Tag Archive for: skin

Beating the Heat

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Climate change is real, and it doesn’t really matter whether it’s man-made or a natural progression of the planet. At least for the foreseeable future, temperatures are rising, droughts are more common, and the storms are more severe. We will most likely see excessive temperatures for days, even weeks at a time. While everyone is at risk, especially those who work in the heat and humidity, children and those 65 and older are more at risk because one of their cooling mechanisms is not working effectively. Today we’ll look at signs and symptoms of heat stress as well as solutions.

Heat Stress in Infants and Children

These signs and symptoms may not all happen within the same child at the same time, but if you see more than one of these symptoms, it may be related to heat rather than fatigue or a possible infection.

Elevated temperature, usually between 100˚ and 104˚F

I don’t think I would have thought to check their internal body temperature to see if the internal cooling mechanisms were working, especially if they were experiencing the next couple of signs and symptoms.

Cool, clammy skin and goose bumps

Those seem more related to being too cool rather than too hot, so checking the internal temperature is a good idea.

Irritability

There can be other reasons such as teething, lack of sleep, or hunger, but this may be an important sign for little ones who can’t communicate well.

More serious signs and symptoms

  • Fainting, dizziness, or weakness
  • Headache
  • Increased sweating
  • Increased thirst
  • Muscle cramps
  • Nausea and/or vomiting

It may be difficult for babies and children who are just learning to talk to communicate a headache or muscle cramps, but I think we would all recognize that fainting, dizziness, and weakness—or vomiting for sure—means something is not quite right.

Heat Stress in Older Adults

Those who are older, generally 60 and up, have some similar symptoms as the young. While infants and toddlers may not be able to communicate effectively because they haven’t learned how to talk yet, those who are older tend to ignore symptoms that may be related to heat stress.

One of my favorite quotes from my father-in-law was his answer whenever I was trying to determine whether he might be having a cardiovascular event such as a heart attack: “Dad, do you have any chest pain?” And his classic response was, “Not too much.” With that stoicism in mind, here are the signs and symptoms of heat stress in older people.

Heavy sweating

If they are fortunate to still have a sweat cooling system, you may notice an unusual amount of sweat.

Cold, pale, and clammy skin

If the internal cooling system isn’t working well, you’ll see this symptom.

Fast, weak pulse

Elevated heart rate may go along with cold and clammy skin because the heart is working harder to pump blood to the skin for cooling.

Other symptoms

  • Muscle cramps
  • Nausea or vomiting
  • Tiredness or weakness
  • Dizziness
  • Headache
  • Fainting

As you can see, there are many similarities in symptoms between the young and the old. The difference in what causes the symptoms is that the children’s systems are developing while the adults’ systems are degenerating.

Heat Action Plan for People at Risk

In the research, the most common recommendations are to stay in the air-conditioned indoors if possible. If that’s not possible, still stay indoors, preferably with fans; if the air is off at home, take a trip to the mall, the movie theater, the library, or another place where you can stay cool for a while. Another recommendation is to drink liquids; mostly water but depending on sweating, a sports drink has electrolytes that can replace those lost while sweating. Too much plain water can dilute electrolyte balance and cause hyponatremia, the lack of sodium in the body.

If you don’t have to go outdoors, don’t. If it can’t be avoided, go outside in the early mornings or the evenings. From the Midwest to the East Coast, we also must deal with poor air quality due to the fires in upper Canada. Again, staying indoors and out of the sun is a great prevention strategy.

Finally, observation is critical for both children and older adults. As a grandparent, I know it’s nice when the kids are outside and the house is quiet; but some children are not old enough to tell you what’s wrong or just don’t know that what they’re feeling isn’t normal, so it’s critical to observe them. That also applies to the older adults in your life; check in with them frequently to make sure they’re doing okay.

The Bottom Line

What happens if you suspect heat stress? Check the symptoms. Try cool baths or showers, and wear as few clothes as is realistic. Drink cold fluids and use ice compresses. Get the kids to sit in the shade and eat a popsicle, thus attacking the problem in two ways.

But if you get as far as the symptoms of dizziness, weakness, or fainting, it may be time for a visit to the ER, especially if there are other health challenges. We can deal with the heat if we just play it smart and look out for each other.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/disasters/extremeheat/heat_guide.html

No Sweat!

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I don’t know exactly when it happened—suddenly I don’t seem to sweat. Disappointing, because it was something that I looked forward to, believe it or not. To me it symbolized getting a good workout, whether during exercise or working in the yard, but it stopped as I approached 70. That means one of my cooling mechanisms isn’t working well during exertion. It also seems to happen in the heat, and it’s not uncommon in people past middle age. How about you? Have you noticed any changes?

