by Marcelle Pick, OB/GYN NP
Conventional wisdom tells women to brace themselves as they age: get ready for your looks to go downhill and your skin to head south.
Cosmetic companies make billions of dollars off the fear of aging skin, with new anti-aging products and topical “miracle” products launched every year. From my own experience and that of my patients, these products mostly wind up half empty and jammed in the back of the cabinet.
Nevertheless, beneath all that marketing hype there has been an authentic leap forward in our understanding of what causes skin to age, and it centers on inflammation.
This is good news! It means your skin really can look better than ever — no matter how old you are — once you recognize that what happens on the inside, on both a physical and emotional front, truly does show up on the outside. That’s because the aging you see in your skin is biological, not chronological, and can be delayed or even reversed with a holistic, natural approach that includes optimal diet, lifestyle and product choices.
This approach to healthy skin works for other bothersome conditions, too, like acne, rosacea, and dermatitis. Whereas conventional medicine turns first to antibiotics, acids, retinol and steroid creams to treat the symptoms of these conditions, our approach helps women resolve them by addressing the core cause — inflammation.
At Women to Women, we see the results of this inside-out approach every day in the skin of our patients — skin that grows younger and more vibrant each day. And yours can too – but the solution relies more upon what you put in your body than what you put on your skin.
So let’s discuss how to get started.
Skin: what the world sees
One of the first things we notice about babies is how smooth and soft their skin is. From the moment we are born, our skin serves as our most reliable barrier between our inner and outer worlds. It is the layer everyone can see and touch. If the eyes are the windows to the soul, then our skin is the causeway to the brain. In fact, our skin has its own kind of independent intelligence: it blushes when we’re embarrassed, “crawls” when we’re afraid, and itches or tingles for no apparent physical reason.
A woman’s complexion is intimately connected with her feelings of self-confidence and power: it’s the “face” she shows to the world. No wonder women spend so much time and money on beauty products and make-up. We’ve been taught to medicate or cover-up our so-called flaws instead of figuring out why they are there in the first place.
No matter what line a beauty company tries to sell you, the basic fact is that a beautiful face is not just skin deep. Think of a plant – the first indication that it needs water is its droopy leaves. It may revive a bit if you spray some water on its surface, but in order to restore the plant to vibrancy you have to water its roots.
Paying loving attention to the health of your skin is one of the best and easiest ways to listen to your body. Whatever is going on inside will eventually show up on the outside. So if you have skin concerns, chances are you need to look beyond the surface to discover what is really going on. Yes, it can be complicated — the anatomy of the skin is linked to all our major functions, including the immune, respiratory, circulatory, lymph and neurotransmitter systems — but caring for yourself on any one or all of these levels will improve the health of your skin.
Inflammation and skin
Skin concerns arise on two fundamental levels: acute and chronic. This article focuses on chronic issues such as premature aging, acne, dermatitis and rosacea — all conditions that have recently been linked to chronic inflammation. Acute skin conditions and allergic responses, such as eczema, hives, rashes and/or unusual thickening, mottling/bruising or mole growth are very individual and may indicate a more serious underlying condition. If you notice any sudden or extreme change in your skin or moles, contact your healthcare professional.
To make significant improvements in the tone and texture of your skin, you need to soothe inflammation on two fronts:
- By neutralizing free radicals (both inside and out); and
- By boosting immune function through good nutrition, supplements, hormonal balance, detoxification, and topical support.
Dr. Nicholas Perricone, author of The Wrinkle Cure and The Perricone Promise, has pioneered a new way of thinking about skin care that centers on inflammation. While his landmark program is highly effective and one I wholeheartedly recommend to my patients, his theory has been known to other cultures for thousands of years.
In Chinese medicine, too much heat is one of the fundamental imbalances that seriously undermine the body’s ability to repair itself. Very briefly, one principle of Chinese medicine is that when the five elements governing the body are in balance, optimal health is achieved. Two of these elements are water (the yin) and fire (the yang), and when a woman’s internal balance is tipped toward fire, one of the clarion signs is itchy skin, flushing or an outbreak of pimples (internal inflammation literally erupts on the surface). Not surprisingly, one surefire way to support clear skin is to drink plenty of water, which helps maintain internal balance.
