Dr. Rajani Katta - Glow: A Dermatologist's Guide to Aging Well

Dr. Rajani Katta and Lauren Bernick explore the intersection of nutrition, skincare, and aging. They discuss the importance of antioxidants and healthy fats in the diet, the causes and solutions for hair loss, and how skincare routines should adapt with age. The conversation also delves into cosmetic treatments, the efficacy and safety of beauty supplements, and the significance of maintaining connections and purpose as one ages.

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 If you want to get in touch with the show, email us at lauren@agelikeabadassmother.com; we'd love to hear from you! 

Transcript

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Hi, friends. Lauren here. Today is a good one. We are talking to Doctor Rodney Carter, a dermatologist, and she's going to help us glow from the inside out. She's we're going to talk about diet for healthy skin. We're going to talk about hair loss, the causes and solutions and stay till the end, because we are going to learn the truth about beauty supplements and collagen. And I just want to thank all of you from the bottom of my heart for making age like a badass mother, one of the top 10% of all podcasts. And please help us to continue growing by sharing your favorite episode with a friend. And don't forget, you can now watch us on YouTube or Spotify and leave a comment. I love hearing from you and I will absolutely answer you back. Thanks, friends. Hi friends, I'm Lauren Bernick and I'm flipping the script about growing older. My guests have been influencers since before that was even a thing. Welcome to the anti Anti-Aging podcast. Welcome to age like a badass mother. Doctor Rodney Carter is a practicing dermatologist and serves on the clinical faculty of the University of Texas, Houston. She is the author of over 100 publications and nine books in the areas of nutrition and dermatology, contact dermatitis, and medical education. She serves on the Media Expert team of the American Academy of Dermatology, and has been quoted in many media outlets, including The New York Times, today, Oprah Magazine, and others, as well as multiple TV appearances. But my favorite book of Doctor Carter's is Glow The Dermatologist Guide to a Whole Foods younger skin diet. And that's one of the main reasons I wanted to talk to her. So welcome, Doctor Carter. Oh, thank you so much for having me. Yeah, thanks for being here. And you said it's okay if I call you, Rodney. Yeah. Is that okay? what made you decide to specialize in dermatology? Oh, boy. You know, when I was in medical school, I wasn't sure what I wanted to do. And, And at that time, dermatology. I think dermatology has a lot of, a lot of people know about it these days. But back in the day, no social media, nothing like that. I didn't know a lot about it, but I did a rotation in pediatric dermatology, and I just had this amazing mentor, Doctor Andrea Domini, and just seeing the way that she spoke to her patients, really focused on education, really focused on prevention as well. It really, it really drew me to the field. Seeing her example of what it could be. And so then I explored it further. And there's so much about it I like. But mainly, you know, the relationships with your patients and being able to really attack conditions that can be so debilitating to your quality of life. So and I should mention that my area of dermatology, I specialize in allergic reactions of the skin. So I tell people I'm not the fun kind of dermatologist, like I don't do the cosmetic procedures and stuff. Instead, I'm the queen of sensitive skin. But, but I have to say, like, having an amazing mentor, you know, somebody to, to follow their example really inspired me. Oh, that's that's nice to hear. Can I ask how old you are? Oh, yeah. I'm about to turn 55, so. Wow. Okay, well, you're doing a good job. I'm 56. I feel like your skin is pretty rockin there. Thank you. Time Ryder, can you believe I. I know you're, like, wow. It's crazy. Do you. What do you. How do you take care of your skin? What do you do to it? Well, like I said, I'm. I'm the queen of sensitive skin. I take care of my patients with sensitive skin, but I also deal with sensitive skin myself. And so I have to be super careful with the kind of products that I use. So I'm not aggressive in terms of anti-aging products or anti-aging procedures. I'm actually very, very careful. But I do use, a retinoid at bedtime. And then in the morning I'm very focused on sun protection and then a vitamin C serum. So I keep it very simple. I don't do a lot of exfoliation, which I know some of my patients are drawn to. But if you have sensitive skin, if you have problems with your skin barrier, you have to really focus on that balance between wanting to rejuvenate your skin and taking it a little too far and damaging your skin barrier. So I keep it very simple. Yeah, and we're going to talk more. I want to talk more about retinoids and all those kind of things later. Do you do can I ask you if you do like Botox and fillers? So I do not not for, you know, I would I've had Botox before. I don't do it on a regular basis, but, but yeah, I'm a big fan of those procedures in the right hands. Meaning you have to be super careful about who is doing your procedures, because I've also seen complications. Yeah, yeah. I mean, your skin looks, apps. I mean, honestly, people can watch this on Spotify and YouTube also. And so they could see like your beautiful skin. I mean, you really don't look like you're 55. You really don't mean you look like you're 40. Honestly, if that I'm going to take that compliment and I'm going to say thank you. That is okay of you get good. I want you to, and I think that one of the reasons that you are aging well is that, you know, you're kind of doing it from, from the inside out rather than the outside in. So can you talk about why our skin does age? Yeah. I mean, if you think about your skin, I think the skin is just amazing and it has to protect us. But so many things, I think we all think about UV radiation, but it also has to protect us from things like pollution and blue light, but it also has to protect us from the internal forces, such as even just the activities of daily living. Our metabolism produces compounds that can start to damage our