Why Your Skin Isn’t Healing: The Gut, Hormone & Inflammation Connection

Early in my career, I noticed that patients’ skin often improved as we addressed their nutrition and gut health. That changed how I approached skin concerns and taught me to look beneath the surface for contributing factors. Today, I’m joined by triple board-certified dermatologist Dr. Mamina Turegano, co-author of The Holistic Psoriasis Management and Nutrition Guide and an advocate for Timeline’s approach to skin health. Together, we explore what your skin can reveal about your overall health and how that understanding can help you make more informed choices about caring for it. You’ll learn: How damaged mitochondria contribute to skin aging, and how urolithin A may support healthier skin through mitochondrial renewal How your gut health, hormones, and insulin resistance may be contributing to recurring acne and other skin concerns How menopause changes your skin, and what to consider if it becomes drier, thinner, or less resilient How strength training may benefit your skin alongside your muscles Which skincare basics to prioritize before investing in newer treatments and supplements Like most people, I care about how my skin looks, but I also want to understand what helps it stay healthy and resilient. That’s how I approach aging more broadly: learning what my body needs and making those choices part of everyday life. Help Us Win a Listener’s Choice Award The Dr. Hyman Show is a finalist in the Signal Awards, and the Listener’s Choice Award is decided by you. If the show has helped you ask better questions or take better care of your health, I’d be grateful for your vote. Just sign up for an account to vote before October 15. Thank you for making these conversations part of your life. View Show Notes From This Episode Sign up for Dr. Hyman’s Brainshaping Academy to learn how to nourish the biological systems that support your mental, emotional, and cognitive health https://drhyman.com/products/brainshaping?utm_source=dr_hyman_show&utm_medium=newsletter&utm_campaign=may_27&utm_content=link Get Free Weekly Health Tips from Dr. Hymanhttps://drhyman.com/pages/picks?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Sign Up for Dr. Hyman’s Weekly Longevity Journalhttps://drhyman.com/pages/longevity?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Join the 10-Day Detox to Reset Your Healthhttps://drhyman.com/pages/10-day-detox Join the Hyman Hive for Expert Support and Real Resultshttps://drhyman.com/pages/hyman-hive This episode is brought to you by Timeline, Sunlighten, Perfect Amino, Seed, BIOptimizers, and Pique. Don’t miss Timeline’s lowest prices of the year. Save 30% on a one-time purchase or 35% when you subscribe and save, plus free shipping. Offer ends October 11. Discover why so many people are using sunlighten.com. Use code HYMAN to save up to $2,100 today and free shipping. Help fill protein gaps at bodyhealth.com and use code HYMAN20 for 20% off. Make your microbiome part of your daily routine with seed.com/hyman and save 25% with code 25HYMAN. Use bioptimizers.com/hyman and code HYMAN for 15% off, special bonuses, and a 365-day money-back guarantee. Elevate your daily wellness ritual at piquelife.com/hyman and enjoy 20% off plus free gifts. 0:00 Strength training, skin thickness, and Sponsor: Timeline 1:46 Sunlighten infrared sauna, SIGNAL awards, and integrative dermatology from the inside out 5:53 Transition from conventional to holistic dermatology 9:29 Beyond the skin: diet, sleep, stress, hormones, and environment 10:14 Gut health, insulin resistance, and chronic skin disease drivers 12:23 Testing for SIBO, H. pylori, hormones, and gluten sensitivity 14:23 Sugar, dairy, environmental toxins, stress, caffeine, and inflammation as acne triggers 18:54 Functional treatment case: acne and psoriasis improvement 20:24 Comprehensive psoriasis workup and hidden drivers 22:16 Challenges in nutrition and lifestyle research; clinical observation 23:08 Healthy skin diet: Mediterranean eating, protein, fats, fiber, polyphenols, and processed foods 24:26 Elimination diets and foundational nutrients for skin health 27:50 The impact of hormones on skin health and aging 31:57 Functional medicine case studies: psoriasis, arthritis, and gut-focused treatment 36:25 Skin aging: effects of nutrition, lifestyle, hormones, and topical care 39:52 Alcohol, oxidative stress, and collagen breakdown in aging 41:00 Collagen supplements and UV radiation impact on skin 46:00 Supporting skin mitochondria: mitophagy, sleep, stress, exercise, and supplements 49:52 Urolithin A, polyphenols, carotenoids, and Sponsor: Timeline, Biooptimizers, Peak 54:52 Reversing skin aging and the role of strength training 57:42 Sun protection strategies for skin longevity 59:11 Melanoma risk, sun exposure patterns, and vitamin D 1:00:26 Major drivers of skin aging: sun, smoking, sugar, sleep, stress, exercise, pollution 1:02:26 Retinoids, vitamin C, and advanced therapies for skin repair 1:08:45 Dr. Mamina’s skincare routine and ingredient safety 1:14:55 Chemical vs. mineral sunscreens and rapid-fire takeaways 1:17:28 Where to find Dr. Mamina and learn about DermClick 1:18:15 Dr. Hyman’s new book, health lessons, and daily self-care 1:19:43 Supporting the show, following Dr. Hyman, and podcast disclaimer 1:20:21 Finding practitioners, Ultra Wellness Center, and closing thanks

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mark Hyman?

  You said that muscle building is one of the best ways, it's a non-skin care intervention for healthier skin in midlife. Can you kind of unpack that?

• 0:06Speaker 01

  There is a study that was really interesting, women in their kind of midlife age range. They compared them doing aerobic exercise to strength training. The participants who were strength training actually had a thicker dermis. You know, so dermis is where our collagen sits. When you're strength training, you're increasing insulin sensitivity. And then that kind of takes a load off of your cells. You're decreasing inflammation as well. Your mitochondria are optimally functioning. When your cells in the dermis are affected by that, they're going to work better. They're going to build more collagen.

• 0:38Dr. Mark Hyman?

  Aging shows up in two ways. There's the aging you can see, the lines around your eyes, changing your skin, the face looking back at you in the mirror. And then there's the aging you can feel, the workout that takes a little more out of you, the hike that feels harder than it used to, less energy, slow recovery. That creeping sense that maybe this is what getting older means, or you just have to settle for less. I don't believe that we should, and that's why I use Timeline powered by Mitopure. A unique form of urolithin A that supports cellular health and mitochondrial renewal. What I love about Timeline is that they use their science to address both sides of aging. Their topical serum is studied to reduce the appearance of fine lines and wrinkles and improve hydration. While their daily Mitopure gummies are studied to support muscle strength and energy. Getting older is inevitable. Settling for less doesn't have to be.

• 1:24Dr. Mark Hyman?

  Timeline enables us to support our bodies as we age from the inside out. And for the first time, Timeline is giving my listeners access to their prime day deal. 30% off a one-time purchase or 35% off when you subscribe and save. Start with your skin, start with supplements or try both. The choice is yours. And right now they're all at Timeline's lowest price of the year. Go to timeline.com/DrHyman, but don't wait. This special pricing ends October 11th. I've been a big believer in infrared saunas for a long time, but I really came to appreciate mine when I was dealing with mold exposure over 10 years ago. My Sunlighten sauna became part of my daily routine at that time, and I felt better every time I used it. So I never stopped. I'm still in it almost every day for circulation, recovery and managing stress.

• 2:07Dr. Mark Hyman?

  And a big part of that reason is simple. It just feels good. All I have to do is get in, sit down, and I'm supporting circulation, recovery and my ability to manage stress. Now Sunlighten's built on that with a new Amplify Red. More intense heat plus red and near infrared light working together for cellular energy and recovery in one session. Sunlighten has been working with infrared technology for more than 25 years. And I like that they continue to find new ways to build on something that already works for me so well. If you've been curious, this is the moment. Go to sunlighten.com and use the code HYMAN to save up to $2,100 plus get free shipping and other exclusive savings throughout the holiday season. Hey everybody, I've got some really exciting news. The Dr. Hyman Show is a finalist for two Signal Awards this year.

• 2:52Dr. Mark Hyman?

  Now, first nomination is for the best live podcast for my conversation with Halle Berry at Udemonia. We had an incredible discussion about menopause, women's health, and why we completely need to rethink how to support women through this stage of life. We're also nominated for my thought leadership for my conversation with Doctors Michael Okun and Ray Dorsey about the alarming rise of Parkinson's disease and what the latest science is teaching us about the connection between the gut and the brain, environmental toxins and a whole bunch more. And I'm really proud of both these conversations and now we need your help. Please help me. Voting is open through October 15th. Just head to vote.SignalAward.com and vote for the Dr. Hyman Show. And as always, thank you for listening, for watching, for sharing these conversations and being part of this community.

• 3:37Dr. Mark Hyman?

  We couldn't do it without you. Mina, welcome to the podcast.

• 3:41Speaker 01

  Thank you so much for having me.

• 3:42Dr. Mark Hyman?

  You know, I've never had a dermatologist on. I'm very excited about this because when I started practicing functional medicine 30 years ago and treating people's health issues, I would notice that their skin would get better by improving their nutrition, by optimizing their gut flora, by helping them get rid of toxins, by dealing with, you know, food sensitivities. And it was quite, it was quite amazing to me how things that were really chronic, persistent conditions, like dermatitis issues like eczema, psoriasis, acne, rosacea, like a lot of the bread and butter stuff. Just people have, it doesn't go away and it has to be managed. It has to be managed. It has to be treated with medication.

• 4:25Dr. Mark Hyman?

  It's, and you know, traditional dermatology is at least the way I learned it because I'm a family doctor. I learned dermatology, you know, basic dermatology, the basic stuff was to put lotions, potions, gels, salves, creams, whatever you could put on the top to actually fix the problem, whether it was steroids or antibiotics or any fungals or whatever the thing was. If it's wet, dry, if it's dry, wet, whatever, like the.

• 4:49Speaker 01

  Right, right. Yeah, that's how they teach that.

• 4:51Dr. Mark Hyman?

  And I came to quickly understand when I started practicing functional medicine was that the skin health is really coming from the inside out. Yes, if you have sun damage, yes, if you, you know, do things that harm your skin from the outside, it can be an issue. But a lot of skin health and the treatment of chronic skin conditions, which a lot of people suffer from, is from the inside out. And it's dealing with the foundational things of nutrition, of gut health, of optimizing nutrient status. And so I think that I kind of want to get into, you know, how you came into this field from a traditional dermatologist and sort of had this awakening that, and I know you kind of were sort of a little bit open to this because your mother's Japanese and you learned about Eastern medicine.

• 5:35Dr. Mark Hyman?

  And how you really kind of flipped the switch and said, oh, maybe there's a different way to approach these chronic dermatological conditions that cause so much suffering. So tell us how you kind of started to kind of understand that there was a different way of thinking about it. And let's sort of unpack some of the basic foundations of integrative functional dermatology.

• 5:54Speaker 01

  So like you mentioned, my mother's Japanese. So just from a young age, I've been exposed to alternative approaches to healing. Instead of just, you know, suppressing symptoms with, you know, over the counter medicine or prescription medicine. My mom would incorporate modalities to really get to the root cause or what I would think. And so it just kept me, you know, you know, gave me an open mind. And when it came to applying to medical school, I was like, do I want to go to a naturopathic medical school versus like an allopathic conventional medical school? And I was so torn and I decided, you know, if I went the conventional route and got my MD, I could always practice, you know, holistic forms of medicine, functional medicine with that background and.

