrum to use the term red light there are devices that are battery powered there are devices that are AC powered there are devices that have high density of Lights there are devices that have low density of Lights the the jewel outputs vary from product
• 72:30 - 73:00 to product so the the overall en catchment is is Broad and it's hard to control for the you know shitty products out there and hard to account for the the ones that are good I like it I have it in my practice we use it post-operatively for certain things like when we do injections for hair we will use red light that's powered right T typically that's a what is that like a cap or is that Capal light yeah it's a we tend to use the medical light um it's
• 73:00 - 73:30 it's a three panel light that we shine on the scalp um we also use it post laser procedure um especially if we're doing ablative lasers where we're destroying the top layer of skin intentionally we will use the red light to speed up wound healing there's some good data that shows that it increases vascularity and blood flow which is how it works to improve wound healing and anti-aging so I like it it's a b it could be an a if we have enough data that comes out and we we see which specific devices and energies are needed
• 73:30 - 74:00 to get those effects reproducibly but just like when anything is good in the market you get a flood of products that are inferior don't work and things like that and that's a problem but I give red light a good be okay amazing yeah on that note and I don't have an icon for this you don't have to rank it you could talk about it what about things like micro needling radio frequency micro needling which has become very popular I heard you have some Nuance thoughts yes radio frequency micro needling I will put as an F okay micro needling I will
• 74:00 - 74:30 put as an A okay great huge difference right huge difference so we're tapping into the world of things that you can do to your skin to improve its appearance and health yeah and that's light based devices energy based devices mechanical based devices things like that why I don't like radio frequency micr needling several reasons number one radio fre frequency treats a whole different part of the skin than does Micro needling micro
• 74:30 - 75:00 needling the the general depth that it can penetrate at most is somewhere around 2 and a half millimeters and when we use micro needling our goal is to stimulate collagen induction through making microscopic pokes in the skin that's what it does and it does it without heat the beauty of micr needling is its mechanical injury not Heat injury so historically ethnic skin like yourself myself you know African-American skin what have you could not tolerate a lot of laser
• 75:00 - 75:30 devices the heat would destroy the cells that produces our skin color the melanocytes so we could do all these things amazingly in white skin and it was studied in white skin but ethnic skin were like yeah you can't use this laser you can't use this laser etc etc we have nothing for you micro needling came about It's actually an old technique very popular in India and the Middle East that was around for many many years and caught popularity in the US more recently as a way to induce collagen without heat but mechanical injury so now we have a way to improve
• 75:30 - 76:00 scars to improve texture radio frequency is heat that's deposited in a layer below where the Micron needle reaches and the problem with radio frequency is it falls in this like ambiguous doesn't work really great Zone it's not deep enough to cause tightening in the fat layer and it's not shallow enough to get the benefits that we're looking for things that treat the top layer of skin so what I see often is it's you know whenever you get an you know whenever
• 76:00 - 76:30 you get um a something that is too good to be true they say it treats everything or it does everything you should start to question it like does it really treat scars and redness and blemish and wrinkles and fine lines and brown spots can't really do that you start to see the the the consequences and the biggest area where I see a lot of patients with problems with radio frequency microing is an ethnic skin where they come in with stamp or pigmentary changes so you see the heat from the radio frequency
• 76:30 - 77:00 cause skin color changes because their body couldn't tolerate the heat micro needling alone amazing love it for acne scars love it for scar revision love it for texture changes that we can improve radio frequency combining them too much injury in the skin too high of a risk F got it that's great well a lot of people will be happy because at least when you see the ads for it and everything else like that or I hear from my wife or what her friends are doing radio frequency
• 77:00 - 77:30 Micron needling which has become so popular they also it's a premium right you're paying a premium for that so Micron needling good enough for most people and is going work fantastic if they choose that as an option and to simplify things even better all of these energy based devices are made to Target one thing they target a certain either depth or color all lasers understand is color so when somebody tells you this device will Target a myriad of things as
