I am thrilled to have Dr. Keira Barr joining me today! Dr. Barr is a dual board-certified dermatologist and menopause specialist. She is a prominent leader in womens' medicine, creating a bridge between hormones, skin, and mind-body medicine to optimize the mid-life experiences of women. She is a fierce patient advocate dedicated to uncovering the root cause of hormonal imbalances. Dr. Barr empowers women worldwide to take control of their health and hormones in menopause.
Dr. Barr takes a different approach to skin health. She realized that as women head north of thirty-five, the emphasis is always on the concept of anti-aging and finding ways to camouflage the effects of aging. So she helps women appreciate that their skin can be an ally because it can help them understand what happens in their bodies and empower them to make the changes that are within their control.
In this episode, Dr. Barr and I unpack the changes that happen to womens' skin from the age of thirty-five onward. We dive into skin physiology, the impact of hormones, and the changes that occur as we age. Dr. Barr explains how our skin reflects our physical, mental, and emotional well-being and talks about progesterone, stress, and regulating the nervous system. We discuss Botox, self-love, the social conditioning of women, the benefits of breath-work, getting enough sleep, and taking the time to enjoy yourself. We talk about psoriasis, food, choosing the best skincare products, and caring for your skin, and Dr. Barr shares her thoughts on skin peels, lasers, and bio-identical hormone supplementation.
I hope you gain a lot from this insightful conversation with Dr. Barr! Stay tuned for more!
IN THIS EPISODE YOU WILL LEARN:
What motivated Dr. Barr to help women navigate middle age and beyond?
Dr. Barr unpacks skin physiology, the impact of hormones on the skin and hair, and the changes occurring in our skin throughout our lives.
How does our skin reflect our physical, mental, and emotional well-being?
The impact of progesterone on the skin and hair.
The impact of stress.
The importance of regulating your nervous system.
How you see yourself will impact what shows up on your skin.
How to make your skin your greatest ally.
How can breath-work and rest help your skin repair, recover, and rejuvenate?
Some skin care tips.
Navigating the choices around cleaner and safer skincare products.
Dr. Barr shares her thoughts on skin peels, laser procedures, and bio-identical hormone supplementation.
“Your skin can be your greatest ally and asset to understand what is happening in your body and empower you to make some changes that are within your control.”
-Keira Barr
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Keira Barr
On her website
Transcript:
Cynthia: Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
The impact of stress on skin, hormones, and wellbeing with an emphasis on the menopause transition is the focus of Dr. Keira Barr's work. She is a traditionally trained clinical dermatologist as well as an integrative medicine specialist. We dove deep into not just the physiology of skin, but also the role of estrogen, and progesterone, and testosterone on changes that occur in the skin naturally. What I love about her work is that, she really emphasizes the net impact of chronic stress and anxiety that shows up on her skin, how stress impacts the symptoms and skin changes, especially as we navigate middle age, how she feels that we should use our skin as an asset to create resilient health rather than somebody to be fixed or covered up. We dove deep into some anti-aging protocols, the role of hormone replacement therapy, we even spoke about vaginal lasers and her experiences there. And [unintelligible [00:01:30] is an inside-out perspective with regard to how she views how women show up in middle age and elsewhere. Also, the importance of reconnecting to our bodies to help us feel more comfortable in our skin, literally and figuratively. I hope you love this conversation as much as I do.
Dr. Keira Barr, I am excited and so thrilled to have you joining me today to really talk and unpack all of the things about skin as women are hitting 35, 40, 45 and beyond all the changes that happen. I've gotten such great response and interest in this podcast episode. I'm so excited to have you with me today. Welcome.
Keira: Thank you, thank you. Excited to have this conversation.
Cynthia: Yeah. Tell me what got you so passionate about talking to women about how to navigate middle age and beyond? I understand from colleagues of ours that you got tired of treating acne, which we know can happen throughout our lifetime. But what made you feel particularly interested/vested in women that are north of 35?
Keira: Because I'm one of them.
[laughter]
Cynthia: Most Importantly right.
