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The S Factors: Stress and Sun and Sugar
1. Skin and What You Do to It
Much as we might wish to stop the clock, skin ages, bodies age -- it's as simple as that. And considering what we do to our skin -- bake it in the sun, frown, squint, pull, prod, pick, rub, blow smoke over it, or just plain old take it for granted -- it remains a marvel of resiliency. Most of us certainly take for granted the miracle that is our skin, which serves vital functions, regulates body temperature, and keeps the elements out and our organs in.
Still, every woman, no matter how scrupulous she is about taking care of her skin or staying out of the sun, will start to see very subtle changes in her skin as the years go by. Sometimes slowly, sometimes with rather intimidating or alarming speed, changes become more pronounced. A typical patient in her late twenties (earlier if she smokes and/or has had excessive sun exposure) or early thirties (if she's been diligent) will become aware that, if she hasn't been paying particular attention to her skin, the bloom of youth is fading. Skin doesn't seem to be as "juicy." She may also see dryness, brown spots, an ashy tone, less resilience and elasticity, and fine wrinkles around her eyes or mouth.
"All of a sudden, I woke up and saw wrinkles all over the place," I'll hear them lament. "I need help!"
First, I joke with them that now is the time to throw away that 10X magnifying mirror -- it's a lethal weapon in women's hands! Magnifying mirrors should be banished from your bathroom, since all they do is highlight your flaws so you become obsessed about the tiniest of imperfections.
Then I reassure my patients that no one ages overnight. In fact, changes in your skin occur very subtly, over time -- more like a creeping progression, percolating in your skin's deepest layers. Once these changes reach a critical mass, it's akin to dumping sand on one end of a seesaw. Add a gentle trickle of sand and nothing happens; add more and the seesaw will eventually reach its tipping point. The tipping point with skin explains why you seem to notice wrinkles one day -- the lines finally become deep enough to suddenly seem to "pop."
To see how you're aging, take a walk down memory lane. Pull out a picture from high school (never mind your clothes or hairstyle!) and compare it to a picture of how you look right now.
The difference between the lovely rounded cheeks you undoubtedly possessed in your high school photographs and the loss of fullness today is due to volume loss. As we age, we lose dimensionality. Fat deposits shift over time. This shift is an inevitable physiological phenomenon. Blame it on gravity and genetics, and realize that this explains why face-lifts don't make you look younger -- only tighter. The key to restoring a youthful contour to the face is replacing this lost volume, which I'll discuss in depth in chapter 12.
Let's take a brief look at what happens to skin as you age.
There are two kinds of aging: intrinsic (biological) and extrinsic (environmental).
Intrinsic aging is determined by your genes, so it happens to everyone. You can't change the inevitability of this process, but you can slow down its progression.
Extrinsic aging, on the other hand, is entirely in your hands. Get a tan, have a smoke, stay up till the wee hours, burn the candle at both ends -- and your skin is going to show it. How you expose your skin to extrinsic aging is something you have complete control over. Which is why the key to an anti-aging regimen is protecting your skin from extrinsic factors in the first place.
On average, the skin covers about eighteen square feet and weighs about twenty pounds. It has two layers: the outer epidermis, the dermis in the middle, and the underlying layer of subcutaneous fat at the bottom. At the bottom of the epidermis, new skin cells are forming. When they're fully formed, they begin to move toward the surface. This process normally takes about two to four weeks. In the meantime, as newer cells push up, older cells near the top die and rise to the surface. This means that all the topmost layer of your skin, the stratum corneum, is comprised of dead skin cells.
Not surprisingly, these dead cells are still strong and sturdy enough to create the barrier layer so necessary to protect the most fragile layers underneath. But they'll soon flake off and be gone for good.
The surface of our skin sloughs off about 30,000 to 40,000 dead skin cells every minute (that translates to about nine pounds a year). But as we age, this skin-cell turnover slows down. Way down. Healthy turnover is about two to three weeks. Aging skin turnover is about two months or more. No wonder your skin looks dull and blah!
Other factors age your skin as well:
- Your skin produces fewer collagen and elastin fibers, the springy structural proteins found in bones, tendons, ligaments, blood vessels, and skin that provide natural strength and elasticity. Healthy elastin fibers can be stretched by more than 100 percent and they'll still return to their original form. Think of collagen as the basic building block that keeps your skin firm and resilient. Its destruction plays a role in the aging not only of skin, but of your entire body -- which is why maintaining healthy collagen is crucial for overall health. (I'll discuss collagen and elastin in more detail starting on page 37 in chapter 3.)
