Season 4, Episode 4: Supplements and Skin Health for Radiant Beauty with Dr. Mark Tager

Evelyne: In this conversation we’ll be talking about supplements for beauty. We’ve seen huge growth in the beauty supplement category. I’m sure you’ve noticed. And I’m sure as a practitioner, you see patients who are concerned about aging skin, about hair loss. Patients want their wrinkles to minimize, age spots to disappear. They want to glow, but they also want to know how to eat, how to supplement, what topicals to use, what procedures to get. And today we’ll go through how you can have this conversation with your patients and provide some solutions. So whether you’re an integrative or functional medicine practitioner or you’re an aesthetic practitioner, you’ll want to continue listening. Mark, before I read your bio, what is lighting you up this week?

Mark Tager: So many of the things I do excite me. I’m so blessed to be in an area where I continue to learn and grow, but really what excites me is this convergence of integrative functional medicine with aesthetics. And there’s so many benefits that this convergence accrues to the practitioners and the patients.

Evelyne: I agree with you. We are so lucky to get to do what we get to do every single day. So Mark Tager MD is one of the country’s leading healthcare communicators. He’s Chief enhancement officer. CEO. I love that. Of ChangeWell Inc., a San Diego organization that assists healthcare professionals and health-related companies to get their message across to clinicians and consumers. He started his career as director of health promotion for Kaiser Permanente in Oregon. He draws upon his expertise in aesthetic, integrative, regenerative and conventional medicine. He was the founding marketing VP for Reliant Technologies where he launched the Fraxel laser and then went on to become CMO for Syneron. He serves as a consultant for Designs for Health and created the Designs for Beauty training course. He serves as faculty at Duke Integrative Medicine, has lectured at numerous universities and healthcare systems, and you probably recognize his name. You’ve probably seen him speak somewhere.

He’s also co-founder of the Vegas Nerve Society and Executive Director of the Root Cause Project, where he’s producing documentary films that explore new paths to health and healing. He is the author and or co-author of 11 different books, including the one we’ll talk about today, Feed Your Skin Right: Your Personalized Nutrition Plan for Radiant Beauty. He got his medical degree at Duke University and trained in family practice at the University of Oregon Health Science Center. Mark is also a dear friend and I feel so lucky to have worked closely with him now for the last year or so. So Mark, let’s talk about your book. Why did you write this book?

Mark Tager: I’ve always been asked the same four questions, mainly by women, increasingly by men. What should I eat, what supplements should I take, what topicals should I apply, and what procedures should I have? And everybody wants … Give me the one answer. Give me the quick, quick, quick, quick, quick. And there is an answer, a very simple answer. It depends. So what the book’s about is what it depends on. And it really is this emerging concept we have right now of personalization. It’s occurring in all aspects of healthcare and particularly it’s happening in nutrition. So we are bringing the field of personalized nutrition into integrative functional medicine and into increasingly aesthetic practices.

Evelyne: I love that. And what does personalized nutrition mean to you when it comes to skin health?

Mark Tager: Yeah. What it means, it is a process of assessment. The questions we ask a patient, the type of physical examination we do, the basic laboratory tests, the advanced laboratory tests, coupling that with the patient’s motivations, some really good coaching and counseling, and coming up with a personalized plan that recognizes that your skin is different from my skin. There’s no two people on the planet with your skin. No two people on the planet with exactly the same skin as me. So all of the factors that … Whether it’s genomics related to the skin or drug nutrient depletions or things you pick up on the physical exam and food sensitivities, dietary assessment, all of this gets factored in in a way that guides that individual patient get what they need for their radiant skin and beauty.

Evelyne: And what are some of those questions that a practitioner … Say it’s the practitioner in aesthetics who’s new to integrative or functional medicine, how can they start to ask some of those questions?

Mark Tager: Yeah. First of all, there’s such an opportunity for people in the aesthetic field. Why? Because they see more patients than integrative medicine practitioners. They are actually better at the cash pay aspects of healthcare. This happened to me. They will argue about a $20 copay, and yet they will go down the hall and drop $2,000, $3,000 on Botox and fillers. So the motivations are very great for these people. Now, the goal here, if you are coming into this from an aesthetic door, the big door into an aesthetic practice, you’re going to ask some very gentle basic questions about diet. Hey, how’s your diet? Would you like some guidance on how a healthier diet might get you better outcomes? Or the conversations. We’re going to be doing a procedure that’s going to involve remodeling your collagen. To do that effectively, we need to have the right nutrients on board. Things like the amino acids that are important. Things like vitamin C and adequate iron and zinc so you can get the optimal result that you want.