• 6:39Dr. Mark Hyman?

  It's kind of the same you have to me. I was going to study Chinese medicine. I'm like, yeah, you know, like, I think about an MD behind my name, I can do more stuff.

• 6:44Speaker 01

  Yes. And oh my gosh, and as you know, like when you're in med school and residency, I just feel like I just got sucked into this vacuum. I was basically just trying to survive, like just studying all the time, not sleeping.

• 6:57Dr. Mark Hyman?

  Brainwashing.

• 6:57Speaker 01

  It really is. It's, it's so ironic, like just the health, like stress that we put our bodies through with medical residency and medical school. And so I definitely experienced a lot of health issues just going through all that. And, and really there's derm residency, even though derm is kind of a fun, more, you know, people think it's like a fun field. It's not as, some people don't take it as seriously as like, you know, thoracic surgery, but, but it's such a hard residency. There's such a learning curve because there's so much to learn in derm residency that you don't learn in medical school. And so I just kind of got sucked into that and went into conventional private practice. But I was always so interested in taking a holistic approach. Like I was president of the integrative medicine interest group during med school.

• 7:41Speaker 01

  And as I was practicing, you know, as you mentioned, we, we put a lot of, we focus a lot on skin, like topical treatments. We do a lot of systemic treatments as well, but so much of it revolves around suppressing inflammation.

• 7:53Dr. Mark Hyman?

  Steroids, you can use oral steroids, but that's another.

• 7:57Speaker 01

  Yeah, oral steroids. It's, it's.

• 7:59Dr. Mark Hyman?

  Like using a nuclear bomb.

• 8:00Speaker 01

  It's so, yeah, it's like using a nuclear bomb and long-term use. There's so many issues that come with that, but also even like biologics too, which are, they're, they're safer than steroids. But there are also a lot of ramifications with biologic use.

• 8:15Dr. Mark Hyman?

  And biologics, just to interrupt you for a second, is basically this class of drugs that is, suppresses your immune system.

• 8:20Speaker 01

  Yes.

• 8:21Dr. Mark Hyman?

  And, and you know, generally works well and doesn't have as much side effects, but does increase the risk of cancer and also lowers your immune system functions. So you're more likely to get serious infections.

• 8:32Speaker 01

  Yeah, more so with the anti-TNF class, the newer classes, they're becoming more specific, so they are more safe. But still, yeah, it's the premise of they're all suppressing your immune system. And it's just like, let's just shut up the immune system so that you can live in peace. But what I've noticed just practicing more and more is that it's not really getting to the root cause. Like I'm so grateful for these treatments because it makes people more comfortable. It makes them survive their day to day, but it's not really getting to the root cause.

• 9:01Dr. Mark Hyman?

  So how do you then think about approaching dermatology now from this new set of lenses and perspectives that you have about how skin health is really from the inside out and it's a systemic problem, not just a skin problem. Your skin is a reflection of what's happening in the rest of your body. So how do you think about that? How do you approach these patients who come in with these really intractable conditions that, you know, require basically a sledgehammer? We use sledgehammers in medicine.

• 9:26Speaker 01

  I know we do.

• 9:27Dr. Mark Hyman?

  And this is, you know, this is a different approach.

• 9:29Speaker 01

  So when somebody comes in, obviously take a thorough medical history, look at their background. But I also go beyond that and look at what they're eating, how they're sleeping, what the stress is like in their life. What hormonal changes they could be going through? Are they going through menopause? What are their environmental exposures? Are they traveling a lot? What kind of environment are they living in? And. You know, what are their, what's their exercise habit like? So really taking all of that into consideration and taking that into account before I come up with a treatment plan for them.

• 10:02Dr. Mark Hyman?

  So what tend to be the root causes that you're seeing like clinically in practice? Like, what are the things that are coming up over and over again that you're like, oh, I didn't learn this in residency or medical school, but this is actually something that is real, that when I change this thing, it works?

• 10:14Speaker 01

  I would say gut and hormones are like the two biggest things that we see when it comes to a lot of the major skin issues, whether it's acne, eczema, psoriasis, rosacea, hair loss even too. You know, we're not really addressing those in conventional dermatology. We have a lot of wonderful treatments, like I said, to suppress the symptoms. We have a lot of things that can help acne, whether it's spironolactone or isotretinoin, but you know, it's not really healing the underlying triggers.

• 10:46Dr. Mark Hyman?

  Yeah, that's true. Like I find that, you know, you start with nutrition and the gut, and then you kind of work on optimizing that. And then you kind of see what's left over. And then, you know, there are other things that might be playing a role, like you said, hormones, we'll get into that, mitochondria, we're going to have that, exercise, we'll get into that.

• 11:03Speaker 01

  Yeah, insulin sensitivity.

• 11:05Dr. Mark Hyman?

  Insulin resistance, which is a big thing for skin health, which people don't realize, which is affecting to some degree 90 plus percent of Americans. You know, function health with our diagnostics, we measure insulin on everybody, which is not something most doctors check. And, you know, we're looking at the reference range from Quest, which is 18 or above is abnormal. I mean, really optimal is probably less than five. I mean, I'm three, two to three, you know, as someone who's 66, who's healthy, who's fit, is like metabolically okay, because I know what to do. That's kind of optimal. But we're seeing even at the reference range of Quest, 65% of members of our over half a million members have high insulin levels.

• 11:50Speaker 01

  Oh.

• 11:51Dr. Mark Hyman?

  And have inflammation. You know, you probably are familiar with Nicholas Pericone, and he wrote The Wrinkle Cure way back when. And it was all about like inflammation and oxidative stress. And, and so the question is like, what is causing this inflammation? What is causing all this damage? And it's things that we can actually identify. So diagnostically, how do you think about approaching these, these patients with these chronic illnesses? What are you, what are you testing? What are you looking for? How do you sort of do an essential differential diagnosis, but based on a new set of lenses that you're looking through?

• 12:23Speaker 01

  There's people who come in wanting to, you know, help their skin with wrinkles and like, kind of coming in for anti-aging treatments. So that's a separate kind of diagnostic approach. But for people coming in with chronic inflammatory issues, whether it's acne, psoriasis, eczema, I do think that it's really important to look at their gut health. And I will often collaborate with other functional medicine docs or naturopathic doctors to do gut testing and really do a thorough examination. Is there yeast overgrowth? Is there an imbalance somewhere there? We do know that there are higher rates of SIBO in rosacea, like that's been established, higher rates of helicobacter pylori. And, you know, we see that in acne as well, really looking at that and targeting those things. If, if they show signs.

• 13:08Dr. Mark Hyman?

  Even fungal overgrowth for rosacea.

• 13:10Speaker 01

  Oh, fungal overgrowth, definitely. When people come in with acne, another thing I really like to look at is their insulin sensitivity or their resistance, testing their insulin level. And even looking at the ratio of insulin to their fasting glucose, I think gives it even a more accurate picture of what's going on with their insulin sensitivity. And yeah, in terms of testing, those are the main things. And like I said, if we need to do more extensive testing, like Dutch test to look at their hormones more closely, I will include, you know, another collaborative physician who, who has more experience in that. But I do think that patients get frustrated and they're like, I just want to know why I have this. They're, they're grateful for medications, but they're like, if I stop it, then it comes right back. So it's, it's, it's not really solving, you know, the deep issue.

• 13:54Dr. Mark Hyman?

  Now, I also find that checking gluten sensitivity and antibodies to gluten is a big one, especially for certain conditions, whether it's psoriasis or, there's a lot of data that gluten can be a player.

• 14:05Speaker 01

  Yes, yes. There, yeah, even like the, in non-celiac patients, gluten can be a player in certain forms of psoriasis, because some people with psoriasis can test positive for those antibodies. And for those patients, I do tell them to stay away from gluten. And then like some random other like dermatitis players, we can see gluten sensitivity.

• 14:23Dr. Mark Hyman?

  And acne is another one, acne is a big one, you know. You mentioned insulin resistance, but again, like, you know, when you have high insulin, in women particularly, it can cause high testosterone, and then sugar. So sugar is a big factor in causing acne. People don't realize that.

• 14:41Speaker 01

  Oh, huge. Yeah, sugar and dairy.

• 14:43Dr. Mark Hyman?

  Sometimes when you're craving something sweet, the answer isn't necessarily to have more willpower. It's worth asking what your body might actually be asking for. And one thing I paid attention to was whether I'm getting enough protein throughout the day. Protein is important for satiety, for muscle, for providing the essential amino acids our bodies need. And that's one reason Perfect Amino's has become part of my daily routine. I take it every day because it's a simple way to supplement my protein intake with all nine essential amino acids without adding a lot of calories. I especially like having on days when I'm traveling, working long hours, or just know that I haven't gotten enough protein from food. It's a small thing, but for me, it's become an easy part of my everyday routine. If you're looking for help to fill protein gaps, go to bodyhealth.com

• 15:25Dr. Mark Hyman?

  and use the code HYMAN20 for 20% off. If you've been listening to this podcast for a while, you probably heard me talk about Seed. The probiotic category is full of big promises and not always a lot of proof to back them up. But DS01 is different. It's the number one digestive health probiotic. And when you look at the science behind it, it's easy to understand why. There are three things that set it apart. First, it contains 24 unique probiotic strains to support the diversity of your gut microbiome. Second, it's capsule in capsule technology, help protect those strains through digestion to reach the colon, where most other probiotics just die in your stomach acid. And third, DS01 has been clinically studied and is shown to reduce bloating, alleviate gas, and improve regularity. It's

• 16:08Dr. Mark Hyman?

  not just marketing, that's real clinical evidence. And that level of scientific rigor, it's exactly what led me to join Seed's clinical board, and why I continue to recommend DS01, and take it myself even after all these years. Go to seed.com/hyman and use the code 25HYMAN to get 25% off your first month. That's S E D dot com slash hyman and use the code 25HYMAN. And dairy, dairy is another one. And I personally have that. If I have dairy, like especially if it's like a American, you know, regular dairy, but it's not, or A2, or regenerative, or whatever, like, or sheep or goat, I get pimples. Like, it's like clockwork.

• 16:49Speaker 01

  Yeah.

• 16:49Dr. Mark Hyman?

  If I eat much dairy, I get pimples. And so, you know, and I've seen this to my patients. So dairy and sugar, and you think about the acne industry, I mean, it's huge.

• 16:59Speaker 01

  Yeah, well, it's huge. And like, if you talk to, you know, like my partner who'd been practicing for 40 years, she said, we did not see this much adult acne, that, I mean, teenage acne has been around for a while. But adult acne has been rising in the last few decades. And it's like, it just makes you wonder what else is going on in our environment. Yes, I think that agricultural practices have changed, like what we're feeding cows, and like, that could be affecting milk, the meat, all like the other endocrine disrupting chemicals that could be out there.

• 17:27Dr. Mark Hyman?

  And glyphosate destroys the microbiome.

• 17:29Speaker 01

  Yeah. I mean, we're seeing more acne alongside like more rates of hypothyroidism, more hair loss, more infertility. Like, there's something going on in our environment that's, that's affecting our whole endocrine system, I think, because these are all hormone based, a lot of it.

