LiveLongAgeWell

Artificial Tanning Beds

Last month I covered sunscreens and sunless tanning lotions, and as a follow-up, there was a recent reclassification by the International Agency for Research on Cancer (IARC) that tanning beds should be raised to Group 1, that is, the highest risk level: “carcinogenic to humans”. While the artificial tanning bed industry has marketed their products as safer than the ultraviolet radiation from sunlight—and as not increasing the risk of melanoma (though they neglect to mention the increased risk of other forms of skin cancer)—the IARC reports a 75% greater risk of melanomas in people who start using tanning beds before the age of 30. Besides the cancer risks, while a tan might make you look better in the short run, in the long run you will end up more wrinkled. And though artificial tanning booths are dangerous, remember that sunless tanning lotions can be quite effective and safe.

Organic Food Not Worthwhile?

A headline from Reuters London caught my eye last week: “Organic food no healthier, study finds”. The author of the English study stated: “Our review indicates that there is currently no evidence to support the selection of organically over conventionally produced foods on the basis of nutritional superiority [italics mine].”  (Really, OK, maybe not proof, but no evidence at all?)

So a quick read might lead you to think it’s not worth the extra expense and trouble to seek out organic products. But this would be a false conclusion on at least two counts. First, the study only analyzed “nutritional content”; this is, what’s in the food, but most people choose organics because what’s NOT in them; i.e., pesticides and other organo-toxins (not addressed in this research). Second, if you look at what they consider “nutritional content”, you find they did not analyze antioxidant content, which is another reason to choose organic. While it’s true that there is not yet proof organics have a higher natural antioxidant content; for me, I’ll stick to organic products whenever I can. Unlikely any future research will find any health benefit whatsoever from eating foods with pesticides. It’s far more likely organic foods suffer less antioxidant loss during any processing, transport, and chemical additions.

Another Reason To Keep Your Cholesterol Below 200

If you know that your total cholesterol level is borderline or elevated, and you haven’t taken measures to change that, here’s another reason to take action. Published in the August Dementia and Geriatric Cognitive Disorders, researchers studied nearly 10,000 Northern California Kaiser Hospital members, and found that those who had total serum cholesterol levels over 200 mg/dL in their 40s, had a significantly great risk of dementia when they reached their 60s and 70s. The risk for either Alzheimer’s disease or vascular dementia was at least 50% percent greater in people with only mildly high levels—over 200. So take measures to keep your cholesterol in the normal range: whether it means a change in your diet and/or increased exercise, and if that doesn’t work, you should ask your doctor about possibly taking a “statin” drug to lower your lipid levels  (which—as logically follows from this study—have been shown may help prevent dementia.)

Here in LLAW we’ve recently covered sunscreens, and that the sun is responsible for a majority of the changes in our skin that we normally blame on aging. It’s not our age, but the amount of sun exposure we’ve accumulated over the years that gives us most of our wrinkles.

If you listen to dermatologists, they will say something like: “there’s no such thing as a safe tan”. Meaning, all tans, while they might make you look good, are manifestations of damage to your skin’s DNA. From a wrinkle- and cancer-prevention standpoint, a pale complexion, while not considered the most attractive, is certainly the most “healthy”.  I have several dermatologist friends who are really serious about the sun issue. They practice what they preach, and I have never seen them with a tan.  But, for me, I’ll take a bit of sun, a bit of that risk. Still, it’s nice to know there’s a decent alternative—self-tanning—something people are moving to as a way of avoiding the risk and damage altogether. Are self-tanners safe?…

In the last few years the cosmetic industry has developed products that won’t turn you a sickly shade of orange.  By blending the tanning chemical DHA (dihydroxyacetone) into a blend of moisturizers, and stabilizing the chemical release, most people can now get acceptably good results. And the active component DHA does truly appear to be safe. It’s derived from glycerin, is not absorbed into the bloodstream, and only works on the outmost layer of the epidermis of the skin. The brownish color is result of a chemical reaction between DHA and the proteins in your skin cells, and, since your dead outer skin cells are constantly shed off, the “tan” also sheds off within a few days to a week.