We’re going to be doing a procedure that will involve some wound care, let’s say. So we need to make sure that nutritionally your skin is prepared for that procedure and will heal rapidly afterwards. So there’s some gentle questions you can ask. Tell me, how’s your diet? None of us has a great diet, myself included. Let’s spend a minute, what’d you eat the last 24 hours. Let’s just talk about that a little bit. How much sugar are you taking in? Are you reading labels? So there’s a very gentle process. And in fact there are in the model that we created for the training course, five conversations that we really encourage the aesthetic practitioner to get into. And they revolve around nourishing the skin, protecting the skin barrier, building collagen, getting the hormones correct and general skin aging. So these are all questions that pretty easy to do and it’s nice to have assessment and products and a process in place.

Evelyne: Let’s dive a little bit more into diet first. So what are the key pieces when it comes to diet for healthy skin?

Mark Tager: Yeah. Americans are number one. We are number one in the amount of simple refined sugar that we consume. Average American gets about 125 pounds of it a year. The vast majority of it is hidden. And if you think about it, what is a hemoglobin A1C? It is a measurement of glycation in which the sugar molecule grabs onto the heme and changes its configuration, its shape. Well, the same thing happens with collagen, and that is a process of glycation of collagen. When sugar attaches to that collagen molecule, it makes it more brittle, more fragile, and that tends to give us the a cross-hatching we see and sometimes these lines. And it’s very interesting, you can speak to a patient about their hemoglobin A1C and diabetes and they say, “I know.” You talk to them about the fact that this can help them with their wrinkles and they all of a sudden have their attention.

By the way, the half-life of collagen in the skin is 10 years. So just think about that a little bit. So this habit … And if you do nothing else … And I think every practitioner should do this, should be able to have three or four very common foods handy, very common prepackaged foods and show a patient how much added sugar is in a yogurt. Could be 18, 20, 25 grams of sugar in a serving. So you’re seeing enormous quantities of sugar in the diet and very quickly that adds up to be well over what our recommended daily allowance.

Evelyne: What are some of the other things diet-wise? So we know sugar.

Mark Tager: Well, you’re heard of fats. The body needs fats. It thrives on fats. Fats are critical for lots and lots of functions. They wrap around nerve cells and they’re essential for the skin. Now, in the skin, fats really are part of the mortar between the bricks, between the skin cells. So they really help with barrier protection. And the real issue that we have is the imbalance we have between the Omega-6s and Omega-3s and this diet that we’ve evolved to after World War II in which we have so many of these heavily refined oils that are pushing this balance, which should be about four to one to maybe 15 to one. Pushing it down the prostaglandin pathway in which we are creating these inflammatory molecules. So I really do believe that everyone should be on an Omega-3 supplement. Then you turn to the other … Glycation is a big problem for the skin. The other one obviously is the fight against oxidative damage, and that is the function of the phytonutrients in plants. I have a big garden. You’ve seen my big garden. I grow incredible tomatoes.

Evelyne: I can vouch for that.

Mark Tager: I take greater pride in growing great tomatoes than writing books. So the point is that the many colors of this rainbow are the phytonutrients and their job is to protect the plants from UV damage. That’s what they do. So there are numerous studies that show that when we ingest these plants of different colors, when we ingest these antioxidants, we actually provide an SPF for our skin of maybe three or four, maybe up to five. You can’t make that as a claim, but it is antioxidant protection. We see that in the studies that look at the minimal erythema dose, the amount of UV exposure needed to create a little rash. So that’s important. Thinking that you can do that. And then hand and glove with all of those great phytonutrients come fiber and fiber is the food for the good bacteria in the gut. That’s their preferred food.

Now, interestingly enough, in functional medicine, we think a lot about butyrate. We think about eating fiber to have the fiber, the bugs in the gut create the short chain fatty acids. One of them is butyrate and that’s actually stays in the gut that is helpful for repairing the gut lining. But there’s two other ones. There’s propionate and acetate. And what’s interesting is the acetate travels in the bloodstream where it hits the skin and it is a very important component of the skin microbiome. So we know for example, that people with acne have much, much lower skin acetate levels and that can predispose them or increase the likelihood of some dysbiosis on the skin. So that’s very important. So lots of good reasons to get fiber. But obviously we know that the connection between the gut, brain, and the skin is a tight one.