skin. And so all of these factors, I really try to break it down when I, when I'm explaining this to my patients, I talk about three major factors that age and damage your skin. And those three factors are oxidation, major and minor inflammation and glycation. And those are the medical terms. But if you think about it as your skin is very similar to a house, well, you know, just like a hailstorm and rain can start to pound away at the roof of your house. Free radicals that are produced from UV radiation and pollution and just the activities of daily living can also pound away your house. And then there's something called inflammation, which is your body's repair processes. And if you think about your house and you have a tiny little leak in the roof of your house, and then you hire a repair man and he comes in and he creates this giant hole that is chronic inflammation. So that's the body's repair processes that have just gone out of control and end up causing more damage. And then the final process is glycation. And if you think about your house again, if you think about termites that start to eat away at the walls of your house and ultimately you end up with the sagging walls, that's glycation. Glycation is when you have excess sugar in your body, and it combines with proteins and it creates new compounds. And those new compounds are like termites because they glob onto your collagen and they start to weaken it. So those are the three major forces that can age and damage your skin. And I mentioned some of the factors that lead to those I mentioned UV radiation and pollution and metabolism, diet is a big part of it, especially when it comes to glycation and and even things like stress can contribute to inflammation in the body. So you start to see how all of these factors can, can start to really damage your skin. Yeah. And so, how how do we avoid those things? I mean, I know we can't avoid pollution, really. Or I mean, we could avoid UVs with with sunblock, but like, collagen damage and and inflammation. How do we avoid or repair those things? Yeah. Like that's the ultimate question. Isn't it great to know about all this. But tell me what I can do. Yeah. What do we do so. Well first of all, when I talk about preventive dermatology, the first thing is really thinking about the things that you can protect against. And maybe it's hard to protect against pollution, but UV radiation, you mentioned that already. You can absolutely protect against that. Being careful about sunscreen. And it's not just you know, I talk about SPF and I talk about speed. So SPF is your sunscreen but spurs your sun protective behaviors. And so you want to be careful when you're out in the middle of the day. You want to use this. You know, a hat. You want to think about shade. And in Houston, I will say one thing that I've noticed is people don't think about how much time they spend in their car. And, you know, some people have a commute that's an hour long, and that UV radiation is coming through your window glass. Yeah. There's a really, famous photo on the internet of a truck driver, and you can just see, I don't know. Have you seen that? Yes, I know what you're talking about. Yeah, because you can see the left side of his face is, like, sagging and, the eyelid is pulling down and he's got texture changes because that was where the UV radiation came through. And the other side looks great. Yeah. So it's a matter of thinking about even things like that. So that's part of it. Yeah. I've noticed that I have like some sun spots on the left side of my face, but what I have done right, and I tell my girls who are like 30 and 31, of my kids that I started putting sunblock on my hands when I was like, I think I was 27. And I noticed, like a little dot on my hand, like a, like a little sun spa. And I was like, oh, hell no. And so every day since then, I've put sunblock on my hands. And you know, when you have your hands on your steering wheel, when you talk about driving you, that's one way to really get. And I don't have any more sun spots on my hands since that one. So do you. Yeah. Thank that one sun spot for that one. Thank you, little sunspot. I know it's because, you know, you're absolutely right. One of the things we say in dermatology is where you can really see a person's age is their neck and the back of their hands. So those are areas that we just don't we don't protect and we don't take care of, you know we don't think about them enough. So yeah that's fantastic. I think about like women in the 50s too. They used to have driving gloves. Right. Like the gloves. That's right. They used to drive with the gloves on, which I didn't think about until later. Like, why were they doing that? I don't actually know, but I'm sure I don't either. But it could be some. Maybe. It was really hard to control the steering wheel. I don't know, who knows. Maybe they needed the grip. I, I don't think they had, like the auto whatever. It's called steering. I don't know, I think you really had to, like, pull on it. Maybe it was hard on your hands, but it could also be for sun protection. Right. Who knows about that back then? But, Yeah. So UV protection is really important. And then our dietary choices are really important as well. Because if you think about oxidation, you know that process that's free radicals. And that pounds away at your skin. Well, if you focus on eating lots of antioxidants in your diet, those antioxidants help quench free radicals. And so that's something that you can actively do. Even if you're protecting yourself against UV radiation, you're still exposed to, free radicals that come about just from living. And so you need those antioxidants in your diet to help combat that process. And then inflammation, you know, if you have chronic stress in your life and who doesn't? That is going to increase your risk of chronic inflammation. But certain foods, certain nutrients, certain compounds, certain dietary patterns can help combat chronic inflammation. So that's why we talk about anti-inflammatory foods. So again this is where your dietary choices can help. And then glycation being careful about the foods you eat so that you don't have those elevated levels of blood sugar. Those right choices can help reduce the risk of. And there are also foods that help decrease the process of