By the time a woman sees visible signs of aging (usually in her late 30’s or early 40’s), it’s highly likely she’s been operating with low-grade inflammation for years. Undiagnosed food sensitivities, poor diet, stress, hormonal imbalance, toxic overload and a sedentary lifestyle form a potent challenge to the immune system, making it harder for the body to fight inflammation on the inside. On the outside, sun exposure, weather, bacteria and environmental toxins trigger an immune response that ultimately weakens collagen, dilates surface blood capillaries and clogs pores.
How this manifests in your skin is individual to you, but for most of us it appears as uneven skin tone, sporadic or chronic outbreaks and, of course, premature aging.
The biology of aging skin
Walk over to a mirror and look at your face, neck and hands. For most people, these are the parts of their skin that wrinkle, thin or sag first. Now roll up your sleeve and look at the underside of your elbow or forearm. Any difference you see between the two is the result of aging.
Now you may think that there’s not much you can do about aging skin — you can’t help getting older every year. But there is. The aging I am talking about is not chronological. It’s cellular, or biological, aging. It means that the DNA inside a healthy cell has become fragmented or shortened, which affects the mitochondria inside the cell.
Mitochondria are the fuel factories in our cells that convert the food we eat into energy. When mitochondria malfunction, the cell dies. How well we age, including our vulnerability to disease is due in part to how healthy our mitochondria are. Recent studies have linked oxidative stress — the accumulation of free radicals in the cell — and genetic defects in mitochondria with premature aging.
And what causes mitochondria to self-destruct? One convincing theory is the presence of systemic inflammation.
A common cause of inflammation in our country is our high sugar diet. Too much sugar or high glycemic food ultimately leads to a metabolic process called glycation (or glycosylation) in which sugar molecules in the blood bond to proteins and DNA, which over time become chemically modified. These new bonded proteins are called AGE’s, or advanced glycation end-products. AGE’s create unnatural crosslinks with collagen proteins and change their shape, flexibility, elasticity and function. The result is premature aging. What’s more, the presence of AGE’s generates additional inflammation (see below).
Inflammation and glycation are two related reactions that impact the body’s natural state of balance and manifest themselves as aging throughout the body’s organ systems, but most apparently in the skin. So what prompts the immune system to respond like this in the first place?
The free radical theory of aging
Free radicals are highly unstable oxygen molecules missing a single electron from their outer orbit. Since electrons like to travel in pairs, free radicals steal electrons from healthy cells, wounding those cells and setting off a complicated intracellular inflammatory response.
These highly destructive free radicals surround us, internally and externally. They are formed on the skin within five minutes of unprotected sun exposure and do a lot of damage, quickly, to the collagen layer of the skin. The sun is responsible for the majority of skin damage I see in my patients, but our skin is also barraged by free radicals externally through pollution, x-rays, chemicals and toxins in lotions and cosmetics.
Internally, free radicals fuel inflammation. The greatest offenders are smoking, hormonal imbalance and a poor diet, including an over-reliance on high-glycemic foods, undiagnosed food sensitivities/irritants, additives, artificial sweeteners and trans fats. Smoking a single cigarette creates billions and billions of free radicals. A burdensome toxic build-up, including heavy metal and prescription drug overload, also creates free radicals.
Antioxidants — at the defense of healthy skin
To counteract free radicals, our immune system relies on certain nutrients that defend the cells from free radicals. These cell-scrubbers are called antioxidants, most of which are plant derived. Antioxidants neutralize free radicals and quench minor inflammation by sacrificing one of their electrons without adverse effect.
Since free radicals are inescapable, we must have a constant supply of antioxidant nutrients to keep our skin cells healthy. In addition, antioxidants may actually encourage our cells’ “fix-it” enzymes to repair damage. Our cells have a wonderful ability to heal themselves, but this mechanism works less efficiently as we get older — perhaps due to damaged mitochondrial function.
