Digest

This episode delves into the multifaceted changes skin undergoes during perimenopause and menopause, emphasizing a holistic and integrative approach to dermatology. Dr. Mamina Toregono, a holistic dermatologist, explains how hormonal shifts impact skin barrier function, leading to issues like dryness, sensitivity, and exacerbation of conditions like rosacea. The conversation highlights the skin as a mirror to internal health, connecting skin problems to gut health, immune function, and hormonal imbalances. It critiques overly complex skincare routines and the potential harm of certain \"natural\" ingredients like essential oils, advocating for simplified, gentle routines focused on nourishing the skin barrier. The episode also discusses the science behind skin cell turnover, the benefits and safe introduction of retinoids, and the concept of \"leaky skin\" mirroring \"leaky gut.\" Advertisements for supplements like Qualia NAD+ and Manuka honey, as well as Graza Olive Oil and MassZymes, are interspersed, promoting overall wellness and digestive health. Ultimately, the episode stresses that optimal skin health is deeply intertwined with overall internal health and a consistent, mindful approach to skincare.

Outlines

00:00:00

Understanding Skin Changes in Perimenopause and Menopause with Holistic Dermatology

This chapter introduces the concept of skin health changes during perimenopause and menopause due to hormonal shifts. Dr. Mamina Toregono, a holistic dermatologist, advocates for an integrative approach, considering diet, supplements, and lifestyle alongside conventional treatments. The skin is presented as a reflection of internal health, with issues often stemming from hormonal, gut, or immune system imbalances. The host shares personal experiences with skin problems during perimenopause, exacerbated by allergies and gut health issues. It's confirmed that conditions like rosacea can worsen due to hormonal changes and a compromised skin barrier, characterized by thinner epidermis and reduced oil production.

00:08:35

Navigating Skincare: Pitfalls of \"Natural\" Products and the Power of Simplicity

This section addresses the potential for irritation and allergic reactions from \"natural\" skincare, particularly those containing essential oils, which can damage the skin barrier. A simplified skincare routine, focusing on gentle cleansers and moisturizers to repair the skin barrier, is emphasized, especially for sensitive or compromised skin. The episode critiques complex, multi-step routines as potentially harmful and advocates for simpler morning routines (antioxidants, moisturizer, SPF) and nighttime routines (double cleansing, actives like retinoids, nourishing moisturizer). Double cleansing is explained as an effective method to clean skin without stripping natural oils.

00:11:56

Advanced Skincare Science: Retinoids, Cell Turnover, and the Gut-Skin Connection

This chapter explores skin cell turnover, its age-related decline, and the role of exfoliation and retinoids in maintaining a healthy rate, with a caution against over-exfoliation on a compromised barrier. The analogy between \"leaky skin\" and \"leaky gut\" is drawn, explaining how increased permeability in both can lead to inflammation and conditions like eczema. The benefits and challenges of using retinoids and bakuchiol during middle age are discussed, debunking the myth that retinoids thin the skin by explaining they actually thicken the epidermis and dermis. The basic layers of the skin and the dynamics of cell turnover are also detailed, along with the importance of maintaining the skin barrier's components: acid mantle, microbiome, and lipids.

00:40:39

Medical Interventions and Personalized Skincare Approaches

This section discusses the potential benefits of microdosing GLP-1 agonists for acne and metabolic health, while noting potential side effects like SIBO. The historical use and current applications of antibiotics like erythromycin and doxycycline for acne and anti-aging are reviewed. Strategies for safely introducing retinoids, including the \"sandwich method\" and short contact therapy, are provided for sensitive skin. The importance of consistency for retinoid efficacy is stressed, alongside the principle of \"low-dosing\" and individualized medicine for optimal results.

