The 3 biggest myths about anti-aging skincare | Prof. John McGrath

Welcome to ZOE Science and Nutrition, where world-leading scientists explain how their research can improve your health. Walk down any beauty aisle and you'll see the promise of younger skin. Creams, powders, serums, all of them claiming to stop time with a bottle. But does your skincare routine actually fight aging? Or are you falling for a beautifully packaged lie? Today, we'll bust the three biggest myths in anti-aging skincare. From wrinkle creams to sunlight and supplements.

You'll learn what really reduces visible aging and what doesn't work, no matter the price tag. We'll also reveal the one product you should use, along with a few others that could really help your long-term skin health. Joining us today is Professor John McGrath, one of the world's leading dermatologists. He's a molecular dermatologist at King's College London and editor of the British Journal of Dermatology. His research has shifted the frontiers of genetics and skin disorders.

and he's led pioneering studies on vitamin D and its effect on skin health. By the end of this episode, you'll understand the truth behind common skincare myths and science-backed steps to take care of your skin. John, thank you for joining me today. My pleasure Jonathan.

So we have a tradition here at ZOE where we always start with a quick fire round of questions for our listeners. We have some very strict rules which are designed to be really hard for scientists and doctors because you can only say yes. Or no? If you have to, you can give us one sentence. Are you willing to give it a go? Yes. Is it a problem that our skin ages? No.

Do anti-aging skin creams have to prove they work before they hit our shelves? They don't. Could certain genes create a natural sunscreen? Yes. Is collagen powder a silver bullet for better skin? Definitely not. Is there a way to reverse a sunburn in 24 hours? Absolutely. Ooh, that one I wasn't expecting.

You're going to have a whole sentence now. What's the biggest myth when it comes to aging skin? The biggest myth is probably that people think there's a magic elixir they can just go out and purchase that will turn back time. And that just doesn't exist. And we're going to get into what some of those are later in the episode. Absolutely. My wife is a dermatologist, so I live in this...

bubble where the only really interesting thing is skin. And so because I often see what's on Justine's feed, I feel I'm constantly being sold like a 10-step skincare regime. or like some powder supplement with a fancy scientific name that promises to stop my skin from aging. And I've now hit a certain age, so even I'm starting to get a little bit more interested. But I do feel like it's impossible to understand what actually works. And you said this really interesting thing about how-

Like skin aging isn't necessarily bad. So can we start there? Like what's actually happening on the surface of my skin every day? Well. this amazing organ that you have, the skin. As an adult, you've got 1.8 square meters of amazing carpet, which we recognize as this barrier that keeps the outside out and the inside in, and also has its own...

appearances too. It's a very dynamic structure. You know, the outer layer of your skin is replacing itself every four weeks in reaction to the external environment. You really have to build up this barrier to protect. And it's rather amazing what skin can do in terms of its function. You know, it's there.

not only to look nice, but it also protects you. It protects you against inflammation, against infection. It makes hormones, it makes vitamins, it has its own immune system. It's a fabulous organ. And so it's worth thinking about and worth... preserving. And of course, over the course of our lifetime, it does change a little bit. And sometimes it doesn't always work as well as it did in earlier life. But that's part of a natural process for this amazing organ, our skin.

It's so funny. I'm listening to this and you sound just like my wife, which is I could see you could talk about the skin forever. And am I right that you think the skin is probably the most important organ in our body? Is there anything more important than skin? Cardiologists might disagree, neurologists might disagree, but I think dermatologists have got it right. I love it.

Now, one thing you didn't mention that I hear a lot more talk about than before is the microbiome of the skin. So is it true? Does the skin have its own microbiome? Absolutely. I mean, your skin is made of 35 billion cells. But on top of your skin, on the surface and down the hair follicles, are 70 billion bugs. So the microbiome really has twice the number of cells that there are in human skin.

microbiome, this ecosystem that we have on our skin is very important in helping the function of the skin and also in deciding our susceptibility or resistance to various diseases as well. So it's amazing. to understand the skin microbiome. It varies from region to region across our body. It's influenced by the much more famous cousin, the gut microbiome. Of course, we know a lot more about the gut microbiome. the skin microbiome and the gut microbiome interact.

But it would be really great for the future of dermatology if we could harness the power of this natural ecosystem and maybe think about treating skin diseases or preventing diseases by manipulating the microbiome in the skin. And also knowing what we can do to change it in terms of topical products or diet. How do we actually get the best out of our skin microbes? When I first started at Zoe eight years ago, there was still a lot of skepticism about...

even the gut microbiome really being very important. And I've noticed that the science on that has really developed a great deal over those last eight years. But there could be some bugs on our skin just because it's the outer surface, but they don't really matter very much for our... health, right? They're just sort of landing there. Do we know whether it actually has any important role in our skin?

That microbiome is established in early life. As soon as you're born, you will start to get a microbiome. And then it will become more established. It will change a little bit as you go through life, particularly during puberty when you get new lipids, things on your skin.

But then in adult life, it's fairly fixed. It will vary according to you have more moist or sweaty parts of your body or drier parts of your skin, but it's relatively fixed. As dermatologists, we would really love to be able to use the microbiome to treat skin diseases, such as dry skin or even conditions like eczema or psoriasis. But we don't have that power and knowledge at the moment. It's the future, I think.

So you know it's important, but at this point, there's not treatments that specifically understand how to... port your microbiome or maybe repair it if it's damaged or something like that. It's off where it was. I think we're at that stage of being curious about what's going on. There are some odd examples where manipulating the gut microbiome.

can impact on diseases of the skin. And for example, who would have thought that changing part of your gut microbiome could make your hair grow back if you've got one of those autoimmune hair loss disorders? So- Hang on, you said that I can-

change my gut microbiome and my hair might grow back. Yes, that's true. There's a very common... autoimmune skin condition called alopecia areata where the body develops antibodies that attack the hair follicles and of course conventionally and quite effectively dermatologists will use steroids and other immune suppressing drugs to try and

get rid of those antibodies and get the hair growing back again. But there are reports now coming out, and again, it's just a few reports, but changing part of the gut microbiome, for example, sounds a little bit obscure, but using a fecal... microbiome transplant, fecal transplant can make your hair grow back again. Shocking news, I guess. I think that's absolutely...