• 77:30 - 78:00 as a provider and we do a ton of lasers usually my Fridays are my my uh cosmetic surgery or cosmetic days we do a ton of lasers and we have a myriad of devices you know that the best devices only target one thing but they do an excellent job at it it's like you know a car if you're saying a car your car can haul lumber can can tow a boat can also race around the track and can also take
• 78:00 - 78:30 eight people and as a sports car you're like that doesn't make any sense it's either a pickup truck or a sports car or a sedan it's one of those things same thing with lasers and energy based devices it they target a specific part or a color in the skin so I tend to shy away from things like radio frequency micro needling when they claim it can do all these things it probably does a shitty job at doing all of them and in fact the consequ es outweigh the benefits particularly in ethnic skin got it got it so the classic adage if you're
• 78:30 - 79:00 everything to everyone you're nothing to yeah yeah 100% jack of all trades master of none so on that Spectrum what have you seen I'll ask you to sort of come up with your own list what have you seen before we get to um fullon surgery and that's a spectrum obviously there's like full face lifts there's little micro surgeries that people can do separate from that what are the biggest bang for buck when it comes to repairing damage that people might have had from their youth from overs sun exposure maybe
• 79:00 - 79:30 crappy diet whatever else was there uh and also to just the natural aging process that we all go through where we're trying to bring some of that youth back which isn't everybody's priority and I get that but for the for the people that it is what has the biggest bang for the buck that isn't surgery if I were to pick one device and one device only and I have no affiliation with any medical device out there so I'm I'm not speaking with a bias and most dermatologists will agree with this if I were to pick one device it's the fraxel
• 79:30 - 80:00 device and it's basically fractionated non ablade of resurfacing and this this is a laser it's a laser okay got it and we love this laser it's been around for a long time because it does three things and it does it remarkably well number one it improves sun damage so sunspots Browns wrinkling it improves fine lines and wrinkles by by stimulating
• 80:00 - 80:30 collagen and more importantly at least to me more recently we found that it decreases cancer risk when it's done yearly by up to 50% and we knew this you know for the past 10 years 15 years that the device has been around that patients who would get this laser resurfacing done for their face they had less sun damage less cancerous changes and less skin cancer but now the Harvard Study last year validat that in a beautiful study that looked at patients who got fraxel treatment and their skin cancer was dropped by 50% and and how does that
• 80:30 - 81:00 work just to cut you off or you can add that into your answer yeah so and to go into that and I can I can assure you almost every one of your favorite dermatologists has had fraxel or wants to do fraxel to their skin you know it's it's it's the gold standard in my opinion the way it works is the laser drills microscopic holes to a certain depth of the skin targeting a certain region of the skin without destroying the top layer so and this is the
• 81:00 - 81:30 Elegance of lasers is it provides heat-based destruction to a certain depth targeting let's say the the sun damag brown spot the freckles that are from longstanding Sun fine lines and wrinkles as a result of collagen breakdown in that area while leaving the surface untouched so you don't have we in bleeding wounds that you used to see from other older lasers CO2 laser being a popular one in the 80s and 90s and
• 81:30 - 82:00 2000s your skin is not raw when you go home you don't have any open wounds but your skin starts to peel in the week and you look amazing if I were to pick one device and only have that that would be it and how does it specifically reduce your risk of skin cancer Yeah by targeting that layer of the skin in which sun damage accumulates it turns that skin over all that damage skin sloths off within a week so the skin on the surface now is healthier and younger
• 82:00 - 82:30 and we actually studied this up at Stanford where we took biopsy samples of skin that was treated with these these wavelengths of light and looked at the genes and before laser treatment and after laser treatment there was a shift back to more youthful Gene activation in the skin so it's not just the appearance it's biologically younger it's biologically healthier so it's helping your skin do what it does naturally just accelerating the process yeah and getting rid of you know all the gunk
• 82:30 - 83:00 that's been accumulated from Sun all the yeah it's I love this device and typically you know obviously it'll vary based on city but as people are trying to prioritize and bigest bang for the buck what do treatments cost and how long should they you know what's the expectation of how many treatments they should do over what time period if they're interested in pursuing it yeah treatments you know and most I don't know why they don't talk about costs whereas everything else is transparent I think it's I think it's silly the the