DHA has been around for 30 years in various cosmetics, and as far as I can find has never been found to be toxic or carcinogenic. While you might hear about other products, such as tyrosine, DHA is the only component that appears to be safe and effective. Certainly avoid any pill that promises to make you tan; these are all dangerous. (And don’t believe that some tanning beds are OK; none of them are safe sun alternatives.)

Sunless-tanning hints:

1. check out products from Jergens (the Natural Glow line, various products for different skin tones) and L’Oreal Sublime Glow Daily Moisturizer. If you like the more “chic” brands, try one made by Clarins.

2. consult the list of products approved by the Skin Cancer Foundation.

3. you might have to experiment with several to see which one works best for you. When you first use one, don’t use it on your face; find an out-of-the-way spot to check the result and to make sure you aren’t allergic.

4. first wash and gently exfoliate your skin before applying, so that your skin is a smooth surface to uniformly pick up the product.

5. use fairly generously, as you would sunscreen, but avoid too much around your elbows, hands, and tops of the feet. Here your skin is thicker and you might get more pigment change. If certain areas turn out too dark, you can partially reverse the process with a bit of hydrogen peroxide or even whitening toothpaste rubbed-in as needed.

6. wash your palms right away, and if you use on your face, don’t forget to apply to your ears.

7. remember you still need to use sunscreen if you get out into the sun! Neither the “sunless tan” or the product themselves will protect your skin from sun damage. However, there are new products that combine 15-30 SPF sunscreen into the self-tanners.

I suggest you try one of these products, particularly if you are worried about the damage you get from even a mild tan, or about possible toxic effects from sunscreens themselves. None of these DHA products out now are perfect, but most people can find one that works quite well.  And on the horizon, being developed in Australia, are self-tanners that work by stimulating our skin’s melanin. If they are shown to be safe (I wouldn’t be the first to use them), they will be a remarkable leap forward in sunless tanning.

First, the big picture: the most important measure you can take to keep a “youthful” appearance—as much as your particular genes will allow—is to minimize exposure to UVA and UVB irradiation from the sun. Of course staying out of the sun as much as possible is the most sure way, but also it’s inconvenient, impractical, and not healthy from many aspects, including the psychological ones, so most people use sunscreens. The problem is finding a good one.

Sunscreen use is critical both to minimize wrinkles and cut the risk of skin cancer, which ranks as the most common cancer of all. But the subject has become complex in the past few years, so today let’s go over some of the current science of sunscreens, and the next post I’ll give some specific ideas on what you can use.

A few years ago it was easy to know what to do. Most people, even dermatologists, felt that if you used a SPF 15 or, then…wow…a 30, you would be highly protected and would not have to worry much, because a 30 was thought to allow you to be in the sun 30 times as long as if you didn’t use any sunscreen. But in the last few years as more products have been released, with higher and higher SPFs, the sunscreen field has become much more murky and confusing.

Some doctors have even gone so far as to state that using sunscreens will increase the risk for the deadliest form of skin cancer, melanoma, because many products will stop the burn (mostly from UVB), but will not stop UVA. This UVA irradiation doesn’t cause as much redness, but penetrates more deeply into the skin causing worse aging damage and a higher melanoma risk. So since you don’t get red, you think you are fine, while the sneaky UVA rays are causing their deep damage.

One simple way to remember the basic difference between A and B is: UVA,  a longer wavelength, is the aging radiation, and UVB causes more burning…however, both, in excess, lead to wrinkles, skin cancer, and even a diminished immune system. And if you sit by a sunny window, know that UVA radiation penetrates glass.

Here is a summary of some recent issues. But don’t get discouraged as you read this, because there are some solutions, which we’ll discuss in the next post…

1. The “SPF” rating only concerns the level of UVB protection. There are no good FDA standards or labeling or SPF ratings for UVA, and many products don’t offer, or even claim, good protection from UVA.

2. Many of the chemicals that do provide UVA protection, perhaps ironically, break down quickly in the sun, which is one reason sunscreens should be re-applied every 2 to 3 hours.