• 17:44Dr. Mark Hyman?

  Yeah.

• 17:45Speaker 01

  And like, I also have my other theories. Like, I do think that we live in a more stressed environment too. Stress is so huge when it comes to acne, as well as, you know, all these other inflammatory skin issues that we see. Stress can, you know, increase cortisol. So cortisol just sends a whole cascade of signals, including just like increased inflammation in our skin, increased, it makes our SIBO more sticky. So like, we get more acne from that too. And yeah, so, so we see that. And, and I'm telling people to stop drinking coffee, but sometimes I do think that it can, if people drink too much caffeine or consume too much, that can artificially increase like their stress response in their bodies too. So that's something I also talk about with patients. I'm like, what's your sleep

• 18:26Speaker 01

  like? How much caffeine are you consuming? I sort of go in there as well.

• 18:31Dr. Mark Hyman?

  Yeah. I don't know if you kind of adhere to this theory, but a lot of these skin conditions are inflammatory.

• 18:35Speaker 01

  Oh, yeah, yeah. Inflammation, I would say is the base for everything.

• 18:38Dr. Mark Hyman?

  Yeah. And so typically in medicine, we use anti-inflammatories, or immune suppressants, or steroids, basically to calm inflammation down. But rather than going to the root of like, why is there inflammation? So could you, could you share a little bit about like your experience with some of these things and, and what you've seen?

• 18:54Speaker 01

  When it comes to, you know, I'm just trying to think of like patient examples. I had a patient with terrible acne, and she had all these side effects to the conventional treatments, spironolactone and isotretinoin. She would respond to them, but she kept on getting.

• 19:15Speaker 01

  Like, like so spironolactone can affect your periods and she was not having her periods, which, which wasn't the problem, but she was also just getting a little bit too dehydrated from it, like it was causing her heart to race.

• 19:28Dr. Mark Hyman?

  That's it. It's kind of a diuretic that also blocks testosterone. So it can help with acne.

• 19:32Speaker 01

  Yeah. And then with isotretinoin, she was getting joint pain. So we were working with a functional medicine doctor and she did some gut microbiome testing on her and saw that she did have yeast overgrowth and, and fixed her, fixed her yeast, but she also did some hormonal testing as well and gave her certain supplements to just help kind of with the hormone balancing and her skin clear. She didn't need any conventional treatments, which I was thrilled about, honestly.

• 20:00Dr. Mark Hyman?

  Yeah.

• 20:01Speaker 01

  And yeah, and then, you know, when, when I talk about when, when patients come in, like psoriasis too. So with psoriasis, I find that these patients have so many other issues going on. They have cardiovascular issues like metabolic syndrome. So, and then prediabetic, they have hypothyroidism, they have low vitamin D. There, it's like a full picture with, with psoriasis. So, so I, I try to also do other workup. I, I do look at their thyroid. I do look at their lipids and the vitamin D and, and make sure that we're addressing all of those things. They're usually sleep deprived. I find that a lot of people who do like night shifts where their circadian rhythm is completely flipped

• 20:45Speaker 01

  upside down. That really sets off psoriasis. It sets off a lot of inflammatory skin issues, but we do see circadian rhythm disruption being a huge one with psoriasis.

• 20:54Dr. Mark Hyman?

  Yeah. I've seen a lot of psoriasis patients and I find it's one of the slam dunks of functional medicine. And even though it's such a, they call it the heartbreak of psoriasis. It's like, you know, and the things that I found were gluten are really top of the list. So anybody who's got that, I get checked for sure. Gut issues and particularly gut and food sensitivities on top of that. And, and also overgrowth of yeast, which is a common one.

• 21:17Speaker 01

  Yeah.

• 21:18Dr. Mark Hyman?

  And then heavy metals, which are kind of often overlooked. And so

• 21:20Speaker 01

  Yeah.

• 21:21Dr. Mark Hyman?

  If you kind of dig around in those, usually you can find a way through. Uh, you need to find a good practitioner like you or a functional medicine doctor to do, because it's something that traditional doctors even think about.

• 21:29Speaker 01

  They don't. I know. And I wish, there's a lot of like people, I don't know, I feel like a lot of controversy out there on like doing some of these forms of testing, but, but to me, we, we don't have all the answers with the conventional testing. And so, yeah, I know, I really appreciate like your mission to, to really bring about these other forms of how do we find out the root cause of these patients, whether it is with heavy metals or gut microbiome testing.

• 21:55Dr. Mark Hyman?

  And the truth is, there's not a lot of research money going towards these modalities of nutrition, of gut health, of things that are really kind of not long-term treatments. Cause think about it, like you, if you get someone on a drug for, you know, acne, like a, a retinoid, I mean, they're kind of on it. So it's like, it's great for the drug company. Like, uh, but if you treat someone and they get better and they're off everything, that's not so good. So there's not a lot of incentives for doing the foundational things. It doesn't mean that because there's a lack of like large double-blind randomized controlled trials, that it doesn't work. I would say the absence of evidence is not the evidence of absence. And I think, you know, as a clinician, I'm observing things over and over like

• 22:38Dr. Mark Hyman?

  you are, and I'm seeing that, you know, there's a there there. And yes, we need more research and thank God the, the Medicare, the Center for Medicare and Medicaid Innovation put up a hundred million dollars to study chronic diseases using functional medicine and lifestyle medicine, which is amazing. There's, there is some things happening, but that's, that doesn't mean we can't already just take advantage of these things. Cause they're generally low cost, they're low risk, and they're very safe to do, changing your diet, changing your lifestyle, exercising, taking a few supplements. Let's talk about nutrition and the skin. What, tell me your philosophy around what should be like a healthy skin diet? And also like what do you use when you start to treat these chronic issues like psoriasis or eczema or acne or so forth?

• 23:18Speaker 01

  Yeah. When it comes to a healthy skin diet, most of the evidence comes back to a Mediterranean-based diet. Basically I would just call it like a well-balanced diet. So adequate protein, adequate healthy fats, low sugar, adequate fiber. I think fiber is also an underrated thing. We're seeing definitely low fiber correlate with a lot of issues, a lot with acne. Um, but anyway, so, so that's the basic premise, but we also want to make sure that we're adding like adequate nutrients, vitamin C, polyphenol-rich foods or supplements. But, but I would say foods would be the, the best route if you can do it. And other flavonoids as well as like carotenoids are huge as well, whether it's like beta carotene

• 24:00Speaker 01

  or astaxanthin. So foods rich in those ingredients. I, it's tough because I, I try not to be overly restrictive with patients. I feel like it ends up backfiring. Um, but I'm like, if we can at least make the goal of making it more balanced, you know, making sure you're having your fruits and vegetables. I know that sounds so cliche, but doing that and making sure you're having adequate fiber, healthy fats, minimizing the processed foods, minimizing the sugar. That's where we have the most evidence.

• 24:26Dr. Mark Hyman?

  Those are foundational principles for general skin health. But then when it comes to people with chronic conditions, like I, I find that elimination diets can be a great place to start.

• 24:35Speaker 01

  Yes.

• 24:36Dr. Mark Hyman?

  Basically gluten, dairy, sugar, processed food. It's like, it just makes such a difference.

• 24:40Speaker 01

  It makes sense. So where we have the most evidence for acne, it's, it's dairy and with sugar. When it comes to dairy, it's more so skim milk than it is whole milk. But, but the evidence is pretty compelling for really all forms of dairy. Uh, and then when it comes to, and then, and then increasing fiber too. We, we're seeing that lack of fiber is also contributing to acne.

• 25:02Dr. Mark Hyman?

  And it affects the microbiome.

• 25:04Speaker 01

  Yep, exactly. Yep. And then there's also this idea where if you're not, you're in a regular with your bowel movements, it can cause a buildup of like certain hormone metabolites as well that could potentially contribute to acne. So something to think about. When it comes to psoriasis, most of the evidence, like I mentioned, is Mediterranean diet, healthy fats. I try to supplement with omega threes and vitamin D and then gluten. It's interesting from what I learned is that if, if they do have a sensitivity to gluten with like certain antibody testing, then I would definitely have them go gluten-free. I'm not as adamant about it if they're negative with those tests.

• 25:41Dr. Mark Hyman?

  I find it's worth trying because there's, there's two parts of your immune system is, as obviously you know, but for people listening, there's the one that's forming antibodies, which we can test for. And there's the one that doesn't form antibodies, which is the ancient immune system or the innate immune system that doesn't form antibodies. And there's a, there's a good body of literature that a lot of people react to gluten from the innate immune system, which is not measurable. So I, I find it often like a good, you know, it, it, you know, just is a good kind of test for like two or three weeks.

• 26:11Speaker 01

  Yeah.

• 26:12Dr. Mark Hyman?

  And not forever. And then, and then you see, what are like other foundational nutrients you recommend for the skin? You mentioned omega threes, vitamin D.

• 26:18Speaker 01

  I keep it pretty basic. Omega threes, healthy fats in general, whether it's, you know, avocado, nuts, fish. I mean, not all the time, but you know, kind of the, you know, incorporating the ones that are smaller. Like I like sardines. I mean, if you get wild-caught salmon, great. And then when it comes to, um, other things to incorporate more fiber, so that's just vegetables in general, fruits in general. But there's really not like one specific thing, you know, I meant, like I mentioned carotenoids. I tell people really try to eat the rainbow. And I know you've like mentioned this too, for, for in general, for like, for skin issues, but, um, there's not like, oh, if you eat more of this specific food, you're gonna, you're gonna get all better.

• 26:59Dr. Mark Hyman?

  Yeah. Well, Nick, Nicholas Perrin was talking about like wild salmon. I think the omega threes are so big. I find that if I would say like, what is the one clearly like clinically effective skin nutrient that I've used over and over again for skin, hair and nails? It's omega threes. If someone's low in omega threes and a function health, we test everybody for the omega index. And, you know, you want to be over eight percent. And most people are not. Most people are quite low. And so, you know, we don't get a lot of, you know, wild animals or wild plants or wild food, which is where typically these omega threes are. So I think it's important to supplement. Talk about how hormones play a role in skin and how, and I know you've talked a lot about sort of female health

• 27:42Dr. Mark Hyman?

  and reproductive health and, um, some of the things that happen around menopause. Like, tell us about how, how you help think women think about their skin health.

• 27:50Speaker 01

  Yeah.

• 27:51Dr. Mark Hyman?

  And then, and then we will get into the aging and that like, how, because I think we've been talking clinically about what are the health, uh, pathologies, let's say, which are, you know, diseases of the skin. But then we're going to get into like, just how do you make sure your skin ages well?

• 28:04Speaker 01

  Yeah.

• 28:05Dr. Mark Hyman?

  And that's, that's sort of topic too, we'll get to, but I want to sort of, sort of just talk about sort of hormonal dysregulation, because you did mention gut and hormones as key drivers of skin dysfunction.