Evelyne: So with that acetate example, is it a matter of we somehow need to apply acetate to the skin or is it just we need to eat more fiber?

Mark Tager: No. We eat more fiber. It’s interesting because if you think about it, the skin topical industry is 166 billion … Excuse me, $186 billion industry. So most of the stuff that we put on our face, hydrates a bit, protects a bit, but it doesn’t really go much further than that. And if you think about it, you’re putting something on your skin, but your heart is beating a hundred thousand times a day and five, six, 7% of that blood flow is going through the skin. So the best way to continually bathe your skin all over your body in the nutrients that it needs to protect itself, to maintain immune function, to have healthy mitochondria and metabolism and stay intact, the best way to do that is from inside out.

Now what I really like is this inside out, outside in combination. I think there is a way in which product lines … Because we want to do something, we want to give people the solution and that’s what they want in fact. Okay. Great. Great. What do I do? Don’t tell me about these bugs with these long names Akkermansia muciniphila. Just what do I buy? What do I do? So I think here is where the practitioner really has a powerful message and that is the message of inside out meets outside in. We know for example, that vitamin C will penetrate the skin. It’s a 600 Dalton molecule, it penetrates the skin. Lots of good studies on that as an antioxidant for the skin. Well, what happens when we pair that with a diet rich in vitamin C and ample supplementation?

Now the other thing I want to point out here is that I know that we’ve been working on a spotlight on skin nutrigenomics test, which is really cool. And the reason that I love that is it is one of the most powerful tools that are simple. It’s easy, it’s a saliva collection. And what it does is it really helps drive personalization and compliance. Because nothing works better than a simple assessment to guide people to why they’re different. So we also know in that process of course, is that people have SNPs, single nucleotide polymorphisms, genetic variants that may make them require more of a certain nutrient. Vitamin C is an example where we have SNPs for the vitamin C transporter gene or vitamin D, where we have the CYP2R1 gene and the GC gene, which control hydroxylation of converting vitamin D to its active forms. So in either of those cases, well, we may have a problem with absorption, transportation and metabolism. Now that’s some of the personalization you can shed to really help people. And that’s exciting about where we’re going in personalized nutrition for skin health and beauty. Excitement is learning more tests, great new tests, great new opportunities to learn coupled with inside out, outside in approach, coupled with a process of … I guess it’s fostering introspection in your patient. It’s helping them make that connection.

They all get it at one level or another. And the other thing that I will say is that we all want the best patients in our practice. Who are the best patients. They do their homework, they’re smart, they’re engaged, they adhere to a treatment protocol, they give you feedback, they refer their friends because they’re so excited. And I really think that this inside out outside in approach can help not only distinguish your practice, but it can help you attract and retain the kind of patients that you want to get and keep.

Evelyne: Mark, you just brought up so many things in the last five minutes that I want to go back to some of them.

Mark Tager: This is what happens when you write a book. You get this curse of knowledge. You say, “Oh, I know a little bit about that. That was on page 56.” And by the way, I do ask people what’s on page 56? People say, “I got your book.” And what’s on page 56? Okay. I will hem and haw. It is a very …

Evelyne: Oh, shining light on dark chocolate. Very, very important indeed.

Mark Tager: Yeah. So that’s what’s on page 56. You’re right. That’s what you see there on page 56. And again, that is if you take cut out that sugar, the epicatechins in chocolate are powerful antioxidants. So at 3:00 every day I go and I grab one of those little DFH, the Fx chocolates and it’s perfect. It’s just the right amount.

Evelyne: I love them too. I guess that’s one thing I’m doing right for my skin health for sure. Let’s drill down on some of those points that you made. The first one being you talked about the importance of blood flow to the skin and you do talk about in your book about exercise. And I actually thought, oh, I don’t often … I just forget that exercise is also important for our skin health and for proper nitric oxide production. So I don’t know if you have any additional thoughts on that.

Mark Tager: Yes. Exercise. You have to do it. I have some young people who work for me and their athletes because I’d like to hire athletes. They glow. You look at their skin and their skin is getting … Because they are training. They are eating the right nutrients. I can’t give them any sugar as a reward. They won’t have a piece of cake and they are running or jumping or swimming and their skin is glowing. So part of that is this combination of training and getting the right food, but part of it is really the activity, the moving the blood flow through the skin. Now I’m a both and guy. I think you do that and you work for nitric oxide. I personally am a big fan of nitrate containing supplements. There’s so much good research there. One of the things that I do is I co-founded the Vegas with an A, Nerve Society.

