What follows is a transcript for the podcast Skin Health - Dr. Molly Maloof - Healthspan.
Topics within the interview include the following:
- How insulin resistance affects skin health
- How mitochondrial dysfunction impacts skin health
- How to eat for great skin
- Why fatty acids are critical for skin health and beauty
- The right types and ratios of protein for healthy skin
- Collagen for your skin: healthy or hype?
- Using carotenoids for a natural glow
- How ceramides combat ‘leaky skin”
- How the gut microbiome influences skin health
- Cutting edge cosmeceuticals for skin health
- Healing unhealthy relationships with food
Dr. Mark Tager: It is my pleasure to participate in some collective insights with Dr. Molly Maloof. Who are we? Why are we here? We are here because we are both part of the Medical Advisory Board for Qualia. I'll take just a minute, introduce myself. Molly, I'll ask you to do the same. Let's wave to the folks. Oh, we're not... We're only on audio, so there's an audio wave. Okay. Anyway, we're going to be the co-hosts for the session.
We'll be sharing our knowledge for some ways to enhance skin health and beauty from the inside out. I've had this passion of integrative medicine, functional medicine anesthetics for decades, and I finally put them together in our newly released book called Feed Your Skin Right: Your Personalized Plan for Radiant Beauty. Really, I've got this passion for how we create glowing skin from within.
I went to Duke University for medical school, family practice at the University of Oregon, but most of my work has been spent teaching and educating my colleagues. I've created many, many online courses, one of them being a 40-hour CME course for personalized nutrition for practitioners for The American Nutrition Association, and that just launched. I've also taught at A4M. I am on the faculty at Duke Integrative Health, and I hang my hat in San Diego where I'm CEO of a company called ChangeWell and where I grow impressive tomatoes, which is easy to do in San Diego. Molly, Dr. Molly, share a little bit of your background with our listeners as well.
Dr. Molly Maloof: Hi, my name is Dr. Molly Maloof, and I started my career as a medical doctor, which I still am, classically trained in allopathic medicine, but then decided to build a medical practice around optimizing health and extending health span rather than just fixing sickness. I also concurrently worked with many different companies and brands in the personalized health space in some biotech, supplements, food, you name it.
I am a soon-to-be-published author, writing a book called The Spark Factor, getting published in January all about how to biohack energy capacity in women. Then, last not but no least, I'm an entrepreneur and have started a few companies of my own, but I'm also the spokesperson of Qualia Skin. Here to talk today about why I love this product and why I love just talking about skin and why skin is such a beautiful window into our health.
How Insulin Resistance Affects Skin Health
Dr. Mark Tager: Absolutely great. Now, you've built a lot of your career on understanding this concept of healthspan, but this is a concept that may or may not be so familiar to our listeners, and it's also a concept that we need to sort out, where does the glowing skin participate? Tell us more about that.
Dr. Molly Maloof: Yeah, so one of the most interesting things I've learned in the last 10 years is, well, first off, some of my friends who've recently seen me who haven't seen me in like three years, they were like, "Wow, you look younger." One of the things that's really gotten me to age in reverse is really, really mastering blood sugar metabolism. This is fundamental to health, but yet a lot of people just don't worry about it until they have a problem. In my situation in my like early 30s, I discovered I was basically borderline prediabetic. I did not have any idea how this could have happened, aside from the fact that I grew up drinking a lot of soda as a kid, eating a lot of junk food, fast food as a teenager. I really do think I taxed my pancreas for a lot of my early life.
Basically, in my situation, I was like, "You know, I need to understand blood sugar because this was a problem that I experienced." I realized that a lot of people have this problem. We have way more people that have prediabetes before they even realize they have it, and a lot of people who have prediabetes will convert to diabetes, so it's really important you catch the stuff early. The reason why it's important for skin, which is what we're going to talk about today, is because high blood sugar does what's called glycation of the proteins and the collagen in your skin, which will cause premature wrinkling, cause increased insulin output, by the way. Just high blood sugar spikes will cause insulin to spike, and high insulin levels will also cause problems with your skin because it will increase acne.
If you struggle with acne or wrinkles and you feel like you look older than your age, then you may want to look at your blood sugar. It was really getting my blood sugar slowly back to normal through increasing fitness, increasing weightlifting, increasing cardio, lowering my carbohydrate intake, really reducing refined carbohydrates, really reducing sugar, and adding certain supplements to my regimen like carotenoids and collagen and minerals that really got my skin to glow. To me, I'm happier with my skin now than ever because it really feels like it reflects what's going on inside my body.
Dr. Mark Tager: So this... We're number one, obviously. The United States is number one because we eat about 125 pounds of refined sugar a year, and that's four or five times more than we really should. That's the average-
Dr. Molly Maloof: Wow.
Dr. Mark Tager: The issue from the aesthetic viewpoint, and-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... you nailed it about being glycation, is that when this excess sugar binds to collagen, it actually makes the collagen brittle. It changes-
Dr. Molly Maloof: Yep.
Dr. Mark Tager: ... the shape and the elasticity of it. Now, where this shows up is in these very fine crosshatched little- ... checkerboard fine lines on the skin. It's not the deep wrinkles, it's not the motor wrinkles. It's in this sort of like a smoker's appearance. When ... you know, with smokers will have that fine sort of checkerboard sort of skin. I think that that's a big piece of it. Important to getting metabolic control. The skin ages, essentially, is the mitochondrial theory of skin aging. As we age, we have fewer mitochondria. They work less effectively. I think this is really one of the roles for the antioxidants and to actually enhance mitochondrial function, so-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... and then all of those things, of course, are very, very helpful that you mentioned.
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: In my book, I address these four questions and I'm sure you get these four questions all the time as well, that-
Dr. Molly Maloof: Yeah, I'm sure.
How to Eat for Great Skin
Dr. Mark Tager: ... what should I eat? What supplements should I take? What topicals should I apply? What procedure should I have? Now, most of this when I get asked this, is most of the time people, "Well, just tell me the one thing I should do. Just give me one answer." You know, I guess I always turn to diet first and the primacy of diet.
Dr. Molly Maloof: Right.