3. Toxicity: some of the chemicals used in sunscreens are absorbed into our bloodstream and may be toxic. Particular concern has been raised about two popular components, oxybenzone and avobenzone, which theoretically could alter our internal hormonal balance, and some doctors advise: don’t use these on pregnant women or children. Then there are the super-small, nano-particles used in some expensive new products. Again, while some have claimed these tiny particles might be absorbed, the super-cautious Environmental Working Group has concluded they are not. But the EWG recommends staying away from spray or powder products that might cause lung damage from the inhaled nano-particles. Finally, some sunscreen chemicals have been shown to produce free radicals when mixed with sunlight, and free radicals (which we try to neutralize with antioxidants) lead to skin aging.

4. While many of those issues are controversial, most doctors agree: very few people use enough sunscreen to provide adequate protection. A large Australian study showed that even “diligent” sunscreen users were only applying about half of what they should to get the advertised SPF protection, and most people only get about a quarter of the protection they think they are.

5. “Waterproof” sunscreens only last for about 40 minutes in the water, and for typical beach use, even these should be re-applied regularly.

6. If you read this blog often, you know I am a big fan of vitamin D, which we naturally get from sun exposure on our skin, and many people are vitamin D deficient. For some, this D vitamin shortage is rooted in excessive paranoia about sun exposure and many of these people use too much sunscreen. Like most things in life, moderation is the best route.

Next: SPFs and good sunscreens.

I was surprised and slightly amused to see acai (properly spelled, with accents açaí, and pronounced ah-saa-EE), the blue Amazonian berry, so heavily promoted as a weight loss aid—and a frequent subject of spam emails—because here in Brazil, where it comes from, acai is more likely seen as something that will make you fat, not thin. Still, acai as a supplement has become a huge industry in the United States, with a marketing frenzy spurred by high-powered endorsers like Dr. Oz and Oprah. What’s the truth….will it help make you thin, or fat, or neither?

I initially heard of this “healthiest fruit in the world” —a reputation it carries in Brazil—on my first trip here in 2001, and since it was exotically blue, tasty, and apparently full of antioxidants, I have eaten it frequently. Acai is a grape-sized fruit from an Amazonian palm tree (another part of the same tree is sold as “palm hearts”), usually sold in frozen packs of blue pulp. Typically it is prepared as a thick smoothie, mixed with banana and the sweet caffeine-rich syrup of another Amazonian berry, guaraná. It’s fashionable to cover the whole bowl with granola.

Acai indeed has the reputation as being mysteriously healthy, full of antioxidants, and the science indicates that it is, but exactly how heavily it’s loaded with antioxidants is controversial. Some studies indicate a medium level, some higher; it depends on which “system” of oxidation in the body or test tube is being tested. It seems likely though that the basic antioxidant content is quite high, somewhere around that of a blueberry.

Interestingly, the value of antioxidants in the body is a hot topic now…are they helpful or could they be in some cases harmful? A recent study regarding vitamins C and E and exercise suggest that antioxidants, at least as pill supplements, might actually weaken our own body’s natural system of mopping up oxidative damage, and antioxidant pills might weaken these defenses. So a new theory is that these supplements might make our own natural antioxidant systems lazy, and in the long run, lead to more oxidative damage, more aging.

But it is much too soon to reach any conclusions; almost certainly, other studies with different formulations of vitamin E, different dose schedules, etc, will give different results. Most scientists seem to agree however that the antioxidants you consume in foods like tea, red wine, colorful vegetables, legumes, coffee, chocolate, etc, are beneficial as far as cutting risk of heart disease, some cancers, and possibly dementia.

Back to acai. Besides whatever natural antioxidants it contains, it is full of the best form of (monosaturated) fatty acids, similar to olive oil, and has lots of fiber. But as a weight loss aid? No proof at all, and no good evidence either. Don’t waste your money. Acai in body creams as a wrinkle reducer? Again, no evidence; better to spend your money on a visit to a dermatologist, a prescription for topical retinoic acid, and a good sunscreen. Still, I’ll continue to eat my acai mixed with banana and guarana, but I’ll rely on the gym and lots of walking to keep my weight in line…certainly not acai, green tea, or any supplement.

We will return to prescription brain drugs later this week, as today we make a brief news diversion to a substance many people consider a mind drug: sugar. An interesting article appeared in the New York Times a couple days ago about how the food industry is recently trending from using High Fructose Corn Syrup (HFCS) as a primary sweetener, back to “natural” sucrose, that is, simply, sugar.