• 28:13Speaker 01

  Huge. Yeah. There's different types of hormones. There's estrogen, progesterone, testosterone, the sex hormones. And then there's also thyroid hormone, which plays a big role with a lot of skin issues. And then insulin being another hormone. So I, I see all of those playing a role with how we age and how that can contribute to inflammation in our skin. So. I mean, just to kind of touch on each of them, when we see thyroid issues, we see more dry skin, we see brittle nails, we see more hair loss, we see, yeah, just like decreased wound healing time, just like the circulation's not as robust. So, so, you know, when I see those issues, anytime somebody comes in with hair loss, I always check thyroid. When it

• 28:56Speaker 01

  comes to insulin, we talked about acne, so insulin resistance, we see more so in acne, we can also see it in psoriasis, it can also contribute to accelerated aging. So that's something we like to look into. And then when it comes to the sex hormones, and you mentioned menopause, so, you know, we have a drastic drop in estrogen when, like, within the first five years of menopause. And estrogen is huge when it comes to just overall skin health. It plays a role, and testosterone as well, testosterone goes down too. And I'll talk about what the benefits are, but, but with estrogen, it's, it activates fibroblast activity. These are the cells that help build collagen. So that's, that's how, you know, collagen production goes down. It also contributes to increased, like, hydration in the skin,

• 29:39Speaker 01

  whether it's increased hyaluronic acid, or just increased lipid production in our cells. So, so our skin barrier becomes altered, our skin becomes more dry when we have less estrogen. And it also plays a role in like the thickness of our skin. So we have what's called epidermal atrophy. And that's where you get like that, kind of that creepy skin, kind of in that post-menopausal period. So estrogen plays a really big role with that. It works alongside progesterone. And then like testosterone, testosterone's really huge when it comes, and the androgens in general, when it comes to like oil production. And so that plays a role with skin barrier dysfunction. That's why we always see dry, itchy people as they get older. Everyone just gets more dry.

• 30:17Dr. Mark Hyman?

  So are you a fan of hormone replacement therapy for women?

• 30:20Speaker 01

  I am a big fan. I think it does wonders for your skin. Yeah.

• 30:23Dr. Mark Hyman?

  And how good is the, how good is the data on that?

• 30:26Speaker 01

  Uh, we haven't really, there, I don't think there's like been a lot of amazing studies that are dedicated to looking at skin health. And I would love for there to be more. It's more just, it's kind of a side effect that we've been seeing.

• 30:38Dr. Mark Hyman?

  So you basically clinically observe this. And, and, and I think it's true. I think women do notice that. And I think, you know, like you say, that these hormones are really play a role. So you've talked about insulin resistance, you've talked about thyroid dysfunction, then you talk about, you know, sex hormones, all playing a role. So I think, I think, you know, getting your hormones tuned up is super important. And as particularly women, as they go through perimenopause and menopause, there's so many things that start to happen. They get more insulin resistant, their thighs often go wacky, their sex hormones are going wacky, and everything's gonna, and then there, of course, their stress hormones are going wacky, because they're in the middle of this sandwich generation with older parents and younger teenage kids and, you know, careers. And it's like, it's kind of a soup of dysfunctional

• 31:18Dr. Mark Hyman?

  hormones, of insulin, thyroid, sex hormones, and cortisol, and stress hormones. So I think, I think that, that, that's often not really well addressed with traditional medicine. But there's ways to look at these things, there's ways to understand where you are, there's ways to work to optimize your health with these, both with, you know, hormone replacement therapy, but also lifestyle, diet, and so forth. Let's sort of get into the skin aging, because I think it's a sort of a separate topic that I want to dive into. But I, just before we do that, I just want to close on this first bit by saying that if you have a skin issue, if you have psoriasis, or eczema, or rosacea, or acne, which are the most common ones that I forget any, that I forget any.

• 31:57Speaker 01

  Yeah.

• 31:58Dr. Mark Hyman?

  Yeah. These are the bread and butter, right?

• 32:00Speaker 01

  The bread and butter of life.

• 32:01Dr. Mark Hyman?

  These, these are things that have solutions, that you're not necessarily hearing from your regular dermatologist, that a functional medicine approach, integrative medicine approach can really help solve. And sometimes it takes a minute to figure it out, to unpack it, to be detective, but it's, it's worth going into that route. And sometimes it does mean modifying your life a little bit. Like, sometimes you can't eat gluten, sometimes you can't eat dairy, sometimes you have to fix your gut, sometimes, like, there's things you have to do.

• 32:26Speaker 01

  It takes work, which is why I think so many people don't do it, too.

• 32:29Dr. Mark Hyman?

  Yeah, but, but the other alternative is just to be miserable.

• 32:32Speaker 01

  Exactly. I don't know, for sure, for sure. Yeah.

• 32:34Dr. Mark Hyman?

  I had quite an amazing patient, I'll just tell you quickly, who has psoriatic arthritis, which is like an advanced form of psoriasis that affects the joints.

• 32:41Speaker 01

  So hard.

• 32:42Dr. Mark Hyman?

  That is a tough condition. And at Cleveland Clinic, we did a, we did a study where we took our patients in our Center for Functional Medicine, we're treated by the functional medicine doctors who has psoriasis or rheumatoid arthritis, comparing it to the rheumatology patients in the rheumatology department, which is rated number one in the world for rheumatology at Cleveland Clinic. So these people know what they're doing. They're really good. And they're treating, and they, and the fellow looked at our data, we didn't analyze the data, they looked at our data, they used all their traditional rating scales for, that they have in medicine for rheumatology. And we did better across the board in outcomes, using functional medicine, not using drugs, compared to them using all the drugs.

• 33:22Speaker 01

  Doing the usual things, like looking at their gut.

• 33:24Dr. Mark Hyman?

  The gut health, nutrition, yeah, everything, elimination diet, the usual stuff. And it was like, I think it was shocking to them, but it was like obvious to me. And I had a patient who was a psoriatic arthritis patient who had multiple other issues. She had prediabetes, she had migraines, she had depression, she had irritable bowel, she had reflux, and obviously psoriasis, and arthritis. And she was taking Stelara, which is a very expensive immune suppressing drug. And she was taking a bunch of other drugs, like her neurologist, and her psychiatrist, and her gastroenterologist, and her endocrinologist for her diabetes, and her prediabetes, and her migraines, and her, you know, psych. And they're all like, these are the best doctors in the world, and they're giving them the best treatments for their, but they're all treating like a, like a blind man and the elephant. And I'm

• 34:06Dr. Mark Hyman?

  like, what is the common denominator in this patient? It's inflammation. All these migraines are inflammation, prediabetes inflammation, irritable bowels inflammation, reflux inflammation, joint pains inflammation, actually psoriasis and skin inflammation. And I said, look, I don't, uh, she has severe bloating and severe, like, reflux and all these symptoms. I think you have SIBO, which is bacterial overgrowth, and I think you probably also have fungal overgrowth, given how many antibiotics or steroids you've been on. And so I basically gave her an absorbent antibiotic, rifaximin, and I gave her an antifungal, not typical treatments for psoriasis. And I gave her some probiotics and vitamin D and fish oil, I think probably zinc or something, and not a lot. And then I put her off gluten, dairy,

• 34:50Dr. Mark Hyman?

  sugar, processed food. I basically put her on my 10-day detox diet, which essentially is an elimination diet, to get sort of all the potential triggers for short term. She came back six weeks later, and she said, I'm better, like, I have no psoriasis, no arthritis, I stopped all my meds. I said, I didn't tell you to stop your meds. She said, well, I know, but I felt better. No migraines, no prediabetes, she lost 20 pounds, no more reflux, no more irritable bowel, and no more depression. And depression is also inflammation, right, in the brain. And so I was like, this is, this is an example of a way that, you know, traditional medicine misses the boat. Like, they just kind of don't understand how to think about the problem. And then by using these other sort of filters to see the same

• 35:35Dr. Mark Hyman?

  symptoms and the same diseases, we see a different set of issues that are going on. And it's almost like we put on special glasses, like you put on infrared or night vision glasses, and you was like, oh, I see what's going on. And then she, you know, she, but, but this is not, people say, oh, it's an anecdote or whatever. And I'm like, yeah, I, I've done this for 30 years. And I can tell you, there's hundreds and hundreds and thousands of patients across the spectrum of different diseases that have responded this way. And not everybody responds to everything. And sometimes it's a puzzle. And like, I had a patient with eczema, couldn't get better. And then I figured out it was mercury. But it's just, it's, it's really about being persistent. So if you're listening out there and you have these issues, don't give up. There's a way forward. You might have to change your lifestyle, but it works. Let's get into, let's get into aging. What's happening

• 36:20Dr. Mark Hyman?

  in terms of, like, skin as we age? Like, what goes wrong? And how do we, how do we improve? Because you see some people like, who look like 100 when they're 45, and people who are like 90, who look amazing.

• 36:31Speaker 01

  Oh, yeah, there's different things happening at the different layers of our skin. And I'll just like briefly touch on it. So, you know, the top layer, the epidermis, as we get older, our cellular turnover gets more sluggish, it slows down. So that contributes to just kind of more dull, uneven skin. And I think of that phrase, like, smooth as a baby's butt, because literally, like, babies, their skin cell turnover is every two weeks. As adults, it's every four weeks. But then, like I said, as we get older, it just becomes more sluggish. So, so that's what creates like the buildup of dry skin and like uneven skin tone. So there's that. And then, you know, we have our melanocytes, which sit at the base of our epidermis, and these are the cells that produce pigment. And their activity just becomes more like unpredictable, like some just poop out. They're like, I'm

• 37:14Speaker 01

  just gonna like, release all this pigment. And we get like more sunspots and like uneven pigmentation as we get older as well. And then we're also, you know, producing lipids and we have sebaceous glands that are living in the dermis, but then they get released into the epidermis and lipids are also responsible, like I mentioned earlier, for keeping our skin hydrated, keeping our skin barrier intact. So as we get older, we get more dry skin. And then below the epidermis, we have the dermis and the, probably the biggest component is collagen, which sits in the dermis. And I mean, there's other components, elastin, hyaluronic acid, or what we call glycosamine glycan, which are these sugar molecules like hyaluronic acid that sort of like live between the collagen fibers and support the collagen and elastin. And as we get older, we get breakdown of collagen, we get more disorganized collagen

• 37:59Speaker 01

  and elastin, and that contributes to wrinkles that we see. And that's a natural part of aging, but there are certainly things that accelerate that, which we can talk about. Below the dermis is the subdermis or the subcutaneous fat, which, you know, as we get older, fat decreases as well. And then below that is bone. As we get older, like our bone, our bone starts resorbing and like, yeah, yeah, we have decreased bone structure. So like, I think of it like a mattress, you know, like the mattress cover is like our epidermis and then the springs are like your dermis and then the actual bed frame is your, you know, your bone structure that's supporting everything. And so, so we need all of that to look like a very appealing bed.

• 38:38Dr. Mark Hyman?

  From your perspective, given what you know with functional dermatology, how do you think about skin differently with aging? How do you, how do you help people take care of their skin differently with nutrition, lifestyle, hormones, gut, supplements?

• 38:52Speaker 01

  I know.

• 38:53Dr. Mark Hyman?

  And skincare. Cause topical stuff does matter.

• 38:55Speaker 01

  It does matter. And yeah, if you were to ask a conventional dermatologist, there, you know, there are a lot of things that we have so much evidence for, decades of evidence, topically that can help your skin, whether it's retinoids, sun protection. There's other things like vitamin C, like topical antioxidants.