The major antioxidants are:
- Vitamin C (found in plants and fruits)
- Vitamin E, specifically high-potency tocotrienols (HPE; good sources are rice bran oil and palm fruit oil)
- Coenzyme Q-10 (found naturally in our cells but decreasing after age 20)
- Alpha-lipoic acid (ALA; found in plant and animal sources)
- Dimethylaminoethanol (DMAE; found in fish)
- Carotenoids (phytonutrients found in the red, yellow and orange flesh of plant leaves, flowers and fruit)
- Flavanoids (found in green tea, soy isoflavones and red wine, among other food sources)
When we don’t have enough antioxidants on board and free radicals get the upper hand, they damage the deep workings of the skin tissue — the fibroblast cells that generate collagen and elastin, two types of protein that form the connective tissue that keeps skin firm, clear and supple. This destructive process is called oxidization. Think of the way an apple turns brown when it’s exposed to the air and you’ll get the picture.
Unfortunately, we now live in an age where there is a convergence of external forces conducive to internal inflammation and early aging. Levels of free-radical-producing substances have exploded. At least 80,000 industrial chemicals are registered for use in the US and more are approved every day. At the same time the quality of our nutrition has been steadily eroding. Faced with such a huge increase in oxidative load and more limited support, it’s natural that our bodies become inflamed internally and end up showing the wear and tear externally on our skin.
Common skin conditions related to inflammation — acne, rosacea, and dermatitis
Acne and chronic outbreaks of pimples, whiteheads and blackheads are caused when oil (also called sebum) and dead skin cells build up in the skin and clog pores. In the case of chronic acne, the walls of the skin cells become damaged and vulnerable to the infiltration of bacteria. The bacteria colonize within the clogged skin follicle, creating an infection and subsequent inflammation.
Acne can affect people at any time, not just in puberty. In fact, dermatologists categorize several forms of acne by life stages: baby acne, related to lingering levels of estrogen from the mother; teenage acne, caused by hormonal imbalance; and adult-onset female acne, which usually appears on the nose, cheeks, chin and jawline and is triggered by fluctuating hormone levels during perimenopause. The good news is that once hormone levels stabilize, adult onset acne does get better.
In cases of acute acne, conventional medicine usually turns to antibiotics and aggressive topical peels as its first line of defense against the bacterial infection. This usually yields short-term improvement, but can actually exacerbate inflammation over the long term if the antibiotics upset the balance of intestinal flora. To truly get to the bottom of acne (and fully support your body while you are on antibiotics, if you really need them) I always recommend a holistic approach first, one that will rebalance the inner workings of the body, cool internal heat and soothe inflamed emotions. And if one needs to be on an antibiotic, just adding a probiotic before each meal can help prevent imbalance of the natural intestinal flora.
Rosacea is another common inflammatory skin condition that affects many women. This occurs when the tendency to flush easily thins and breaks the tiny capillaries at the surface of the skin, resulting in a permanently rosy complexion. Many women see the first signs of rosacea in their late 30’s. It is exacerbated by poor diet, hot temperature, alcohol, caffeine and stress — anything that turns up your internal thermostat!
There is also some indication that people with certain temperaments are more prone to rosacea than others, typically women who have perfectionist tendencies and are more vulnerable to feelings of guilt and shame (the emotions that cause one to blush). For more information on this connection, read my friend Dr. Christiane Northrup’s wisdom on rosacea.
I find that in most of the cases of rosacea that I see there is also a digestive component that creates inflammation. Identifying and eliminating food sensitivities and problems with the gut, and adding probiotics to the diet, will dampen internal heat and help curb future bouts of rosacea. Many new exciting technologies, like pulsed laser, can be very successful at reducing existing damage.
Dermatitis means “inflamed skin,” and this class of skin disorders includes chronic conditions such as seborrhea (dandruff) and eczema. While there are genetic components to these conditions, soothing inflammation from the inside out by eliminating toxins and allergens will certainly improve the body’s natural ability to heal these concerns, and identifying any possible external allergens or irritants (such as synthetic fabrics or plastics woven into clothing) may also help. Some of my patients have had success combining topical use of essential oils with a detoxification plan.