- Pores are the passageways from hair follicles up to the surface of the skin. Oil-producing sebaceous glands are attached to pores and, much to our dismay, they grow larger with each passing year. Not only do pores get bigger, but they also become packed with dead skin cells that aren't turning over as quickly, so they look even larger.
- Ironically, these sebaceous glands grow larger yet produce less oil. Your skin becomes much more dry.
- The production of melanin, the substance $355 a yeah but yeahthat gives skin its color, also decreases.
In your twenties, the epidermis is nice and juicy, plumped up with healthy collagen and elastin in the dermis, and skin cells that easily renew themselves every twenty-eight to thirty days. Underneath the surface, however, infinitesimal changes are beginning to take place. The stratum corneum, or top layer of protective dead skin cells, thickens slightly while the skin itself starts to thin. Some fine lines may appear. Smokers and sun worshipers will notice these changes sooner, especially with lines around the eyes and lips.
In your thirties, cell turnover starts to slow down. So does collagen, elastin, and oil gland production. Skin doesn't look as fresh. It can appear blotchy, with enlarged pores and hyperpigmentation (brown spots). In fact, it can look downright sluggish, dull, and uneven, with more fine lines and perhaps deeper wrinkles, especially in the naso-labial fold (the line between the nose and the mouth). If you smile or frown broadly, you'll be able to pinpoint the areas where lines that are most likely still fairly transient will eventually deepen.
In your forties, signs of aging are inevitable. You'll continue to lose collagen and fat. Cells retain less moisture and lose their firmness, and skin can become much more dry than it's ever been. Smile or frown, and the glabellar (between the eyebrow) lines become more prominent. There are more wrinkles around your eyes and on your forehead. Hyperpigmentation spots become more plentiful as well as darker. Women in the premenopausal phase called perimenopause will start to experience subtle hormonal shifts that can wreak havoc on skin.
In your fifties, sixties, and up, the hormonal shifts of menopause, with a dwindling estrogen supply, can wreak havoc. Your skin becomes much more dry, hairs can sprout on the face, especially in the chin area (while turning white or gray on your head -- charming!), and acne and the redness of rosacea can suddenly appear, particularly in the cheeks. Loss of estrogen means more skin dryness and a visible loss of luster. Skin can get rough and scaly. Fat and hyaluronic acid continue to disappear, so you can appear gaunt or sag. Jowls and under-eye bags develop, lines and wrinkles deepen and thicken, while lips thin and the chin seems more pointed. Eyelids and neck skin can look crepey and droopy too.
All this makes us look old. Even if we don't feel old.
And let's not forget gravity. It's always been there, exerting force upon our bodies; it's just that we don't have the same strength in our skin and bone structure to withstand it effectively as we grow older. This is especially true for those women whose skin tends to sag, so their features (foreheads, eyebrows, under-eye bags, jowls) appear to move on down, much to their consternation.
To add insult to injury, once we stop growing, our skeleton that supports our skin starts shrinking. Calcium supplements help, but that's not the whole answer. The size of your face eventually shrinks (called bony reabsorption ) overtime as well. Earlobes seem to grow, not just from the weight of earrings over the years, but also from lost volume and resiliency. Noses also start shifting down. And, think about it -- if you lose volume in your face, making it smaller, your nose is going to look bigger; it's like painting a picture on a smaller canvas. So you're not going crazy if you think your nose is turning into Pinocchio's -- everything is relative!
But take heart, as there are plenty of things you can do to stave off your biological destiny -- and turn back the clock.
While scientists and physicians haven't figured out how to stop intrinsic aging, extrinsic aging is another story altogether. This is both good and bad. Good if you've used sunscreen religiously and taken care to stay out of the sun, have never smoked, watched your weight, exercised regularly, eaten a healthy diet, minimized stress whenever possible, and gotten enough sleep. Bad if you haven't!
Extrinsic aging is a result of your own habits: sun exposure, an unwholesome diet (especially an overconsumption of sugar, which I'll discuss in chapter 2), lack of exercise, not getting enough sleep, and stress. Equally important is your attitude toward aging and how you manage your daily life. The old chestnut "You're as young as you feel" is really true. If you feel old, how can you look young? And if you're going through a bad patch in your life, the pressure you're under is going to show, too.
Even small changes in bad, even entrenched, habits can reap large rewards in your skin's appearance.
The worst (and yet most easily correctable) of these bad habits is allowing your skin to be exposed to the damaging ultraviolet radiation of the sun, day in and day out. An astonishing four out of five wrinkles are directly caused by sun damage alone. I like to kid my patients that the only day they don't need to wear sunscreen is during a hurricane -- but, in truth, there's not much to laugh about when it comes to sun damage.