• 39:10Dr. Mark Hyman?

  Yeah.

• 39:11Speaker 01

  But, but there are also things that we can do internally that really help our cellular activity, repair the cells. And like you mentioned, nutrition, stress, sleep, other like environmental like stressors. I mean, we know that UV is huge, but whether it's pollution or like, and like other, like endocrine disrupting, you know, chemicals, these all come together. And then also just being sedentary too. These all just come together and accelerate aging. Oh, sorry, I forgot to mention cigarette smoke. I mean, a lot of people I feel like are not smoking cigarettes as much these days. People still do, but cigarette smoke is huge.

• 39:46Dr. Mark Hyman?

  Europe they do.

• 39:47Speaker 01

  Yeah, very common there. But yeah, cigarettes and alcohol definitely just create more inflammation.

• 39:52Dr. Mark Hyman?

  Okay, cigarettes, I think people understand if you smoke, you look kind of haggard and you get wrinkles fast. And if you want to wrinkle and age quickly, definitely smoke. But alcohol, I, I don't think people know. Can you talk about alcohol and skin?

• 40:04Speaker 01

  Yeah, alcohol can accelerate skin aging. So our bodies are exposed to a variety of different toxins, but our liver thankfully is there to help stop, or to help just kind of decrease that toxic burden. But when that burden accumulates, if our liver is stressed or distracted by things like alcohol or potentially other medications, then that toxic burden can increase and increase stress on our cells, what we call like oxidative stress. And that causes cells to not function as well. So when it comes to collagen, we're not building collagen. Inflammation from oxidative stress can also break down collagen more quickly without.

• 40:40Dr. Mark Hyman?

  So Nicholas Pericom was right, oxidative stress and inflammation are a key to skin breakdown and aging.

• 40:45Speaker 01

  Huge, yeah.

• 40:46Dr. Mark Hyman?

  So, so you mentioned collagen a few times. People hear about collagen and they take collagen.

• 40:53Speaker 01

  Right.

• 40:54Dr. Mark Hyman?

  Supplements. Is that a thing? Like, is there data on it? Is it just?

• 40:59Speaker 01

  Yeah.

• 41:00Dr. Mark Hyman?

  Is it just window dressing? Like, what is actually going on with the?

• 41:02Speaker 01

  Yeah.

• 41:03Dr. Mark Hyman?

  Industry? Cause you know, people think, oh, I'm taking collagen, I'm getting collagen. Is that actually happening?

• 41:07Speaker 01

  I know, it's, it's not a straightforward answer. I would say overall, yes, I think that there's enough data to support collagen consumption. But, you know, a lot of the data that is pretty compelling is industry backed. So you kind of have to take that with a grain of salt. Anecdotally, I do see, I do see a lot of improvement in patients who do take collagen peptides. And yeah, just because you take collagen peptide doesn't mean that that collagen goes to your skin. It's more so that the collagen peptides can send signals to help your body build better collagen. But I also advise patients, you, I'd rather you also get better sleep, get sun protection, decrease the stress in your life, strength train.

• 41:49Speaker 01

  I would rather, like have that all dialed in before you're incorporating collagen peptides. I don't think it's like the easy switch to just add collagen peptides.

• 41:55Dr. Mark Hyman?

  To can't eat crap and be stressed and not sleep and just take a bunch of collagen supplements and think you're fine.

• 42:01Speaker 01

  Yeah, exactly. But the short answer is yes, I do think that. I'm on team collagen.

• 42:05Dr. Mark Hyman?

  Okay, great. Amazing. I think that's helpful. I think I've always wondered, cause I, you know, I think they're, they're good in the gut and they can be, but I always wondered, do they get really absorbed and used properly? But the other thing sort of, we didn't really get into yet was sort of the, the sun.

• 42:20Speaker 01

  Yes.

• 42:21Dr. Mark Hyman?

  You know, I think UV radiation. And then, you know, when you get a sun burn, that's because the sun's creating oxidative stress and inflammation and damaging the skin. And that's why you get it sunburned. And that, and that creates lasting damage. How, how does that work? And, and, and what happens in the mitochondria in the skin? Because we didn't really talk about mitochondria, which are basically little energies, powerhouses in the cells, but they are also key to skin health. And, and can you kind of tie that together or how all that connects?

• 42:52Speaker 01

  UV radiation is probably the number one extrinsic factor that contributes to skin aging.

• 42:58Dr. Mark Hyman?

  So beauty from the outside in, but also sun from the outside in.

• 43:01Speaker 01

  Sun.

• 43:02Dr. Mark Hyman?

  Inside out and outside in.

• 43:04Speaker 01

  Yeah. I mean, yeah, we know genetics plays a role and all these other things, sleep, stress, nutrition, exercise, these all play a role, but, but we, but by far it's, and smoking too, but by far it's, it's UV radiation. And yes, as you mentioned, it increases oxidative stress in our cells. Basically it's, it's causing like a localized stress response within our cells and it's causing DNA damage. And you know, it's all fine because if you're healthy, we have the DNA repair mechanisms in place that go in and like repair that DNA. We have like the antioxidants that can fight those free radicals, those unstable molecules from oxidative stress. And you know, we can repair and heal from that, but with enough hits, your body's like, okay, like we've done enough. And that's why you see those, the consequences of just prolonged and like just chronic sun

• 43:49Speaker 01

  exposure come out later in life, because it's like your body has already done so much to try to combat that, that it just comes out later in life. And so when you have this oxidative stress within your cells from UV radiation, it affects the function of the organoids and namely mitochondria. The mitochondria, I mean, as we age, mitochondrial function does decline, but, but stressors like UV, UV radiation definitely accelerates the, the mitochondrial dysfunction within the cell. So when your powerhouse of the cell, the mitochondria aren't working as well, then that cell itself will create more oxidative stress to your body. And, and like your body just has a harder time like fighting it, like it's almost winning.

• 44:32Speaker 01

  And then, so when your cells aren't working well in the skin, you get more collagen breakdown. Like those are like the fibroblasts, which are the cells that make your collagen. Yeah, don't work well. And then, yeah, it just continues. And then like your epidermis, the keratinocytes, the top layer of your scalp, they're, I mean, our skin's a dynamic, living, breathing organ. You know, we think the skin's just there to like make you look good, but no, it's doing so much. It's, it's, our cells are constantly regenerating, we're building things. So when you have that mitochondrial dysfunction, which like in addition to UV radiation could be from a bunch of other things, but when you have that, then yeah, that's, that's where you can see a lot of cellular aging and then skin aging from that.

• 45:07Dr. Mark Hyman?

  Something people don't really talk about is like, you know, skin health related to mitochondrial health and how much energy it takes to have a healthy skin. As we age, you said the mitochondria become more injured and damaged just because of aging itself, because of some resistance, because of generalized inflammation in the body, because of sun damage, because of poor diets, because of all these reasons that we, we accelerate mitochondrial injury. And it doesn't just affect the energy in, in the cells and our tissues and organs, but in our, in our brain, but also our skin. And I think some people don't really realize, and then I would love you to talk about this process of sort of how do we, how do we take care of our mitochondria? And how do we think about like the repair, regeneration, renewal of mitochondria? There's a concept in medicine called autophagy, which means cellular cleanup essentially means

• 45:52Dr. Mark Hyman?

  self-eating. Like at night when we sleep, our bodies will gobble up with lysosomes, all these old parts and recycle them. But also the mitochondria have a process like that too.

• 46:02Speaker 01

  Yeah.

• 46:03Dr. Mark Hyman?

  Called mitophagy. So can you talk about mitophagy and, and skin and how that all connects? And how accumulating damaged mitochondria leads to more skin aging? And how to use mitophagy to help clear and fix that for healthy skin aging?

• 46:15Speaker 01

  Yeah, there's, there's, and there's multiple ways to address mitophagy. So yes, mitophagy is what you said. It, it helps clear out that kind of the damaged mitochondria, the mitochondria that aren't functioning, because they're really just like taking up space and then the cells aren't working as well. So to optimize mitophagy, we want to decrease the stress in the cell, oxidative stress in the cell. So doing things like, you know, decreasing processed foods, those can, you know, add to the stress in the cell, decrease UV radiation. And that's a whole nother topic, because I know the sun is important too.

• 46:49Dr. Mark Hyman?

  Vitamin D.

• 46:50Speaker 01

  Vitamin D, all of that. But there's a way to do it responsibly. But yes, but, but minimizing like chronic UV exposure. So there's that, there's nutrition, actually.

• 47:01Speaker 01

  You know, sleeping adequately, sleep is when we're doing so much repair, not only, you know, within our, within our skin cells, but like our whole body. So, so important. And then, uh, stress, minimizing stress, stress contributes to more oxidative stress, literally within our cells. So minimizing that. I know we've talked about strength training. When it comes to, to exercising, we know it's nourishing ourselves, like with the circulation, but it's also, you know, improving things like insulin sensitivity. And when you, when you have just all these other markers functioning better than, unless, and you have less inflammation, your, your mitochondria are going to work better. So by minimizing all these things.

• 47:41Dr. Mark Hyman?

  And also increases the number and, and the

• 47:44Speaker 01

  Yeah, the number of mitochondria.

• 47:45Dr. Mark Hyman?

  Function of mitochondria of exercise.

• 47:47Speaker 01

  Oh, yeah, definitely. Yeah, yeah. I know. Exercise, I think it's like so amazing for mitochondria. And, and there's also supplements that you can take too. Like it's, it's, we live in a toxic world. So it's hard to, to really combat all of these stressors with our bodies. I mean, yes, we, we do have

• 48:03Dr. Mark Hyman?

  You need the foundations, but supplements help.

• 48:04Speaker 01

  The foundation, but supplements do help. And things that are anti-inflammatory are helpful. I mentioned, you know, we talked about omega threes for a while. And then, you know, vitamin D supplementation can also help with that oxidative stress too, actually. And, um, and then I'm also a fan of things like Urolithin A, where it really does target mitophagy directly. And you, you can get some endogenous Urolithin A, like, you know, it's a byproduct of, uh, like things like walnuts and pomegranates from your gut. But, but I do think that oral supplementation, uh, can definitely benefit everyone because it's like only 40% of people can actually create their own, like Urolithin A. So, um,

• 48:45Speaker 01

  and then Urolithin A, we know helps with mitophagy within your cells. And I mean, there's, there's oral versions, there's topical versions, but that's something that I would certainly consider. I would also consider things like, you know, just polyphenols, whether it's through foods or through supplements. You know, there's decent data with EGCG, which is from green tea.

• 49:05Dr. Mark Hyman?

  Yeah.

• 49:06Speaker 01

  As well as like, uh, like cocoa flavanols. And then we, I mentioned carotenoids earlier, which include things like astaxanthin and beta carotene. These all help kind of reduce that oxidative stress burden within your cells, which then will in turn help with mitophagy.

• 49:21Dr. Mark Hyman?

  Astaxanthin is something that's in salmon, because it's from the algae.

• 49:25Speaker 01

  It is. Yes.

• 49:25Dr. Mark Hyman?

  With the, with the salmon eat, that makes it them, uh, orange.

• 49:29Speaker 01

  Makes it orange. Right, right. I know some people.