Keira: Most importantly. It's all about me. No, I'm just kidding. I think part of it is, when I was practicing dermatology, so, I've full transparency. I'm not in a clinic right now, I really do take a different approach to skin health. But I was clinically treating skin cancer and melanoma and then I was behind the microscope. Looking anytime you had a biopsy, I was the one making the diagnosis. Always going beneath the surface. I wasn't on the aesthetic side of things. And really, I think what bothered me the most is, as we're heading north of 35 is the emphasis is always on this anti-aging concept and not being who we are, where we are, trying to camouflage, and cover up, and make feel pretty shitty about ourselves like, "Who you are is not who you're supposed to be right now. You're supposed to be x years younger." Knowing what skin looks like underneath the microscope, what causes those things, I think it really informed my interest to help people view their skin from a different perspective that it's not something to be covered up or fixed. It can be your greatest ally and asset to understand what's happening in your body to empower you to make some changes that are within your control.
Cynthia: I think for many people, they don't acknowledge or understand that what manifests on the exterior part of our body, it can be a reflection of what's going on, whether it's gut microbiome issues, or inflammation, or the choices we make in our diet. I would imagine that since you have this tremendous breadth of clinical experience and also a very unique lens with which you view healthy aging, which is incredibly refreshing, because I feel most women are conditioned to believe that we want to subjugate our needs, we want to become invisible, our needs are no longer important, and if we lean towards social media, or lean towards print ads, or what we see on movies, it's a society that's very focused on never aging. Never aging, never looking your age, never being your age, never admitting your age, all things that I think can be tremendously unhealthy for women to be exposed to on a chronic habitual basis, because I know that I'm at the stage and age, where a lot of my girlfriends that aren't in the healthcare space will ask me questions, "What do you do, what do you use? Do you do laser, do you do Botox, do you do injectables, do you do this--?" Because there's so much misinformation that's out there. So, that's why I'm particularly grateful to be able to connect with you, to be able to share your knowledge with our listeners.
I think if we start from the basics, let's unpack a little bit about skin physiology, the impact of hormones and for those that are listening, there are some people that are still way before perimenopause, we've got plenty of people in the perimenopause and menopause phase, but the changes that occur throughout our lifetime in our skin.
Keira: Yeah, there's a lot to unpack there and so much of what you said. I feel there's so much to say.
Cynthia: [laughs]
Keira: This social conditioning is huge, and the beauty industry is a $500 billion plus industry, and it really is designed to make us feel not good enough in many ways. That's not to say that there aren't some amazing products out there and taking care of your skin from the outside in is important, but really taking care of yourself as a human being from the inside out is even more important, because more than just a reflection of our physical wellbeing, your skin is a reflection of your emotional and mental wellbeing, too. There is such a connection between our mind and our skin. If you're embarrassed, you get flushed. If you're stressed out, you may notice that your acne, or psoriasis, or eczema is flaring. Individuals, who are stressed may have trichotillomania. They're pulling their hair, may scratch and cut them. It manifests in so many ways. I really want to emphasize that when we talk about skincare and the changes, it really is taking care of the whole person and that's where I focus most of my time now is in the emotional and mental wellbeing. So, that plays into the role that hormones play in our skin over time.
Certainly, those of us in perimenopause can start in our mid to late 30s. For some women, for myself, it definitely was in my late 30s and it can last anywhere. The textbooks will say four to 10 years, but it's very unique and individual. What we start to see, estrogen does play a significant role in the health of our hair and our skin. Estrogen plays a role in collagen formation, so, giving us that youthful appearance. It plays a role in skin hydration by production of the glycosaminoglycans, which is the hyaluronic acid. The filler that so many of us get injected into our face is hyaluronic acid, which your body makes naturally, which estrogen is playing a significant role. Estrogen also plays a significant role in the hair growth cycle. So, your hair grows in three phases. A resting phase, a growing phase, and a falling out phase. Estrogen prolongs the growth phase of the hair. That's why when women are pregnant, their hair is lush and full, they give birth or I should say people, who are giving birth, when after they give birth, their estrogen levels drop. Their hair, all of a sudden, is falling out in clumps and they may not understand that's actually normal. It's just the natural process of your hormones diminishing.