Dr. Mark Tager: We're both spokespeople for Qualia Skin. I love Qualia Skin. It is a fabulous formulation. We'll talk more about it in just a little bit, but the reality is you can't out supplement a crappy diet. I mean-
Dr. Molly Maloof: Right.
Dr. Mark Tager: ... you and I cannot prescribe for patients or recommend for patients a diet, a supplement regimen that's going to help them get over eating like crap. Now, I know we all both talk about the SAD diet, the Standard-
Dr. Molly Maloof: Sure.
Dr. Mark Tager: ... American Diet. Now, let's go kind of back and forth about that just a little bit. What's your thoughts on the SAD diet and skin? Let's share some tips with the folks out there about what they really should be doing with diet-
Dr. Molly Maloof: ... I was looking at epidemiological shifts in nutrition in the last hundred years, and one of the things that I was kind of astonished by was that if you just look at globally what's really wrong with the diet of the world, we are eating too much vegetable oil. We're eating too much refined carbohydrate, which is basically dense acellular carbohydrate, a carbohydrate that has had the germ protein fat removed from it. We are also... and fiber, for that matter. We are also consuming far too much processed meat and confined animal operation meat, animals that are raised in really inhuman conditions where they're sick and unhealthy. We are also consuming too few vegetables, too few fruits, like way too little produce.
If you just look at these problems in society globally, you can understand that the American diet is largely comprised of packaged processed foods, which are dense acellular carbohydrates that are often fried in vegetable oil. They are... Like Fast food is largely confined animal operation meat, processed cheese, refined bread, refined corn syrup in soda, white potatoes are fried in vegetable oil. Pizza is largely, in America, not healthy cheese made from an artisanal farm. It's from processed cheese from like large factory farms, and it's refined wheat, which often has glyphosate in it. We've got a lot of things that are in the human diet that are just not optimal for health, period, right?
Why Fatty Acids are Critical for Skin Health and Beauty
Dr. Mark Tager: So if we go back a bit-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... you can go back to before World War II-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... and at that point in time, we were getting a much healthier diet, particularly in terms of the fatty acids. Now, fatty acids are critical for skin health and beauty.
Dr. Molly Maloof: Right.
Dr. Mark Tager: One of the folks who was on your Instagram and they wrote in, "Well, what about dry, itchy skin?" There are two pieces to dry, itchy skin. The first has to do with having inadequate amounts of the omega-3-
Dr. Molly Maloof: Omega-3-
Dr. Mark Tager: ... fatty acid. What happens is that, and I think this is an important concept for our listeners-
Dr. Molly Maloof: Yes.
Dr. Mark Tager: ... it has to do with the balance. It started out ideally, prior to World War II, we were getting a mixture of three or four to one omega-6s to omega-3s. Not all the omega-6s are bad-
Dr. Molly Maloof: No.
Dr. Mark Tager: ... obviously-
Dr. Molly Maloof: No, no, no, and actually- that's... I just want to add a point. It's not that omega-6s are bad on their own. The problem is that when they're vastly outweighing the amount of omega-3s-
Dr. Mark Tager: Right.
Dr. Molly Maloof: .. that we consume-
Dr. Mark Tager: It's the ratio.
Dr. Molly Maloof: ... and the ratio, but also-
Dr. Mark Tager: Yes.
Dr. Molly Maloof: ... when they are repeatedly fried or heated in high temperatures, they become far more rancid and-
Dr. Mark Tager: Yeah.
Dr. Molly Maloof: ... in fact, in animal and human studies, more carcinogenic.
Dr. Mark Tager: Yes.
Dr. Molly Maloof: The processing, the frying, the industrial frying, and then the ratio being off to me is the reason why omega-6s are-
Dr. Mark Tager: Yes-
Dr. Molly Maloof: ... we are consuming up to 500 to 700 calories more per day of vegetable oil, so-
Dr. Mark Tager: Yeah.
Dr. Molly Maloof: ... even if they aren't bad on their own, anything in excess is problematic for-
Dr. Mark Tager: Sure.
Dr. Molly Maloof: ... health.
Dr. Mark Tager: Well, let's bring this to the skin. The skin obviously needs these essential fatty acids, but the other piece of that, and this is where you and I really sync up around the concept around inflammation. What happens, a portion of these omega-6s get converted into something called prostaglandins. Prostaglandins are inflammatory molecules and they go throughout the body. One of the places they go is to the skin as well. We are seeing an inflammatory diet that obviously begins in the gut, and we can talk about the journey with the gut just a little bit, but I think that that's so important.
We've got this sugar. We've got the lack of really good balance between the omega-6s and omega-3s. We have how people cook today, which you've raised that issue of cooking on high temperatures, which actually causes these advanced glycation end products also.
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: All of that, I think, is really important in terms of what not to eat. Now-
Dr. Molly Maloof: Right?
Dr. Mark Tager: ... the what to-
Dr. Molly Maloof: What to eat?
Dr. Mark Tager: ... what do we eat? Well, here's the way I look at it. Well, I have a garden. I have a COVID garden. I'm a New Yorker. I never had a garden before. I didn't know anything a out gardening, and I put in this COVID garden, and every day I go out there and I look at my vegetables and I think that I've got 5,000 phytonutrients.
Dr. Molly Maloof: Wow.
Dr. Mark Tager: The chemicals in these plants are different colors whose job is to protect the plant against the ravages of the sun and the wind and pests. If you think about it that way, you want to get as many of these phytonutrients from different colored plants into your body as you can, so you lean on vegetables. You lean on fiber. You lean on unrefined carbohydrates. That becomes the basis of a diet, nuts, seeds, fruits, whole grains. Then, we get into beliefs and philosophies, and we go with the question of, what kind of protein sources? How much protein?
The Right Types and Ratios of Protein for Healthy Skin
Dr. Molly Maloof: Right. This is a big question I've been trying to talk about. I'd love to talk to you about this.
Dr. Mark Tager: This is... Let's riff on this a little while because-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... I think this is... This is intriguing to me because if you look at, for example, protein requirements-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... they vary according to age, to objectives. A bodybuilder needs significantly more than-
Dr. Molly Maloof: Or just an endurance athlete.