Fascinating. So you're saying swapping out my gut bugs and suddenly I can get my hair back. Sounds crazy. And I love the way that science keeps figuring this stuff out. So I know I pulled us off to talk about the microbiome and I feel like...

Probably you were going to talk a little bit about what happens as our skin ages. Yes, that's right. I mean, classically, dermatologists will talk about two. sides of skin aging one of them is the intrinsic aging just old father time as the clock ticks by and then the other one is extrinsic aging which is to do with all those environmental triggers which might impact

on the rate of aging. So things like sunlight and smoking and pollution and various other toxins that we might encounter. So those are the two aspects and both of them. can overlap and both can contribute to the process we know as skin aging. What is aging? Of course, it is to many people, it's just the appearances of the skin. The skin becomes drier.

It becomes a little bit more scaly. It can then start to get more prominent blood vessels in it. It can start to sag. It can start to become wrinkled. I'm not doing a very good job for selling aged skin, I think, at the moment. But these are mostly the sort of disappointments that we have in life of our skin just changing. And we think...

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Head over to zoe.com slash daily30 to start this week. And we're offering our listeners a free Zoe tin and magnetic scoop with every order. So order yours today at zoe.com slash daily30. I mean, none of the things that you described are things that anyone wakes up and says, oh, I'd really like to have more saggy and wrinkled skin. Not attractive, is it really, to most of us? And is any of that... a cause of any ill health or is this entirely sort of superficial and it isn't?

really causing anything that's going wrong? Or is this sort of like a sign that somehow your skin is not as effective as it is, as I think about my children?

If you just focus on the appearances, then you can think of it in fairly straightforward terms. It's just the appearances. But of course, there's a lot.

more things going on you know we are accumulating damage in our skin as we get older and some of that damage may not just be benign it may start to promote the development of skin cancers particularly in people with a paler skin so we're Fighting this battle of the appearances, yes, but also this accumulation of damage, which can partly be repaired, but as we get...

older our repair processes in the skin and in the body in general deteriorate a little bit and therefore we have other aspects of skin aging which can be more medical rather than just social and their appearances.

And John, why is it that my skin is starting to sag? that it starts to become more wrinkled. You know, as far as I know, my heart is still doing a good job and it's like working the same way that it was hopefully when I was little, but clearly my skin is really changing. What's going on there?

that's causing that. Yes, again, just like the visible changes are there, there's all sorts of rather depressing changes going on structurally in your skin. So you're losing collagen your elastic tissue which is important for the recoil in your skin the stretchiness in your skin is losing its function the fat that we have in our skin you know 80 of the your body fat is is in the skin

But as we get older, it starts to redistribute. And part of that redistribution can affect the way the skin appears. Our bones change a little bit as we get older as well. So that can affect the overall scaffolding. that we have in our skin. So each layer of the skin from the outer epidermis through to the underlying dermis where those collagens and elastic tissue are right down to the underlying fat and bone.

will be changing, remodeling, reducing in some of their vital components. And that's part of the story of aging. That's really interesting. So one of the things you're saying that's happening is that I have less stretchiness because I don't have as much collagen as I used to have. Do we understand why that's happening? Well, collagen is produced by some cells in the dermis part of your skin called fibroblasts.

and they produce a lot of the collagen in earlier life but as those fibroblasts age they lose their ability to keep generating lots of new collagen fibers And the elastic tissue, the recoil, is quite interesting because what happens there, it's not necessarily just a lack of elastin. You can produce quite a lot of the elastic tissue, but it just doesn't work in the way it used to. So skin will not stretch and recoil.

coil in the way that it did when you were young. So it's an accumulation of lack of some fibers and other fibers that just aren't working as well as they used to. And is everybody aging at the same?

And I asked that question sort of feeling pretty confident that it doesn't seem that way as I look around, I don't know, the people who I went to school with and I'm now 50, you know, what do they look like? I feel like there's a very wide distribution, in fact, of... how they appear to have aged. I think that's right. I mean, we wonder on one level whether it's just the clock ticking all the time, but people do age.

at different rates and that applies to both their innate biological aging and also the way they look so yes everybody does differ in their appearances and their actual aging Do we understand why skin might be aging at different rates and therefore potentially can think about things we might do differently? Partially, I think we've...

got some ideas about some of the processes. The genetics is important. We know that there are key factors that control our metabolism that will be important. Everybody is aware of antioxidants and the processes they do to try and... mop up some of the damaging chemicals that we have in our skin and other tissues things that are called free radicals so there are different ways of

monitoring that damage that's building up and it varies from person to person some people get a lot some people don't get much and there are already people doing things to try and impact on that through things they might take in their diet, maybe things they might do in their lifestyle, other ways that they might influence the appearances and that underlying ticking clock that we all have. Now, let's say you're 50 or 60 or something.

been an adult for quite a long time. Like what are the key things in one's lifestyle that are likely to lead to sort of faster skin aging than average? Yes, that's the challenge, isn't it? If we could just pick out all of those key factors and then say... yep stop those and i will stay young and look younger so what can we do are they the stories about things like sleep and hydration and stress maybe to some extent

But I think most doctors are going to focus on some of the things that may be relevant, like smoking and sunlight. And maybe those are the bits that we can affect our lifestyle to try and influence a bit.

So those are having some real impact. Like if you smoke, it's not just a story, it is actually affecting your- your skin over time so i'll give you a little bit of science on that one because what happens when you smoke is it activates a destructive enzyme in your skin called a matrix metalloproteinase so these are enzymes that will actually break down So if you smoke, obviously it will do things in terms of nicotine and some of the other potentially damaging agents in that cigarette. But...

it will actually in your skin activate matrix metalloproteinase, which will break down your collagen, produce wrinkly, sagging skin. So if you do smoke and you don't want to have wrinkles, don't smoke. What about vaping? Yes, I suppose that is slightly less studied. One looks that that might be a safer alternative, but I think you'll also find activation of these destructive enzymes from vaping too. So there is no escape. Don't smoke, don't vape.