I’m not alone. There’s another at-risk group: babies and children, especially during the kind of heat we’re facing in many areas of the country. The question is why are these two groups more at risk than others? There’s little to no research on the heat response in the young and the old with one exception: during exercise. Other than that, it’s a topic that doesn’t seem to attract much attention.

Research has found that the cause relates to the lack of development and aging. The very young haven’t yet developed their skin’s sweating mechanism, but it improves as they continue to develop.

The problem as we age is that our skin declines, along with other physiological mechanisms. Our skin loses sweat glands, our heart doesn’t pump as much blood, and it goes downhill from there.

What can we do about it? More important, what are the signs and symptoms of heat stress? I’ll cover that on Saturday.

With Paula’s knee surgery on Thursday, we’ve delayed the Insider conference call until July 26. You still have time to become an Insider before then.

What are you prepared to do today?

        Dr. Chet

References:
1. Eur J Appl Physiol. 2018 Oct;118(10):2233-2240.
2. J Athl Train. 2021 Aug; 56(8): 801–802.

The Facts on Collagen Supplementation

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After covering collagen basics on Tuesday, two questions remain. Are collagen supplements absorbed or are they digested just like any other protein? Second, does research support the use of collagen supplementation to improve skin quality? Let’s take a look.

Collagen Absorption

The data on collagen absorption is sparse. In almost every study, dipeptides or tripeptides are used; then the change in serum peptides over several hours after ingestion is measured. There’s enough data to suggest that the tripeptides are absorbed as a whole without being broken into individual amino acids.

What hasn’t been tested yet is whether protein ingestion from a meal may interfere with the digestion and absorption process.

Is Collagen Supplementation Effective?

Several review articles have summarized the absorption of collagen. Eleven studies with just over 800 subjects were included in the latest review; eight of those studies used collagen hydrolysate, 2.5 to 10 grams per day, for eight to 24 weeks. They tested whether the supplemental collagen benefitted people with pressure ulcers, dry skin, aging skin, and cellulite, with generally positive results. Two studies used collagen tripeptides, three grams per day for four to twelve weeks, with notable improvement in skin elasticity and hydration. Again, positive results.

I was disappointed to find no research on whether collagen may benefit other connective tissue such as tendons and ligaments. That may help the recovery from rotator cuff or Achilles tendon surgery, among many other conditions.

Practical Application

Based on the data, it appears that collagen tripeptides are absorbed intact to some degree, although I’m still concerned about the absorption in relation to meals. I’m already recommending that essential amino acids be taken at least 15 minutes or longer before a meal. But I think to help with absorption, take collagen tripeptides, usually collagen I and III, about 15 minutes before a meal if it contains protein or a couple of hours afterward. Giving the digestive system a head start may increase absorption. I put mine in my second cup of coffee because it has no flavor and the heat doesn’t impact the tripeptides.

The Bottom Line

Although the evidence is not overwhelming, there are positive results using collagen supplements to benefit your skin. Research shows that it will be absorbed in a form that can help the body make structural collagen for the skin. While the studies I cited used differing amounts of collagen for varying amounts of time, I would try 5 to 10 grams per day for at least 90 days to see results. And pay attention to your muscles and joints; you may find they benefit as well.

What are you prepared to do today?

        Dr. Chet

References:
1. Biol Pharm Bull. 2016;39(3):428-34.
2. StatPearls. Biochemistry, Collagen Synthesis. Marlyn Wu; Kelly Cronin; Jonathan S. Crane. 2021. PMID: 29939531
3. J Drugs Dermatol. 2019;18(1):9-16.

Are Collagen Supplements Effective?

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I spent the past weekend with a few thousand of my closest friends, some in person and others via live broadcast; that always means I get some good questions, including one about collagen I couldn’t answer.

A healthcare professional had told one attendee that collagen supplements were broken down into individual amino acids before being absorbed, as proteins are from any source, thus he was wasting his money buying collagen supplements. I decided that the answer could benefit everyone, so this week we’ll cover collagen basics.

Collagen is a protein and therefore is made up of amino acids. We can manufacture it, but just like other characteristics of aging, we make less as we get older. Collagen provides structure to all connective tissue such as skin, tendons, bones, and ligaments. We notice it most in our skin. Crepe skin? Smile lines around the eyes? Those come courtesy of reduced collagen. There are close to 30 types of collagen that have been discovered, but the most prevalent are types I–IV. Of that, over 90% are type I.