Dr. Mark Tager: Endurance athletes need more, so we're looking at any place... Let's say you are a... I happen to be a 70-kilogram person. I'm a 70-kilogram man, so the normal recommendation's about 0.8 grams of protein per kilograms, so 50- 60.
Dr. Molly Maloof: 0.7 is the recommended daily allowance.
Dr. Mark Tager: 0.7, excuse me, 0.7. That's right, 0.7, so, you know-
Dr. Molly Maloof: But ... I think that's far too little.
Dr. Mark Tager: ... and I do as well, particularly if you want to build muscle, if you're doing any resistance training, and as you age, you are getting sarcopenia. Sarcopenia and loss of muscle mass, or if you are a teen and you want to build muscle. I mean, that's important for them. I think that the protein requirements are anyplace from 0.8 to 1.5 times the body weight, so in kilograms. Sometimes even 2 and I've seen. I've seen studies with older individuals where they're doing resistance training and eating more protein. What are your recommendations for protein sources? You do yours, and I'll do mine.
Dr. Molly Maloof: Well, I mean, look, I'm a researcher for healthspan extension, so the problem I have with a lot of the world right now is this deep sense of we absolutely must be eating plant-based proteins. The reason why I'm I have problems with that is, number one, a lot of the processed soy in these fake meats is a processed food product, and so I don't really understand why we think it's okay to eat processed meat, but it's... or it's not okay to eat processed meat, but it's okay to eat processed soy. My reasoning behind this is that if you even just look at Japanese populations that are known to consume soy, they don't consume more than two and a half servings a day, and so what we're seeing is like in America, everyone eats more of everything.
I do see a lot of people consuming quite a lot of soy in America, and there is evidence, at least in women, that greater than I think it's 40 milligrams of isoflavones a day, which is at least... I'd have to look up the numbers, but more than four servings of soy per day will increase problems with fertility. I do think that soy is a useful... I mean, I consume soy. I have tofu in my fridge, but I try not to get more than like one to two servings a day.
I do consume some other plant-based protein powders like fermented pea protein is something that I have, but my personal preference for protein comes from meat. I enjoy fish, I enjoy... I do eat lean red meat because I'm an APOE4 carrier. I do consume chicken, I consume game. My favorite meat to eat is wild game, personally, but not everybody has the advantages that I have, which is I can get access to high-quality food because I have friends that are hunters and family that... and I have friends that are farmers and have different farms. I think we need to really start figuring out, how are we going to feed the world with protein? How are we going to create regenerative practices that are honorable to animals? But-
Dr. Mark Tager: Sure.
Dr. Molly Maloof: ... in the meantime, you can get... I think protein personally should come from both plants and animals if you can tolerate them.
That being said, people who struggle with autoimmunity, which is rising in our country, which is usually a result of gut dysfunction, first and foremost, compounded with genetics, you do see people struggle with the plant-based protein products. You see them struggle with beans and legumes and grains, and so in those individuals, they really do need to eat a more ancestral diet, and they often thrive on a more ancestral diet.
It's a really tricky subject because, A, there's a lot of people saying the meat that we're consuming is destroying the environment, but on the other hand, it's like some of these plant-based diets are actually just not conducive to health in certain individuals. I think we're just barely beginning to understand how to predict which people are going to thrive on different diets, but a lot of it right now is trial and error.
Dr. Mark Tager: Yeah. There is some good nutrigenomic work being done. We can talk about that. I talk about that book to a large extent-
Dr. Molly Maloof: Yeah.
Collagen for Your Skin: Healthy or Hype?
Dr. Mark Tager: ... already. There are these SNPs, these single nucleotoide polymorphisms, these little genetic variants that predispose people to various skin conditions. In terms of glycation, we talked about that, in terms of pigmentation, in terms upon needs for certain nutrients that are greater.
Since we're talking on the subject of proteins and meats, the most common question that I get asked when I speak to consumers all the time is, "What about collagen?" I mean, you can't go to any sort of a meeting or a conference and without that question being raised. I get to ask a lot about that, and here's where I come down on it because, obviously, we both are firm believers in the-
Dr. Molly Maloof: Sure.
Dr. Mark Tager: ... neurohacking product. There's really no collagen in that. My sense about collagen is as follows.
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: I think we've done an incredible disservice in the aesthetic community by teaching people collagen, collagen, collagen, collagen, collagen. There is this mindset that we have set up in many people. "I'm going to eat this collagen and it's going to go right here in my face. See this little spot right here where I need to fill in," and that's certainly not going to happen. The reality is you eat this collagen, it's broken down into its constituent amino acids, and there's three amino acids that make up collagen, two of which are essential-
Dr. Molly Maloof: Yep.
Dr. Mark Tager: ... glycine and proline. Those are two essential acids, and the third one is hydroxyproline, which the liver can make if you have enough vitamin C and enough iron. If you eat meat, you are getting essentially all of those amino acids. If you eat high-quality fish, you're getting all of those amino acids. Now, then, I think the question become for the vegan, for the vegetarian who's not eating a lot of that-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... is it helpful to eat, take come collagen? I've kind of moved a little bit off the don't waste your money with collagen to I could see a role for this in some folks who are not eating a diet with meat and fish in it. I think there's room for it, but we just can't have this simplistic mindset that we're going to eat collagen and it's going to go rushing to our skin. It's just amino acids that go into the body, and the body determines what it's going to create, how it's going to use its nutrients.
I think that that's a fun question. Well, let me ask you this one because we're both firm believers in Qualia Skin. Now, 60 to 80% of Americans take a multivitamin. The question that many people will ask both of us is, "Do I really need a special supplement for skin health and beauty? Don't I get enough of that when I take my multiple vitamin and my multiple mineral?" How do you answer the question? I'll tell you how I answer that question.