glycation itself. So if you're indulging in your donuts, this weekend, there are still certain foods that can help reduce that process. So for example, herbs and spices can help reduce the process of glycation. Cinnamon, cloves, things like that. And so there's two ways of thinking of your dietary choices. Some can promote the bad stuff and others can protect you against the bad stuff. And so, so thinking about your dietary choices and both ways, how can you, benefit your skin and how can you reduce the harm associated with certain foods to the herbs and spices have to be fresh or can they be, like, dried in a bottle? Well, with the research that's been done, I think most of the research has been done in a laboratory with dry spices. So I'm a big fan of whenever you can add an herb or a spice, whether it's fresh or dried, I think you should be adding very generously. And I think a lot of people have heard about turmeric. In research studies, turmeric has been one of the most anti-inflammatory foods that's been studied. But it's not the only one. And it's not even the only spice. They have shown a lot of benefit with a lot of other herbs and spices. And I also think sometimes the research, I think you can study just about any urban spice and probably find a benefit, but they've spent a lot of time looking at things like oregano, thinking about cinnamon. Cinnamon has been highly studied, but not just turmeric and cinnamon. They've also found benefits from things like human and, then a Greek and cloves and basil. It's kind of, it's almost like whatever herb or spice you can think of that they've studied. They found benefits. That's good. And the turmeric. I've heard that you have to put pepper with it to, like, help activate it. Is that true? Yeah. Well, black pepper, increase the level of absorption. Oh, okay. Yes, that's what it is. You're right. So if you have a and it helps if you have a source of fat as well. So that's why if you think about and I find it fascinating that if you go back to culinary traditions from different cultures and you look at how they've been doing things for centuries, I think the reason they've been doing things a certain way is that they started to notice, by powers of observation that certain things worked better. And so if you think about traditional Indian cooking, they don't just use turmeric by itself, ever. They have a fat source, you know, your oil, and then they're putting in turmeric, but they're also putting in a lot of other spices, including pepper. Often. And so that pepper helps improve the absorption of turmeric. And so I think the, the classic ways of cooking, there's a lot that we can learn from that. And you have a lot of recipes in your book as well in your book glow that kind of incorporate all of these things. Yeah. Yeah I think what are some. Oh go ahead. I was just gonna say what are some of your favorite like. Well first of all what should we be eating. You're talking about. So is it fruits, vegetables, legumes whole grains. Is that. Pretty much. Those are amazing. So when I talk about eating for healthy skin, I talk about three main rules. And the first rule is eat power, which means eat foods that are rich and powerful nutrients. And if you break that down, one of the categories I have six different categories for eat power, but one of the main categories is foods that are rich in antioxidants. So this is where, just as you just mentioned, fruits, vegetables, and you can add in there things like green tea even. But there's a lot of studies on green tea, but even white tea and black tea. And then I put herbs and spices into their own category because they're so powerful, because they're one of the most concentrated sources of antioxidants, and they are one of the most successful at anti inflammatory foods. And they even have antique like Haitian properties. So that's why I think herbs and spices get their own category of, of being really powerful. And then you mentioned legumes. And that is something that's so great. I actually call them power carbs. Because if you think about carbohydrates, if you can eat your carbohydrates, and if you can somehow package them with antioxidants and fiber and protein, if you could put a carbohydrate and have all those extra, nutrients, that would make it really powerful. And that's what you see when you go to legumes. So beans, legumes, whole grains as well. Those are your power carbohydrates. And then you mentioned fruits and vegetables. Vegetables kind of fall into several categories because they're really rich in antioxidants. And if you think about black beans, that's a power carb. But I have a separate category called prebiotic foods, because I think now people have heard a lot more about the gut microbiome, which for those powerful microbes that live in our gut and in terms of the skin, those powerful microbes produce substances that help strengthen our skin barrier. So from a skin standpoint, the gut microbiome is so important. And this is where foods that are prebiotic foods, and what that means is that they provide the nutrients that help the good gut microbes grow and thrive. And a lot of it comes down to the fiber that's found in vegetables. So there's yeah. So there's a reason it's fruits and vegetables, legumes, nuts, herbs and spices. This is, you know, I have a lot of doctors on to talk about preventing heart disease and cancer and Alzheimer's. It's all the same diet. It it's all the same diet. So I hope people are starting to get that from listening to this podcast because we've had, you know, Doctor Furman, Doctor Gregor, Doctor Barner, Doctor Klapper, they all are coming on and saying for this particular ailment you need to eat fruits, vegetables, legumes, whole grains, spices, nuts and seeds. So I hope people are starting to absorb that into their right brain. Yeah, I think too, because if you think about like one of the reasons I'm so interested in this topic too is this idea that this kind of diet, and whether you are calling it whole foods plant based, or if you're going Mediterranean or diet or mind diet, the basics of these dietary patterns are the same. A focus on really nutrient dense foods, right? But you know, the fact that it helps your skin just gives you one more reason to focus on these things. And, and I also think about when we're talking