Collagen is made of repeating sequences of tripeptides or three amino acid blocks; they form three chains that twist to make a triple helix. The primary amino acid sequence of collagen is glycine-proline-X or glycine-X-hydroxyproline where X can be any of the other 17 amino acids. Glycine is the amino acid with the smallest structure; that allows the collagen triple helix to twist tightly and thus adds strength to the structure wherever it’s used, including the skin.

That’s the structure of collagen. On Saturday, we’ll answer the absorption question and look at how to use collagen most effectively. In tomorrow night’s Insider conference call, I’ll cover collagen more in depth as well as comment on the recent United States Preventive Services Taskforce on vitamin supplementation. If you become an Insider before 8 p.m. Eastern Time tomorrow, you can join me live to get your questions answered.

In the meantime, maybe you should just be proud of those smile lines—you’ve earned them, after all.

What are you prepared to do today?

        Dr. Chet

Reference: StatPearls. Biochemistry, Collagen Synthesis. Marlyn Wu; Kelly Cronin; Jonathan S. Crane. 2021. PMID: 29939531

Planning Your Infrastructure Upgrade

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In order to give you some ideas to help you focus on your body’s infrastructure, I’m going to share my list. I’ll give you my issues and why I feel they’re problems for me; I hope that will stimulate your thinking so you can determine your infrastructure upgrades for 2021. I don’t know that I can accomplish all of them in a single year, but I do know I can make a good start, and that’s what I’m hoping you will do as well.

Increase Muscle Mass

If there’s one getting-older issue that I completely underestimated, it’s the loss of muscle mass. It just sort of crept up on me and while I can’t quantify it in terms of pounds or percentage, I know I’ve lost strength in my upper body, and my legs seem to be a shadow of their former selves. Part of the reason that my legs lost so much mass, I believe, is directly tied to my inability to run consistently. I have no idea when I’ll be able to run freely again, if ever, so strength training is going to be critical to increase strength if not mass.

Improve Skin Quality

I have to confess that I never examine my skin. I don’t spend a lot of time looking at my face in the mirror, and I ignore my arms completely. But lately I’ve noticed that my skin is thinner and a slight scrape against the door frame that doesn’t even hurt can leave a huge purple spot. I’m not trying to recreate the quality of skin I had in my 20s, but I know it can be better than it is. (Has anyone in my household been nagging me about this for years? Um, maybe.)

Decrease Body Fat

The one that drives me crazy is the increase in body fat around my waist. I weigh 45 pounds less than my highest body weight ever, yet my waist circumference is greater now than it was then. The reasons are complicated, from the loss of muscle mass reducing metabolic rate to the gradual reduction in hormones as I get older. I know that there’s no such thing as spot reduction, and I don’t know if the general rule “you lose it first from where you put it on last” applies as you get older. But aside from increasing muscle mass, this one is just not acceptable and is a priority for me.

Increase Bone Mass

I’ve made no secret of the fact that I have osteopenia. In fact, I’m one-tenth of a Z-score from having osteoporosis. I have improved my vitamin D and calcium intake since my last bone-density test. I’ll find out in April whether that has resulted in any change. I’m not interested in continuing to be the amazing shrinking man, so this is an internal infrastructure change that must happen in 2021.

Improve Posture and Balance

This one seems a lot less obvious, but it’s still critical to overall health. Why? Because working on improving posture now, which means resetting the resting “tone” of the postural muscles will help with balance as we get older, and balance is critical if we hope to make it to an advanced age. The inner ear is part of it, but our ability to be able to move and do the things that we want to do can be dramatically impacted by poor balance. The modifications in muscle mass and fat mass, as well as bone mass, will have an impact, but it’s also critical to specifically work on posture and balance movements as well.

The Bottom Line

There you have it: my infrastructure plan for 2021. I’ve begun working on some, but there’s still research to read to find better solutions. That will include different approaches to exercise, whether weight training, stretching, or aerobic exercise. There could be specific dietary approaches that apply rather than just cutting calories. Supplementing with nutrient isolates and specific dietary supplements may also be part of the solution.

How about you? You may have cholesterol and HbA1c that needs to get lowered, cardiac output that needs to increase, and a microbiome overhaul; maybe you need to build strength in specific areas to compensate for arthritis and loss of cartilage.

Identify your three to five areas and write them down. As the year progresses, I’ll share the solutions I’ve found with you because my goal hasn’t changed: to help you become the best version of yourself. Specify where you want to go and let’s get started.

What are you prepared to do today?