Using Carotenoids for a Natural Glow
Dr. Molly Maloof: I mean, the main reason why I think Qualia is so useful is there's just a lot of really interesting research on healthspan with carotenoids, and it has all of these plant pigments from you name it, pomegranate, peach, amla fruit. These carotenoids have been shown, at least in some clinical studies, to actually enhance the way you look, so they can make you more attractive to the opposite sex, and they've actually done studies on this. I think the reality is that most people really pursue beauty because the biological imperative underneath the surface is to survive and reproduce. People want to be seen as attractive to the opposite sex because it enhances their chances of finding a partner and having children, which I don't think a lot of people is this programming that's running the show underneath the surface of a lot of your behaviors.
I noticed that when I started taking Qualia, and I gave some to my sister to take, both of us developed a lot rosier skin, and it was almost like it gave us like a natural rosy glow. I think to me, if you struggle with feeling like your skin has that beautiful glow, it can actually really make a difference. I mean, I saw a totally difference when I started using it.
Dr. Mark Tager: I approached it a little differently, you know?
Dr. Molly Maloof: Yeah, I'd love to hear about your experience.
How Ceramides Combat ‘Leaky Skin”
Dr. Mark Tager: Having spent a year and a half producing a course on personalized nutrition and all the work I did for the book, I was going to do my own formulation, and I really wanted to lean very heavily on patented ingredients because with patented ingredients, you know you've got quality. You know you've got potency. You know you've got safety. You know that there have been some studies done on the ingredients that have been reported on and are good studies. I started to assemble those patented ingredients, and lo and behold, the list that I had and I put together was very, very similar to what Qualia had.
If you think about it, you want ceramides. Ceramides, we use them topically in dermatology a lot, but there's good data showing that these oral ceramides, which actually help with the skin barrier, they're part of the glue that hold these skins together, and so very often... There's one ingredient that's HydroPeach, which is Japanese peaches that... the inside of it, and that is a ceramide-rich product. Really, really important. In fact, most plastic surgeons, dermatologists will not do procedures on people if they have sort of leaky skin, leaky skin with poor skin barrier, so ceramides are important.
I'm a big fan of the Red Orange Complex. It's oranges that are grown on the side of Mount Sicily by and produced by a company called BIONAP, and what they do-
Dr. Molly Maloof: Cool.
Dr. Mark Tager: ... they have these blood red Sicilian oranges and they three of them and they're grown... There's no trucking. I mean, essentially they're not refrigerating or trucking these herbs far. The farm's right there and the manufacturing's there. You know, the resveratrol from French grapes, I think, is important. You mentioned pomegranate, and then they've got just the right amount of some minerals and some vitamins without going overboard.
I think that if you think about that, they've created these stacks for skin resilience and skin firmness and skin elasticity, and I really admire the formulators there. I mean, I think they do a superb job of putting together such a great blend, so I think that... What I personally do is I do take a multiple vitamin supplement. I will take a fish oil often with curcumin in it, and I will take my Qualia Skin. I will use some of the other products as well, and I do the Qualia Sleep at night. Really, that's... You need... We're not getting enough of these powerful phytonutrients from plants, and-
Dr. Molly Maloof: Yep.
How the Gut Microbiome Influences Skin Health
Dr. Mark Tager: ... you're not seeing that in these multiple vitamin preparations, so... but I want to segue here. You, I know, are a bit of an expert on gut-brain-skin. It is such an important emerging area, and because all disease "begins in the guy" because we know so much about leaky gut and the microbiome and all the things that the microbiome does, talk to us about the connection between the gut and the skin.
Dr. Molly Maloof: Well, I'll just give you some interesting things to think about, I guess, to begin with. The first is your guts are kind of like the roots of your body, but they're on the inside. Trees have roots on the outside, and we have hair, skin and nails on our outside, and trees have bark and leaves and fruit. When I look at a human versus a plant, I'm looking at two separate kinds of organisms that have very different designs, but have actually they're both require nutrients and water and air to grow. We have these roots on our insides. Our gut health is really fundamental to our ability to absorb nutrients.
I've actually seen people with micronutrient deficiencies and because of malabsorption from small intestinal bacterial overgrowth, I've seen people who basically have dysbiosis from years of antibiotic use and it's reared its head through acne and through problems with detoxification. You really need to look at your gut health and ask yourself, is your gut health also affecting your mental function? We have a vagus nerve that's traveling from our brain stem to our gut, and it helps us modulate the parasympathetic arm of the nervous system. This is the arm of the nervous system that actually technically has what's called the dorsal and the ventral arms, but the ventral arm of the vagus nerve is designed to help you basically rest and digest and tend and befriend. It's here to help you relax.
On the other flip side, we've got the sympathetic nervous system that helps us get out of danger, (29:56) but the problem is that a lot of people are living in existences that are constantly stressful, so that constant state of stress can actually impact your digestion, so your brain can actually affect your gut. That can affect your skin, and you can actually just tell by looking at someone who's been highly stressed out or doesn't sleep well. They just don't look like they have as much illuminosity of the skin. They don't have as much energy. Then, at the same time, maybe you have inflammation in your gut from dysbiosis, that can actually cause inflammation in the brain. 30:20
There's this bidirectional relationship between the gut and the brain that if one of them is off, it's going to affect the other-
Dr. Mark Tager: Sure.
Cutting Edge Cosmeceuticals for Skin Health
Dr. Molly Maloof:... and that's the beauty of the connection of the body. I've love to actually ask you a few more questions about yourself. Earlier in your career, I know you were part of a team that created the Fraxel laser, which I know is very-
Dr. Mark Tager: Yes.
Dr. Molly Maloof: ... and you basically introduced this concept of fractional resurfacing to clinicians and consumers all around the world. This was like one of the many breakthroughs in skin rejuvenation. I know this is something people are really interested in learning more about, so I would love to know what you think that we should know as consumers, because I'm not obviously an expert in lasers and resurfacing and radio frequency. What should we be thinking about procedures?
I'm 38, and I'm sure there's a lot of women out there that are in their 30s. I mean, what would you be recommending a woman in her late 30s start to think about in terms of different types of interventions? I do admit to doing a little bit of Botox, but that's it. I don't do fillers. I haven't done anything else aside from using skin topicals.
Dr. Mark Tager: Yeah. Let's start there, though, because-
Dr. Molly Maloof: Sure.