When we're in this natural phase of life, those of us who will go through menopause, your hormones are declining. What you may find is your hair is getting thinner and finer, not growing as quickly. You will also notice that your skin is getting drier and it's not just on your face or your arms, your legs. It's also in your intimate bits, because your vaginal skin is skin. Same thing with collagen. You may notice more fine lines, wrinkling, sagging, gelling. In the vaginal skin, that tissue is going to atrophy. It's going to be thinner, because you're not generating as much collagen. Because of that, people may also experience urinary frequency and urgency, because the tissue around the urethra and the--, everything is impacted. So, that's just a beginning place to start. That's a lot of information, but I just want to--
Cynthia: No, but it's so helpful, because a lot of those connecting the dots pieces. People maybe think, "Oh, that explains why I feel I have to go to the bathroom more frequently." "Oh, that explains why my ponytail isn't as full as it was before. Because I think there's a lot of focus on in the beauty industry are collagen and elastin, and people to understand like, "What does that actually represent?" And then also, unpacking things like progesterone and I think people think about progesterone like, "Oh, progesterone helps me become mellow and it helps me with sleep propensity," but there's so much more to it than that. I always like to think of progesterone and estrogen as doing this delicate dance and maybe as we get closer to menopause, we may have more circulating estrogen than we have progesterone, which explains some of the symptoms we experience. But it's reassuring to know that we have these estrogen and progesterone receptors throughout our body. It's not just localized in one or two places we're led to believe.
I always say that, I went to a pretty darn good university and I know more about hormones. Now, I never had a healthy respect for the endocrine system until now. I feel now I really respected and understand this careful orchestration. You had mentioned autoimmune issues that can manifest as skin problems, you touched on the role of stress and how that can manifest. But when your cortisol is up, that can manifest as different changes in the skin as well. So, I think it's really helpful for women to know/reassuring that a lot of these changes are very normal. If we are able to live long enough, we will see changes throughout our body. It's not just localized to one organ.
Keira: Yeah, it's so true and certainly, a couple of things. With progesterone in particular, there isn't as much in the literature of how progesterone impacts the skin as estrogen. However, progesterone is thought to play a role in skin thickness and elasticity. Where progesterone can play a more significant role is with our hair. Typically, progesterone declines first, then estrogens behind that, then your androgens. Now, your androgens, testosterone is converted to a more potent form dihydrotestosterone and it does that through an enzyme called 5-alpha-reductase. Progesterone in normal healthy levels acts as a stopgap. It blocks that conversion from testosterone to its more potent form. As you're heading into perimenopause and progesterone is declining, you don't have that blockage as much. This is why some women may notice a widening of their part, because testosterone or dihydrotestosterone on the scalp, what it does is, it causes a shrinking of the hair follicles something called miniaturization. The hairs are more fine, more thin, you have this male pattern, female pattern baldness. On the face, it has the exact opposite. Dihydrotestosterone will stimulate hair follicles. Women may notice they feel they're going bald or growing a beard, WTF, seriously.
[laughter]
Keira: This is not funny. That is exactly, part of it is, it is that lack of inhibition from progesterone and the relative dominance of the androgens at that time that's causing. This is something that you'll also see with PCOS and other-- It's not just as you so eloquently pointed out. Our hormones are always in this constant delicate balance and bringing stress into it. Stress is the worst for our skin on so many levels, because our primary stress hormone, cortisol, not only if you're talking about aging gracefully, cortisol will cause a destruction of your collagen and your elastin and it will also prevent repair. That acceleration of the aging process, stress is going to do that every time. It also directly stimulates your oil glands. Those individuals who are like, "Oh, my gosh, I'm feeling stressed out, my skin is breaking out." Exactly. It's a feedback loop. You're stressed out, cortisol is going up, it's stimulating those oil glands.