So that's interesting. So you think that vaping would also have an impact on your skin? Because I think often I consider it something that's a safe alternative to cigarettes. Less well studied. Less science, but potentially the same destructive effects might apply. So I think you're telling me this story that it's sort of normal for my skin to age, that sadly I haven't got as much collagen as my children, which I sort of know, but now you're helping to understand why it is that they're like...

Daddy, your skin's a bit saggy, isn't it? My daughter said recently. I was like, thank you. But there's this enormous industry that's trying to slow that down or even tell you that you can reverse the skin aging. So today, I'd love to talk about what actually helps with this and what is just hype.

I have three myths that our listeners put forward as the things they were most interested to ask one of the world's leading dermatologists about. The first one was expensive creams can erase wrinkles.

I see ads for them everywhere. Do they work? Well, that would be a wonderful thing if they did, wouldn't it really? Part of the challenge with all of these creams that you might see that claim to actually... treat wrinkles is that they don't really they are cosmeceuticals by and large what is a cosmeceutical it's not a drug it's a product

that's something that might impact on your skin. It sounds like a made-up word, which is partly cosmetic and partly a pharmaceutical. But these are compounds that don't really have to prove that they work on the underlying... problems in aging. They really just have to prove that they are safe. Now some of them may have some benefit on the skin.

They certainly, in terms of what they actually do to the anti-aging process, they work in the lab. If you set up some amazing cell culture model or model of aging skin in the lab and you test high concentrations of many of the ingredients, ingredients of these anti-wrinkle products, they might do something. But then the reality is when you make a product, is the concentration the same? And most importantly, can you deliver it to where it needs to be delivered in the skin?

I've already mentioned that the skin is a very effective barrier. If you're putting a cream onto the outside, then is it really going to penetrate right the way through the epidermis into the dermis to get down to where your sagging collagen fibers might be, where it actually needs to do its effect? I suspect mostly not.

the other thing just to mention about those creams of course is if you notice the advertising they no longer claim to treat wrinkles or to improve wrinkles the advertising actually now says may improve the appearance of wrinkles which might tell you something that you're having a more superficial impact rather than getting really deep down to where the skin is contributing to actual wrinkles. John, could you paint me a bit more of a picture? Because I can't tell my epidermis from my dermis.

I think like everybody else who's actually thinking about buying these creams, I'm like, well, that makes sense. The wrinkles are on the surface. I put it in. Hey, presto, isn't it like builder's putty, just filling it all in? Problem solved. If only. That's right. So the epidermis is a brick wall on the outer part of your skin. And literally, that does not contribute directly to the appearances of wrinkles.

What you have underneath are the collagen fibers, the elastic fibers, and these are the ones which are affecting the texture of your skin. So the epidermis over the top is really just like a protective barrier, a layer of carpet that's just over the top of your dermis where these destructive aging changes are taking place. So there are some changes in the epidermis as you get older that contribute to dryness and so on. But really those things that we see as wrinkles.

are deeper down and so for an effective treatment you're going to need to be able to get down to those deeper parts of the skin and topical preparations are not really going to get there in most cases

You're saying you've got this protective barrier, this epidermis, and basically I'm putting these creams on and they're just preventing it getting through. I mean, it's doing its job by being... I'm thinking about it almost like the waterproof coat on my flat roof in the house is this sort of like...

Paid good money to make sure the rain can't get through. And this is sort of what the outer layer of my skin is doing. Absolutely. The skin is doing a good job. Of course, as we get older and it gets a little bit drier, maybe there are a few leaks in that particular tarpaulin that you've got. You're quite familiar with.

my flat roof, I can see. But mostly, of course, the skin will just do its job and keep the outsides out. What many of those products do, of course, is that they actually feel good on the skin. And there are some products which are cheap and cheerful and others which are much more expensive. And it's usually in those more expensive products, there is a particular preparation, the way it's put together, that actually makes it feel expensive, luxurious.

And it ought to work, shouldn't it, at that price? So there is a real difference in feel, and that can be part of your experience to enjoy it, but isn't necessarily going to change its ability to actually penetrate deep enough into the skin to have the impact on aging that you're looking for. That's a very good summary. I mean, you as the buyer have to determine whether you think paying 200 times more for one of those more luxurious creams is really worth it. It'll make you feel better, I hope.

So I feel like we see more and more creams in white bottles with lots of scientific ingredients. I feel like there's definitely been a shift where, despite what you're telling me, it all feels a lot more scientific than it used to. Is that true? And if so, what's going on? Yes, you might think the marketing is very important in terms of how you package things and bottle things up. And one of the interesting things from some of my colleagues around the world, they investigate it.

What sort of packaging are consumers going to be most interested in for skincare products? And just to cite some research from colleagues in Thailand, they studied mail. toiletries cosmetics things that were to do with anti-aging and they packaged them in all sorts of different bottles

formats, creams, gels, but mostly the study was around the packaging, working out whether the color, the style of packaging really works. And what they found, perhaps to people's surprise, because you might think for male toiletries, cosmetics, something... chunky, bold, silver, gray, graphite type of appearances might be most appealing to consumers. Actually, they found that it was products in white bottles, white.

products, white tubes, where people sort of assumed some medical relevance or impact from these cosmeceutical products. And so those were the ones with greatest appeal. So packaging and marketing can contribute to the overall experience and expectation of what one might get from what's actually inside those bottles or tubes.

You're making me laugh because all the skin creams that have survived on my side of the bathroom are basically in white tubes, quite low key. I'm just a victim of marketing like everybody else. You are indeed, Jonathan. So I just want to pick up on one other thing that you mentioned in the quickfire random questions, which I found very surprising. I asked about whether they need to prove that these creams work before they're able to sell them.

That's right. A cosmeceutical does not need to have scientific proof that is actually doing something in the skin which is reversing or treating or preventing some of the aspects of aging.

And so most companies will actually just produce something that is safe, and then it goes back to the feel of the product and the consumer reaction to it. There are some... cosmeceutical products in which the manufacturers in collaboration with their scientists and dermatologists have gone the extra step and maybe have sampled part of the skin to look at some of the fiber changes that occur after placing products on the skin.