• 49:31Dr. Mark Hyman?

  It's like carrots. It's like the same thing.

• 49:33Speaker 01

  I know there's this trend with young people. It's called like tan maxing and they like are consuming all these like carrots and astaxanthin supplements, so they could like look more.

• 49:41Dr. Mark Hyman?

  I, I did that once. I, I wasn't intentionally. I said, carrot juice was good for me. Some way back when, and I was drinking carrot juice every day. And I was like, wow, I'm like orange.

• 49:50Speaker 01

  So orange. Yeah.

• 49:51Dr. Mark Hyman?

  It was crazy. I, I want to double click on Urolithin A. For people listening, it's what we call a postbiotic. So when you eat certain compounds, and these are polyphenols, it can be pomegranate, green tea, cranberry, walnuts, whatever. Your bacteria, if you have the right bacteria, will process that and create metabolites. And some of those metabolites, uh, have beneficial effects. So, you know, people don't understand that probably a third or half of the metabolites in their bloodstream are from their gut microbiome. They're not, they're not made by your cells. They're made by these bacteria that are producing all these molecules. And when you have bad bugs, they're producing bad crap. And they're producing, when they have good bugs, they're producing these beneficial things.

• 50:32Dr. Mark Hyman?

  And so Urolithin A is, like you said, most people don't have microbiome because I mean, I, I give talks. I'm like, who here has never taken any antibiotic? I remember a thousand people, like, nobody will raise their hand. Or like, I think once somebody raised their hand out of a thousand people, like, oh, I didn't ever drink any antibiotics. Like, it's not very common. I mean, all of us have had antibiotic. We kind of kill off the bugs. And so it's really important to help, um, to support that, those bugs. But also like you, you, you can actually take a, a supplement, a Urolithin A supplement. And it's, it's something that actually, um, I use every day, uh, but mostly from, from, from a metabolic function, from a brain function, from a muscle function, from mitophagy. I don't think about it for

• 51:14Dr. Mark Hyman?

  my skin so much, but now I do. And, and I think, uh, there's a lot of data on it. And one of the things it also does, seems to do is reduce inflammation. So it can reduce CRP. It helps with all these benefits. So I, I think it's one of those supplements that has a lot of research. And I, I think, you know, this is the millions and millions of dollars of research on this, which is not typical for most products. So I think, I'm impressed by it. It's in, published in Journal of American Medical Association, major journals. It's not like in some supplement journal somewhere. It's, it is, is good science. So I, I think, I think this phenomena of, of, um, taking care of your mitochondria as a concept is really important. Like you're only as healthy as your mitochondria. And as, and when you age, your mitochondria decline and function declines. And a lot of the things that we know

• 51:59Dr. Mark Hyman?

  for healthy aging, whether it's, you know, overnight, like 12 to 14 hours fast, or whether it's exercise, or whether it's, you know, Urolithin A, these are all things that help your mitochondria function better. So I think it's so, it's so important.

• 52:11Speaker 01

  And like with Urolithin A too, there's, I learned that you have to be cautious too, with which products have Urolithin A. Like there's really just like that one, like Mitopure, that has the, like the properly studied amount, or like the accurate amount of Urolithin A. Cause like, if you look at some other brands, they've been studied, like with third party testing, where it doesn't actually show like the adequate.

• 52:33Dr. Mark Hyman?

  Yeah, the, the dose, the dose. Yeah. If you take one milligram of aspirin, it's not going to do anything. I, I agree. I, I, I have been, um, a big fan of Timeline Nutrition and Mitopure for a long time. I've taken it for a long time. I think, you know, that's why they're one of the sponsors of my show. And I think, you have to be transparent about it. I think it, you know, yes, they're, they're sponsoring the podcast, but also like, I, I looked at the science and you have, and you know, it, it makes sense. And it, and it's, it's valid science. And it, it's impressive compared, compared to a lot of other products people take.

• 53:04Speaker 01

  Yeah.

• 53:04Dr. Mark Hyman?

  It's, it's impressive.

• 53:05Speaker 01

  Yeah.

• 53:06Dr. Mark Hyman?

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• 53:49Dr. Mark Hyman?

  of Bioptimizers rolls out during certain windows. And every order is backed by their 365 day money back guarantee, so you can try it with confidence. These statements have not been evaluated by the FDA or the Food and Drug Administration. Its product is not intended to diagnose, treat, or cure, or prevent any disease. As a doctor, one of the things I find really interesting about matcha is that it's more than just another source of caffeine. Matcha contains compounds like theanine and catechins, including EGCG, that make it a pretty unique way to get your morning energy. The combination of caffeine and L-theanine can give you a more calm, focused feeling than you might get from coffee alone. And you're also getting those antioxidant compounds from the tea itself. And one of the reasons I've been drinking matcha for years, and why I really like working

• 54:31Dr. Mark Hyman?

  with Peak is their Sun Goddess Matcha is organic ceremonial grade matcha that's sourced from Japan. And it's screened for over 500 pesticides. I love whisking it into a warm drink and starting the day with that calm, focused energy. If you want to try it, go to peaklife.com/hyman and get 15% off for life. That's P I Q U E life.com/hyman. When, when someone has skin aging, is there a way to kind of reverse it? Or is the damage already done?

• 54:58Speaker 01

  There, there's definitely ways to modify your cellular function. I don't know if you're going to be 100%, you know, reversible, but like, you know, if somebody comes in, they're 70, we're not going to make them look like they're 25. But there are certainly, I know it, right?

• 55:13Dr. Mark Hyman?

  I'm 66. I was hoping for a miracle here.

• 55:17Speaker 01

  I definitely think that we can for sure optimize cellular function, uh, you know, regardless of how old you are.

• 55:24Dr. Mark Hyman?

  And one, one of the things that sort of ties a little bit into, and I'm wondering if it ties into this, is mitochondria is, is this exercise. And you said that muscle building is one of the best ways, it's a non-skin care intervention for healthier skin in midlife. And I don't really understand how strength training would affect the skin. Can you kind of unpack that for?

• 55:43Speaker 01

  I know. Yeah. I'm basing that off of, there is a study that was really interesting. It was a small study. It was like 60 or so participants. They were mid, uh, women in their kind of midlife age range. And they compared them doing aerobic exercise to strength training. And they both showed improvement with like hydration and barrier function in the skin. But they act, and they, they were measuring, you know, different layers of the skin. The, the participants who were, who were strength training actually had a thicker dermis, you know, so dermis is where our collagen sits. And I think that it makes sense, you know, when you are, you know, when you're strength training, and I've heard you talk about this before, you're increasing, you're increasing insulin sensitivity.

• 56:29Speaker 01

  And then that kind of takes a load off of your cells. You're, you're decreasing inflammation as well. Your mitochondria are optimally functioning. And when your cells in the dermis are affected by that, uh, they're going to work better. They're going to build more collagen. So I, I, to me, it makes sense. I would like to see more studies, but, but I do really appreciate that.

• 56:50Dr. Mark Hyman?

  I'm kind of, on my face, obviously I've had a lot of sun damage. And, but I, I noticed like I'm 66 and I look at my skin, I have the elasticity, my body, it, it don't really have a lot of skin aging. Um, I mean, I notice it a little bit thinner in some, some ways, but, you know, I've been eating well my whole life. I've been, you know, exercising my whole life. I've been trying to, I mean, stress is another thing, but I know I've been taking, you know, basic nutritional supplements. And like, and I'm just like, kind of amazed at, you know, what, what you can do if you actually take care of yourself and you, you do the right things. And it's, it's something I think, uh, it's good to start early.

• 57:27Speaker 01

  Yeah.

• 57:27Dr. Mark Hyman?

  But also you can start at any age and, and slow the process down. And, and I'm curious, like, from your perspective, like, what are the highest value interventions for people listening? Like, what are the things that, you know, for, for skin longevity, like, what are the highest target?

• 57:42Speaker 01

  The highest value. So yeah, I know we, we want to talk about how, what we can do from the inside out, but I do have to say, sun protection is probably the biggest thing you can do.

• 57:53Dr. Mark Hyman?

  The sunblock.

• 57:54Speaker 01

  Yeah. Sunscreen, um, and like when you're outside.

• 57:59Speaker 01

  You know, try to minimize the time you're in, you're outside during like those peak UV hours, which is like between 10 a.m. and 2 p.m., wearing some protective clothing, hats. Those all play a role now.

• 58:13Dr. Mark Hyman?

  Like you need UV blocking clothes?

• 58:14Speaker 01

  You don't need it, but, but like, but sunscreen is not 100% gonna block out all your UV rays.

• 58:20Dr. Mark Hyman?

  Can you get us like sun damage through your clothes?

• 58:23Speaker 01

  Oh, yeah, yeah, yeah. UV can still penetrate clothes, not as, you know, it's still a form of protection. But, but UPF material does a much better job at like blocking out UV rays. So just some things to consider, and I know that we, you know, also, I just want to take into consideration the fact that the sun is really important too, right? Like for vitamin D absorption metabolism, as well as like circadian rhythm regulation.

• 58:47Dr. Mark Hyman?

  Light in your eyes.

• 58:48Speaker 01

  Definitely like getting that sun early in the morning. But I think that you can still do all those things. You can go outside, wear sunscreen, don't try to, don't try not to bake outside for prolonged periods of time. That's where we, that's where we see a lot of the skin cancer. And, you know, with melanoma, it's for people who have that intermittent prolonged exposure. So it's interesting.

• 59:11Dr. Mark Hyman?

  When you go to the Bahamas for a holiday, you'll only on the beach all day for seven days.

• 59:15Speaker 01

  Exactly. For men, the most common location for melanoma is the back. And for women, it's the legs, but those aren't areas that are seeing the sun every day. But for like those intermittent bursts of sun exposure, like going to the Bahamas and you're just getting like burned on your back. That plays a bigger role with melanoma development, whereas the non-melanoma skin cancers like basal cell carcinoma or squamous cell carcinoma, those are from just like chronic daily sun exposure that just build up over time. But all of that can contribute to skin cancer development as well as accelerated aging.

• 59:44Dr. Mark Hyman?

  But not, not all melanomas are skin sun exposure related, are they, or are they?

• 59:48Speaker 01

  Well, yeah, you're right. Not all, because we can see melanoma between the toes. We could see anal melanoma.

• 59:53Dr. Mark Hyman?

  That's what I mean.

• 59:54Speaker 01

  Yeah. So there's other components too. And what's interesting too, we have studies to show that low vitamin D can, can make melanoma, like can put you at higher risk for melanoma, which is kind of ironic, right? Cause we say stay out of the sun, you know, to prevent melanoma. So it's, it's about finding that healthy balance. Vitamin D is, is important for melanoma prevention too. And, you know, we, we always talk about supplementation and trying to get vitamin D through food. But like I said, you can still go outside, just got to do it responsibly. But I'm sorry, to answer your question, the highest impact is sun protection.

• 1:00:26Dr. Mark Hyman?

  Sun protection.