Not surprisingly, there is often a disconnect between a woman's biological age and her skin's appearance when these women have spent many years in the sun. I've seen patients in their late forties or early fifties who come in, shaded by broad sun hats and swathed in scarves, and look decades younger than many of my smoking, sun-worshiping patients in their late twenties and early thirties. Take a good look at the skin on your buttocks, which has had next to no sun exposure throughout most of your life, and you can see what skin protected from the sun looks like -- smooth, unwrinkled, and unmottled by hyperpigmentation. So smokers and tanning bed junkies are almost always chronologically older than their biological age.
I've found that few of my patients truly understand (or want to believe) just how accelerated their aging is due to sun exposure, or how to find the right sunscreen and use it properly. I always tell them that, frankly, there's no point in spending thousands of dollars on advanced treatments if they're going to immediately undo what they've just paid for -- by going right back out in the sun without adequate protection.
The absolute easiest and least expensive way to prevent photo-aging is to use a good, broad-spectrum sunscreen every day and apply it properly. It takes only a minute or so. Not only will it save you thousands of dollars in skin-care products and treatments over the years, but it may well save your life. Skin protected from the sun is much less likely to develop skin cancer.
I'll discuss sun damage, called photo-aging, in depth in chapter 2.
Sleep deprivation is reaching epidemic levels in America, and nearly a quarter of all American adults use some sort of narcotic sleep aid, such as Ambien, to help them fall asleep. Few get the necessary seven to eight hours of deep, uninterrupted sleep that bodies need.
During sleep, our bodies secrete growth hormones and replenish cells and tissues. Skin that's mercifully not assaulted by the daytime barrage of free radicals has time to replenish itself. Cortisol, the hormone that helps regulate body maintenance (and stress management), is secreted early in the morning. Studies have shown that if you go to sleep before midnight, you secrete more growth hormone during the wee hours. Go to bed at three in the morning and get up at noon...well, it's not the same thing. Over time, this can accelerate the aging process throughout the body. If, on the other hand, you stick to a regular sleep schedule and get the amount of rest your body needs, it will affect your hormones in a positive way.
Without enough sleep, you are tired, irritable, sluggish, and more prone to depression and stress, leading to a weakened immune system -- and it shows. Don't forget that the skin is the body's largest organ, and as the largest source of elimination (through sweat) it reflects what's going on inside. Just take a look in a college dorm during finals, when students are pulling all-nighters to study. Even young adults, who normally have faces free of wrinkles, will look like hell when they don't get enough sleep, with waxy, blotchy complexions, breakout clusters, and deep, dark circles under their eyes.
Bottom line: Make your bedroom a haven from the stress of daily life and get some sleep. When you do, you're improving your skin with the absolute least amount of energy possible! Adequate, refreshing sleep is without question the easiest thing you can do to stimulate the production of growth hormone, help your body function better, and help your skin look better, too.
Here's my recipe for instant aging: Go to a tanning salon with a cigarette.
If that doesn't work, bake your skin to a crisp on a beach with a cigarette!
My patients who are smokers are usually astonished when I ask them how long they've been lighting up as soon as they sit down in the examining room. Even when they lie (as they often do, since they're ashamed they're unable to quit), I can always tell a smoker's face, as certain markers are visible to my trained eye.
The toxic chemicals in cigarettes (acetone, ammonia, arsenic, benzene, lead, mercury, and tar) and cigarette smoke (gases such as carbon monoxide, formaldehyde, hydrogen cyanide, and nitric oxide) interfere with the microcirculation of blood and nutrients to the skin. There's a sharp drop in collagen production, causing a loss of firmness. Nicotine constricts small blood vessels, so less oxygen is available to nourish the skin.
As a result, smokers have a particular yellowish-ashy tint to their skin that makes them look hard and older. Their skin is dull and sallow. They get more blackheads; their collagen decreases and their pores become enlarged. The dirtiness of smoke lands right on their faces (whether they think it does or not). They have crow's-feet around their eyes, from squinting. And they have fine lines around their lips from all the pursing activity, so the area around their mouths and noses usually looks pretty awful. In fact, a Korean study reported in the International Journal of Dermatology in January 2002 reported that current smokers have a higher degree of facial wrinkling than nonsmokers and past smokers. Fortunately, heavy smokers who finally stopped smoking had fewer wrinkles than current smokers, but microscopic, or as yet unseen, superficial wrinkling was evidenced in smokers age twenty to thirty-nine.
Nicotine also blocks estradiol, a form of estrogen in the skin. (This may also explain why smokers often have a harder time getting pregnant.) With less estradiol, skin becomes drier and thinner. This may explain why women tend to have smoker's face more visibly and sooner than men who've smoked for the same amount of time.