And what’s interesting, we know how important these nitrates and NO is for vasodilation of blood vessels. But also in the gut, it is responsible for relaxing the muscle when the vagus nerve through acetylcholine actually contracts that stomach, you get contraction and relaxation and those two things go hand in glove. And when that’s disturbed, we get something like gastroparesis occurring, which we’re seeing a lot more with the semiglutides. So I’m a big fan. I love beets. I will eat beets. I grow beets. I grow all sorts of dark leafy greens. I will grow a lot of arugula. But for most of the year I will depend on a supplement to get enough nitric oxide.

Evelyne: Great. I want to dive more into the supplements. You’ve already brought up a few. What in your opinion are the top supplements for skin health?

Mark Tager: Yeah. And again, I’m going to go with my standard line, it depends. But there’s some things I think that everyone should take. Now let’s start off with everyone’s favorite. It is the one driving the beauty from within category and it is collagen. Five or six years ago, I would be discussing with my dermatology colleagues and others and we would say, “Oh, there’s no science to this. How can this really do anything?” Of course the overlay of that is with traditional medical colleagues, they’ll say, “Oh, you don’t need vitamins and minerals. You get all the nutrients you need and the food that you eat.” Well, we know that’s not true. So the point there is that over the last five or six years, increasingly there have been in the literature articles coming out to support the fact that these bioactive collagen peptides can help with skin health and beauty, can help with collagen regrowth. Collagen stimulation.

So here’s the point of this. And I’ve switched my thinking. The following reasons. One is that many people don’t get enough protein. I’m the classic 70 kilo guy. The national guidelines say I should have 0.8 grams per kilo, that’s 56 grams a day. But if I’m older and I am, and I want to maintain my muscle mass and I work out and I do a lot of resistance training, I really should be closer to one gram per kilogram. And athletes 1.2, 1.4 where they’re actively building muscle. The reality is if you don’t eat a lot of meat based products, it’s not that easy. You have to be eating a fair amount to get to attend to that protein need. So here’s where these collagen peptides are very important I think. They’re adding protein.

Now collagen is a triple helix molecule and it’s created primarily through glycine, proline and hydroxyproline. And you need all three of those. Now what’s interesting is that I was just at a conference where one fellow was reporting … When we do these radio frequency micro-needling procedures on patients, the vegans don’t seem to do as well. Well, that makes an enormous amount of sense. Because when you are bringing heat into the dermis, what you’re doing is you are unwinding it and you are shortening it and you are denaturing it. You’re essentially bumping it off. And that collagen, that unwound collagen becomes the scaffold on which new collagen is built. So it sends out signals and says, okay, get all those amino acids, get me some zinc, get me some vitamin C, get me some iron, get me some copper. I need to make new collagen. And that process we call collagen remodeling. It can actually take place for up to six months after a stimulatory procedure.

So vegans are not getting hydroxyproline. They can convert proline into hydroxyproline if they have enough C and enough iron. But if you’re a 30-year-old menstruating female who’s a vegan who’s not getting enough protein, you’re going to have a hard time getting those essential nutrients. Now unfortunately, there are no vegetarian vegan sources of collagen. Most of them are the collagen proteins that come either bovine or fish. So I’m increasingly a fan. It would be really nice if you could tell the collagen … Put a little AI or a little chip or something in there and say, “Look, go right here. I need a little here.” But it doesn’t work that way because you’re distributing this collagen throughout your body. But I do know that when we signal the body through doing a procedure that brings heat or cold or even mechanical injury into the tissue, you are signaling the body to bring those amino acids there for remodeling and redevelopment.

Evelyne: So those bioactive collagen peptides, I sometimes get the question, how is it that they actually help the body’s collagen? Can you explain that a little more?

Mark Tager: Yeah. All of us are in this war. We’ve got tissue being built up and tissue being torn down. We have osteoblasts, we have osteoclasts. So you’re always working to have more of a build-up than a tear down. And what’s important is when you build up, you need the ingredients, the elements to build things up. Now what’s also interesting … And we see this in the spotlight on skin tests, there are people who have SNPs for MMPs. These are the enzymes that break down collagen, and there are people who will break down their collagen through these enzymes faster than other people. So that’s a wonderful point to say, look, you’ve got these SNPs, you’re breaking down your collagen, you’re more prone to collagen breakdown, or you are more prone to glycation or oxidative damage or microbiome instability. And then you can pinpoint that supplement and you’re doing your patient an enormous favor because you are personalizing and getting them what they need. So we see that in collagen. So that’s the process. The process is if you don’t have these amino acids on board and they’re not there in sufficient quantity, you don’t have the vitamins and minerals, you’re just going to not build that collagen.