about a healthy skin diet, a lot of this is focused on collagen. How can you keep your college and strong, and how can you keep it flexible? While collagen is not just in our skin, collagen is also in our blood vessels. And if you can keep the collagen in your blood vessels strong and flexible, that's going to reduce your risk of heart disease. Yeah, okay. I'm putting that together now. So is that, Doctor Esselstyn talks about it all the time. Your endothelial cells. Is that what you're talking about? So, or is that different. So it's slightly different. So the endothelial cells are the lining. The inner lining lining. But right outside of that you have the smooth muscle and the outer lining of your blood vessels. And so there's collagen in that outer part of your blood vessels. So if you can keep, you know, whenever your blood vessels get stiff, it's, you know, it's harder to respond when your heart needs extra blood, but if you can keep it very strong and very flexible, that's going to help you with heart disease. And, I guess it might be the same. So for, for, what I learned about keeping your endothelial supple is that you need a lot of nitric oxide. Is that the same for collagen building or. I haven't seen that discussed as much. Okay. About the skin. That's interesting. But yeah, I haven't seen that discussed as much. And I know that you lose a lot of nitric oxide as you age as you lose collagen. And so I guess it's the same kind of like we just talked about for the nitric oxide. You're trying to eat like a lot of green leafy vegetables and things like that. And, I had some testing done for because I had heart disease. That's how I came to this whole way of eating in this whole lifestyle. And, had proof that I've reversed my heart disease. And by eating this way for ten years and, my nitric oxide levels were very high, like, even the cardiologist was like, I can't believe you're in your 50s and your nitric oxide levels are this high. But, but he still wanted me to eat a paleo diet. I was like, get out of here. You don't know what you're talking about. If you reversed your heart disease, that's fantastic. I know, I know, but, so that's the green leafy. So how much? How much if, like, the college and loss and all of this is genetic because I also like I looked at my mom's skin and I see where I'm aging and it's like the exact same. Isn't that interesting? I don't I don't think anybody really knows. It's really hard to do those kind of studies because there's so many different factors that affect aging of the skin. I think for sure, genetics plays a big role. Because I've seen people who've done everything right and, you know, and they're still, you know, and their skin is still aging at an accelerated rate compared to others. So but I don't I don't think anybody knows exactly what role it plays. What. Yeah. Yeah, yeah. All right. So I think that that's the, the takeaway is to start, eating more fruits, vegetables, legumes, whole grains, nuts, herbs, spices. Yeah. And, you know, to heart disease. I just wanted to, something, which is when we think about anti-inflammatory food patterns, those are closely correlated with heart disease. So there's a marker of inflammation. You can do a blood test, and it's called C-reactive protein. Yeah. And you have high levels of C-reactive protein. That's an indicator that you're at higher risk for heart disease. So they've done all these studies where they've actually given people different foods or different nutrients. And they have shown in some cases that you can drop your level of C-reactive protein with certain foods. And, and an example is turmeric. But they've also studied other anti-inflammatory foods. And, and this goes back to the recipe thing, which is, some of the strongest anti-inflammatory foods. People hear about turmeric, but garlic, onions, ginger, those are highly anti-inflammatory. And then you think about putting that all together. Well, okay. You know this information. How can you incorporate it? Well, I think about a dish that my mom makes and, it's chickpea, we'll call it chickpea curry. If you order it in a restaurant, it's called China or an Indian restaurant. Yum. Love Indian. Oh. Thank you. Yeah. But my favorite. Oh, also, it really is. Well, if you think about making chickpea curry, you know, the way my mom makes it, she starts with a base of, you know, she starts by heating the oil, and then she's putting in their ginger, garlic, onion. And then as she seasons it, she's adding turmeric. And she's also adding spice mix called masala. And her particular masala uses cinnamon cloves, cumin. And so you start cardamom. Is there cardamom in there. Not in her. No masala. And in some there is. Then you know, the base is chickpeas and then you serve it with cilantro on top. So. Oh gosh. So all of a sudden now you've got your, power carbohydrates with your chickpeas, you've got your lots of herbs and spices, you've got your prebiotic foods because onions are highly, beneficial for our gut, gut microbes. And then, there's also a base of tomato sauce in there. Yeah. And lycopene and tomato sauce is an incredibly powerful antioxidant. And so in this one dish you've got all of these powerful nutrients. So that's just one example. If you think about anti-inflammatory foods here it is in one is that in your in in your book I saw some recipes but I saw daal or I have the oil also. But yeah the chickpea curries in there as well is in there. Oh wow. Okay great I'm going to make that I love curry, I make it quite often and not very well either. I think that, you know why I don't really use oil. And I think that that's kind of difficult. So I usually like I grind the spices. I know that that's important to grind the spices. And then kind of cook them. Yeah. Just in a pan first. Yes. But I know it doesn't quite, doesn't quite get it. But I'm lucky because literally down the street from me, there's an Indian restaurant and they will do oil free. They'll do vegan and oil free. I know it's yeah. And there's is good and it is oil free because I can taste oil a mile away. But they do a good job. I don't know what they do, but it's yummy. And then you talk about power fats to muffins and puffers. Can you tell us what those are? Yeah. Modern saturated fatty acids and polyunsaturated fatty acids. Okay. And the motto, unsaturated