Dr. Mark Tager: .. the average woman in her lifetime, one survey showed, will spend between 200 and $300,000 on topicals, and ... yeah, except I was in... gave a talk in L.A. and some woman said, "Is that all?" Cut the number in half, it's still a big number, and you think about it, if you ask our female viewers to open up their medicine chest.
Dr. Molly Maloof: Yeah.
Dr. Mark Tager:... what do you have there? You've got 20 products in various stages of disuse, and use a little of this one and then you heard that this was better. I think you really want to have good skincare, which is really four things. It's you need a mineral-based SPF and a good one that you use-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... early and often. You want to have barrier protection, so this is the concept of moisturization.
Dr. Mark Tager: Most things, the reality is that most of the topicals just work by moisturization. Then, you start looking at, what are the active molecules that can help the skin? The real question is, what gets into the skin? The skin is really designed as part of that innate immune system. It's a barrier function. It doesn't like to let a lot of stuff in, so the molecules have to be small. Vitamin C is the poster child-
Dr. Molly Maloof: Interesting.
Dr. Mark Tager: ... because its size is something called... it's 600 daltons, which means it's small to get in the skin. I think that vitamin C is important. I think that mixing that with hyaluronic acid, which will only go down to the dermal-epidermal junction for the most part, but can help draw things into the skin. I think that's another important one.
There are peptides that are spectacular these days. There's been so much research. I don't know if we can mention it, but there's a technology called TriHex, the company is Alastin, and they make a beautiful peptide molecule, and there's other peptide molecules. Now, the next step is the retinols or retinoids.
Dr. Molly Maloof: Right.
Dr. Mark Tager: The reason that you use that is that as you age, your skin turnover gets slower and slower and slower, so for you, in your 30s, maybe you're turning your skin over every 35 days. I'm older than you, so normally I would maybe be 40 days, but with the retinols and retinoids, you can turn your skin over in two weeks, and so you get this new skin being created every two weeks. I think that's important as well. Those are your sort of basic categories. Now, once you move over into injections and procedures, of course, every woman now is really listening very carefully for this.
Dr. Molly Maloof: Right.
Dr. Mark Tager: I break them down into two categories. There are the hyaluronic acids, which are injected into the face. They're basically inert. They don't stimulate really anything. As long as they're there, they're attracting a thousand times their own weight in water. They're puffing the skin up. They are filling in areas that are depressed, and when they go away, when they're catabolized, broken down, they're gone. Then, there are injectables that are biostimulatory. Now, the biostimulatory ones, remember we talked about all those collagen... those amino acids?
Dr. Molly Maloof: Right.
Dr. Mark Tager: Well, they can redirect them to a place in the skin to start making collagen, and that's what biostimulatory things do. There are different kinds of injectables, I talked about them in the book, that are biostimulatory fat. When you take fat from one part of the body, micronize it, put it in small little pieces, put it into the face, that's biostimulatory. Then you have-
Dr. Molly Maloof: Gotcha.
Dr. Mark Tager: ... to use the biostimulatory kinds of procedures. Now, in the book, I don't talk much about facials because their part of routine skincare, but I really like to focus on the energies that enter the skin and have the skin and have the skin respond. That was the basis of the Fraxel. Fraxel brought... made these little columns, which allowed there to be healthy skin around each little hole, almost microscopic holes, and the skin healed very quickly. What happens, we also shocked the skin at the deeper level-
Dr. Molly Maloof: Okay.
Dr. Mark Tager: .. and that causes biostimulation. That's what we do when we bring heat into the skin with-
Dr. Molly Maloof: Oh.
Dr. Mark Tager: ... ultrasound or radio frequency. We are essentially heating up that dermis, and here's-
what happens. Here's what happened.
Dr. Molly Maloof: It causes a little injury.
Dr. Mark Tager: Exactly-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... and now what happens when you heat up the dermis, the collagen molecule unwinds and shortens. It essentially becomes inactive and it becomes the scaffold upon which new collagen is created. That's how that process... and that process may take up to six months for you to create new collagen.
Dr. Molly Maloof: Oh, I see.
Dr. Mark Tager: Sometimes called collagen remodeling or collagen neogenesis, new collagen. I'm a firm believer in those kinds of things, so [inaudible 00:37:21]-
Dr. Molly Maloof: Would an example of that be like the Profound laser?
Dr. Mark Tager: Well, you know, I don't want to get into names-
Dr. Molly Maloof: I'm sorry.
Dr. Molly Maloof: I'm just curious, like what's an example of
Dr. Mark Tager: Well, an example, let me give you
Dr. Molly Maloof: ... it says radiofrequency.
Dr. Mark Tager: ... let me give you examples of categories.
Dr. Molly Maloof: Okay.
Dr. Mark Tager: You can bring heat into the skin with ultrasound. You can bring skin into the... with laser energy. You can bring in... Wound the skin with microneedles. It's a little different kind of an injury, but you can do that in cooperation, in conjunction with radiofrequency. Very often you're seeing these microneedling with radiofrequency. Now, I say all of this and we sort of toss it out rather glibly, but the real issue, I think, is to make sure that you are going to a well-trained individual in any of these more invasive kinds of activities. I have personally seen complications with every single one of these.
Dr. Molly Maloof: Wow.
Dr. Mark Tager: You will see it. It's rare. I'll see it reported at a meeting. Incompetent hands. People should always feel comfortable.
Dr. Molly Maloof: Oh, which procedure was this again?
Dr. Mark Tager: ... this is for all of the energy-
Dr. Molly Maloof: All of them?
Dr. Mark Tager: ... anytime you are doing something to wound the skin, you have the possibility of wounding it too much. Or people have different skin types as well. We have to be very, very, very careful on people of darker skin types, the reason being is a hyperpigment. You will bring too much heat and they will hyperpigment, or you'll flare up melasma. Melasma is a-
Dr. Molly Maloof: Oh yeah.
Dr. Mark Tager: ... terrible problem mainly for women. It's a hormonally-induced pigmentation. It's chronic for the most part. It flares up with heat. It's very, very challenging. All of those are... Again, we come down the issue of personalization.