• 83:00 - 83:30 the discussion about cost is it's widely variable right depending on what is done what devic is used if there's additional things done but it falls somewhere in the Thousand range maybe it's a little bit more in certain treat or is that like usually per treatment um somewhere around there maybe 1,200 maybe, 1500 maybe a little bit less but somewhere in the ,500 range I as as somebody who runs these lasers all day and night you know um in our practice I tend not to like
• 83:30 - 84:00 packages I I think just treating the patient seeing how they respond after one treatment a tailored approach is the best way to do it you may not need a package you know you may come in and say hey Doc I'm tired of like looking like this what can we do we come up with a tailored approach and we say hey let's try one if you need it again then we'll do it again at this time point if you need it again down the line we'll do it again but I think I think uh kind of a customized uh personalized approach is the way to do it I think packages are
• 84:00 - 84:30 very common in things like Med spas and things you know things like that but people do Botox or what yeah yeah and and that's that helps the bottom dollar it helps you you know save a few bucks but I think when you're doing things like laser resurfacing of your face or kind of these more elegant or complicated treatments I think um I think it's a one step at a time and I have no familiarity with lasers besides the fact that I know that my sisters have done them sometimes here and there my wife done so fra this fractal laser yeah you know you put at the top of the list so that means that if somebody's going to it's it's an S fraxel is an S
• 84:30 - 85:00 fraxel sorry I said fractal um so one treatment is enough for somebody to see a pretty big difference yeah usually it's like once a year if anything last time my wife did it was like two years ago great so you have people spending hundreds of dollars every month on Cosmetics that may or may not work not that it's a either or but this could be something that somebody might want to consider yeah and obviously what you're what concerns you will dictate what devices used right like if you come in and you say hey I'm like I hate this
• 85:00 - 85:30 redness every time I'm talking I'm at a social event I I flush you know this redness bothers me it looks like I'm embarrassed but I'm not you know I have spicy foods my cheeks turn red there's a different device for that fraxel will do absolutely nothing for that but there's a device called the vbeam laser that I use to treat the redness so what bothers you will dictate what the best device or treatment option is and we do a ton of surgery but what I've noticed is people are falling especially in the big cities falling out of favor for things that
• 85:30 - 86:00 have a lot of downtime we live a 247 lifestyle we want we want our results we want it immediately and we want nobody to know that we had it and we don't want it to slow us down right and we can't really achieve that but you know a a traditional facelift has downtime the results are remarkable when done right you look markedly younger but it's surgery it's redraping your face it's making incisions and repositioning
• 86:00 - 86:30 things the way they need to so come with it the consequences and the cost now I'm not knocking facelifts I love it they're they they are an amazing tool but the younger and younger patients I think in my opinion shouldn't be jumping straight to surgery I think it's nonsense to have 20 30 early 40 year olds coming in for big surgeries yeah especially with what we know about diet and lifestyle all these other
• 86:30 - 87:00 things a huge um% a huge role in things you know on that note are there other things that are lwh hanging fruit yeah that is not a a device let's go back to Lifestyle for a second lwh hanging things just even like what moisturizer you use or how much water you drinking a day that are like no brainers we're all doing them but by by tweaking it a little bit you could significantly improve the look of your skin over a period of time yeah so if we're looking
• 87:00 - 87:30 at look I'm going to play Devil's ad Advocate a little bit you know on my own words sure sun protection takes a little bit of a bigger uh bigger role if we're looking for aesthetic uh Improvement or protection then some form of sun protection consistently is is key whether it's a broad brimmed hat whether it's some sort of shade or sunscreen that's very easy to do and is that typically correlate with the UV index what is your thoughts on that yeah I tend to I I have a pragmatic approach
• 87:30 - 88:00 trying to avoid the sun day in and day out to make you look younger actually makes you look weirder you know so I think obviously midday Sun summertime you want a little bit more protection I 100% agree follow the UV index follow look at the weather pattern look what you're going to do during the day and then decide you know I I'm bless my heart uh my wife's heart but she isn't a big sunscreen fan you know she just doesn't like it she forgets to put it on you know she's always lived this she has olive skin she's always had the ability to tolerate the sunw so to get this new