fatty acids. If you think about how avocados have become so popular, we actually have research showing that, and these are, this is a short term study, but, that consuming avocados helped improve elasticity. Certain measurements of elasticity in the skin, and then polyunsaturated fatty acids. One example, you know, a lot of people know about walnuts, omega three fatty acids. But one study I like to really look at is one that looked at 12 weeks of flaxseed oil every day. So these particular patients had very sensitive skin. That's why I'm so interested in the study. They had very sensitive skin. And they ate, a serving of flaxseed oil every single day. And at the end of 12 weeks, they were able to demonstrate that they had reduced irritation from certain substances that irritate people with sensitive skin. So something about these polyunsaturated fatty acids helped to improve the function of the skin barrier. So it's interesting that they've had studied it, you know, both the monounsaturated fatty acids and then the omega three polyunsaturated fatty acids. I think that, I wasn't eating enough fats because I did this, this protocol for my heart disease called prevent and reverse heart disease. And it was very low fat, and it no oil, no nuts and seeds, no avocado. And I did that for about six years before I was like, I feel like I need some fats. And I, I think that I, you know, and I was 46 years old when I started that. And I think that I should have probably been eating a little more fat. And so now I have added in the nuts and the seeds and the avocado a little bit. Yeah. And, I think it's helped a lot. And actually within the last year I had some hair loss. I want to talk about hair loss because, I think I also wasn't getting enough protein. And I wasn't getting enough fats. And I feel like. Can you talk about hair loss? Yeah. I mean, there are lots of different causes for hair loss, but there is a particular type called Telogen effluvium. And that's a kind. You can also think of it as hibernation hair loss, meaning that with a certain triggering event, your hair follicles can just go into hibernation. And I've seen this. I actually experienced it myself twice. Once with pregnancy, but once when I was in my 20s, I had gone overseas, and in the span of two months I had lost 15 pounds. And about 3 to 6 months later, my hair just started like you could. I could run my hand and just pull out. Yes, strands of hair. That's what was happening to you as well. So yeah. And and what happens is if there's a shock to the system, your hair follicles go into hibernation. And some people call it the hairbrush line. Like you can just take a hairbrush. Yes. Full of hair full. And some of the common triggers are a sudden weight loss or a sudden reduction in protein. Because your hair follicles are very metabolically active, they need a lot of nutrition to grow well. And so, you know, and sometimes it can be from surgery or pregnancy or even sometimes intense emotional stress can trigger your stress. Yeah. Hibernation. But in your case, you know, as you're describing that you probably didn't have enough protein. That can definitely be a trigger for Telogen. Effluvium, I think I think it was triggered by stress. But I think I also wasn't having enough protein. And I, I've really made sure I'm doing that now. You know, tons of, in my, like, oatmeal or whatever in the morning. I'm doing soy milk instead of oat milk, and I'm doing, hemp seeds and I'm doing some walnuts, and then I eat a little. I always have some cubed tofu around. I eat that in the morning. My flax. Do you think you mentioned the the study with the flax oil? Do you think flax seed would ground? Flax seed would do it as well. I it wasn't studied particularly, but I don't see any reason why. As long as you're grinding the flax seeds that you would have. Yes. You should get the same benefit. And by the way, I love what you're describing right now. Like how you've added more protein because those are not difficult things. No. Like the was it. Yeah. Like it's amazing isn't it. Sometimes it's small changes. It's really just a matter of being intentional and really thinking about it. And look at this. You made it happen. That's fantastic. Yeah. Yeah. And you know, I, I, I saw a Texas chili recipe in your book and I also we're in Texas and I have one on, on my website too on well elephant um.com that I have a Texas chili recipe too. I put Shiner Bock beer in mine instead of instead of starting with oil, I started with Shiner Bock beer. Interesting. I've never heard that it's good. Has to be Texas beer for Texas chili. And and and I have a ton of beans. So I'm getting like a cup and a half of beans just with that. So it's, you know, it's so easy to add in these delicious foods. It's really good. I want to ask you about building a skincare routine. I mean, is it different in your 40s, 5060s and beyond? And what ingredients should we be looking for? It definitely is different. If you think about your skincare routine in your 20s versus your my 20s versus my 50s, I don't think I had a skincare routine right in my 20s. It just be beautiful. That's it. It's easy just you're so right. That's my skincare routine, right? I know it's so irritating to watch them like, damn you and your collagen, right? That elasticity. Yes. So, Yeah. So you're absolutely right. You have to really pay attention. And not only to your age, you have to pay attention to the seasonal outside. You really have to tailor your skincare regimen to your skin. Environmental factors. But the basics I, I talk about, Cessna. So cs na. So if you think about in the morning seas cleanser for the morning and then your, you have to think about your sun protection and. Yeah, I'm going out of order, but what's the. Yeah, the is so easy for your ingredients and then okay sun protection and then na at night nighttime cleansing and then active treatments. And so you really have to think about what your goal is. So some patients the goal is anti-aging. But for others it might be treatment of acne or treatment of hyperpigmentation. But if you think about your major goal that's going to help you determine what that extra treatment is in the morning and then what that active treatment is at night. Okay. So let's just say, okay, it's safe for you. What do you do for