00:54:26

Hormonal Impact on Skin Post-Menopause and Future Skincare Directions

This chapter focuses on persistent or worsening skin issues in post-menopause due to decreased estrogen, leading to thinner skin, reduced collagen, and a weaker barrier, with potential benefits from HRT. The connection between skin aging and bone health is explored, linking hormonal shifts and stress to accelerated aging. The profound impact of hormones on skin is reiterated, noting improved skin aging in patients on HRT. The episode concludes with encouragement for collagen building and skin health post-menopause, suggesting exploration of peptides, growth factors, and antioxidants in moisturizers. Dr. Mamina shares her resources, including social media, website, and a co-authored book.

Keywords

Q&A

• What are the main changes in the skin during perimenopause and menopause?

  During perimenopause and menopause, hormonal shifts, particularly decreased estrogen, lead to a thinner epidermis, reduced oil (sebum) production, less hyaluronic acid, and a weaker skin barrier. This can result in drier, less plump skin, decreased collagen, and increased sensitivity or the emergence of conditions like acne or rosacea.

• Can retinoids thin the skin, and what is the truth about their effect on skin thickness?

  The belief that retinoids thin the skin is a myth. While they increase skin cell turnover and can regulate the stratum corneum (the outermost layer), they actually stimulate the production of collagen and thicken the epidermis and dermis overall, leading to healthier, more resilient skin.

• What is the skin barrier, and why is it so important, especially during hormonal changes?

  The skin barrier is the outermost protective layer of the skin, crucial for retaining moisture and defending against environmental irritants. During perimenopause and menopause, hormonal changes naturally compromise the skin barrier, making it thinner and less effective. Maintaining and repairing this barrier with gentle products is vital to prevent further issues.

• What are the potential risks of using "natural" skincare products, especially those with essential oils?

  While natural ingredients are appealing, some, like essential oils (e.g., citrus, tea tree, bergamot), can be highly irritating and trigger contact dermatitis or allergic reactions, especially on a compromised skin barrier. Dermatologists often advise caution with these ingredients.

• How can someone with sensitive skin or a history of reactions safely start using retinoids?

  For sensitive skin, it's recommended to start with gentle over-the-counter retinols. Using a "sandwich method" (moisturizer, then retinoid, then moisturizer) or "short contact therapy" (applying retinoid for a few hours before washing off) can help build tolerance. Consistency is key, aiming for regular use without causing irritation.

• What is the connection between gut health and skin health?

  There's a strong connection between the gut and skin, often referred to as the "gut-skin axis." Issues like "leaky gut" (increased intestinal permeability) can lead to systemic inflammation and immune responses that manifest on the skin as acne, eczema, or other conditions. Addressing gut health is often crucial for improving skin health.

• Why is a simplified skincare routine often recommended over complex, multi-step routines?

  Overly complicated skincare routines with numerous products and active ingredients can overwhelm and irritate the skin, potentially damaging the skin barrier. A simplified routine focusing on gentle cleansing, moisturizing, and sun protection is often more effective for maintaining skin health and addressing specific concerns without causing adverse reactions.

• What are the benefits of NAD+ for the body, and why is it relevant to aging?

  NAD+ is a crucial molecule for cellular energy production, DNA repair, and overall cellular function. Its levels naturally decline with age, impacting energy levels and contributing to the aging process. Supplements like Qualia NAD+ aim to replenish these levels to support energy, focus, and healthy aging.

• What is the role of hormones like estrogen in skin health, particularly after menopause?

  Estrogen plays a significant role in maintaining skin health by supporting collagen production, skin hydration, and barrier function. After menopause, declining estrogen levels contribute to thinner skin, reduced elasticity, decreased collagen, and a weaker skin barrier, leading to visible signs of aging like wrinkles and dryness.

• What is the concept of "low-dosing" in medicine and skincare, and why is it relevant for retinoids?

  Low-dosing involves using the smallest effective amount of a substance to achieve a therapeutic outcome. For retinoids, this means starting with a gentler formulation or using it less frequently, gradually increasing tolerance and frequency. This approach minimizes irritation and allows for consistent use, which is essential for seeing results.

Show Notes