More than that, all our hormones are derived from the same building blocks. In this beautiful cascade that our body has created, cortisol is going to be the queen and it's going to basically shut down the other hormone production, which means your sex hormones, which are already on the decline are going to take a bigger hit. More dryness, more irritation, your skin is going to become more vulnerable to rashes, and redness, and a disruption of the skin microbiome. So, it's a cascade effect, which is why I spend so much time teaching women how to regulate their nervous system, how to take back control of the things that we can control. Listen, we all have stress, but it's a matter of our perception and how to help our bodies function the best that they can, because life is challenging enough, we are going through menopause at some point or another. It's how can we do this from a place that is we can enjoy this part of our life rather than suffering and struggling through it.
Cynthia: Well, and I think really starting the discussion, I've come to find as I've gotten older, I've started to fine tune the women that I interact with. And on so many levels and I'm laughing, because last time I use this as an example, my kids know if I'm really busy with work, sometimes, when I'm having downtime other than exercising, being outside being with them, I will watch something mindless, I'll stream something mindless on my iPad. One of the Real Housewives shows came up and sometimes, I'm just so fascinated with the degree and the depth of body dysmorphia that I see.
Keira: Oh, my God, yes.
Cynthia: It's like a train wreck. I can't help watching it. My 16-year-old last night was like, "Mom's watching Real Housewives, again. I guess, she must be in busy mode." I was like, "No, you got to look at this, look at this." Not to be cruel, but I find it utterly fascinating that as a culture, we are in positions, where we are fighting so hard against what is otherwise a very natural process. I say this with love, because I'll be honest. I'm fully transparent with all my followers, listeners, everything, but there has to be a point to which you draw a line in the sand and say, "I'm not going to do this" and that's okay. For each one of us, that might be very different, but I'm utterly fascinated with the muppet look. I just call it, they look like muppets, because everything is so overfilled, overtaught, I'm not even sure if it's all surgical. It might just all be injectables. But it's utterly fascinating and also disturbing to be completely fair.
Keira: I'm laughing, because I literally just had this conversation with my teenage daughter and I said like, "We should not be watching this. This is so toxic for our brains. But it is. It's like a treatment. You cannot look away." It is just such a testament to our social conditioning. And just like you, I would be a complete asshole hypocrite if I said, I've never gotten Botox, I've not done fillers, and I think part of it is the studies, Botox, with depression, where I would say people, but especially, those socialized as women, who have been made to feel that, if your boobs aren't this size and your butt isn't this size, you're just no good, that if you are looking in the mirror and you're just scowling at yourself. That inner critic is just going to have their way with you. But if you cannot, if you paralyze those muscles, so you can't make that nasty face. It softens a little bit and then when you look in the mirror like, "Hmm, maybe it's not so bad." There's nothing magical about Botox, but it is this gateway of opportunity to maybe have a little bit more love and self-compassion.
I think it's all about perspective like, "Why are we getting the Botox? Why are we doing the filler? Why did--?" Because earlier, that I straighten my hair. From a place of I love myself enough to take good care of myself and I want the outside to look as good as the inside versus if I do X, Y and Z, I will be lovable, I will be worthy, people will look at me, they'll pay attention. We'll never get a return on investment from that perspective. I do think that there is a place for all of these things. If we're honest with ourselves as to why we are choosing to do them and I think that makes a huge difference. I was watching Housewives as well and there was a physician, who was making comment like, "A little dab will do this" and pointing up the person's flaws and I was like, "As a woman, you're a part of that problem." Let them come to you and say versus a lot of times, people will come into an office and say, "What's wrong with me? Fix me." I'm like, "Nothing's wrong with you. Nothing."