me? You know, if I'm thinking about anti-aging, I use a very gentle cleanser in the morning because you also have to think about what type of skin type you are. Are you sensitive? Are you oily, or are you normal or are you dry? So based on your skin type is where you start to choose not only the active ingredients but also the vehicle meaning is it a cream? Is it a lotion? Is it something that's really thick and moisturizing? So for me, sensitive skin, dry skin, anti-aging. In the morning I'm using a very gentle cleanser. I'm not using anything with an exfoliant. My extra treatment would be vitamin C in the morning and then my sun protection. I use a product called Vana cream. Facial moisturizer with a mineral sunblock. That's a super gentle, lightweight facial moisturizer. And then at that time, you think about your nighttime cleanser and, I like for people with sensitive skin. I like a product line called servi. So I use, a gentle nighttime cleanser. And then for my active treatment, that's the retinoid. And so you can start to see how you have to adjust those active ingredients, but you also have to adjust the particular vehicle that it's in. Vehicle is what carries. Yeah. Like oil versus cream versus okay, should everybody be doing a retinoid at night? I mean, I think for people who are concerned about, who are seeking anti-aging, retinoids are just a great ingredient. They don't work for everybody. If you have very sensitive skin, you might not be able to your skin might not be able to handle it. But there's so many different retinoids. There are ones that are very, very mild and ones that are really powerful. And they also have a lot of different vehicles. So some come in the form of a gel, which is kind of harsh, and some come in the form of a very moisturizing cream base. And this is where talking to your dermatologist can help you find a retinoid that your skin can handle. So not everybody needs to be on one. But I have to say, for anti-aging benefits, it's probably the best ingredient in terms of both effectiveness and then this ability to adjust the vehicle to try to find one that your skin can handle. And I know that you have to be really extra, vigilant with your sunblock if you're using that, right? Yes. I'm so glad you mentioned that. It does make you more sensitive to, to sun, exposure. And so you have to be very careful about your sun protection, and then it can cause irritation. So you have to learn how to use it correctly, and you have to find the right product that that works with your skin. And you said that there's some common mistakes and retinoids. Is that the same as, like, alpha hydroxy and beta hydroxy? Is that what a retinoid is or is that different. And that's different. So alpha hydroxy acids and beta hydroxy acids fall into a category. Well, so for example, glycolic acid is an ingredient that you might see in a lot of products. And that's an example of an alpha hydroxy acid. And basically they help increase skin turnover. And so it might so that's a separate category of ingredients. Retinoids are particular molecules that also can help improve skin turnover. But in a more gentle or not a gentle way in a, in a more, sustained way. Okay. So you should probably not be using both of those things together so some people are able to but when you use the both together, you really increase your risk of skin irritation. But some patients will use a retinoid at bedtime, and then their morning cleanser has an alpha hydroxy acid in it. Okay, because retinoids are typically only used at bedtime. And so good morning, they might be able to use an alpha hydroxy acid. And I should mention I have a breakdown. If anybody's interested on my website. Yes, of, of sort of different examples of what to look for in terms of ingredients, depending on your skin type. Yes. I will put that in the show notes. So, you said there are some common mistakes with retinoids. Do we cover those or. No. Yeah. Those are the basics. I mean, those are you have to learn how to use it properly. So the prescription retinoids for your entire face, you only need a pea sized amount. So it's a very small powerful amount. And you have to do a very thin layer. So one of the mistakes people make, one of the most common mistakes is they're just too aggressive with the retinoids. They just use too much of it. And you have to give your skin time to get used to it. So instead of using it every single night, you have to use it probably every other night to to help your skin get used to it. When you start out, when you start it every other okay, and then you build up okay. What about, what are some other things we should look like? Hyaluronic acid or niacinamide? What are what are some other ingredients that we should look for so that there's, those are additional potential ingredients depending on what your goals are. So nice. And amide is a gentle skin reducer. So for some people who can't handle retinoids, they might use niacinamide instead. Hyaluronic acid is what I call a temporary plumper. So if you want a temporary improvement in that, you know, plumping up your skin, hyaluronic acid is a nice one. It's good for sensitive skin. As long as the vehicle that it's found in doesn't have ingredients that irritate the skin. But hyaluronic acid is a nice moisturizer, so that could be one of your morning ingredients. Okay, that sounds good. What? What do you think about red light therapy? Oh, you know what? I've been asked this, and I don't know. So the the stats on it is still very preliminary. I spoke with one of my colleagues, and she's a cosmetic dermatologist, and she loves it. She thinks she's seeing results. And so she's recommending it to a lot of her patients. I just I'm a very late adopter when it comes to technology because I'm so anxious about side effects. So, so personally, I haven't started recommending it yet just because I don't know enough about the long term side effects. But she's not the only, cosmetic dermatologist colleague who likes it. So it is something that's becoming more popular. I just don't know enough to be able to recommend it myself. Yeah, because I got a mask and I kind of like it. I have to say. Yeah, it's pretty good. So back to, Botox and fillers and sculpt dry and all that. You know, I got Botox. I was really late to. I was like, I'm not doing