• 1:00:27Speaker 01

  It is. And it's, I mean, we have studies to show that it plays the biggest role, probably about 80%. And when it comes to skin aging, there's genetics, but then, you know, there's other factors too. So smoking, we talked about, thankfully, you know, I think people aren't smoking as much. They, people still do smoke, of course, but that's huge. Like when they look at identical twin studies and like they see the twin who's out in the sun and smokes drastic difference. So that, and then when we talk about nutrition, so sugar can accelerate aging. I've heard you talk about advanced glycation end products or AGEs. This is when sugar, you know, when you have more sugar that can bind to your collagen fibers. And that can make your collagen more brittle and like break down more easily and like not remodel as well.

• 1:01:11Speaker 01

  So sugar is huge. And then of, of course, if you have insulin resistance from sugar, that's going to create more inflammation and further aggravate, you know, collagen breakdown. Try to like minimize processed foods as well, but most of our data is with sugar. And then when it comes to what to add, we, we touched on this briefly, but just like just nutrient dense foods, foods full of polyphenols. I just say like just colorful foods, you know, like vitamin C, your citrus, your, your bell pepper, like the berries. Just things that are full of polyphenols is important. And then, um, yeah, and we talked about carotenoids too, whether it's, and also lycopene, beta, beta carotene, as well as assazanthin. And then sleep is huge.

• 1:01:53Speaker 01

  We do have some good data to show that poor sleep, circadian rhythm disruption, that can all accelerate aging. Stress is huge and stress is like harder to quantify just because, you know, like what is stress? Like we all deal with so much stress. So, um, but, you know, just a matter of incorporating stress decreasing modalities into your life. And then exercise, we have data to show that that helps with skin collagen production. Those, and yeah, minimizing pollution, I would say those are like the, the biggest levers with sun protection being the biggest one. And then we also have a ton of evidence when, if you just put it in a vacuum, like if it's just, if you're just focusing on skin,

• 1:02:33Speaker 01

  topical retinoids, we have decades of studies to show the impact of topical retinoids for skin health.

• 1:02:39Dr. Mark Hyman?

  It's got vitamin A derivative.

• 1:02:40Speaker 01

  Vitamin A derivative. Yeah. So the, the most popular example is retinol, which can get over the counter. Then there's the prescription retinoid, which is tretinoin, the brand name is Retin-A. Those are the most common forms. There's retinal, retinaldehyde, there's tazoret, serotene, adapaline, there's a lot. But anyways, there's a lot of studies to show that that really helps with collagen remodeling. And then topical antioxidants, vitamin C being the most studied example shows. So after sunscreen, we like retinoids and vitamin C.

• 1:03:05Dr. Mark Hyman?

  So put vitamin C and, and retinoids on your skin.

• 1:03:09Speaker 01

  Correct. Yeah. Yeah. Vitamin C in the morning, because that works alongside sunscreen to help with like the oxidative stress from the sun as well as pollution. And then retinoids at night to really contribute to that repair process when you're sleeping.

• 1:03:22Dr. Mark Hyman?

  Okay. I need, I need to up my game here because I, I've been focusing on, you know, my exercise and diet and skin care. I'm like, ah, you know, I'm a guy. I don't really care.

• 1:03:31Speaker 01

  I mean, if you want to like, for overall longevity, you gotta do all the, the exercise and diet. Like that's going to be better for overall.

• 1:03:36Dr. Mark Hyman?

  I'm curious about like, you know, I, you know, I, I don't want my skin to age faster than it needs to. And these sounds like simple things, like the vitamin C and retinoids. And you can do the retinol over the counter.

• 1:03:47Speaker 01

  You do retinol over the counter.

• 1:03:48Dr. Mark Hyman?

  Is that strong enough or?

• 1:03:50Speaker 01

  Yeah. And for a lot of people it is, and the thing is it's just slower acting. Tretinoin is faster acting. Your retinol has to get converted. It has to go through a couple of stages before it gets converted to tretinoin. So tretinoin works faster. It has a higher irritation potential. So people who have sensitive skin or are just starting out, we do recommend something like a retinol. Yeah. And, and I would say we have the most evidence behind that. I know Timeline has their topical, like you could do topical urolithin A, which we do have some studies to show that that can help with wrinkle reduction as well as increasing hydration and barrier repair in the skin.

• 1:04:26Speaker 01

  And so, yeah, something else to think about too. There's some supportive ingredients in those products, like there's topical niacinamide. We do have some nice data with topical niacinamide for barrier repair and wrinkles too. As well as, you know, things like hyaluronic acid, ceramides, these are like nice hydrating ingredients.

• 1:04:43Dr. Mark Hyman?

  Great. And this is, it's a, it's a good list. It's a good list of how to keep your skin healthy. Now, people are talking about, I just kind of briefly want to kind of dive into this, but people are talking about a lot of these sort of newer therapies, whether it's exosomes, peptides, growth factors, NAD products, red light therapy. Can you kind of, is it hype? Is it science? Like what, what's the 80/20 on this?

• 1:05:04Speaker 01

  Yeah, I know. People talk about those a lot. I would say, don't do that unless you're already doing sunscreen, retinoids, vitamin C. But yes.

• 1:05:13Dr. Mark Hyman?

  And lifestyle.

• 1:05:14Speaker 01

  And all the lifestyle things that we talked about. But yeah, let's, I guess we'll talk about peptides because so many people, that word is just so popular mainly because of the injectable peptides. But because the injectable peptides have become so popular, topical peptides has just gaining so much more buzz. But they've been around for decades too. And there are a bunch of different types of topical peptides. Some are better than others, but in general, I am definitely a fan. I think it's so easy to incorporate peptides into your routine. There's a lot of moisturizers that incorporate it, a lot of serums that already have it. There's even some in some sunscreens, but basically they send signals to your cells to build more collagen or they send signals to your cells to increase hydration. So definitely all about.

• 1:05:53Dr. Mark Hyman?

  Like topically or like injectable?

• 1:05:55Speaker 01

  Topically.

• 1:05:55Dr. Mark Hyman?

  Cause like GHKCU is a thing a lot of women are using for their skin.

• 1:05:59Speaker 01

  Right, right.

• 1:06:00Dr. Mark Hyman?

  Is that like legit or?

• 1:06:01Speaker 01

  I'm sure it, it helps, but as of now, we don't have the evidence or like the safety measures in place to fully recommend it. Like, uh, yeah, so I'll say that, but we do have topical GHKCU, the topical, uh, the copper peptides, which we definitely have good evidence for. I mean, not as good as retinoids for sure, but that helps with collagen recycling and rebuilding. So incorporating copper peptides is wonderful into your routine as well as some other like hydrating peptides and collagen building peptides. And there's also like neuromodulating peptides. So some people like to call it like Botox in a bottle because you know, Botox essentially like paralyzes your muscles. So you're not creating those deeper contractions. Super mild form of that with these neuro peptides for people who are like Botox averse.

• 1:06:46Speaker 01

  It doesn't compare to Botox, but anyways, so that's peptides. It does, depending on the peptide, you could do a lot of different functions in the skin. Then there's growth factors you mentioned. Growth factors are also signaling molecules that I think we do have some pretty decent evidence for. Growth factors are pretty large molecules. So, so just because you're putting growth factors on your skin does not necessarily mean it's penetrating the skin and doing its thing. So I would say you have to make sure you get the right growth factors. Not all of them are equal, but we, I do like them. And then there's PD-RN, which has gained a lot of buzz because of the whole K beauty, Korean beauty, kind of.

• 1:07:18Dr. Mark Hyman?

  What is PD-RN?

• 1:07:19Speaker 01

  So PD-RN stands for polydeoxyribonucleotide and it's derived from salmon sperm. And most of the data is with PD-RN injections into the skin. We, we know that it helps with collagen remodeling when it, when it gets into the dermal layer. It helps with wound healing, topical PD-RN. We have some evidence for its efficacy, but doesn't compare as much to the injectables. But I, I, I like it. I think it's a wonderful ingredient to have in your moisturizer. So, and we're seeing more of that.

• 1:07:47Dr. Mark Hyman?

  Salmon sperm.

• 1:07:48Speaker 01

  Salmon sperm, salmon sperm facials is what we're calling it.

• 1:07:52Dr. Mark Hyman?

  What about things like exosomes and stem cells? Like people are injecting those in their face, topically.

• 1:07:56Speaker 01

  Once again, it's one of those areas where it's a little bit controversial because we do still need more safety data. I think it's still kind of the wild, wild west with that. There are a lot of products out there that have topical exosomes in them. And they are lovely and they seem to work, but whether or not the exosomes are doing anything or what exactly they're doing, it's hard to say. Because it's so hard to stabilize exosomes at room temperature, like they need to be like frozen, um, at a negative temperature.

• 1:08:23Dr. Mark Hyman?

  I wonder about these creams or?

• 1:08:24Speaker 01

  Yeah. And, and also it's like what exosomes are the best? Like umbilical cord exosomes or like mesenchymal exosomes from bone marrow or like fat, fat cells? Yeah, there's different kinds and that kind of goes along with stem cells too. You know, which ones are the best? So I think we still have more to come with that, but. I think it's promising.

• 1:08:45Dr. Mark Hyman?

  I, I, I know you've been a dermatologist for a long time. I can't tell how old you are. I want to know your skin routine.

• 1:08:51Speaker 01

  Okay. Wait, wait. Should I have you guess how old I am?

• 1:08:55Dr. Mark Hyman?

  I kind of would say like maybe late 30s.

• 1:08:59Speaker 01

  Yeah, I'm 43.

• 1:09:00Dr. Mark Hyman?

  Yeah.

• 1:09:01Speaker 01

  So that I'll, I'll take that. Thank you. But yeah, so you know, I mentioned the topical skincare regimen. I definitely for a while have been incorporating sunscreen. I didn't for most of my twenties and it wasn't until I started derm residency where I was like, oh, okay. I guess I should do this. Um, so I do sunscreen. I do some type of retinoid at night. By the way, you can't use a retinoid when you're pregnant and then, um, I do vitamin C in the morning. But I do, I use, I use serums and, and moisturizers that incorporate peptides and/or growth factors. I do use a product with PDRN and copper peptides. I use a serum that has a neuromodulating peptide to help soften my lines.

• 1:09:41Dr. Mark Hyman?

  Do these things stack? You just put one after the other?

• 1:09:44Speaker 01

  So, okay, you, so it's so funny because I, I hate overwhelming people because there's so much noise out there in the skincare world. So what I tell people is really the, the foundational skincare regimen is a cleanser. It's like washing your face is important too. It's kind of underrated.

• 1:10:02Dr. Mark Hyman?

  I never do that.

• 1:10:02Speaker 01

  The buildup of pollution, like all that stuff during the day, like that accelerates skin aging. Those are, that creates oxidative stress on your skin. So washing your face is so important. And then moisturizing because once again, because of the elements, our skin barrier is disrupted. Our, our keratinocytes are working hard to repair the barrier and like, if there's stress on our skin, um, it needs help. So moisturizer is important and then sunscreen. So those are the three minimal things to do. And then after that, a retinoid and vitamin C. And then if that's well established, then you can incorporate another serum that might have like peptides or growth factors. And then like, just find a good moisturizer that has all the fun things that has growth factors and peptides too.

• 1:10:40Dr. Mark Hyman?