Smoking also wreaks havoc on the internal organs, especially the lungs. Smokers' cells can't regenerate as quickly. They bruise more easily, bleed more during surgery, and take much longer to heal. This can have dire consequences for anyone contemplating surgical procedures to improve their appearance. I tell my patients that I know that nicotine is exceptionally addictive -- more so, even, than opiates like heroin, or crystal meth, or alcohol. Few of my patients want to keep smoking; they confide that they've tried everything -- acupuncture, nicotine patches and gum, hypnosis, you name it. It's hard for any dermatologist to see anyone suffering from an addiction, especially when the patient knows full well what damage is being caused.
The best way to deal with smoking is to treat it as you do sun exposure: Don't start in the first place. If you smoke now, try your utmost to quit. Smokers who manage to stay off cigarettes notice improvements in their skin almost immediately.
Stress and How to Manage It
No skin-care system will work on the outside unless you're willing to work on the inside as well.
Stressing over your age is a surefire way to look and feel old. And if you feel old, you will become old. I've certainly treated enough unhappy patients to see firsthand the havoc wreaked upon their skin by emotional turmoil. When stressed, your body releases cortisol, a hormone that causes a spike in your insulin level, which then triggers mood swings and sugar cravings. Many who confide in me during their appointments try to spin a layer of positive thinking on what's going on in their lives, but with just a few gentle questions I can see what's lurking underneath: mountains of negative thinking. Confronting and uprooting those mountains take work, effort, and often involve some emotional pain. But in the long run it will be worth it -- not only for your skin, but for every aspect of your well-being.
There are two aspects to this kind of work that have helped me tremendously, and I have no doubts that they can help you too.
I'm living proof of how a body-mind system can have transformative results. I'm always working on myself. I need to do this work, not only to keep myself healthy, but also to keep up my energy when dealing with the dozens of patients I treat every day. What keeps me going is that I truly love my work. I love meeting new patients and seeing old ones. I love educating them about the best skin care, and I love helping them look their best. I love doing the research about new products and technology. I love developing a skin-care line with wonderful properties and ingredients.
Loving your work and finding contentment in your life are profound aspects of healthy, vital living, but they're often overlooked and underrated. Happiness manifests itself in your appearance -- just take a look at wedding photos or new parents cooing over their babies. It's not a cliche to say that skin glows when people are happy, no matter what their age.
But even those who thrive in a high-pressure profession, as I do, have to manage stress. Sure, stress is a part of life, and some days are better than others, but my patients don't come to me to be confronted with my worries. If I'm tense, it shows in the clenched muscles of my face. That anxiety will immediately transfer to my patients, making them anxious, too, and harder to treat (especially with needles!).
So I made a conscious decision years ago to figure out how to manage my stress - not on a temporary basis, but on an ongoing, daily basis that demanded commitment. I explored all the options in terms of exercise, diet, and holistic treatments, and decided upon a basic, sugar - and gluten-free diet (which I'll discuss in chapter 3), yoga (which I'll discuss in the next section), meditation, and acupuncture.
Commitment is something you can't buy. It's a crucial component to both managing stress and improving your skin. Countless patients have come into my office wanting a quick fix for all their skin concerns. Yes, I can often give them nearly instantaneous improvements with a wide range of injectibles, but it's up to them to take the time to commit to sticking to my recommended maintenance program.
This is especially true with OTC (over-the-counter) skin-care products. Anyone starting a specific skin-care regimen should see some results in a month. (After all, you can't undo a lifetime of skin abuse overnight.) But only by sticking to a new regimen religiously and as directed for at least twelve weeks will you begin to see profoundresults.
The Wonder of Yoga
I used to enjoy pounding my joints while jogging on the streets, and many of my friends swear by running and other forms of intense aerobic exercise. What works best for me, my body, and most especially my skin is yoga.
Even with my jam-packed schedule, I make time for yoga five to six days a week, for at least one to two hours every morning. Clearing my day to slot in my yoga practice is not a luxury; this is a crucial aspect of maintaining my health.
There are so many aspects to yoga and its benefits that most novices don't know about, especially now that yoga is considered trendy and something that celebrities boast about -- even though it's been around for a mere five thousand years! Yoga in its purest form not only opens up channels of energy in the body and realigns the joints and organs, but with what's called Pranayama, it trains and liberates the breath. It improves concentration, clearing all extraneous junk from the mind when you enter a meditative state (this is called Samadhi). I've found yoga to be fantastically calming, and when I enter the Samadhi state, it helps me manage my stress in ways I never could have before. And at the same time, it is also remarkably energizing, giving me what's akin to a turbo-charged effect. It's as if I'm using the "exhaust" of having done the yoga postures and breathing to fuel and propel the next experience. Anyone who does yoga on a regular basis will undoubtedly experience these states as well.