        Dr. Chet

The Skin Microbiome: Skincare and Cosmetics

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While the state of the current pandemic has restricted the ability to socialize to any great degree, it may turn out to be beneficial for the skin microbiome. Be honest. If you don’t have to go to work or out into the public, do you still maintain the same personal grooming practices? Do you put on all your makeup? Based on what people say in virtual meetings, the answer is no. Why is that beneficial for the skin microbiome?

The final potential insult to our skin microbiome is from products we willingly use. Most people apply some form of skincare and/or cosmetic products every day, plus deodorant or anti-perspirant, haircare products, moisturizers, and a plethora of make-up products. Here’s the key point: most of these products contain anti-microbials to maintain the safety of the product before use. That means when applied to the skin, they could also impact the microbiome of the skin.

After reading a review article on the state of research on the entire gamut of skincare products, several researchers outlined the type of research that should be done. While encouraging, that means that not much has been done. I couldn’t find any research that directly examined the impact of skin and cosmetic products on the skin microbiome. We just don’t know.

Strategies for Healthy Skin

There are several things we can do to indirectly help our skin.

  • Drink one-half your body weight in ounces of liquid every day.
  • Take 1 to 4 grams of omega-3 fatty acids every day. There are many reasons to take your omegas, but one is to help reduce the production of inflammatory hormones.
  • Take a probiotic with several types of bacteria with a prebiotic every day. They contribute to a healthy immune system and internal microbiome.
  • There are several supplements that may also contribute to the health of the skin including biotin, vitamin C, and collagen. They may not affect the skin’s microbiome, but starting with a healthier surface may be beneficial.
  • Regular exercise increases blood flow to all areas of the body, including the skin. That can deliver nutrients and help remove waste products.

The Bottom Line

Our skin microbiome is part of our first line of defense against microbial invaders. At this point, there’s not enough research to know whether the skincare routines we’ve become accustomed to are beneficial, harmful, or at least neutral. Is that worth stopping all skincare and cosmetic products? Should we stop taking showers? I don’t think we need to do any of those, but if we start paying more attention to the products we use and make better choices in selecting them, that may give us an edge while science catches up with this amazing part of our immune system.

What are you prepared to do today?

        Dr. Chet

Reference: Int J Cosmet Sci. 2020 Apr;42(2):116-126. doi: 10.1111/ics.12594.

The Skin Microbiome: pH

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The water we shower and bathe in may impact our skin microbiome, but we don’t generally just rinse off with water. We use soaps and shampoos as well. How could they impact the microbiome of the skin? Let’s take a look.

Normal healthy skin has a pH range of 5.4 to 5.9. At that pH, the body maintains a normal microbiome. Researchers examined the pH of shampoos and soaps in about 100 different products. Most soaps were highly alkaline with a pH that averaged between 9 and 10. Shampoos fared much better with most in the 6 to 7 pH range.

Will the exposure to these products damage the skin microbiome? If it does, will it be temporary? After all, the exposure will be limited depending on the length of the shower or bath. We don’t have all the answers on that. The closest I’ve seen to sequential testing was a multi-country study that found that the skin pH was still elevated six hours after washing with soap. The rise was less than a single point; still, the actual impact on the microbiome wasn’t evaluated. There’s still much we don’t know.

We’re still not done with the skin microbiome so we’ll finish this up on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Int Microbiol. 2019 Mar;22(1):1-6. doi: 10.1007/s10123-018-00049-x.
2. Indian J Dermatol. 2014 Sep-Oct; 59(5): 442–444. doi: 10.4103/0019-5154.139861.
3. International J of cosmetic science. 2006 DOI: 10.1111/j.1467-2494.2006.00344

The Skin Microbiome: Birth and Water

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I began last week’s focus on the skin microbiome based on reading an interview with a scientist who hasn’t taken a shower in over five years (Clean by James Hamblin). We’ve established the basics about skin and the microbes that are supposed to reside in the skin microbiome. This week we’ll cover how the skin microbiome is affected by our environment. What are we doing to our skin that may be impacting our health?

It actually can begin at birth. If we are delivered via the birth canal, we are immersed in vaginal microbes that seed our skin with microbes. In the 1970s, C-sections began to rise from 5% to the current rate of 30%. That means close to one-third of newborns don’t get the initial exposure to skin microbes. Does that result in an increase in skin conditions such as dermatitis? Maybe, but there’s no confirming research to date.

Depending on your water supply, the water may be treated with chlorine and fluoride. While they can kill bacteria to make the water safer, those chemicals may also damage the microbes that live on our skin, hence Hamblin’s avoidance of showers. That impacts the skin microbiome and consequently, our immune system.