Evelyne: Yeah. And that’s a great clinical pearl too, what you mentioned. Well, not just about the spotlight on skin tests, which is so exciting, can’t wait to take that. But when you get these procedures like microneedling, which is so common that you need more collagen. So I think that’s fantastic. So we’ve talked about collagen, you talked about Omega-3s earlier. What are some of the other supplements that are really beneficial for skin health?

Mark Tager: Well, again, I’m an enormous fan of vitamin C, both inside out and outside in. Ideally it should be liposomally encapsulated. You’ll get better absorption, greater bioavailability that way. So I think vitamin C is important. Vitamin D also plays a very important role in skin barrier protection. If you think about it, you’ve got two surfaces whose job it is to read the environment, to protect us from harmful invaders. There’s the gut, and if you think about it, the gut lining … This always blows my mind. If you laid the gut lining out its surface area equals a double tennis court. That’s how much surface area there are. And there’s only one cell thick. It’s one cell thick. In the skin we have a number of layers obviously. There is this immune function. Vitamin D is very important in the skin as well. It’s critical for that immune function.

Now we’ve seen a lot of an uptick in vitamin C. Excuse me, vitamin D with after COVID, during COVID. But it is important for the skin health. We do have a significant number of people who are not getting the estimated average requirement. They’re not meeting that. And it’s even worse than aesthetics because what are we doing now? We’re putting on hats. We’re slathering ourselves with SPF 30 and above. It’s all great stuff. But it is our skin that is responsible for making that vitamin D. And I do encourage people to go out in the morning, early morning sun where you don’t have the burning rays. To get out and expose yourself a little bit. So I think vitamin D is another important one. C.

Collagen, vitamin D. There’s not a lot of stuff. But then you also get to the point where you want your nitric oxide product. Now as far as antioxidant protection, even though I eat lots of vegetables, I really like to lean on astaxanthin. I spent a lot of my time in Oregon and I’ve watched those salmon go upstream and I say something’s got to be powering those mitochondria. Whatever it is, I want some of that. So the mitochondrial health piece is I think very important. And then we didn’t talk about the overlay of drug nutrient depletions. So I know that Designs for Health has an excellent checker that folks can use. But that’s so important. So if you’ve got 26 million Americans on statins on those, statins are known to deplete CoQ10. CoQ10 is essential for mitochondrial energy. So when you see someone who comes in low energy and they’re on a statin you know right away that you’ve got an issue with mitochondria, you’ve got support that mitochondria. That mitochondrial support. There’s lots of things that do it of course. My favorites tend to be the magnesiums. And I actually am a big fan of Magnesium L Threonate for its ability to cross the blood-brain barrier. I think you take with-

Evelyne: Are those your secrets?

Mark Tager: A cup of coffee in the morning.

Evelyne: That’s pretty simple.

Mark Tager: Slide in a little dark chocolate at 3:00 and lord knows what you can do. Those are my favorites. And it gets simpler. Get seven hours of sleep at night. I’m going to Vegas like six times over two and a half month period to talk. I go to bed at 10:00. I’m boring. I hate to say this. I go to bed at 10 and I get up at five. I do that. I really work hard to maintain that. The other thing that’s really simple to throw into the mix is time-restricted eating. I think that’s a pretty simple one, or at least getting people to when they’re done with eating, get done. Don’t have that late snack. Don’t have that last glass of wine. Curtail your eating. Try to get that 13, 14, 15 hour period. Eat breakfast a little later. I also encourage a lot of people to move more of the calories into the morning. That’s really important.

Evelyne: Mark, you’ve been instrumental in the last year in creating this new brand within Designs for Health called Designs for Beauty, which I am just so excited about. And we have created a whole practice solution including protocols and a dispensary and all of these amazing tools. And I’d love for you to speak to some of the elements, particularly like how a practitioner, whether they’re a functional medicine or integrated medicine practitioner or an aesthetic practitioner, might use some of these tools to work this approach into their practice.