And they have demonstrated at, albeit low scientific resolution, some changes in the skin that might show a slowing down or reversal of some of the aging products. So it's putting a little bit of proof. onto a story where it isn't actually required. And of course, for a consumer, you may take that and say, wow, this is amazing. There is some science here. This must be a credible product. But it's unlikely to be anything like those studies I mentioned.

in the lab where you can make a model of skin or use some cells and use a higher concentration of the active ingredients. There is limited data on this. Maybe some products have a small amount of data. And the evaluation tools are not necessarily the ones that we would use in pure science, but there's a small story for some of those products, and I wouldn't want to dismiss it completely.

You've been very careful, John, I can hear. Last question around there. So you said that these expensive creams can't really erase wrinkles. I do definitely see ads where they sort of show a before and after of putting some sort of cream on and people say, oh, you know, you can't see as many wrinkles as before. Is that totally untrue?

Not completely, but I would encourage everybody who looks at some of those adverts to look carefully at the before and after pictures and think... has the lighting changed is it more oblique is the photograph directly comparable is it exactly the same angle that's being shown there is the subject wearing different makeup are they wearing different clothes is there anything else to enhance appeal between the before and after pictures and you know if somebody calls their cream a creme

then probably you're more in the marketing sphere rather than anything more efficacious. But improves the appearances of wrinkles can take on many meanings and marketing opportunities.

It's brilliant. I'd like to move on to the second myth. And we had so many questions around this. The sun is the enemy, is I think how I would describe this in simple. What happens when sunlight hits our skin? So sunlight... as we know is composed of lots of different wavelengths and these will penetrate the skin. Many of your listeners will have heard of UVA, UVB, UVC, visible light, and all of these will have different penetration capabilities through your skin.

But ultimately what they're doing is either causing damage to your genetic material, the DNA, or directly some of the structures and fibers in your skin. So it is an enemy on one level. but actually in moderation, sunlight is good for you. There have been many epidemiological studies that show sunlight is really good for your heart.

So cardiovascular health can be improved by sunlight exposure. So that probably means next time you're not in the gym and you're lying on the beach and somebody phones you up and you say, just doing a bit of cardio. It actually may be telling the truth. So dermatologists always worried about DNA damage, about cancer, about molds turning malignant, what we call melanoma, and some other skin cancers. But...

There are other clinical and human health issues that are beneficial. We all feel good, of course, because of the endorphins that sunlight releases into our skin.

I was actually going to ask John, could you explain for a minute how can sunlight be good for my heart? And in fact, then I'd love you to explain how sunlight can make me feel good because it definitely does. What's going on? So let's take the skin part first of all. So when you- shine sunlight on your skin, it is damaging the DNA in your skin. So tanning, I prefer the word DNA damaging.

So you're actually damaging the DNA. And when you have damaged DNA, it will produce a chemical, which we call POMC, pro-opio-melanocortin. And pro-opio-melanocortin, POMC, is then broken down into various other sub-chemicals, some of which will stimulate the suntan, something called alpha-melanocyte stimulating hormone. But one of the other breakdown products of POMC, believe it or not, is beta endorphins.

So everybody knows about endorphins being a sort of stimulus to making us feel good, to feel better. Exercise can stimulate endorphins. Other things can stimulate your endorphins. sunlight can stimulate beta endorphin in the skin. And maybe this is one reason why people like lying in the sun or going to tanning salons because you're becoming almost a natural junkie with your endorphin release in the skin. And so that's why we feel good to some extent. In terms of your cardiovascular health,

It's the chemistry and the science is much more deep than that. You're controlling inflammatory chemicals called nitric oxide and other destructive antioxidant quenching as well can be useful. We don't know it for sure, but from population studies, we know it's good for your heart. You can save a lot of lives from cardiac ill health by having sun exposure. Do we understand how the sunlight is contributing to my... heart health? Is it as simple as just...

I definitely feel much happier on the days when the sun is shining and somehow I'm just overall, it's reducing my stress or is there something else going on? There's going to be some science there. I think the simple way to think about sunlight is...

You have this double-edged sword. When sunlight gets shined on your skin, it quenches various toxic chemicals that could... be destructive to your general health including your heart so you have the benefits of quenching those damaging chemicals offset against that is the dna damage in your skin which could promote the acceleration and development of skin cancer. So that's kind of the double-edged sword of sunlight, I think. The show you're listening to right now.

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It's really interesting. So there's a sort of balancing act here. Potentially some of the messaging we've all been getting for the last 30 years of like all sun is dangerous because you're going to get skin cancer. There's also, you're losing out on some benefits, which we're talking about for heart health, for our mood, all the rest of it.

Is it possible to have a middle ground? Is it possible to have a situation where you shouldn't be avoiding sun all the time? That would be my recommendation. It's a question of just where you set that line, and it will vary from person to person. But I think an important message is that some sunlight is good for most people.

And when you look around what most people might be doing in the Western world, whether that's the States or the UK or France or whatever, are most people protecting their skin? enough from your perspective, too much or not enough? If I put my dermatologist hat on, I would say probably not enough because it's really just the start of... education for people I think in terms of how to look after your skin

People have been aware of this since the rising incidence of skin cancer in the 1960s and 70s. People really started to understand that the sun wasn't always our friend, particularly when it was taken in excess. And gradually, different parts of the population around the world are getting the message. It seems that older men are still slow to get the message about protecting your skin health.

You know, in some countries around the world, New Zealand, Australia, the message has been there for 40 years plus, and people are sensible, take action. know what to do in terms of good behavior and bad behavior. And I think it's important to keep the message going that there are things we can do to look after our skin, to protect our skin, to reduce the incidence of aging and skin cancer.

But at the same time, all of us need to enjoy a bit of sun every now and again. Now, you mentioned writing the quickfire again, something that I was very surprised by. Because you said that it was possible for those of us who might have been in the sun for too long and got sunburned, there might be some way to reverse it. And I'd always assumed that that was an old wives' tale. And if you were burnt, you were burnt. It's possible to do something about this?