It’s interesting since HFCS has, over the past 30 years, crept into most all sweetened sodas, fruit juices, cookies and salad dressings and most every other food available in a bottle or a can. As it has silently and rather stealthily taken the place of sugar, many health experts have claimed that HFCS is a much less healthy replacement, and has been a major contribution to the U.S. obesity crisis. Food manufacturers, aware of their bottom line, substituted HFCS for sugar to boost their bottom line, as it was cheaper than real sugar. HFCS is easier to keep and transport, and extends the shelf life of many products, so it cut production costs, and initially few people seemed to care.

But more and more consumers have become alert to HFCS as a potential villain; the Times article mentions that Michelle Obama has pledged not to allow her children to consume it, certainly not good news for corn farmers. HFCS comes in various forms, but most commonly is chemically very similar to simple sugar (about 50% glucose and 50% fructose), though HFCS has slightly more fructose. HFCS is of course made from corn, but only after an extensive chemical process, this corn is magically transformed into…basically liquid sugar, but of course, it’s not exactly the same as the truly “natural” product.

If you want to wade into a big mess of a controversy, look into the various merits of HFCS vs. sugar. It’s hard to come to any good conclusion…is HFCS one of the reasons Americans have become so fat? Is fructose so much worse than sucrose for our livers? Does HFCS prevent us from feeling full? Does it lead to a rise in VLDL (the worst of the blood lipids)?

It’s hard to know what to make of the various arguments, and one reason is that many of the studies have been sponsored—sometimes indirectly so it’s difficult to know—by the sugar cane or beet or corn industries, and they can “buy” and release whatever research results they want. But here is what I have concluded so far: I would stick to simple sugar (sucrose) over HFCS whenever possible. Moreover, try to cut your sugar consumption as best you can, as those empty calories don’t do your body much good except provide a very temporary energy boost. The long term effects of sugar are for my book and later posts, but sugar does nothing good for your aging. There is intriguing research suggesting that sugar damages our skin proteins, and is one reason for diminished elasticity of our skin as we get older, and…premature wrinkling.

I received a number of calls and emails regarding my recent post on Botox, so here’s a brief update regarding two issues.

First regarding the cost. In the U.S. an average Botox treatment runs about $300 to $400 for “one treatment area” (in Brazil, about R$ 400), so before you agree to being injected, ask the doctor how many “areas” she wants to treat, and what will be the total cost. You might be able to negotiate that a bit, particularly for more than one area. Don’t be shy about asking. Many plastic surgeons are negotiating charges these days.

Expect to pay more in big cities and on the East Coast, but I wouldn’t make my choice based on price, but on the qualifications and experience of the plastic surgeon or dermatologist. And while you may have heard of “Botox parties” (most common in California)…personally, I would run away from any doctor who participated in such an event. Injecting “the most potent toxin known to man” is not a trivial medical procedure; it carries risks and you want it done in a relatively sterile environment, with the doctor paying attention only to you, not to a crowd and with an eye on his marketing presence.

The second Botox issue is that a new type of Botulinum toxin should be FDA approved this year; a decision is expected by mid-April.  Apparently the new form (brand name Reloxin, and already available in Europe as Dysport), has several potential advantages over the current Botox made by the Allergan Corporation.

The cost to your doctor for each vial of Reloxin will be lower than the cost of Botox, so the cost to the patient should be less. And while the new form is also, like Botox, a form of Botulinum toxin A—and very similar to the standard Botox—Reloxin contains less “protein load” so it is thought patients might form less antibodies to this new toxin, and so the beneficial effect might last longer. And the onset of action is said to be somewhat faster, though this is probably no big advantage.

Once Reloxin is released, for me personally, I wouldn’t run out and be one of my doctor’s first patients. Reloxin is said to spread in the tissues more than Botox, and the concentration of Reloxin is different than Botox, and for any new procedure, there is a “learning curve” for your doctor while she or he gets acquainted with the nuances of the new medicine. I’ll give another update when the drug is released. Some cosmetic experts are expecting “price wars”, but for sure, expect to see lots of new ads…

Next post….pills people are taking to boost brain power!

When a new patient walked into my office I would occasionally test myself, and try to guess just by looking at her face if she was a smoker or not. Usually I was right, and I could tell by looking for vertical wrinkles around the mouth, typically much more pronounced in a smoker. Why is that? Why should smokers have more wrinkles?