Cynthia: That's a really important distinction. Self-love is where things originate from and I think on many, many levels, there's certainly, a culture of everything is fixable. If you don't like the way your nose looks, if you don't like the way your foot looks, if you want to appear to be taller, you're going to wear super high heels. You can run the gamut from being very benign all the way to some extreme surgeries. I was trying to explain to my teenagers that probably before I even met my husband, many years ago, there was a show called The Swan. I don't know if you remember this, but it was another almost a train wreck, where you were drawn into watching these women go from looking themselves to looking someone else's version of what they should look like. I wonder if hundred years from now, things will have gotten to a point that people will look back retrospectively and laugh at the degree of ridiculousness. However, I would imagine things are just going to get more ridiculous as they move on that people can't have, a lot of people not everyone. There are many people who aren't happy with who they are, where they are in place and time, and what they do to their physical appearance is a manifestation of or a reflection of what's going on internally for them.
Keira: 100% and that's why where I am so passionate about this work of helping. I work with women in particular, but helping them feel comfortable and confident in their skin, because how you show up in this skin of yours impacts what shows up on it. If we're worried about fine lines and pigmentation, yes, I can make some recommendations of products. I can give you a three steps skincare regimen, but it's how we view ourselves and so much of it goes back to our childhood when we were shamed for some behavior. We have this protective mechanism like, "I don't want to be seen, I want to be seen." Like, "I don't want the real me to be seen. I want the version of me to be seen that won't be criticized I was back then." I have the sign behind it. I have, it says, let's go skinny dipping and the name of the program is Skinny Dipping Method. I use that as a reminder, because I am the person, who has all the layers on many times, I was made fun of as a kid for what was on my skin. I never put the dots together as to why I went into dermatology just because I felt so uncomfortable in my skin, most of my life. Just found the science really fascinating, but it's a reminder that on a physical level, we have to get naked in order to save our own lives.
Skin cancer, melanoma, the most common cancer essentially in the world, melanoma the most deadly, but we have to in order to thrive be willing to get naked emotionally and mentally as well, and really be able to look beneath the surface, so that we can heal. So many of like stress is the number one reason people go to the doctor. Well, actually, skin-related issues are the number one reason people go to the doctor and the vast majority of that are have underlying stress-related issues. I think it's just a matter of talking about it openly, there is no shame. So many of us have experienced so many microtraumas, macro traumas in our life and it shows up in our behavior, which is reflected on our skin. Your skin can be your greatest asset in terms of, "Hey, those dark circles under your eyes, you're breaking out-- Are you sleeping, are you adding any pleasure or joy into your daily routine, who are you spending your time with, what are you feeding yourself with, both with food and other ways?" Your skin can give you information that it needs your support, and it can also be your greatest cheerleader, and glow crazy when you're taking better care of yourself. So, from that perspective I think that our skin is an amazing organ. [laughs]
Cynthia: Absolutely. You think of it as a litmus test or validation that you're doing the right things, and I'm sure you probably would agree, because you probably trained in the 90s, I trained in the 90s, and I remember hassling the residents with questions in the middle of the night, not purposefully ever, always being respectful. But that's back in the days when all healthcare professionals worked insanely long hours during their training, they were exhausted. You don't eat good food when you're stressed. You cravitate towards-- In Baltimore, it was Krispy Kreme doughnuts, which I never liked, by the way, and copious amounts of caffeine and whatever you can readily just grab and go with, walking through-- I can't even remember. It just makes me cringe when I think about all the junk that we ate.
But acknowledging that our skin at that time was probably not a good reflection of how well we were taking care of ourselves. I look at photos of me in my 30s and I'm like, "Gosh, I look so much healthier." Well, I got more sleep, I had met my husband, I definitely ate better, I definitely had more disposable income to eat better, I probably got in lots of exercise, slept better. So, I love that you tie in that our skin is a manifestation and a reflection how well we're taking care of ourselves and that is impacted by so many of those lifestyle markers that I just alluded to.
Keira: Yeah. 100%. Yeah, when I was going through my training, there was no such thing as an 80-hour work week. I remember, I graduated medical school, my husband was a year ahead of me. It was a time when we were in training, post cut, we wouldn't see each other for a week at a time. I remember thinking it was a good idea to follow him around the emergency room just so, I could get a glimpse of him, and then I saw him do a procedure, and I was like, "Oh." I was like vomit. I was like, "I don't care, but I don't see you for two weeks. I'm never-- This is fine." Yeah, it is so true that your skin can be that litmus test and it doesn't require doing a lot. You don't need to invest a ton of money or even a ton of time.