Yes, I mean, this is not mainstream science at the moment, but what we have are some new ideas about treating sunburn. None of us should really get sunburn. We should all be sensible, shouldn't we? But what tends to happen is that... People will go out on the beach. Maybe it's a nice day. Maybe they'll stay there too long. And then come the evening, people will think,

Oh no, I've overdone it. My skin's going red. I'm going to have a terrible night. It's going to be blistering. I'm going to be peeling. I'm going to be in agony. The rest of my holiday is ruined. Where's the doctor? What can I do? I haven't got any aloe vera or something like that to put on my skin.

Can I get some steroids of some sort to calm it down? So, John, you've painted a beautiful picture. I'm going to really tease our listeners because I want to come on to my myth number three before we tell the answer, because I know you're going to give us actionable advice.

You're going to tell us the answer for what to do in that horrible situation? Yes. Hang on in there. I'll tell you the answer soon. Don't normally do this. Let's see what the feedback is. Because I would like to go on to myth number three before we switch to really all the actionable advice.

It's interesting, we had a lot of questions about this. And I feel it's a topic that five years ago, I hadn't really even heard about and it's collagen powders. And so we had lots and lots of questions, which are all basically the same, which is Is it true that collagen powders, you know, if I eat them, drink them, can sort of plump my skin from the inside out? Maybe start with a theory of how they should be doing this and then tell me, does it work?

So the challenge, of course, is people think that what happens when you age is that you lose collagen in your skin. And most people will think, well, if I lose collagen, can I just replace collagen? And how do I replace collagen?

ah, there are these supplements out there. It says collagen. Is it just a question of taking something from the pot and putting it into my skin? That would be really great if that happened. But it makes no sense for us as... doctors and scientists because this collagen protein what happens you take it by mouth it goes into your acidic stomach

And it's into what we call the digestive system. And that's exactly what it does. It digests this complex polypeptide protein into individual amino acids or tiny little peptides. Many of those will then be absorbed somewhere through the gut and they will contribute to the protein diet that you are taking.

But what's going to happen to them? Can we really expect those little individual amino acids, peptides, to know what to do? Are they really going to go into your bloodstream, circulate around and think, ah.

This is a nice place, the skin where there's missing collagen. Let me land here and start assembling myself into a collagen fiber to replace what is missing. It just... doesn't seem logical and there is no science to support that idea at all there may be some types of collagen where people have a little bit of evidence i see no proof of course what they can do is if you're taking...

protein diet. Some of it may finish up in the skin. Some of it may complex into bigger protein structures. Some of those may then absorb water or contribute to increased hydration in the skin, which might give a plumper appearance. So it might improve some of the appearances, but actually we should dispel this myth that a collagen supplement will lead to more collagen in the skin. That simply cannot be true.

That was pretty strong because, you know, people are selling these, they're expensive. So people choosing to do this versus, you know, buy something else, maybe a better diet. You sound like you really just believe. This is junk and doesn't work. I will believe good science when I see it. As I mentioned, maybe there's a little bit of something around some of those marine collagen, but...

It's not great restorative, anti-aging, new skin dynamism type of results. I think it's safer at this stage to say case not proven. And just be careful if you go out and think about buying some of these collagen supplements because very little of it and perhaps none of it will finish up in your skin. You're being a bit tough.

on the myths. So I'd love to actually talk about what people can actually do if they want to keep their skin both as effective as possible, because you've talked about how important it is as this barrier. but also hopefully looking as young as possible. I think the obvious place to start is sort of skincare routine. Should there be a daily skincare routine? And if so, what really should be in it?

There is such thing as a good skincare regime, and it's typically divided up into three bits. And most dermatologists will give similar advice. The first one is about cleansing.

and what sort of thing you do to cleanse. And there are a whole range of cleansers out there. For those of us who are quite naive on this, what do I need a cleanser for? Well, just to get rid of any dirt and grit and dead skin on the surface that you may have accumulated over the previous few hours. It just removes some of the products there.

I think most people will just probably use something in the shower or quick wash in the basin, but that still constitutes cleansing to some extent. But there are a number of products which are out there as cleansers. You're not sitting here saying, oh, that's all a bad idea. I'm stripping my skin of what you shouldn't do.

Actually, cleansing gets a thumbs up. Cleansing of some sort is probably a good idea for most people. And then the second stage after that is around moisturizing. And this is, again, a little bit... contentious because some people just don't need a moisturizer. But probably about two-thirds of the population would benefit from putting a moisturizer onto their skin. Choose one that's more creamy perhaps than greasy, particularly if you have a spot.

or acne prone skin. Grease can make things worse. And nobody wants to look ultra shiny after putting that on. But some moisturiser may be helpful after that cleansing, particularly as the cleanser may dry the skin to some extent. And John, what does a moisturiser do? So it's just providing some hydration to the superficial part of the skin. Again, it's not penetrating. It is just providing you with some lipids or some other related moisture retaining compounds on the surface.

to improve your appearances of your skin, to maybe reduce the amount of water loss that naturally occurs through your skin and to deal with any dryness that might be there. So it can be a good idea. And it's a very personal choice about what moisturizer you use. And sometimes some of the cheaper products are just as good as some of the more expensive ones. So moisturize would be phase two.

And then the next phase I think that dermatologists will lobby hard about is the sunscreen. And it is a good idea to put sunscreen on. How to do it? what to choose. These can be personal choices, but most dermatologists would recommend you don't use a sunscreen with a low sun protection factor. 30 plus is the minimum that most dermatologists would recommend, sometimes 50 plus. When you look at the label on it, look for something that gives ultraviolet UVA protection as well.

And on most sunscreen products, there's a little logo. It says UVA in a circle. And that's so something to look at. So you're looking for something Factor 30 Plus with a UVA logo on. And then it's important to think, how much do I actually put on? Well, if you're putting on your entire body, obviously, most people won't be doing that because they'll be dressed and ready to go. But if you were to cover your entire 1.8 square meters of adult skin... What's that? That's like...

10, 12 square feet? Yes, it would be quite a lot, wouldn't it really? Then you would need at least six teaspoons worth of sunscreen. Another analogy people sometimes think is a shot glass full of. sunscreen. That would be enough for one application of sunscreen. Which is quite a lot of sunscreen, isn't it? Yes, because I think one of the big problems we have, you look at something, it says SPF 30, SPF 50 or something like that. But actually...