Now, I think there's some things that everybody should do. I think you should take your Qualia every day, your Qualia Skin, and some of their other products, which you could certainly speak to as well, but-
Dr. Molly Maloof: Yeah.
How Mitochondrial Dysfunction Impacts Skin Health
Dr. Mark Tager: ... then it's there's no other person on this planet, Molly, with skin that's the same as yours. So what you need and how you are aging and your nutrient needs and your exercise habits and your hormonal status and the drugs you may be taking that cause drug nutrient depletions. I mean, we've got 26 million Americans on statins. You talk so-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... eloquently about mitochondria, and yet we know that those statins deplete CoQ10, which-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... is essential for mitochondrial function.
Dr. Molly Maloof: I have both my parents on Coenzyme Q10 so that they can make sure that... The thing is, people don't realize is that when you deplete Coenzyme Q10, you cause mitochondrial dysfunction. That's part of the reason why I think we're seeing insulin resistance in a lot of statin patients. I mean, like a lot of people don't even realize that their statin can cause insulin resistance and an increased risk of diabetes, which can increase risk of heart disease, by the way, and so-
Dr. Mark Tager: Sure.
Dr. Molly Maloof: ... I'm just not convinced that we have the right strategy, you know?
Dr. Mark Tager: Yeah. You know, so I'd love for you... I've been reading a lot more about obesity as an inflammatory disease. You know, I'll talk to some people and they'll say, "Well, I'm not really that bad. I've got a gut. I've got a higher BMI than I should, but you know, I'm a I'm a guy. I'm tough. I look really good." Then, how do you segue and have that discussion about fat being an inflammatory organ? If it's inflammatory, it's inflammatory to the skin as well?
Dr. Molly Maloof: Well, so the thing that I really want people to realize about fat and inflammation is that not all fat is created equal in the body. Subcutaneous fat distributed evenly throughout the body, which I have, which everybody has, is far, far, far better for you than visceral fat. I don't have... I have very little visceral fat. I had my body tested with a DEXA scan, and that's extraordinarily protective because visceral fat is the inflammatory fat. Now, this is my personal perspective on visceral fat. I'm definitely using metaphors and I'm definitely using my own interpretation, so don't take this as like firm scientific grounding, but I've tried to explain to people who don't understand visceral fat, like this is the way I see it, because it doesn't make a lot of sense why our bodies would store fat in two different places.
There's this concept of ectopic fat storage, so our body has certain storage depots where it can distribute leftover food and store it as extra energy. Fuel is really necessary to survive. I have about 120,000 calories on my bottom that would last me about a month if I were starving. We have to have fat on our bodies to survive. The problem is is that you can be basically overfat and overweight, or not overweight. There are plenty of people who are lean and overfat, just as like there are plenty of people overweight and also overfat.
What do I mean by this? I mean that there's parts of your body that are going to have ectopic fat storage, which means fat stored in a place where it shouldn't be. but there's this concept of it ectopic fat storage. You should not be storing a bunch of extra fat around your organs. That is not healthy. Our organs are supposed to a lot less fat than they do with modern American diets. The theory behind ectopic fat storage is that when you fill up a lot of your storage in your subcutaneous locations and/or you... I think the theory is that if you're consuming more food than your body can actually keep up with, which is a problem with overeating and overconsuming high-fat, high-sugar foods in particular that are particularly bad for insulin output and insulin resistance.
Dr. Molly Maloof: What you end up having is the body has a spillover effect, and so your body spills fat into the viscera. That basically ends up putting fat around organs, which is where they cause problems. Your body is like responding to this extra fuel like, "Wait, what is this doing here? I don't know what to do with this. I got to go put it somewhere." It spills into the viscera, which makes sense, because that's where it's processed.
Dr. Mark Tager: Right. Sure, sure.
Dr. Molly Maloof: So whether or not I'm completely right here or not, it makes the most sense to me, and I've sat around thinking deeply about metabolism. We forget first principles. We forget that you can't take a car and pour a bunch of extra gas in the gas tank without it filling it up and spilling out. I don't see why the body is that much different.
Dr. Mark Tager: Yeah, so if you look at the different types of fat-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... subcutaneous fat is actually what we use when we harvest some stem cells-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... so within this fat, there are a portion called the stromal vascular fraction.
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: What it really is are the stem cells, and some of the body's healing proteins, exosomes, that actually we harvest them and we reinject them. We spin them down. We purify it, and we put it back into areas of the face. Through improved techniques, if you are young, young being under 55-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... you can get about 80% of the fat to take, to stay there, and it's better in a lot of ways than some of the fillers because of its permanence. If you are much older than 60, 65, that really drops down to 30 or 40% taking, but it does show the importance of fat as an important metabolic organ. Of course, then, there's also brown fat, and brown fat, of course, we don't have a lot of it. It is-
Dr. Molly Maloof: Sure.
Dr. Mark Tager: ... metabolically active fat, but there are some nutraceuticals, some compounds that will upregulate the brown fat in the body, and brown fat is, since it's metabolically active, it will burn some calorie, so-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... I think that's an interesting concept as well, certainly. Let's come back to the gut because I think that that would be a good place to almost kind of begin our wind-down. I think of the gut health in two parts, sort of leaky gut and that concept-
Dr. Molly Maloof: Gotcha.
Dr. Mark Tager: ... of how that affects the skin, and then the microbiome. With the leaky gut, what we have is we have these gaps and these endotoxins, these bacterial fragments get in the outer shells of some of the gram negative bacteria, but things that shouldn't be in the bloodstream get in the bloodstream.
They actually go to organs in the body where they can create something called molecular mimicry, which is there's this little protein fragment, these peptides, and they're floating around in the blood. They shouldn't be there and they go to a knee and the cartilage, and then somehow rather they kind of sort of fit into the receptor site and there's inflammation at that site. The first set of principles would be to obviously reduce this leaky gut.
Dr. Molly Maloof: Sure.
Dr. Mark Tager: Tell me one, and we could talk. I'm curious about your strategies for what you do for leaky gut. Another piece of that ... I'll come back to that, and I always tend to ask two questions, so we can-
Dr. Molly Maloof: Sure.