One of the things that I always teach the people that I work with is breathwork is actually probably the greatest asset and tool that you can use to help your skin repair, recover, and rejuvenate. You don't have to add anything on to your to do list. You're already doing it. But most of us aren't paying attention to how we breathe. Most of the time, we are holding our breath and just that awareness of breath can reset your nervous system from that fight or flight to that rest and repair, and your skin, it'll start to show. You'll feel a little bit more relaxed and more calm, because that cortisol level, if it is staying jacked up, it is just wreaking havoc on your skin.
Cortisol-melatonin, that interplay, it's affecting your sleep-wake cycle, and melatonin is one of the most potent antioxidants our body produces so powerfully reparative for our skin. It helps repair DNA damage. We need that rest and recuperation. I think we live in a society. I see it all the time on Instagram that hustle culture. That's the worst thing for your skin. It's the worst thing from an emotional and mental wellbeing, too. I think just shutting all that, it's so hard. But shutting stuff off, deleting stuff that isn't serving you and really fighting that urge, that fear of missing out, I know that I have that at times, but I think that drives my stress response so much that I can just shut things down.
Cynthia: No, that brings up such good points. It's interesting. The breath work piece makes me think of one of my favorite books I've read this year by James Nestor, Breath and I tell people all the time, I never would have imagined that a book that was talking about breath work would be so interesting, but really tapping into the autonomic nervous system. We have fight or flight, which is sympathetic and then we have this parasympathetic rest and repose. As a society, it's a constant onslaught. Unlike when you and I were growing up, where I don't care if you had cable TV, at some point during the night, the TV went off and that was just the way things were. There was no this total connectedness all the time. There was no FOMO, because everyone just went to bed. That's not what happens now. When we really think about things that are serving our best interests and helping to support that hormone balance. You mentioned cortisol, talked a little bit about sympathetic dominance that I remind people that when cortisol goes up, you're not going to get good sleep quality, you're not going to tap into those master antioxidant benefits with melatonin, which the more you learn about melatonin the more fascinating I find that hormone to be, because it's just about sleep, it's about so many things, and how there are so many different receptors throughout our digestive system. In response to when we last ate a meal, and when we tried to go to bed, and what our blood sugar's doing, and whether or not we're eating more than we're fasting really has a huge impact on our health in ways that we probably don't even fully appreciate and realize, yet.
Keira: Yeah, it's fascinating. It really is. To that point, when we are in that sympathetic overdrive, that shift in hormones. Cortisol is elevated and what gets shut down, like, your digestion is shut down. Your libido goes in the tank. The impact on metabolism and thyroid hormone too, and again, how that shows up on your skin, lateral third of your eyebrows is a classic sign that when those are thinning, it could be your thyroid. Your skin also can get really dry. Some people experience deposition disorders, myxedema, and skin is doughy. Again, we will always have stress, stress can be a great motivator, and, again, it's not that something happens. It's our response to it, and being in this chronically activated state, and it's understandable. We are still in a pandemic. There are still going to be a ton of emails in your inbox that you have to deal with, bills to pay, social injustices in the world. Yes. And so, to equip yourself with tools to help you regulate that response to stress, so that you're not always feeling anxious and overwhelmed is so key for your overall health and wellbeing for your sleep, for your ability to digest and assimilate nutrients.
But if we're talking about skin health, so that your skin can truly repair, and regenerate, and recover, and glow. [laughs] We really need to focus our attention on that. I think we underestimate the impact that stress has and I was just at an Integrative Derm Conference a few months ago, because even though I'm not actively practicing, I'm still fascinated by the science since I'm certified in that, too. I think that's an illness that some of us have, like, you just need more and more certifications [unintelligible [00:29:05] on with that. [laughs]
Cynthia: I think [crosstalk] curiosity.