My yoga teacher and trainer, Carl Sheusi, sees his clients literally transformed by a commitment to yoga. "Often, they'll come to me and say, 'Okay, well, I mean, you know, I want to do this posture, I want to learn this style of yoga, I want to lose weight, and get more flexible. I'm looking to do all these things,' " he told me. "My response is, great! You'll get that. But you're going to get so much more because you've come to the wish-fulfilling tree. And that tree is the source of all things -- which is within you. My job is simply to give it back to you. What you're looking for isn't out there, it's already inside ."
Yoga wakes up the subtle energies in the body, energies that have stagnated from either misuse, lack of use, or some form of trauma (such as tight connective tissue and muscles). The proper form and the positions in yoga allow those energies to flow unimpeded, bringing about a vibrant state of relaxation and well-being. And since your circulation will improve, it naturally follows that your skin's appearance will, too.
Remember that your skin is the largest organ of elimination in your body. Yoga helps to eliminate toxins, through sweat and through the exhalation of breath. Once you become better at it, it will also bring an incredible suppleness and elasticity to the joints, the internal organs, and certainly to the skin.
Aside from the physical benefits, yoga helps me think. The meditative aspect to my yoga practice helps me focus and brings me awareness. This becomes an amazing tool in my life, allowing me the opportunity to make changes that I hadn't been aware of before (because I didn't know I could experience them).
I believe that this wonderfully calming meditative aspect to yoga - the bringing together of body and emotion into a profound sense of mindfulness - is as important as what you eat or what treatments you use on your skin. While meditation is a wonderful tool when you're stressed, it's something that you can apply all day long. If something happens in your office or your home and you feel yourself about to flip, try to take a step back. Focus your thoughts, use calming breathing techniques, and your stress will become more manageable.
Of course, I don't want to imply that your skin won't look wonderful if you don't want to incorporate yoga into your life. I grew up with parents who ran a candy store, and trust me on this - I never thought I'd become a yoga devotee in my forties. I didn't realize just how much I needed yoga until I began to devote more time to it. (And finding the time to commit to this kind of mind-body exercise was the first step in making my body as healthy as it could be.) For me, it's a profoundly important weapon in my anti-aging arsenal.
It takes a very healthy mind-set to commit to a yoga practice. As with everything that involves serious work and challenges, changes will not happen overnight, but they will happen. Systematically, over a period of time, we can literally transform our minds and bodies. When the body is less toxic, the mind becomes less toxic, and then everything else in your life can change, too.
Carl recommends that beginners to yoga start with whatever level and frequency makes them feel comfortable. (Needless to say, you need to discuss any exercise program with your physician prior to starting.) There are many different kinds of yoga -- Ashtanga, Bikram, Integral, Iyengar, Jivamukti, Kripalu, Sivananda, and Viniyoga, to name a few -- with different emphases. Some are more attuned to the spiritual/meditative aspects, and others are more physically challenging. Some move at a slow, contemplative pace, and others are aerobic and intense workouts.
When you first begin your yoga practice, challenge yourself slightly, but don't overdo it, as you might injure yourself. Injuries can happen to those who are inexperienced yet who can't help comparing themselves to more flexible, experienced classmates. Don't judge yourself against anyone else if you take classes. Set your own goals and work at your own pace.
And enjoy it!
- Make a list of all your habits that contribute to extrinsic aging: smoking, stress, sun worship, not getting enough sleep, et cetera. (This should only take a minute -- hopefully, less!)
- Then take 10 minutes to figure out how to undo each habit. Write this down. Keep it in the back of your mind. Even if you can spend only 10 minutes a day undoing a habit, that's enough of a start to keep you going.
- Go to bed 10 minutes earlier each night until you're getting enough sleep.
- Buy several bottles of sunscreen at a time and keep them in the house, office, and handbags. Reapply often.
- Spend 10 minutes taking a break from your family or other demands and sit somewhere quiet where you can relax in peace. Set a timer so everyone knows that this 10 minutes belongs to you -- and don't give in before the 10 minutes are up!
- Stay away from secondhand smoke.
- Stretching for a few minutes every morning or even mid-afternoon will give you an energy boost.
- Do 10 minutes of yoga to start. If you can't get to a class, watch a video. Start slow.
Copyright © 2007 by Fredric Brandt, MD