• 88:00 - 88:30 thing into her lifestyle has been hard she's like you know my skin looks great why do I need sunscreen she's not wrong she's she's on to something because clearly it's helped her this far but she's only going to get older she's not going to get any younger so we make small Lifestyle Changes maybe now that you're going out to the park for baseball honey wear wear sunscreen or wear a hat you like hats great you know you weren't 20 you're not going to be 20 forever should we clip this and put it on social media we can dagger yeah EXA that's that'll be the end of that um but
• 88:30 - 89:00 those are simple tweaks that you can make as you see your body change the other simplest thing is a is a retinol a prescription retinoid every dermatologist secret it's a simple effective way to improve the quality appearance and health of your skin it's the only medicine that we have and it's it's a the active forms of a prescription I'll go into that in just a second but it's the only medicine we have that has been shown to reverse the
• 89:00 - 89:30 biologic age of our body when it's applied it's freaking amazing and it's just a cream it originally people put it on at night at night and it originally came out for acne you shouldn't wear it if you're trying to get pregnant or if you think you're pregnant right so so looks like you you you're well versed on the retinoids and the reason for that is the sunlight inactivates Tron which is the most common prescription retinoid that we give it's not that you can't wear it in the sun when you get a lot of
• 89:30 - 90:00 UV on the medicine the medicine becomes an inactive form so you've wasted wasted the efficacy it's not that you'll have a problem you should not use it if you're trying to conceive or become pregnant but that data comes from the oral version of this cream which is which is Accutane there isn't strong data to show that and the reason I'm saying this is I don't want people who are trying to conce to all of a sudden freak out because they've been using some retina and now they're like oh my God I'm going to am I going to have a problem but
• 90:00 - 90:30 because it's the same medicine same drug we assume that you will get some absorption from the cream which means you will have the same consequences so avoid it during pregnancy um um or or conception time you can use it while you're breastfeeding and this a common misconception women think you cannot use it while you're breastfeeding absolutely no problem you can use retinoids all you want while you're breastfeeding the problem is is a developing feed it can affect the development of a fetus got it yeah uh another question that I often hear from males and women that
• 90:30 - 91:00 listen to my podcast if they've struggled with really bad acne I had a little bit of this um through a combination of a crappy diet hormones other stuff and actually a dairy intolerance I had terrible acne all throughout High School the crazy thing is is when I left high school and I started my freshman year of college I started reading a little bit about um how Dairy doesn't work for everybody I got off a dairy and my acne went away in
• 91:00 - 91:30 literally two weeks and I thought oh my gosh I just wasted four years because I was drinking milk every day and that's not the case for everybody but I think that was the case for me gut inflammation being tied to acne mixed in with some hormones but as my skin started to repair I noticed that I had a lot of scarring and then I don't know the medical term for it but there are these little craters in the skin I they've gotten a lot better and I don't know what I did I didn't do anything specific for it I didn't do any treatments for it probably had a little
• 91:30 - 92:00 bit of you know collagen my diet but is there anything for people who feel like they have these little craters from having really bad acne back in the day and is there a medical term for it yeah what you're describing is a form of um acne scarring called ice pick scars they're like essentially like an old ice pick that poked your skin and that's a result of inflammatory acne eating away the collagen the skin as a result of the inflammation um and we see this a lot and there's there's actually amazing treatments for it the simplest form that
• 92:00 - 92:30 you can do at home is to use a a topical retinoid so topical retinoids improve the appearance of acne scars they re remodel collagen and they increase collagen density in our skin so at the minimum I love patients to be on just a cream at night which is a topical retinoid now if that isn't enough and you want to address this there are many ways we can treat this I tend to treat ice pick scars with a technique called TCA cross which is an old school