  Yeah, that's good. I mean, just kind of a brief aside, because I think this is an issue for, for, for me, I think about this, which is what's in the skincare products besides the active ingredients? And are those harmful? And I had, I had a patient once who used sunblock all the time. When I checked her urine, she had extremely high levels of parabens, which is a plastic, like a petrochemical toxin that they use in these compounds. So are you fixing one thing and hurting another thing? And how do you, how do you manage that? And, and what do you think of the skin deep, uh, database from environmental working group that kind of grades skincare products based on levels of toxins in them?

• 1:11:18Speaker 01

  I respect the fact that something like this exists out there. I do take it with a grain of salt because the data that's in the EWG database is from studies where there are usually like insanely, almost impractical doses, insanely high amounts of these products or ingredients that are used on like animal models. And we can see issues in animal models or whether it's endocrine disrupting issues, uh, potentially cancer, you know? And, and it's, it's hard to extrapolate that to human data for a lot of these things, for things like parabens and like, um, even like some of these chemical sunscreens too.

• 1:11:59Speaker 01

  And, and so I think like theoretically, it seems scary like, oh my God, when it's given in insanely high doses to animals, like we should not do that. We shouldn't use it as humans, but I wouldn't, you know, if people have been using a lot of these products, I wouldn't freak out. Like just because somebody has a bunch of parabens in their urine, the question is, okay, what, but what exactly? Like what is, how is that manifesting in their skin?

• 1:12:25Dr. Mark Hyman?

  I mean, my, my philosophy, and maybe this is right or wrong. I don't know. But if you wouldn't eat it, don't put it on your skin because everything you put on your skin gets absorbed through your skin.

• 1:12:32Speaker 01

  Okay. So I have something to say to that. I have something to say to that because our skin is, honestly, our skin does serve as a great barrier. Like it's one of the functions of the skin is to protect our, our body from like the outside elements, from pathogens, from irritants and all those things. So there is an element of really good barrier protection on the skin. But the other thing I want to add too, is that not necessarily everything you eat is good for your skin.

• 1:12:55Dr. Mark Hyman?

  This is true.

• 1:12:56Speaker 01

  Like lemon, like lemon will destroy your skin.

• 1:12:58Dr. Mark Hyman?

  Really?

• 1:12:58Speaker 01

  Yes.

• 1:12:59Dr. Mark Hyman?

  Juice, lemon juice?

• 1:13:00Speaker 01

  Lemon, yeah, lemon can cause like irritation from the acids in the skin. I mean, we have stomach acids that can, that can deal with that.

• 1:13:07Dr. Mark Hyman?

  Putting lemon on your skin or eating lemon?

• 1:13:09Speaker 01

  So eating lemon is good.

• 1:13:10Dr. Mark Hyman?

  Oh, yeah.

• 1:13:10Speaker 01

  Putting lemon on your skin is not good.

• 1:13:12Dr. Mark Hyman?

  I wouldn't do that. Okay.

• 1:13:13Speaker 01

  Yeah. So, so, so, so, but yeah.

• 1:13:16Dr. Mark Hyman?

  You want to put chili peppers on your face.

• 1:13:18Speaker 01

  Right. Exactly. Exactly. But no, but I, I, I do appreciate you saying that, like, we have to be, you know, if we can eat it, like, then, you know, it's potentially safe for our skin. But I, I also want people to know that our skin is there to protect us too. And like, a lot of these things usually just penetrate to the, through the epidermis, not really getting into our vasculature. Of course, there's things that get into our vasculature as well, but our skin, I would give it more credit. It really does do a good job at keeping a lot of the things out. I'll say, I'll say that, but, but yes, there are definitely things that, that can get absorbed that aren't.

• 1:13:49Dr. Mark Hyman?

  I mean, because I always wonder about it because then as a doctor, I'm like, when you, someone comes in the emergency room, they have a heart attack. You put nitroglycerin paste on their chest.

• 1:13:56Speaker 01

  Yeah.

• 1:13:58Dr. Mark Hyman?

  Topical hormones.

• 1:13:59Speaker 01

  Yeah.

• 1:13:59Dr. Mark Hyman?

  You've got, uh, you know, all these topical drugs that we deliver through the skin, whether it's fentanyl patches or like, it's, it's a known thing.

• 1:14:08Speaker 01

  It is a known thing. Yes.

• 1:14:09Dr. Mark Hyman?

  So like, it's not like they don't get through.

• 1:14:11Speaker 01

  No, for sure. And there's certain vehicles that deliver these things more effectively than others. So, so it's, it's a matter of like what the product is, but yeah, no, for sure. Like things definitely can get absorbed to.

• 1:14:23Dr. Mark Hyman?

  So if you have a choice between something that doesn't have a lot of bad industrial ingredients in it versus something that does, would you choose the one that doesn't? Or you don't care?

• 1:14:32Speaker 01

  Of course I would want to look at the safety data behind it too, but, but I would try to minimize like anything that has this like toxic burden to the skin for sure. Yeah.

• 1:14:41Dr. Mark Hyman?

  Okay, good. I, I guess.

• 1:14:42Speaker 01

  Yeah.

• 1:14:43Dr. Mark Hyman?

  I think you're right. There's probably not enough data. Like what happens when you put all these things on, but like, just like at a high level, like I wonder if anybody's in the studies to see if you put this stuff on your skin and measure the blood levels or urine level of these compounds. Has anybody done that work?

• 1:14:55Speaker 01

  Yeah. I mean, I think that, that some of it has been looked at too. Like we, we do see higher absorption with chemical sunscreens in our bloodstream.

• 1:15:03Dr. Mark Hyman?

  Is it better to use mineral sunscreen then?

• 1:15:05Speaker 01

  So, yeah, I mean, if, if that sort of freaks you out, then yes, I would use mineral sunscreen. The FDA kind of puts that in the category of generally recognized as safe, whereas the chemical sunscreen is not in that category. Mainly because you do have extensive systemic absorption with it. Whether or not that does anything is, is just still up for debate. So.

• 1:15:26Dr. Mark Hyman?

  Wait, are you saying that the FDA says that, that these chemical sunscreens are not generally recognized as safe?

• 1:15:31Speaker 01

  That's right.

• 1:15:32Dr. Mark Hyman?

  Wow.

• 1:15:32Speaker 01

  But there's a new one that just came out this past year that is, it's B E M T parcel shield is another name for it. That is, it's a chemical sunscreen that is lumped with generally recognized as safe. But yeah, no, we need some work with the chemical sunscreens, but, but I have to tell people they're still effective. They're still overall safe. We don't have the human data to show that it does anything, but it does absorb more into your bloodstream.

• 1:15:55Dr. Mark Hyman?

  This is such a great conversation. Uh, are you up for a few rapid fire questions?

• 1:15:59Speaker 01

  Let's do it.

• 1:16:00Dr. Mark Hyman?

  Okay. So what's the biggest driver of premature skin aging?

• 1:16:02Speaker 01

  UV radiation.

• 1:16:03Dr. Mark Hyman?

  Sun. Okay.

• 1:16:04Speaker 01

  Yeah, the sun.

• 1:16:05Dr. Mark Hyman?

  Can you take aged skin and actually improve it or not?

• 1:16:08Speaker 01

  Yes, you can. There's hope. There's hope.

• 1:16:10Dr. Mark Hyman?

  What matters more for skin health? Is it longevity, skincare, exercise?

• 1:16:15Speaker 01

  It depends on what your goals are. If you want to live longer, I would say exercise. If you want your skin to look smooth and wrinkle free, skincare.

• 1:16:21Dr. Mark Hyman?

  How about mitochondria? How important is it?

• 1:16:24Speaker 01

  Yeah. Mitochondria. Oh, at least a nine.

• 1:16:27Dr. Mark Hyman?

  At least a nine.

• 1:16:27Speaker 01

  Cause there's a lot of other factors that also contribute to aging too. It's not just mitochondria. We, we need.

• 1:16:34Dr. Mark Hyman?

  And your Lithin A is the data there or not?

• 1:16:37Speaker 01

  Your Lithin A is, yeah, I would say we have really good data with your Lithin A.

• 1:16:40Dr. Mark Hyman?

  Amazing. Okay. And then what's the most overrated anti-aging skincare trend?

• 1:16:46Speaker 01

  Okay. So there's like products that are.

• 1:16:47Dr. Mark Hyman?

  TikTok trend should people be like, wait.

• 1:16:49Speaker 01

  Oh, there's a couple of things, like a lot of people are into like beef tallow and they think that that protects their skin from the sun. It's, no, it does not. It's an okay moisturizer, but it's not anything miraculous. We have a lot better moisturizers out there.

• 1:17:01Dr. Mark Hyman?

  Be fat on your skin, not a thing.

• 1:17:03Speaker 01

  It's, it, yeah, it's, it's.

• 1:17:04Dr. Mark Hyman?

  I don't even use coconut oil. It's like.

• 1:17:06Speaker 01

  Coconut oil can be helpful. It is comedogenic. So be careful if you're acne prone, but, but beef tallow is also comedogenic as well. But people think it's like a miracle cure and it's not.

• 1:17:17Dr. Mark Hyman?

  Amazing. Okay. Wow. Well, thank you so much, um, for your insights, your work, your, your advocacy. Cause there aren't enough, I would say, integrative functional dermatologists out there.

• 1:17:28Speaker 01

  Yeah.

• 1:17:28Dr. Mark Hyman?

  They really aren't. And, uh, I had the privilege of learning from some of the OG ones, you know, back in the day. And, and I think that, you know, if you're listening to this, you know, there's really two issues. One is healthy skin aging and two is skin conditions. And there's a lot to do about both of them.

• 1:17:43Speaker 01

  Yeah.

• 1:17:43Dr. Mark Hyman?

  And hopefully, uh, you know, we can really, uh, help people to understand what they can do. Tell us where people can learn more about you, find you, learn about your work.

• 1:17:52Speaker 01

  I am very active on social media. My handle is, uh, Dr.Mamina, D R dot M A M I N A on Instagram, TikTok and YouTube. I have a website, DrMamina.com. And if you're also interested in prescription skincare, I'm a co-founder with other derms for a prescription skincare service called DermClick.

• 1:18:09Dr. Mark Hyman?

  Amazing DermClick. All right. Well, so good to meet you and have you on the podcast and thanks for your work.

• 1:18:13Speaker 01

  Thank you so much for having me.

• 1:18:15Dr. Mark Hyman?

  Hey everybody, it's Dr. Mark here. I'm so excited to share that my new book is officially available for preorder today. After more than 30 years of practicing medicine and caring for tens of thousands of patients, I've written the book that brings everything together that I've learned about helping people get healthy and stay healthy as they age. It's called A Hundred. What to Do Today to Live A Hundred Healthy Years is a whole body guide to living a hundred healthy years. It's grounded in a new understanding of how our bodies work. It's the new map of the body. And inside I walk you through the seven core systems that drive your health from your gut and hormones to how your cells make energy. And help you understand the signals your body's been sending you all along. Now, a lot of what's in the book, I learned the hard way through my own body.

• 1:18:57Dr. Mark Hyman?

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• 1:19:43Dr. Mark Hyman?

  If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional.

• 1:20:27Dr. Mark Hyman?

  This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at UltraWellnessCenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening. When it comes to supplements, you only want the best for your body, the kind with the highest quality, cleanest and most potent ingredients you can get.

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