For skin to look good and alive, it needs to be nourished by the blood vessels that feed it. These vessels are the pipes that send fresh blood, oxygen, and nutrients to the skin, and then carry away the bad stuff. But in a smoker, the small blood vessels that feed the skin get irritated and inflamed from the cigarette toxins, and when the vessel walls get irritated, cholesterol can more easily stick to the inflamed surface. So like a pipe filled with any sort of crud, the flow of oxygen and nutrients decreases, and the skin basically loses its elasticity and slowly dies.

The same thing is happening to the smoker’s blood vessels that feed the heart and the brain, and everywhere else in the body. We just don’t see the pipe build-up problem like we do in the skin. In the heart the smoker can experience angina (heart pain) or a heart attack. In the brain, the smoker loses brain cells faster, and are more prone to a stroke. In the penis, since a firm erection depends on good blood flow to your organ, even if you aren’t impotent, your erections won’t be as good.

Besides wrinkles, a few more reasons smokers tend to age much faster:

•    The smoke slowly kills your lung capacity, so if you DO manage to get to an old age as a smoker (note that smokers live an average of 13 to 14 years less than non-smokers), you won’t be able to handle athletic activities well; even climbing stairs might become a chore. Bad lungs severely limit your ability for fun, and there’s no cure at all. Carrying an oxygen tank is a big hassle.

•    Smoking ruins your breath, stains and loosens your teeth.

•    Smokers have a much higher rate of osteoporosis and bone fracture.

•    The risk of that much advertised affliction, ED, or erectile dysfunction, is about 50% greater in smokers.

•    Smokers are twice as likely to get macular degeneration, a common form of blindness, as well as cataracts.

•    Many plastic surgeons will refuse to operate on smokers, because they heal from surgery so much worse, and have a much higher complication rate.

•    Yes, smoking can keep your weight down somewhat, but there are better ways, and is being a little thinner worth all the negatives, and let us include: a higher risk of baldness for men and for women, increased breast cancer and a two times higher risk of cervical cancer?

Facial Fillers For Wrinkles

We are all probably aware of the huge popularity of botox for smoothing facial wrinkles, but you might not realize how big is the next new wave in cosmetic dermatology: “facial fillers”—substances injected into slightly depressed areas and wrinkles in the face to fill and smooth and give a younger appearance. Amazingly, about 1.5 MILLION of these procedures were performed last year. Most patients seems satisfied with the results but still, there are risks, and if you think you might ever consider one of these procedures, read this report and talk to your doctor first about the possible complications before getting plumped up.

“Health Care Town” In South Korea

Another surprising figure is that some 750,000 Americans last year sought medical treatment outside the U.S., typically because surgery here, even if you are covered by insurance, can be exorbitantly expensive. Americans are traveling for everything from open-heart surgery to hip replacements to face-lifts. The total cost, even including travel, can be a fraction of the cost in the U.S. It’s estimated that within several years, millions of Americans will be traveling abroad yearly for care.

It’s a trend worth watching, especially if you ever require an expensive operation. (Of course, quality and follow-up of care might be your primary concerns.) Read this fascinating New York Times article for a look at this phenomenon. Featured is the newest of the countries welcoming foreign patients, South Korea, where the government is building “Health Care Town” on a resort island, complete with prime beaches and a 18-hole golf course, presumably for whomever goes along with you on your trip.

On Monday I addressed the importance of moisturizers and sunscreen for your hands, fingers, and arms. Many people remember sunscreen for their face, but forget about it elsewhere, so, over time, your face might look pretty good but your hands—because they were not well protected—look like hands of an old person. (Remember too that sunscreen decreases the risk of skin cancer, which occur commonly on the back of the hands.)

Today we consider other creams you can use for your hands. First you might ask: should I see a dermatologist? Yes, if you have spots you are concerned might be cancerous, or you already have extensive aging changes. A dermatologist has many stronger treatments than you can find over-the-counter; her arsenal includes (from easiest to most complicated): prescription-strength bleaching agents and Retin-A, chemical peel, intense pulsed light, laser resurfacing, and injection of filling agents. Your doctor can combine several of these, and they tend to be very effective.