• 92:30 - 93:00 chemical uh peeling agent that we place in the scar itself and it stimulates the scar to fill in on its own another option for ice pick scars that's great is is um micro needling we love micro needling at a certain depth that stimulates collagen induction everything that we're doing everything that we try to do is just to get your body to fill in that voided collagen to get the skin to come up and then fraxel laser or blade of non ablade of resurfacing kind of resurfaces everything in the second layer and helps improve that tone so
• 93:00 - 93:30 there's a lot of things you can do but at the minimum just start with a prescription retinoid great so we were asking and we were on the topic of lwh hanging fruit anything else you want to put in that category you already you mentioned retinol yeah a retinol a retinol a sunscreen that's like 90% of your of your regimen then simple things that you can also do obviously improve your diet that's you know if eating crappy your Skin's going to be crappy if you're eating clean you'll see the change in your skin and then you know
• 93:30 - 94:00 knowing your skin if you're oily you should you should wash the oil off you will eventually break out they will clog the pores in your skin you'll get blackheads and white heads as a result so if you're oily you know wash that oil off if you're dry replace that moisture and a common misconception I hear all the time is oh I'm drinking 8 glasses of water I'm like drinking water has absolutely no bearing on skin hydration the amount of water you consume will not affect whether your skin is dry or oily unless you're clinically dehydrated
• 94:00 - 94:30 which most people are not so um just do your normal diet things for fluid intake but if your skin is oily clean that oil off if your skin is dry you know moisturize that in and of itself some form of some protection some retinoid and you know simple things is more than 90% of having easy access loow hanging fruit to skin Health um I myself and this is no plug but I do it every day I I take my sun powder it provides the things that sometimes I forget provides
• 94:30 - 95:00 all the antioxidants that I may not get on a busy operative day um it's a way that I can protect my skin if that's not you know if you don't have to pick that you can pick another form of an antioxidant take your you know multivitamin provide your vitamin C if you like AIS anthon supplement with that these are things you can do at home you don't need to see a doctor for collagen yeah yeah collagen I love collagen collagen used to be like collagen was an F in dermatology five years ago right and it's it's an a now yeah I love it the I think we have it somewhere on our
• 95:00 - 95:30 our list over here so we'll bump that up to an a it and it's because of the amount of studies that have come out on it yeah the amount of studies and we're understanding okay there's a few things collagen itself is made of three amino acids that are nonessential meaning your body can produce these amino acids with just any diet so for many years you know scientists Physicians were saying this is non essential your body can make collagen even eating a pure carbohydrate diet so supplementing is useless because
• 95:30 - 96:00 our body can make a a a ton of it we found a few things as we've gotten more and more into 20 and 21st century restrictive diets fad diets are much more popular people don't consume the same diets that we used to in the 50s and 40s which was a little bit more umbrella likee um and we found that protein collagen consumption and just overall diet quality is poor so when we've looked at recent studies of the last five years including randomized studies that gave patients collagen supplementation versus not there was a
• 96:00 - 96:30 measurable Improvement in the quality of their skin and one thing we didn't account for is that coll when you consume collagen water comes with it you get intracellular and intravascular water uptake so your skin actually plumps up more you look a little bit more hydrated we call it that oncotic pressure of our blood or the osmotic gradient goes up so it draws water with it so there is a measurable Improvement collagen is easy to take it's usually very well tolerated it's very you know cost effective so it's become a really popular thing that a lot of people
• 96:30 - 97:00 recommend now most of the time our bodies can absorb 5 to 15 grams the rest of it actually is pooped out and you can measure it in the stool the amount of collagen you consume and you measure the stool output and most of it's in the poop so you don't need as much as you think but collagen is great the other problem with collagen is it's a large molecule it doesn't cross the gut very easily so for forms that are broken down we call them you know collagen peptides or hydrolized collagen peptides are much more bioactive and absorbable it's the
• 97:00 - 97:30 it's actually one of the reasons why that's the form we have in SunPower um but you want a form that's easily absorbed and you also want to have it with vitamin C because you can consume all the collagen in the world but if you don't have a form of vitamin C and most people you know have a diet that will you know have the daily recommended amount you can't remake that triple helix the way collagen works when when you consume it is your body breaks it down into the letters and then your body will reform the sentence that is the