How those numbers were calculated is quite different from what we do in practice. So those SPF numbers were calculated in a laboratory by putting a certain amount of sunscreen onto a square centimetre or a quarter inch of skin. and shining light on it and then generating numbers and showing what an SPF can mean in the lab. But actually,

None of us, myself included, ever put sunscreen on as thickly as it was done in those laboratory calculations. Is that right? It's like put on really thick to show you that it works really well. And then in reality, we just put like a little dab on. It's a standardized laboratory approach, but we actually just dab and... smear, don't we really? And that comes onto the next point of sunscreen application is that you should really try and

Think about putting it on repeatedly throughout the day. Every two to three hours is a good idea. So once before you dash out of the house is not enough. every two to three hours you should be thinking about putting your sunscreen on and that is a good regimen cleanse moisturize sunscreen and you're done

Can I ask about the sunscreen a little bit more? Because you just talked also about the balancing factors between the risk of cancer on one side and some of these other benefits. So maybe my first question is...

Is the only benefit of sunscreen to avoid the risk of cancer? Or does it also help against the sort of some of the skin aging that you've been talking about previously? Both. So sunscreens will... protect you against both aspects of that type of problem so the aging aspects and also the malignancy the cancer risk that everybody can experience with sun exposure so a double hit

Is aging only about this damage to collagen or is there other things that are going on? Because I definitely see this. I definitely notice I'm old enough now to notice that friends of mine who really love the sun. Definitely look older today than those who have had what I now consider a Japanese attitude to sun. And I say that because I went to Japan once on holiday. I had a wonderful time and I was really struck by the fact we're on this trip with quite a lot of Japanese people.

and certainly all the women basically had an umbrella in the sun over their head as we walked around to make sure they didn't get sun on their face, which I guess is even better, presumably, than wearing SPF. So I consider that the extreme. I definitely feel like I've noticed a difference in sort of the visible aging, but I realized that's not a scientific experiment. Is that real? Or am I just sort of?

putting things together in the wrong way. No, you're right. And in fact, many of those people in hot countries in Asia, for example, will be putting sunscreen on as well as using some sort of protection and a UV umbrella. is what they they tend to go for i grew up in japan myself so maybe as there is some legacy for me too but for most people i think the idea should be when should you start putting sunscreen on

Obviously, if you're going on holiday as a child, that's fine to put your sunscreen on. But those regular sunscreen applications, mid-20s, early 30s, is probably when you should start doing that regular, everyday sunscreen. application that's interesting because i feel like one of the things that you're most told to do is put sunscreen on your children when they're little and yet you're saying actually

I shouldn't worry about that as much? If they're going on holiday or they're going outside a lot, yes. But if they're just running around... Let them have a little bit of sunshine. I don't see any problem, but do stop them getting burnt. So it's more like if it's really sunny and they're going to be out all day, then sunscreen is a good idea, even if they're five or 10. But if it's not particularly sunny, they're not going to get burnt.

you're saying you probably don't need to worry so much? Worry less, I would think. But obviously, you do need to think about clothes. You need to think about the amount of... time that kids are spending out in the sun and avoid them getting burnt. But what we're really saying about the regular sun application is part of this cleanse, moisturize, and apply every day approach from your mid-20s onwards.

Do you know someone with a 10-step skincare routine or a shelf full of fancy moisturizers and a collagen habit? Share this episode with them right now. A leading molecular dermatologist breaks down what actually works and what doesn't. They may learn something and save a bit of money, and I'm sure they'll thank you. We're recording this podcast in London and England. It's very gray and wet outside right now. And for much of the winter, it's pretty dark. Do I need to wear sunscreen?

on my face every day or only in the summer when there's more light around. This is going to vary from country to country, of course. But as you say, we're in gray, rainy London. And if you look at where the sun sits in the sky and the potential damaging rays...

I think, Jonathan, we can let you off between November and March, as long as you're not disappearing off for a sunny holiday somewhere in between. But the sun is so low at that time, and the number of rays that are coming through and potentially damaging the skin is low. I will give it a rest between November and March. I think it's really interesting. Do you feel that as a dermatologist, your advice on this is?

less absolute than it would have been 20 or 30 years ago. I feel like I've been hearing slightly more balanced advice about this than maybe I was. getting in the past? I think that's right. All dermatologists will focus on not letting kids or adults get burnt. But a little bit of sun exposure is good for you. Common sense and regular applications of the sunscreens is also common sense.

it's this balanced approach to life nobody wants to stop people enjoying the sun but we have to take a sort of sensible attitude and i think a lot of people have taken that on as part of their regular lifestyle now they know the sun is both wonderful and potentially harmful. What about if I didn't put my sunscreen on and I lay out in the sun in Florida all day and now I've gone a beautiful lobster and it's starting to hurt? You suggested them...

Obviously, I should have worn the sunscreen. That's very clear. I've heard it loud and clear. But if I didn't... You said there might still be something I can do? Yes, I'm reprimanding you for that behavior, Jonathan. I feel reprimanded. Yes, very good. So that's it. You're sitting there and you've gone red.

and you're going to blister and you know the next few days are going to be in in really very uncomfortable and there's not much you can do about it or is there i guess before we get do that we probably ought to think what has actually happened in your skin jonathan now you've been lying on the beach so you have

got this red skin and what's going on in your skin, if you could put a microscope into your skin, you would see inflammatory cells, cells called macrophages and neutrophils would be starting to come into your... damaged skin. They would be releasing lots of inflammatory chemicals, one called TNF alpha, tumor necrosis factor alpha, that would be starting to be expressed in your skin. This would cause your blood vessels to dilate and leak and other inflammatory cells would be recruited.