If you are younger and your hands currently look quite good and you want to keep them that way, or you have only mild changes at this point, there are effective products you can buy “OTC” (over-the-counter).  First are the alpha-hydroxy acids, and with these you can give your hands a mild chemical peel. They may give some mild benefit, but by far the most effective creams are the retinoids, derived from vitamin A (Retin-A is the prescription-strength form).

Retinoids are, well, fantastic, and I will devote a future post just to them and how they work, but in short, they are the very best agents we have to restore the collagen framework—the firmness and elasticity that your skin loses from aging and sun. The best OTC form is retinol, and I recommend the Neutrogena line because they are high quality and not overpriced (in skin creams, you can spend a fortune for a chic package and a psueudo-European name complete with accent marks, but often these are far inferior to the less flashy brands such as Neutrogena). One good choice is Neutrogena Healthy Skin Original Formula or the stronger Neutrogena Anti-Wrinkle Intensive.

Spread about a pea-sized amount on your hands, at first every several days, and if you don’t get any irritation, slowly increase to every night use. The main side effect is redness and irritation, and if that occurs, use it less often, then after a few weeks again try to use it more frequently. You need at least a month to see any improvement, and if you aren’t happy with the results after three months, see a dermatologist. You might benefit from a stronger retinoid or other types of treatment.

Finally, retinoids have the catch-22 that they make your skin more sensitive to sun damage, so it’s best to use them at night, and you need to be really serious about using a sunscreen. Monday I mentioned Lubriderm with SPF 15, but if you are using retinoids regularly, you might move up a notch in sun-protection to something like Neutrogena Norwegian Formula Age Shield SPF 30 Hand Cream. Carry a tube in your bag to use whenever you wash your hands, so even on-the-go keep up your younger hands program!

I hope you now have a good idea how to get younger-looking hands, and Friday, we leave the most superficial part of the body and dig towards a much deeper subject.

You may know that a current hot procedure in cosmetic dermatology involves “facial fillers”—artificial and in some cases natural substances, such as one’s own fat cells, injected to expand facial areas that have shrunk as a natural result of aging. But you might not be aware that these same plumping-out techniques are becoming all the rage for a different area—the hands. More individuals, who may have young-looking faces, are directing attention now to their hands, which, they feel, “give away” their age. It’s a valid concern, and they want something done.

As detailed in this New York Times article, more than a few people are spending a small fortune trying to reverse the natural tissue shrinkage (which gives a “bony” or “veiny” look) that occurs in some people’s hands over time. The cost of filling procedures for the hands can range from $3,000 for results that last about a year, to $12,000 for results (using fat) that might last a decade. Certainly not a trivial amount, so you will be happy to know there are several simpler, cheaper, and less painful routes to help prevent, and then treat, some of the age-related changes that might occur.

Besides the atrophy, or shrinkage, problem, other age-giveaways are hand wrinkles and brown spots. Prevention is best of course, and if you are in your 20s or 30s still with perfect hands, notice your grandparents’ hands and consider: sun damage may have caused much of the changes you see, and in large part, it’s preventable.

Point one: faithfully use at least an SPF 15 sunscreen (with both UVA and UVB protection), on the backs of your hands and fingers…wrists and arms too if they are sun-exposed. Do this no matter if you are young and unwrinkled, or already have a problem…even if you already have wrinkles, this will help slow down their progression.

Two: moisturize and hydrate your hands, and your body in general. For a daytime hand moisturizer, best is to use a moisturizer-sunscreen combination. One quality, economical, and convenient choice is Lubriderm Daily Moisture with SPF 15. Leave a 16 oz press-top dispenser handy, and make a habit of using a couple squirts before you go out into the sun and weather.

Then hydrate your skin from inside by drinking enough water. Especially with winter approaching, the indoor heated environment can be very drying, wrecking havoc on your skin, so consider purchasing a portable humidifier or two for your home. It’s slightly inconvenient to deal with filling up the device, cleaning it, changing the filters, etc., but the results are well worth the effort. Your wrinkled skin might noticeably “flesh-out” as the humidity rises in your environment. And the increased humidity has other health benefits that will be detailed in a future post.

On Wednesday… several specific creams that work well for age spots and wrinkles!