this. And then I did it and didn't do anything. Have you. So I don't, I don't administer Botox or fillers myself, but I have a lot of cosmetic colleagues. And, and if Botox didn't work for you at all, it probably does, and it's fine. Dose. No, it was actually get because I got, I went back and I got more, which is so funny because I'm like, I'm never doing Botox. And then I finally decided, okay, I'm going to do it. And then it didn't work. And I was like, that's what I get. And also I don't need to be doing Botox. That's not for me, really. Clearly, if it didn't even take me and my my dermatologist just said, does it work? It's some people. She's like, I guess you're one of them. I was like, okay, well you have strong facial muscles. Okay. We're good. We're going to think of a way that that's a good thing. It's good, it's fine. But what do you, I know that that's not your area of expertise, but like, I see girls, like, in their 20s and 30s getting Botox, and I'm like, what are y'all doing? Why? That worries me. What do you not? Yeah, well, it worries me. Not in the sense that I think there's going to be long term side effects from starting early, but more just that when you think about preventive medicine, I mean, the idea of young women getting it very early is to prevent the prevention of wrinkles. So if you can't, if you can't make a smile, if you can't smile, you're never gonna have a smile line. So that's kind of the concept. So I think from a medical standpoint it's fine, but it worries me because I don't want to pathologize every single wrinkle. Like, yes, there's signs of a life well-lived. Yeah. And so that's the part that worries me, is that the messages that we're getting from social media especially, is perfection in all things. And it's not just unrealistic, it's it's a really harmful message. You can be beautiful in so many different ways. And, and I don't think wrinkles are a bad thing, especially smile lines or crow's feet, you know, because you've smiled and laughed a lot. But, you know, but everybody but on the other hand, I'm also very careful because different things bother different people in different ways. So I respect that. I mean, I get that and I, you know, I'm I'm really kind of grateful that that Botox didn't work because, you know, I call this, podcast the anti Anti-Aging podcast because we're all aging and you shouldn't be punished for that. You should be celebrated for that. And yet here I was kind of succumbing to that. And so I was you know, I did feel that pressure, but I was kind of so glad that also it didn't work. I was like, okay, that gives me an out. Well, I can't get Botox. It doesn't do anything for me. So I'm not wasting that money. And also, do I need to be doing that? And you know, I don't know. It's it is really, difficult. And, you know, I'm glad of all the things that you're saying because when I, when I see these girls getting Botox in their 20s, in their 30s, they're like, it's so we don't get wrinkles. And I'm like, yeah, but then you got to keep doing it for the rest of your life. And it's also, I don't know, like you said, wrinkles aren't the worst. They're kind of they are kind of a sign of, you know. Yeah. One of, one of my guests called them Marks of Distinction. And I kind of like that. My my cousin just reminded me of that. Yeah. She was like, yeah, I loved when she said marks of distinction. I was like, yeah, that was good. Oh, I like that a lot. Oh, that's a good one. Yeah, it is good. Well, is there anything else that you think that we should know about our skin now? I think we've covered a lot. I really covered a lot. I will say one thing. So I speak to a lot of media outlets because of my work with the American Academy of Dermatology, and I've noticed a definite trend. Reporters are asking me a lot about supplements, beauty supplements. Oh, okay. And so I've started a number of medical journal articles now about beauty supplements. And one thing I want people to know is it's an unregulated area. And so you have to be incredibly, incredibly careful. And a supplement is meant to make up for a deficiency. But it's never going to take the place of a really nutrient rich, whole foods based plant rich diet. You know, there's no supplement that's going to be able to do what foods, you know, the really nutritious foods are going to be able to do. So really be careful. Talk to your physician. Some of the supplements I've written a lot about side effects are beauty supplements. Biotin is in a lot of supplements, and it causes interference with laboratory testing. So you have to tell your doctor if you're taking a supplement that has biotin because it can interfere with tests for heart attacks and tests for thyroid function. Yeah. So biotin can be, can be dangerous in that sense. And, some hair loss supplements contain saw palmetto, which can cause may cause birth defects. So there yeah, there are definitely side effects of beauty supplements. So they're not you know, people think oh it's just a supplement. No. You know, if it has an effect, it can have a side effect. So be very careful. That's such a good point. And I see them advertised all the time and. Right all the time they're everywhere. Yeah. That's really good. That that reminds me of something I did want to ask you about that I did it was you know, I don't take this because I'm vegan, but like, I see a lot of my friends taking collagen supplements and they're made out of, like, what? I don't know, dead cow. I don't even know what they're. Yeah. What are they made out of? And do they help? Well, for to answer your first question, what are they made out of? We did a small study where we looked at 54 different collagen supplement products, and we tried to figure out where the collagen came from. And over half of the products did not disclose where they're college and came from. And one of the products had four different sources of collagen and one product, and one of them was cowhide. So my big concern with a lot of these products is where are you getting your collagen from? Is this industrial byproducts? Is this fish skin that's been discarded, which, you know, on the one hand, I'm happy that they're recycling that fish skin. I'm using, like, is this this that is low and mercury or is it high in mercury? There's no testing that goes into most of these