Dr. Mark Tager: ... chat for a long period of time here. Is... You know, the role of the short chain fatty acids, this is where the-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... fiber goes and it makes these short chain fatty acids, the bacteria-
Dr. Molly Maloof: Right.
Dr. Mark Tager ... but proportionately is [inaudible 00:48:01]-
Dr. Molly Maloof: Oh, tell me more about propionate.
Dr. Mark Tager: Aah, yeah, yeah, yeah, yeah. Well, there's three short chain fatty acids made-
Dr. Molly Maloof: Right.
Dr. Mark Tager: ... by the bacteria, feeding on their favorite food, fiber. What you have, butyrate, you have acetate, and you have proprionate. Of the three, the butyrate stays more in the gut to heal the gut lining. The proprionate is what goes out into the bloodstream in the largest percentage in quantities, and that's what makes its way to the skin, so this... Another reason, at least chemically, we talk about... I like to... I started a society with a colleague called The Vagus Nerve Society-
Dr. Molly Maloof: Love it.
Dr. Mark Tager: ... vnsociety.org. What we talked about is the... we talk about the afferent part of vagus nerve system. 00:48:51 The vagus nerve has efferent, signals go from the brain to the gut, but 80% of it is from the organs, primarily the gut, to the brain.
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: Even though we say, well, you love to say, the gut makes 80, 90% of the serotonin and the neurotransmitters, that doesn't make it to the brain per se. It doesn't cross the blood-brain barrier. It tickles the vagus nerve, and that vagus nerve innervates pretty much everything. I like to say that we are electrochemical beings.
Dr. Molly Maloof: Yes.
Dr. Mark Tager: We've got these chemicals-
Dr. Molly Maloof: Feeling and voltage.
Dr. Mark Tager: ... exactly, exactly-
Dr. Molly Maloof: Yes.
Dr. Mark Tager:... and we have to... That's really what we're doing when you think about it, when we tickle the gut.
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: We're tickling the bacteria, we're tickling the gut.
Dr. Molly Maloof: Well, we're also not realizing that there's a there's microbiome-mitochondria interactions-
Dr. Mark Tager: Yes.
Dr. Molly Maloof: ... so they definitely influence each other, and, I mean, we derived mitochondria from primitive bacteria, so it's not surprising that there is this quorum sensing and crosstalk between these two systems. It makes sense because they help... Our microbiome helps us regulate our energy. I mean, literally, our microbiome helps us determine how much energy we can derive from food, so it's not surprising that there is a relationship there.
Dr. Mark Tager: Yeah. This... 00:50:16 You know, when you think about the most attractive person you know, the healthiest person, you'll always describe them in terms of radiant, energetic, passionate, glowing.
Dr. Molly Maloof: Yes.
Dr. Mark Tager: You know, I've been in aesthetics for a long time. We see people who come in who, you know, they want to be beautiful, but they also need to be beautiful from the inside out 00:50:41
Dr. Molly Maloof: Yeah.
Healing an Unhealthy Relationship with Food
Dr. Mark Tager: Do think that this concept of feeding yourself, loving to feed yourself-
Dr. Molly Maloof: Yes.
Dr. Mark Tager: ... healthy food, deserving healthy food.
Dr. Molly Maloof: Oh my God. Can I tell you... personally, I just want to add something really interesting.
Dr. Mark Tager: Sure.
Dr. Molly Maloof: Having been a woman for like my entire life, but having like been a woman who in the last year finally got over emotional eating, it was a really, really big piece of it was trying to drop all shame I had around food-
Dr. Mark Tager: Yes.
Dr. Molly Maloof: ... and any trauma in my life that I've experienced. I feel like a lot of women don't realize that unresolved emotional pain is part of the reason why they're searching for food to quell their stress. We have this primitive response in fear to go into a state of finding food and finding nutrition and nourishment because we think that that's what's going to make us feel safe, but no amount of food is ever going to feed and fix emotional pain.
I know there's a lot of women listening to this today and aren't realizing that a lot of their emotional eating is not their fault, but it's there's stuff under the surface that hasn't been addressed yet. It's been a really interesting experience to like not feel like I'm driven by my cravings anymore. It was-
Dr. Mark Tager: Gotcha.
Dr. Molly Maloof: ... really fixing that. I mean, it really came through working on my psychospirituality more so than even working on my diet that got me to this place.
Dr. Mark Tager: This is fascinating. I'm going to bring something totally out of left here.
Dr. Molly Maloof: Sure.
Dr. Mark Tager: Just one of the things I've done for about five years is train healthcare professionals to become irresistibly powerful communicators.
Dr. Molly Maloof: Ooh.
Dr. Mark Tager: Along with a colleague, we do a program called Present Well. We used to do it. We trained about 1200 so far.
Dr. Molly Maloof: Wow.
Dr. Mark Tager: We'd usually lock people in days before the pandemic in our room for a couple of days. We helped them work through their fears, their barriers of being a powerful communicator, both in person and on camera.
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: Here's the issue. Within every single one of those people who are struggling, there's a couple of things. There's a wounded individual-
Dr. Molly Maloof: Always.
Dr. Mark Tager: ... or a wounded healer because we drawn to medicine for so many different -
Dr. Molly Maloof: Absolutely.
Dr. Mark Tager: ... reasons. Along the way, it beats us up. I mean, there's suffering and pain and [inaudible 00:53:12]-
Dr. Molly Maloof: There is suffering. I mean it is literally PTSD-inducing for most doctors.
Dr. Mark Tager: It is PTSD-induced, so-
Dr. Molly Maloof: Almost everybody who becomes a doctor has PTSD from becoming a doctor.
Dr. Mark Tager: Exactly, exactly. What has to happen? I think you've really touched on this, and that is the ability to jump over that barrier, make that leap, become comfortable with yourself. Then-
Dr. Molly Maloof: Got it.
Dr. Mark Tager: ... once you do that, you can radiate authenticity.