You'd be activating other pathways in the skin which could be potentially damaging. Nitric oxide synthase. All of this damage is starting to go on. This raging inflammation that's going on in your skin. And in fact... One piece of recent research that some of my colleagues in the U.S. have helped generate is to show that single high-dose vitamin D3 can do amazing things in restoring your damaged skin. So how does it work? Well, vitamin D3.

is something that will activate directly on inflammatory cells in the skin called macrophages. It turns them from pro-inflammatory to anti-inflammatory. It calms down. the other neutrophils, the chemicals that are driving this particular inflammation. So it has direct anti-inflammatory effect. It's nothing to do with being a vitamin.

that will actually impact your bone health or anything. We're using it as an anti-inflammatory approach, but we're not talking about the same dose that you might do for a supplement that somebody might take every day. What we're talking about here is a single high-dose treatment where you can actually switch the fate of these macrophage inflammatory cells.

And most importantly, by the following morning, your skin should be pretty much back to normal. No steroids, no aloe vera, no other chemicals at all. Just the simple anti-inflammatory effects.

of high dose vitamin d3 don't worry about your calcium levels your phosphate levels because your kidneys will protect you against all of that the benefits are directly onto those inflammatory cells and it helps and it will actually improve your skin and you'll be ready enough to have a second day in the sun albeit this time jonathan i think with applying some sunscreen

Firstly, the description of what happens is rather terrifying when you burn yourself. Secondly, this sounds magical. I guess two practical questions. What is a high dose? And are there any risks? Because I know we've done a couple of podcasts around vitamins. And one of the things I discovered from that is that ultra high levels of vitamins can actually be dangerous, which shocked me.

Yes, I think that's right. So a caution about vitamins. Many vitamin supplements, many doctors will question whether they do any good at all for people's health. But you're right, there are some vitamins which are fat soluble, vitamin A, D. E and K are fat soluble and potentially you could build up high levels of those. But we're talking about a single dose. Now, the supplement dose that most people take is something like 1000.

international units or 25 micrograms. So that's the same 1000 international units is 25 micrograms. The dose we're talking about here for sunburn is something like 50 times that. Maybe 100 times that. So 50,000 units, international units of vitamin D would be a useful place to start. Many of us would recommend taking 100,000 units just as a single dose. And this could be taken any time between 1 to 12 hours after the sunburn.

So that would be the effective window of taking this single high dose vitamin D3. So that's the high dose. What about the safety of this high dose vitamin D3? There is no need. to worry. As I mentioned, your kidneys protect you from surges in calcium and phosphate and no other...

potentially adverse effects have been demonstrated. You know, there are other medical indications that we use this for beyond sunburn, but in terms of sunburn, this is a very useful thing to do. So I think what I'm hoping you will do jonathan for your holiday is pack your spf factor 50. But alongside that, maybe you will also pack some vitamin D3 that you've picked up at the health food shop. That would be a good combination to take, but please don't burn yourself.

Brilliant. And presumably you shouldn't do this if you're not healthy. So you're saying it's fine if your kidneys are fine. There may be some caveats and it may be worth taking some additional medical advice, but for the vast majority of people, this will be a great remedy.

for your acute sunburn. Now, I think we talked about actionable advice in terms of sort of cleansing and moisturizing and sunscreen. The one product I haven't heard you talk about, which comes up a lot, is retinol.

Could you start by saying what retinol is and then tell me your view about whether or not there's something real and actionable that you can do there? Yes. So retinol is a... derivative of vitamin A. It's part of a group of compounds that dermatologists use in their practice called retinoids.

Many listeners will have heard of retinoic acid, which we can use as dermatologists in either cream or gel form and apply to the skin for acne, for aging, anti-aging effects as well. And retinol is another version of that, which... is not necessarily requiring a prescription. It's something that is in a lot of products, can be bought over the counter, and may have some of the same benefits as retinoic acid. So it is something which can have.

anti-inflammatory effects on the skin and may have some benefits for improving the appearance of aging and maybe even reversing some of the effects of aging so it's out there in products and something that people can apply off prescription And so unlike some of the things you were talking about before, like the collagen powders, the sort of real science behind this, this actually does something. I think so, because what most of us do in...

dermatology is to look at the literature and to see what sort of clinical trials or comparative studies have been performed. We know that there is 60 years history of retinoic acid being used for anti-aging and acne and other. dermatological indications but we know that there have been comparative studies using retinol to ask the question is it

similar to retinoic acid? Is it more effective? Is it less effective? Does it have similar side effects, different side effects? And most of us then will look at the information. And in the literature, there are a number of... well detailed studies, which we call systematic reviews, where people have actually gone through thousands of scientific papers and studies, filtered them to get only the most robust findings out.

analyzed those studies and then made some conclusions and those conclusions suggest that reginal can be as effective as retinoic acid in some studies. It can cause less side effects like dryness or irritation, and it can have some anti-aging properties. But at the same time, there are also some other studies which show that it is less effective than retinoic acid and may not have much benefit at all.

Even the robust studies are giving us some slightly conflicting data, but there may be benefits to using this vitamin A derivative, retinol. You're saying it's not as strong maybe as the retinoic acid that you're going to get prescribed by your dermatologist. Is that what I'm understanding? So it's sort of like a weaker version that you can get off the shelf. And that's hence you're being a little bit more cautious. Is that? Yeah. So the percentages of retinoic acid.

just like they can for retinoic acid in any product can change. And that will alter some of their effectiveness in terms of what they're being used for. But usually retinol is a better tolerated. a less irritant product than retinoic acid, and it may have some of the same benefits. And we had quite a lot of questions about at what age someone should start using retinol and...

this discussion about the fact that there's this huge growth in using all sorts of skincare, even amongst early teenagers or younger, because what they're seeing on social media. What are your thoughts here? For retinol, it's probably the same sort of story. Mid-20s, early 30s would be a reasonable sort of time to start thinking about it. You know, I have dermatologist colleagues applying retinoic acid or retinol onto their skin for...

30, 40, 50, 60 years. And they have beautiful skin, almost wrinkle-free skin, but a small price to pay, I think, I suppose, or maybe it's a big price to pay for having to do that on a regular basis. And would you have any concerns about applying it if you were 12 years old? Yes, I wouldn't advise applying retinol at that age. I think that children, teenagers, young adults should really avoid.

all of these products on their skin. We've mentioned that some of those other skincare routines need to kick in much later. So I think it's an important message. for anybody who's really maybe under the age of 25 is don't be taken in by a lot of advertising, by a lot of social media trends as well. You don't really need to be doing a lot of things to your skin at that age.