Skin care and your diet
The first place to start improving the health of your skin is your diet. Following a cleansing, anti-inflammatory diet, will help you understand how powerfully your diet relates to the condition of your skin. Once you see the difference, you can continue to make positive food choices a way of life.
And while you are cleaning out your insides, you should also check into your emotions — because your feelings can be as inflammatory as dietary and environmental factors.
Emotions and skin
Skin is a fantastic communicator — often revealing our unspoken emotions to the world. Who hasn’t heard of turning crimson in anger or blanching with fear? Why does stress cause some women to break out in hives and others in pimples? The answer lies in the body’s individual response to inflammatory stressors. If you are a highly emotional person, or conversely, if you bury your emotions, your skin tends to expose your true nature — perhaps more than you realize.
For example, two Japanese researchers, Makoto Hashiro and Mutsuko Okumura, have published studies in the Journal of Dermatalogical Science showing that eczema (also called atopic dermatitis) occurs more frequently in people prone to anxiety and depression than the general population.
But even on an everyday level, your personal tendencies are manifested by the state of your skin. In the Ayurvedic tradition, there are three constitutional principles, or doshas, at work in the body, and generally speaking, one influence predominates for each of us and governs our body type. Each type is defined by a certain metabolic predilection (fast, slow, moderate) that influences health and emotional outlook. Interestingly, each body type, as well as its corresponding emotional tendencies, is characterized by a certain kind of skin (dry, ruddy, oily).
It stands to reason, then, that internalizing anger and stress may have as much to do with chronic breakouts as excessive sebum. Some practitioners look at acne as a buildup of subterranean emotional issues that need to “burst” out. As we learn more about this powerful connection, perhaps stress-relieving alternative techniques such as biofeedback and meditation will be used as often as we use creams and pills to treat chronic skin disorders.
And speaking of creams, it is useful to consider the products you apply to your skin every day when you think about what could be causing skin-damaging inflammation in your body.
The hidden hazards in beauty products
The FDA leaves synthetic additives in cosmetics largely unregulated, yet many of these compounds have been proven to disrupt endocrine function, interfering in the metabolism of sex hormones. This can seriously impair fertility and might contribute to breast cancer, especially in the subset of the population that is more sensitive.
Many of the chemicals in cosmetics and creams may, in and of themselves, breed free radicals (and the resulting inflammation), giving lie to their claims of being youth-enhancing. Even more troubling is the preponderance of petroleum-based chemicals in toiletries and cosmetics. One ubiquitous category, called pthalates, has recently been reviewed by an expert panel that found several potential health risks associated with exposure. Pthalates are everywhere, including cosmetics and lotions, but the best way to reduce your exposure is to eat organic.
Additionally, few studies have looked at the dangerous cumulative and inflammatory effects of combining so many different skin products over a lifetime — or how those chemicals interact with all the other chemicals we’re exposed to. The average woman uses 5–12 different products on her skin — an untested chemical soup — each and every day. If one of my patients has a skin or hair concern, the first thing I tell her is to go home and throw out the products that contain synthetic chemicals (which usually mean all of them).
Luckily, a growing awareness of this problem has led to a number of reasonable natural alternatives. The Body Shop, Burt’s Bees, Kiss My Face, and Avalon Natural Products have all agreed to be free of chemicals that are suspected of causing cancer, mutation or birth defects.
Anti-aging skin care
When you look closely at the various factors that influence your skin, it’s not surprising to find that most over-the-counter skin care products fall short of what they promise. Caring for your skin means caring for yourself, from the inside out.
Our approach to skin care at Women to Women has two primary goals: 1) to soothe inflammation; and 2) to support your body’s natural anti-aging and healing properties. Here’s how to begin at home:
Eating whole foods with relatively low glycemic index values. Increase your intake of antioxidant-rich foods, such as colorful vegetables, berries, fruits and green tea.
Drink at least 8–10 eight-ounce glasses of filtered water a day.