products. So that's my concern. Number one is I don't know enough about the sourcing of the collagen. I don't know enough about the safety of the product. And then the second concern I have is about efficacy. I'm still waiting on a company. So there have been studies that have been. So the reason collagen has gotten so popular is there have been multiple studies that are showing some benefits, mostly with hydration, not that many studies looking at wrinkling, which is what most people are concerned about. But the studies have all these confounding factors. Like some people give the collagen with all these vitamins and minerals. So is it the vitamins? Is it the collagen? I don't know. And then almost everyone has been sponsored by the manufacturer. So yeah, the short answer to that question is that I don't take them myself because I'm concerned about safety and I don't know about efficacy. Now I'm open to being convinced if a company came out with a really good study and they showed me exactly where they got their college from and that it was safe and that it was effective, yeah, I'd consider it. But right now I tell people, be very cautious and like, I don't want to be eating cowhide. No, I do not. I do take, some silica. I think that that's like a vegan collagen. Yeah. I don't know what do you think about that? No. I just haven't seen anything to convince me with silica. Okay. I also have not seen, worrisome reports. You know, with collagen supplements, some of them have been contaminated with heavy metals. So I have seen some reports. I haven't seen much on silica one way or the other. So. Okay. Well, that's all good to to think about. Do you, have a best piece of advice for aging? Well, boy, you know, when I think about that, I think about how important it is to stay connected, stay connected to people, to your community, and stay connected to a purpose. The, the individuals that I've seen who are aging really well, they have a purpose. They have a reason to get up every morning. And whether that's their family or whether that's a project they're working on, that's what I want to keep doing. Yeah, I couldn't agree with that more. Do you, do you have just a best piece of advice that you've ever received? It doesn't have to be age related. Well, I, I think about this a lot. And it's the saying that everything is hard before it's easy because I started a website like ten years ago, and it was so incredibly painful. And I kept telling myself, I'm not good at technology. This is so hard. Why is this so hard? And, and I had to really, like, remind myself everything is hard before it's easy. Right. That's really true, isn't it? And here you have a podcast. I'm sure it's easier now than it was when you started. Oh my gosh. Yes. I had to just, not think about it. I was like, just just take one more little step. Just do one more little thing. Just don't think about it because you'll be so overwhelmed. You'll be incapacitated. So, yeah, I mean, especially technology, all the things, like you said, are your parents still alive? Yes, my mom and my dad, they live in Tucson. Yeah. So we get to see them every week. They are. What have you learned from watching them age? Well, I think about my mom and how connected she is. She has really done a fantastic job of staying connected with friends all across the country, in the world. And she's very intentional about that. So I really I really admire that. Oh that's good. Yeah. That connection thing is so important. It is I think that people can't stress that enough. You know, I love I love, I've heard even about these people who are getting, like, tiny house communities and all their best friends are living on the same street and all that for when they age. I mean, yeah, you have to stay connected to your to your people, to your friends. Do you have a favorite health or beauty product? This is a good one to ask you. Well, I was going to say for a health product, I, I have a foam roller and couldn't have been my favorite. A few years ago, but I developed a tendonitis and my physical therapist taught me how important it is to, to, you know, to to not just stay flexible, but to really help your fascia. And so I'd have to say a foam roller right now. Oh that's good. Yeah. Yeah. Fascia is like that's the new. We had somebody on just talking about fascia. It's crazy. It's crazy because that was not even on my radar like five years ago. Like what the heck? I like I know what fascia looks like because I've cut into fascia. But to think it's like that, right? Yeah. It's like, is it like a net? Well, it's it's more a covering over your muscles, but it can get really tight. And so you have to make sure your muscles can, smoothly move. But the fascia, the covering of the muscles can smoothly move across the surface in the muscles. Because if it all gets tight and, you know, then I developed tendonitis and I had all this knee pain because of it. So, what this is, I always ask this question just because, for my own amusement. And I love music, but do you have a favorite concert you've ever been to? Oh, boy, I wouldn't say ever, but this summer I saw a journey, in Utah. Oh. Oh, that was so much fun. Oh, who's their lead singer? Well, now they have Arielle Pinata, who is a singer that they found in the Philippines, so. Oh, that's right, I heard about that really interesting story. They have a documentary about it and everything. And yeah, I mean, listening to the music, you wouldn't you wouldn't know that it was. He sounds just like Steve Perry, right? Absolutely. I mean, the music movies. That's pretty like an interesting topic right there. Yeah. I don't know how they I don't remember how they found him, but it was remarkable. Yes. I do remember that, like hearing that they just discovered him and that he just sounded so much like Steve Perry that they put him in the band. Amazing, right? That's crazy. Well, I have just really enjoyed talking to you. You've been such a good guest. So informative, and I appreciate it. And everybody should, take a look at Glow, the Dermatologist's guide to a Whole Foods Younger Skin diet. And thank you. And also go to your website. We'll put it on the show notes. My thank you, Doctor Carter okay. Take care. Bye bye. Bye bye. Thanks for listening, friend. From my heart to yours. Be well. Until we meet again.