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... but until you get over that barrier, and so much of that, those eating behaviors are a way to sort of numb your body, numb your senses as it-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... dampen tying things down, push things down. I really do think that part of being beautiful is the ability to accept and love yourself and get over and accept and get over the trauma. Some of it's really painful, but we have to get there.
Dr. Molly Maloof: ... it's the secret to weight loss.
Dr. Mark Tager: Yes.
Dr. Molly Maloof: A lot of women who struggle with weight loss, obviously, you do need to clean up your diet, like-
Dr. Mark Tager: Sure.
Dr. Molly Maloof: ... the reality is that if you don't clean up your diet, you're not going to lose weight, but I've seen a lot of women do that and adopt a lot of the habits and behaviors that reduce calories and increase exercise and they're not losing weight. Every doctor just says, "Eat less and exercise more," and yet when people aren't getting those results, it's often because their body is in a state of threat and hypervigilance and fear. The mitochondria in that state do not have normal metabolism.
There's actually this brilliant, brilliant theory called The Cell Danger Response. I believe it's by Naviaux, and he's this researcher in mitochondria health. Basically what he presupposes is that for a lot of people, especially people with chronic disease and chronic illness and obesity, their mitochondria becomes so dysfunctional because of years of dealing with chronic stress and chronic threat and trauma, maybe even abuse and neglect from childhood. Their nervous systems are so in tune to danger and threat that they can't drop into safety. It's in that state of safety and relaxation, comfort-
Dr. Mark Tager: Yes.
Dr. Molly Maloof... trust, love, that we are able to actually have normally functioning mitochondria and normally functioning nervous system. When I figured this out, I was like, "Holy crap, like modern medicine is missing something really big because we're trying to throw these really big guns at these really hard problems, and we're not seeing great results or outcomes, and we're also seeing doctors falling apart at the seams. This system that we've created is particularly good for battlefield medicine, but not good for chronic disease. Then, we need to start creating new systems for chronic disease based upon new theories and new first principles. When I really just got deep into mitochondrial science, it made everything make more sense, you know?
Dr. Mark Tager: Sure.
Dr. Molly Maloof: It made everything fall into place for me, and my health dramatically improved.
Dr. Mark Tager: I'm in violent agreement with you. We-
Dr. Molly Maloof: Love it.
Dr. Mark Tager: ... you know, we have our patients, our friends, even ourselves are often in these states of sympathetic dominance. One of my colleagues, who I started The Vagus Nerve Society with, coined a term "vagal insufficiency." We are-
Dr. Molly Maloof: Mm-hmm. I love this.
Dr. Mark Tager: ... so sympathetic dominant, so that all of the really good things that we do, breathing and yoga and meditation and Tai Chi and taking a hot bath-
Dr. Molly Maloof: Yeah.
Dr. Mark Tager: ... all of that is designed to bring up parasympathetic tone, and-
Dr. Molly Maloof: Yes.
Dr. Mark Tager: ... one of the real issues that I find is that people haven't learned to control and master the workings of their parasympathetic nervous system to help them in this state, to get into states of relaxation and healing, so-
Dr. Molly Maloof: Right.
Dr. Mark Tager: ... I think that we do this with mitochondria. We do it with the gut health. We do it with vagal nerve stimulation, we do it with lifestyle changes. The interesting thing, and I'm going to come to our... be doing a little bit of wrap-up here, all of that stuff and the right phytonutrients and the right-
Dr. Molly Maloof: Sure.
Dr. Mark Tager: ... the right combinations help to create beautiful, glowing skin, and-
Dr. Molly Maloof: Got it.
Dr. Mark Tager: ... the way I described this to my colleagues, because I speak to colleagues in integrated medicine and colleagues in aesthetics, is that there's this room. Molly and I, Dr. Molly and Dr. Mark want to get people in a room, and that room is to be the best you can be, have a great healthspan, live a wonderful life, be a great person. If we can get you in through that door called Skin Health and Beauty-
Dr. Molly Maloof: Yep.
Dr. Mark Tager: ... we can walk you into the door of you want to look, but you know what? To look good, you got to be healthy. You've got it with VA nerve stimulation. You've got to get those mitochondria working, and the metabolism working and your energy, so that's where I look at Qualia Skin, it's an aid for that, it's an aid for getting the right combination of nutrients, minerals, and these critical phytonutrients, which are great phytonutrients. Dr. Molly, what fun. We should do this again.
Dr. Molly Maloof: You really are great.
Dr. Mark Tager: Let's do this again.
Dr. Molly Maloof: I learned a lot from you, so thank you so much, by the way.
Dr. Mark Tager: Same here.
Dr. Molly Maloof: It really means a ton.
Dr. Mark Tager: Thank you.
Dr. Molly Maloof: I think what I'll leave the audience with is like, at the end of the day, for you to be able to relax into safety, trust, and love, it always begins with your relationship to yourself and your ability to really connect with who you are and how you feel about you. From that place of deep inner compassion, it'll be so much easier for you to find love outside of yourself.
Really, it's through our relationships, our family, our friends, our community, our partners. That's where we find real, true healing, and a lot of people don't realize that the greatest factor associated with long-term health and happiness is, in fact, healthy human relationships. Love of who you are and love of others is really the secret to great skin, but also it's some really cool evidence [inaudible 00:59:41]-
Dr. Mark Tager: Yeah, so amen to that.
Dr. Molly Maloof: Carotenoids are helpful, too.
Dr. Mark Tager: Yeah, carotenoids are there, right. They'll fiber. For folks who want to stay in touch with us, what's your social media handle?
Dr. Molly Maloof: Sure. I'm @D-R-M-O-L-L-Y.co, drmolly.co and on Twitter, @mollymaloofmd. Follow me on LinkedIn, @mollymaloofmd, and follow me on LinkedIn at MollyMaloofMD, and I'd love to hear from you.
Dr. Mark Tager: Yeah, and I'm on LinkedIn as well, and I do Instagram @mtager and my best website, if you want to learn more about my background, is drtager.com. Yeah. Great. Thanks Molly, Dr. Molly.
Dr. Molly Maloof: Thank you.
Dr. Mark Tager: See you. Take care.
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