• 97:30 - 98:00 collagen triple helix so you need that vitamin C but I love it great product I take it myself fantastic yeah uh you know on the so we talked about the lifestyle things just as we're winding down over here touching back on the screening aspect yeah obviously you know find a dermatologist somebody that you can go to it's a non-invasive exam you know they're going to check you out is there anything else that you can do or if people have done their because you mentioned that so much of skin cancer is
• 98:00 - 98:30 genetic family history hereditary is there anything in our typical genetic screenings a lot of people have 23 and me they have other stuff is there anything there that people can be looking at to look at their risk of skin cancer so that's a so I want to digress and make a couple points on this family history genetic history is is one of the largest implicating factors in skin cancer that this doesn't mean that Dr solmani said Sun plays no role go outside and burn all you want obviously be sun smart don't burn just
• 98:30 - 99:00 you know be cognizant of the fact that too much UV will increase your genetic predisposition but that doesn't mean we should be sun avoidant so you can enjoy the sun wisely that's number one number two and I I emphasize this all the time because I see such bad Cancers and things in patients that could have been caught earlier you know your body better than any doctor does you know your intuition your second brain which is the
• 99:00 - 99:30 nervous system in our gut it's the same reason why you get like a weird feeling when something bad is about to happen your gut intuition will tell you that something is not right better than any doctor so if you feel like something is off don't be blown off by your dermatologist your primary care doc your orthopedic surgeon what have you I see this all the time where patients come and say hey I'm not sure about this and they say oh it's nothing fast forward 5 years it's been neglected now there's a wonking something that shouldn't have been there so if you don't feel
• 99:30 - 100:00 comfortable about it and your do you didn't like the way your doctor approached that seek a second opinion you're not insulting anybody you're advocating for your health and in the United States particularly we have to advocate for ourselves more than any other time in our lives so that's one important thing you know yourself better the other things that I would say you know things that you want to watch out for most common things is a pimple or what looks like a bug bite that doesn't heal in a month that's a first sign that
• 100:00 - 100:30 you should see a doctor one month is our cut off from things that are inflammatory acne zit mosquito bite Etc they should go away within a month after a month then we start to think could this be a skin cancer could this be something that shouldn't be there so uh pimple or bug bite that doesn't go in a month something that bleeds easily that's the most common presenting sign for Basil cell carcome is patients you know wash their face and they see a spot of blood on their nose or a spot of blood on their cheek and they haven't really done anything for it to bleed and
• 100:30 - 101:00 then the third is a new or changing mole so if you see any of those things this these are fundamental screening things that you can do at your house before you even seek a doctor if you notice any of those things go see your doctor go see your primary care go see your dermatologist in terms of genetic screenings when we talk about genetics we look at traditionally we talk about what's called mandelian genetics meaning the genetics that are inherited predictably from Mom and Dad to Children blue eyes um you know you know height
• 101:00 - 101:30 things like that um um things that are okay if you have I don't know red hair and dad has red hair you have a 50% likelihood of getting the problem with Cancers is it doesn't follow mandelian genetics it doesn't follow hereditary patterns I loved 23 and me and I say it in a past tense because A lot's changed way back when I was up up north I did 23 in me and I got a bunch of data that was meaningless at the time except the fact that I can explain to my wife why I drink six cups of coffee a day but other
• 101:30 - 102:00 than that other than that it didn't it didn't uh provide much and I don't really drink that much but you get my point the testing for cancer genetics is convoluted it's really complicated it's all over the place there's there's question about penetrance cancer genetic Expressions incomplete penetrance things like epigenetics that play a role when we talk about cancer genes we talk about things like the common people think about bua breast cancer brca that's a
• 102:00 - 102:30 hereditary Gene that if you have is you know almost guarantees that you're going to get breast cancer or ovarian cancer we talk about the retinol blastoma Gene the RB Gene if you have that you're likely going to get a retinol blastoma it's what you see in kids when they take a picture of their eye and one eye looks a different color in the old Polaroids you say you know most cancer genes aren't that hereditary like that so to go and seek a test for skin cancers with the exception of a few rare conditions