Take a medical-grade nutritional supplement rich in calcium, magnesium and essential fatty acids. EFA’s exert an overall anti-inflammatory effect and help keep skin supple and moisturized at its deepest layer.
Talk to your practitioner about DMAE supplements, both ingestible and topical. Some women do find DMAE causes redness and irritation. Other antioxidants may be ingested as supplements, but you need to do so under professional guidance.
Consider taking a probiotic supplement daily to boost beneficial anti-inflammatory flora in the digestive tract.
Avoid or limit sugar, caffeine, artificial sweeteners, food additives, trans fats and simple carbohydrates, especially if you have acne or rosacea. These are highly inflammatory to many people.
Try to cleanse and rest your system a few times a year by practicing regular detox. The Fat Flush Plan by Louise Gittleman and Frank Lipman’s Total Renewal are two good places to start. Otherwise, try eating only organic, washed fruits and vegetables for a few days and drink lots of filtered water (this is easiest in the spring and summer).
If you are smoking, try to quit. Smoking can add ten years to your skin’s appearance.
Exercise daily to reduce stress, support your body’s natural detoxification, and reduce inflammation.
Throw out unnecessary products in your medicine cabinet and cupboards and any products that contain toxic additives or the mystery ingredient “fragrance”. If they won’t tell you what’s in it, chances are it’s not good for you.
Examine your hidden emotions or emotional tendencies. If you think you may be harboring some unexpressed emotions, find a safe place to free them. Negativity has a way of manifesting in the skin. Emotional Freedom Techniques (EFT) is a wonderful method of releasing pent-up feelings of anger, anxiety, and fear. Meditation, deep breathing and mindfulness exercises are also healthy stress-relieving practices. If you need inspiration, look at the skin of most yoga teachers!
Skin care regime:
Cleanse your skin morning and night with a gentle, soap-free cleanser. Do not scrub! Scrubbing actually breaks capillaries and damages cell tissue, which encourages invasive bacteria. Use a wad of cotton or your fingertips. Rinse thoroughly with clean, tepid water and dry gently.
Try to keep your hands off your skin unless they are clean; your fingers can transmit oil and bacteria. Don’t pick blemishes — it damages cell tissue and permanently widens pores.
Use an all-natural exfoliant 2–3 times a week to remove excess dead skin cells (we have one made from date seeds that our patients love).
Moisturize and protect with an all-natural moisturizer/sunscreen. Use sunscreen with an SPF of 30 when out in the sun for more than 15 minutes. Find a product that contains valuable topical antioxidants like co-Q10, ALA and vitamin C ester. Dr. Hauschka and USANA offer reliable, professional nontoxic skin care lines. Dr. Perricone and Obagi are other proprietary programs with excellent results, though the products are not all-natural.
Discuss the usefulness of a regular facial peel with a responsible aesthetician. Glycolic or hydroxy (alpha or beta) peels can help the texture and appearance of surface skin while stimulating new cell growth underneath.
Use natural cosmetics. Aveda, Burt’s Bees and The Body Shop have branched out into a growing array of cosmetics. You should be able to replace your favorite lipsticks, mascara and foundation with chemical-free alternatives. Your skin will thank you!
If you have made all the positive diet and lifestyle changes to support your glowing health (and skin) but still feel your outside doesn’t reflect your inside, there are other steps you can take.
Investigate dermabrasion to resolve deep scarring and imperfections. Talk to a professional aesthetician about pulsed laser technology (IPL) or other laser therapies for unwanted hair, sun damage, spider veins, rosacea and other discoloration.
If your acne is not improving, go ahead and use antibiotics. Just be sure to support your body through proper supplements and diet, and discontinue the antibiotics as soon as possible. Talk to your medical professional about what will work best for you.
Look into a “natural facelift” through acupuncture. Acupuncture works by increasing blood flow and muscle tone, as well as by soothing inflammation. This is an amazing technique that works!
And when you look in the mirror, see beyond the minor imperfections and laugh lines to the glowing spirit that lies within. Honor yourself and the skin you were born in by taking the best care of yourself that you can. You and your skin deserve it!