Keira: Yeah.
Cynthia: I always think about it from the perspective like, we love to learn, and we always want to be learning, and so, I tell my kids like, neuroplasticity is a good thing with our brain. You're creating new connections. So, I think it's a way to keep us sharp. That's what I tell my sons.
Keira: I love your rationale versus the-- Again, still, we teach best what we need to learn the most. I teach about managing the stress response, learning self-love and self-compassion, because I've spent the majority of my life not being kind to myself. Always thinking that I wasn't good enough, really thinking back to all the incidents of not being in front of other things like in childhood, so I'd rather take on your approach. But again, we're learning, we're evolving, and what came up specifically at that conference is, psoriasis, eczema, hidradenitis, some of these very chronic, very debilitating isolating diseases, because when people see psoriasis or really bad atopic derm or hidradenitis, they don't understand that it's not infectious, it's not contagious. The individuals who struggle with this feel very isolated and don't want to have intimate relationships or don't feel like they can.
The thing that came up is, this creates a lot of stress, and distress, and emotional dis-ease. But it's the missing piece in our field. There is a subspecialty called psychodermatology, but there are a very few dermatologists, who are trained in that or have the bandwidth if you're an insurance-based model, so I feel like I want to fill that gap for people, because it's such an important piece of the treatment protocol that we're not including. If we can get help regulate our nervous system, no doubt the people who have psoriasis, acne, eczema, those are some of the top three things that people go to the doctor for, all of them, there's a huge component. I wouldn't say all, but a huge component that is tied to stress exacerbating it and the stress as a result of having the condition. So, learning how to manage that stress is going to be a key thing for resolving, improving, and maintaining skin wellness.
Cynthia: It makes complete sense and I might have thought I've shared this on the podcast before, but 20 plus years ago, I was bit by deer tick had the classic bullseye rash, happen to go in and see my primary care provider. She saw it and immediately started antibiotics and for which I'm very grateful. But six months later, I developed a patch of psoriasis on my forehead and I recall when I read about psoriasis and looked at photos. The photos you see in medical journals or in medical textbooks are like the worst-case scenario. Well, and there are a lot of people, who certainly suffer with more significant psoriasis. I had very mild psoriasis and I dealt with it intermittently with topical steroids over the years and it wasn't until I met my first integrated medicine specialist and she said, "You realize your psoriasis is related to the fact you are on antibiotics and you developed an autoimmune issue, because of the antibiotic. It has impacted your gut microbiome." And how my entire world changed, when I just took gluten out of my diet and my psoriasis went completely away. Again, it was very mild.
However, I recall as a 20 something being very concerned that I was going to end up with this really significant case of psoriasis, because there was such little information and what was out there was really scary to be honest. I love that you are marrying these two desires together in a way that will make things a whole lot less distressful for patients, because you're right. Their traditional allopathic medicine model is you get five, 10 minutes with a patient if you're a physician. If they gave you more than one or two complaints, it's going to mess up how quickly you get on to the next person. Being a Nurse Practitioner, I always had more time, but we sometimes got saddled with hospital discharges, which were usually pretty much disasters. But the point of why I'm sharing this is individuals that are listening understand that it's not that your healthcare provider doesn't want to hear all the things.
Keira: Right.
Cynthia: But they're not trained to do it. It's extra training, this extra realization that you're realizing there's more to it, more to dermatology, more to skincare than just getting a diagnosis, writing a prescription, and sending you on your merry way, and giving you a 10-second spiel on, "Oh, by the way, don't do this, this, and this." And then the patient goes home and feels completely lost. One of the things that came up with some frequency on social media, when I mentioned that we were connecting was a lot of women feel that there's, again, a lot of pressure on certain terminology, certain types of products. They "should" be using at the stage, and middle age, and beyond. So, do you have ways that you suggest navigating beyond the cognitive behavioral stuff that you're already doing, ways to navigate choosing cleaner, safer products that are out there that came up frequently was, "How do I choose products? Are there brands you trust? What are the things I need to be looking for? How can I support my health in healthy ways?"