• 102:30 - 103:00 is unlikely to be fruitful don't waste your money yeah you're better off just going to a standard SC yeah and and you would know if you have the genetics already you mom had it mom's mom had it mom's sister had it you're like okay there's something there I haven't tested the gene for it yet but I know my family lineage has it there's melanoma has a two two or three genes that are really important like that and then basil cell has another genetic group that's like that but aside from that when we talk about family history it's a whole Myriad
• 103:00 - 103:30 200 plus genes that are implicated in this that are passed down in not well understood ways but just simple pedigree looking at your family hey Dad's Dad's on his sixth cancer on his ear dad's dad had it you know I burn easily so you you're like oh my family history is like I'm likely going to get something important important 100% uh Dr ta this has been fantastic we've covered so much here and most
• 103:30 - 104:00 importantly I want to acknowledge you because not only are you a wealth of information appreciate that from both understanding the evidence-based but also something that people don't often remember is that part of evidence-based medicine is clinical experience and you're bringing all your clinical experience apprciate to the table especially when it comes to some of these more controversial topics like seed oils and other things that are out there and some of your other uh you know takes that sometimes go against the grain of what people talk out there but you have the experience to back it up so
• 104:00 - 104:30 you've brought that uh evidence base your clinical experience your understanding and you've packaged it all with the fact that you're great communicator who also has good skin so shout out to you in your genetics and you've made it all easily to understand and made it super digestible for our audience today for a topic that you know the truth is that people find thems going on all these sorts of wild goose chases they spend a lot of money or they get caught up in the marketing of stuff
• 104:30 - 105:00 uh and that goes on both sides of it it could be somebody in the health space saying ah don't worry about the sun ever when the truth is we've all seen that you know you have one summer where you've spent a lot of time in the sun even if you're super freaking healthy you're like wow my skin has aged and I'm young and I'm healthy so we have to be smart about it based on our goals that are there and you've definitely helped us do that contextually in today's conversation so thank you so much for that I I I appreciate that man I know our audience is going to be a huge fan of yours thank you after listening to
• 105:00 - 105:30 this episode where is the best place for them to follow you where are you most active I appreciate that I have a small social media presence it's teos solmani MD on Instagram um we have a practice website which is cdms or California Dermatology and most surgery Specialists um you can find us on our website which is just californ dermatology.com um pretty straight forward but um anywhere you guys can message me email me uh everybody has my phone number my patients have my phone number so you
• 105:30 - 106:00 guys can call or text I will try my best to respond to everybody but I say this all the time my goal my my role will always be to be a doctor first you know my I my practice you know my group we see 250 patients a day and we will always be um centered on patient care myself particularly in skin cancer skin sun damage surgery and things like that and I think I think there's a lot of information out there's a lot of data out there but not a lot of information
• 106:00 - 106:30 and the problem with data is you can chop it up in any which way you want to get the message that you're trying to push across I mean we we didn't even talk about the most common things like you know Botox and things like that that people spend a lot of money on there's so much to talk about but I think I think to look at an overarching picture look at what happens to patients in real world settings and then say hey maybe we shouldn't be heavily leaning on this side maybe we shouldn't be heavily leaning on this side but somewhere in
• 106:30 - 107:00 the middle and picking a step this way or that way to optimize our health is the right way to do it we've skewed so far on one side in in healthcare in the United States in general that we've replaced Common Sense things with a pill a prescription a a a surgery or a device and I don't think we need to do that well said well once again appreciate that man thank you for being on the show pleasure to meet you YouTube If you enjoyed what you just saw keep watching for more great content on how to improve your brain and your life it is just
• 107:00 - 107:30 genetics it's gravity it's the fact that you're alive and what happens to the collagen of your skin that pretty much everybody once you hit the age of 60 has got some type of looseness of their neck skin