What else can impact our skin? I’ll cover more on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: Int Microbiol. 2019 Mar;22(1):1-6. doi: 10.1007/s10123-018-00049-x.

The Skin Microbes: What They Eat

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When we talk about the microbiome of the digestive system, it’s well-known what they eat: sugar. That’s also mostly true for the skin’s microbiome, although those microbes eat other substances as well. In today’s Memo, we’ll cover the types of bacteria and where they’re located. Then we’ll look at their diet.

The Microbes of the Skin

It may come as no surprise that the type of bacteria and other microbe depends on the location. That makes sense: what may grow well in moist areas may not grow well in dry areas.

The sebaceous sites on the head and torso are dominated by species of bacteria that like fatty environments. Remember that sebum is primarily a type of fat, so the type of bacteria that will grow in that area has to be able to thrive in that environment. The Propionibacterium species dominates in the oil glands.

The moist and humid sites contain bacteria such as Staphylococcus and Corynebacterium species. They thrive in the bends of the elbow and the feet, as well as other locations.

Bacteria are not the only important microbes in our microbiome; there are plenty of fungi as well, and I know how gross that may seem to some readers, but try to think about how much you like mushrooms. They’re there to do a job: protect us. The genus Malassezia are found at core body and arm sites. The feet are more diverse in fungi species: Malassezia, Aspergillus, Cryptococcus, Rhodotorula, Epicoccum species as well as others. Here’s something that may comfort some of you: bacteria were the most abundant and fungi were the least abundant.

What about viruses? They seem to be specific to the individual without any single virus dominating. Based on the longitudinal studies of the skin microbiome, they remain largely stable for as long as two years, the length of the longest studies. Pretty amazing considering how the seasons change in places like here in Michigan.

What the Skin Microbes Eat

The skin provides a cool and acidic environment for its residents. The primary nutrients are protein and fats. The microbes have adapted to what’s available in the sebaceous glands, the sweat, and the dead skin cells of the stratum corneum.

For example, the anaerobe P. acnes can survive and thrive by using protein enzymes to break down the amino acids found in the dead skin cells of the corneum stratum. Not only that, they have lipases to breakdown the triglycerides in sebum to use fat as a fuel as well as provide the means for the bacteria to adhere to the skin.

The lipids that can be liberated from the oily sebum and the stratum corneum are also used by the fungi for lipids as they cannot manufacture their own lipids. The Staphylococcus spp. have developed several strategies to survive the dry areas of the body. They’re tolerant of the high salt content of the skin and can use the nitrogen group from urea as a nitrogen source. They also produce chemicals that can break down the stratum corneum to extract nutrients from there as well.

As the researchers who wrote the review paper said, “the skin harbors a heterogeneous community of microorganisms that each have distinct adaptations to survive on the skin.”

The Bottom Line

As you can tell from this week’s memos, the skin microbiome is not just a few bacteria that decided to take up residence and are along for the ride; they have adapted to their environment to survive. How are they impacted by the water we bathe in, the soap we use, and the chemicals we use to look and smell better? That’s what I’ll write about next week.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Reviews doi:10.1038/nrmicro.2017.157

The Skin Microbiome: Anatomy

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The skin microbiome is amazingly complex. Not only do we have all the beneficial bacteria and other microbes, we also have microbes that can be beneficial or damaging depending on how we treat the skin. Let’s begin with location: where are all these microbes located? For that, we need to understand a little bit about the structure of the skin.

The skin is the largest organ of the body and is constructed of two different layers: the outermost or the epidermis and an inner layer called the dermis. The outermost layer called the stratum corneum is composed of dead cells that are chemically crosslinked with each other and with cells below to provide a true barrier. As they’re sloughed off, they’re replaced.

To say “skin is skin” does this organ a disservice. It varies in different locations in the body and provides amazing microenvironments based on UV light exposure, pH, temperature, moisture, and sebum content. What is sebum? That’s the product of sebaceous or oil-producing glands, primarily located on the face, the chest, and the back. The sebum provides a coating that repels water and provides an antibacterial shield to hair and skin.

There are also areas of the body that are moist such as under the arms, between the toes, and in other more private areas. Those areas contain sweat glands which modify the pH of the skin and make it more acidic. That created an unfavorable environment for the growth of some bacteria and other organisms.

That’s the anatomy of the skin. The next question is what type of bacteria and other microbes are found on the skin and exactly what do they eat? We’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Reviews doi:10.1038/nrmicro.2017.157