Keira: Yeah, I love that because it is a comprehensive approach. There're so many different things that we need to look at from our gut microbiome, and the gut-skin connection, and your skin microbiome. From an inside out perspective, I think we touch on some of them really. Sleep is so key and as we're heading into this perimenopause, post menopause phase of life, where hot flashes can make sleep a challenge. Doing our best to set ourselves up for success, sleep doesn't just start at our bedtime. It really is a 24-hour cycle from the moment you get up, starting your day, maybe with getting outside in natural sunlight to make sure that you're helping maintain that circadian rhythm, adding pleasure into your day. I actually have it in my calendar, pleasure first. Whether it's reading a passage in a book, or petting my dogs, or something that really starts your day from a place of joy really frames the day. With regards to sleep, making sure that your room is really dark, and a cool temperature, and that there is not a lot of clutter. I don't know about you, but clutter does stress me out. So, I'm not saying it to be a neat freak, but it's really just using your bedroom for sleep and sex.
If you have a TV in your room, I strongly encourage you to remove it and use that elsewhere, because that blue light in your room is not a good thing. I actually just got this new eye mask that has little pressure points that I have found really helps my sleep tremendously. Nourishing, nutrition, I'm talking to like the expert here. That is so important with how we nourish Whole Foods, plant powered, but I truly believe there's room for everything. I will never be dogmatic about what kind of food people should eat. I really want people-- I'm all about embodiment and that somatic experience, eat for how you want to feel and not just in the moment for that instant gratification. In a couple hours from now, how's your mood? Are you pooping? That's an indication like what you're eating may or may not be serving your body. With regards to skincare specifically, it's tough. There's a lot of great products out there. So, I know that you know Environmental Working Group is a good resource, but it's not perfect, but it's a place to start. I really like to keep a skincare regimen very simple, because I'm lazy and non-compliant. [laughs] I mean, perfectly honest. Yeah, I'm the worst. When it comes to that, I think most doctors are.
But washing your face, okay, and if you don't wash your face in the morning, okay, wash your face at night for sure. Because air pollution is right behind UV rays in terms of causing damage to your skin, it can break down the collagen, the elastin causes hyperpigmentation. At least, wash your face at night to get all the daily grime off, especially if you live in a city. Washing your face with a gentle cleanser. An antioxidant serum, vitamin C and E at a minimum, those two synergistically work very well together to help repair DNA damage. You need vitamin C for collagen production. That's the other thing with stress. Your adrenals need vitamin C to produce that cortisol and it's going to be taking it away from your collagen production. Vitamin C, topically foods that are rich in vitamin C intake, and then in the morning, a tinted moisturizer with SPF 30. The reason why I say tinted and thankfully, there are many companies that have all shades to accommodate people of all colors. Thankfully, it's about downtime is because okay, I'm sitting in front of a window glass. Is sitting in front of a window, UVA rays penetrate your window glass. UVA rays are the aging rays. Whether it's COVID and you're working inside or just that's your life, you've always worked in an office, you are getting Sun exposure all day long if you are sitting in front of the window, you want to protect your skin.
Now, we are on Zoom right now. We are in front of our devices. Blue light coming off our screen. Studies have now shown that the blue light can also cause pigmentation issues and damaging hair collagen and your elastin. The iron oxide in a tinted moisturizer will help block the blue light. That is why tinted moisturizer SPF 30 or above. Most of us are not putting on the recommended amount of sunscreen on a daily basis. You're not truly likely getting SPF 30. For those of you who are concerned, "Oh, but the vitamin D, we cannot wear sunscreen." Okay, I call bullshit on that studies. Most of us, listen, yes. If you're putting on the research study amount of SPF, it will block some UVB rays. However, studies have shown the vast majority are not doing that.
Cynthia: [crosstalk]
Keira: For your whole body, for your whole body. Most of us aren't doing that, nor are we reapplying, and it breaks down most of th