You're in a wonderful time when your skin can just work at its best and do great things for you. So don't spoil it. Don't damage it. Just let it be. And if there's parents listening to this who I think I would, you know, I'm probably maybe in that group that worry that potentially this might cause harm. So it's not just that it's a waste of money, but actually it might actually be harmful. Can they be relaxed or are they right to?

worry about this most of the time it won't do any harm apart from probably to the parents wallet i think or credit card but to the kid themselves or the young person themselves i don't think there'll be any sustained benefit But there may be peer pressure, there may be social media pressure, people may need to try things. But if you are in a position just to say no and forget about it and just get on with life, then that would be a much better option for you. Brilliant.

We haven't mentioned anything about nutrition. Is there any food that I could add to my diet tomorrow that could actually have an impact on my skin? It would be wonderful. And there'll be many listeners hanging on to see what... is going to be recommended at this stage? Or is it going to be the usual thing of talking about oily fish, nuts and seeds, fermented products, leafy green vegetables? Probably it's going to be more of the latter in terms of where we are.

For your skin, it's the same sort of trends that go through. Avocados, cucumbers, other types of product may be there. And some of this may be just be driven by social media rather than science. There are many... fruits out there which could have remarkable effects on the skin but i would probably be guilty by promoting one or more of them but we could start a trend maybe jonathan let's say i'm quite interested in the geck

fruit, GAC, GAC fruit, because it is incredibly high in some amazing chemicals called lycopene, which will protect you against the sunlight. And it's very high in beta carotene, which will mop up various free radicals in your skin. The Gakfruit, also known as a baby jackfruit, is amazing in terms of its potential.

And there are people across Southeast Asia who are using it all the time in their cooking and so on. But it's not really out there at the moment. But maybe we can set a trend and say that fruit, that food that will give you the anti-aging properties could be cat fruit. but it might be something different next week. But I think the good advice that Zoe has given around a healthy diet for your gut can also apply to your skin as well. A varied diet, a mixed diet, but stick to the oily fish.

and the grains, the fermented stuff and the leafy green vegetables and your skin should at least show some improvement. John, that was fascinating. We covered a lot. I'd like to try and do a summary.

The thing that immediately comes to mind is this idea that we can all be natural junkies by just lying in the sun Because the sunlight goes onto our skin, like it starts damaging the DNA, which sounds bad. It's going to make me look old and wrinkly and maybe get skin cancer. But it can produce this chemical, which you call PMOC.

And that then gets broken down and gives me endorphins. So basically I could do something really hard, like run a marathon, or I could just lie in the sunshine and I get this natural high. And this is part of why we all love it when the sun comes out and suddenly we get the sun on our skin. And did I get that right? Absolutely. You're a convert to that story. Yeah. Well, I love this idea that there's now the science understands what's going on.

What you said, though, is it isn't just about feeling good. There's actually real evidence that this helps our heart health and that the sunlight we can also see is sort of, you said, quenching these toxic chemicals. So we talk a lot about fighting inflammation on this show. and it sounds like you're saying the skin itself.

has this role if it gets the sunlight on it. And so we've all heard the story that sunlight is bad for you because it causes skin cancer. And I know that's very serious and people die from it, but you're saying there is also these benefits. And so we now need to think a bit more. balanced way between those. The other thing that I, of course, picked up on is that the skin microbiome is real. You said there are

billions of these bugs and that although we're only just starting to understand it, you know, we might be doing this show in 10 years time and really talking about ways to treat people specifically. Then we started talking about all of these myths. And my big takeaway was that my skin is a really good barrier. And you talked about this thing being the epidermis. And I think about it as being almost like this sort of waterproof layer, like I might put on my house. And so

Pretty much the creams that you put onto your skin can't really get below that. So actually most of their claims you have to treat with a grain of salt probably can't really work just because they can't get. down to where they need to. And what I understood is where they really need to get to is into this collagen. Sadly, I have less collagen than I did when I was younger. This is why my skin is starting to look saggy and more wrinkles.

There are lots of ways to make the collagen worse. So you said, you know, too much sunshine, smoking or vaping, you know, sounds like a really bad diet, wouldn't help. Unfortunately, just popping a collagen pill. isn't going to fix this. So that was definitely thrown out with the myths. And similarly, there isn't some magic cream that's going to fix it because actually it's more that they do clever things with their advertising than that actually it breaks through this epidermis and gets.

to where the real wrinkles are. Perfect summary. What you did say is there is skincare routine that matters. So like... Cleansing is a good idea. Get the dirt off your skin. Moisturizing, I think you said two thirds of us would benefit. Make sure you choose something that's more creamy than greasy because that hydration matters. sunscreen, despite the discussion before about how a bit of sun is good.

We had a very long discussion about putting lots of sunscreen on. So I think you're still allowed to be a dermatologist. And you said like 30 plus is minimum, make sure it protects against UVA. But interesting, you were saying a lot of this is, think about this, you're into your 20s or your 30s.

know, if you're younger, then certainly you shouldn't be worrying about putting retinol on, but also you're saying, you know, don't be completely paranoid about the sunscreen. There's benefits to the sun as well. So, you know, if they're at risk of getting burnt. put it on, but otherwise you don't need to worry as much. And you said, if you live somewhere that is cold and dark, so that's London or Canada or wherever, then actually in the winter months.

you probably don't need to wear this sunscreen. So you said, you know, in London, like November to March, I could actually be allowed not to put it on. Quite right. And then the final thing. which I'm sure anyone listening to is really struck by is if you do get burnt, there is something you can do. You can take this super high dose of vitamin D3. I think I wrote down 50,000 or even 100,000 international units.

units, you know, fast, like within 12 hours and you wake up the next day and you're all fixed. Try it and see. Wonderful. Now, if you listen to the show regularly, you already believe that changing how you eat can transform your health. but you can only do so much with general advice from a weekly podcast. If you want to feel much better now and be on the path to live many more healthy years, you need something more.

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