Mark Tager: I guess what we’re really thinking about is two things. Oh, more than that. But there are the basic tips. These are the things that every integrative functional practitioner knows already. They know that what’s good for the gut and the brain is good for the skin. They know that a good night’s sleep will make everything better and you’ll look and feel better. Now they know that. And what the integrative functional practitioner needs to do is use this hook of beauty to reorient their dialogue so that it resonates with a major motivator of that person coming in to see you. Now, yes, they may be coming in for weight. Yes, they may be coming in for longevity. Yes, they may be coming in for hormone imbalances. Yes, they may be coming in for thorough work up for their fatigue. All of that’s possible. But occupying a large chunk of their brain is beauty, and they are looking themselves in the mirror all the time. They’re on zoom all the time. This is really important to every patient.

So for the integrative functional practitioner, it’s that morph. It’s that it’s the additional questions. It’s the additional positioning. It’s the additional messaging that taps into deep-seated motivations that gets you healthier outcomes and call it adherence, call it compliance. They are much more likely to follow through with the regimen you’re suggesting. Now let’s move over to the other side. For aesthetics, it’s that brave new world. Now, I could go into an aesthetic practice and say, “Hey, anybody here who would disagree that the people who eat better have better skin?” Everybody’s, “Oh, absolutely.” We get there. That is one of those universally held beliefs. If you eat better, your skin’s better. We all know that. Then you ask the next question. Say, “Okay. Now that you know that, do you have a program, a process, products that you can recommend that cut through the clutter that these poor people are dealing with? Do you have that?” And then that’s when I get the Texas answer. The Texas answer is, “Well, not really, but we’re fixing on doing it.”

So I think what’s really been cool working with Designs for Health and helping to work on this training course is that knowledge is one thing. It’s great to have knowledge. But you really need to apply it and you need a process and then you need the products. And in reality, you need everybody on the team to be reading from the same page. Because what happens is that … The third part of our training course is the patient journey. And there’s a journey that happens when they hit your website and then they call you on the phone or get online and make an important appointment, and they go and they speak to the front desk and then they see products and they see services. The ability to flavor all of that dialogue and that process with this beautiful flavor of beauty from within, that’s how you attract, retain, and grow your practice is how you distinguish yourself.

Well, I went for my Botox and my filler and you know what? My doctor talked to me about … My esthetician, my nurse injector talked to me about my diet for a while. And you know what I did? I’m doing this real inexpensive test. They took my saliva. Next week, I’m coming back, we’re going to go over why my genes mean that I need to have a certain very specific regimen. And we did a finger stick test for some vitamins and minerals as well. And the doctor, you know what she had me do? She had me stick out my tongue. I didn’t realize that that’s the first place in the body where we can find nutrient deficiency. And she gave me some guidelines about sleeping better and when I should eat, when I shouldn’t eat.

The beauty of that, and I’ll tell you the secret of growing a great practice. And the secret of that is if you buy into this beauty from within, this combined approach, you’re going to be meeting a patient who’s going to come in several weeks, a month later, two months later, “Oh, Dr. Smith, I feel and I look so much better and my friends are telling me how my skin is glowing.” Here’s what I do. I do a timeout and here’s what you say. “Jenny, thank you so much. It means so much to me and the whole team here to know that we’ve helped you and we’d love to be able to help other people just the way we’ve helped you. Would you mind saying that again? Let me just grab my iPhone. Just say that again for me right now. Great, thanks. Oh, you don’t want to? Fine. Leave us a great review. But this means so much. Would you be willing to say that?” Hand them a release. And you grab that and you put three of those up on your website and now you are the go-to destination.

Evelyne: I love that.

Mark Tager: For an inside out meets outside in Designs for Beauty approach for radiant skin, and that’s the process. Simple. Simple. It’s a focus. It’s a mindset and a focus.

Evelyne: Mark, I’d also love to ask you about Vitamin E. I definitely hear a lot about vitamin E, both topically and orally.

Mark Tager: Vitamin E is another critical component for skin health and beauty and for lots of reasons. One, it is essentially the synergistic vitamin with vitamin C. So we always talk about C and E, and also selenium gets thrown in there to create this powerful synergy. Now, Designs for Health has actually been leading the way and helping us understand that not all vitamin E is created the same. We have these eight types and we’ve focused for many years on the wrong form of vitamin E. The tocopherols. When we know that the tocotrienols offer many, many more benefits and great benefits for the skin. So this is actually an example of where you’ve got a powerful synergy of inside, out and outside in. Vitamin E plays a critical role in the skin. First of all, it’s a cofactor with vitamin C and selenium and some other minerals, and those are all very important. They work very synergistically together. So internally they’re critical. And the most important is the recognition that it’s the Annatto tocotrienols that are going to give the most benefit. Now, when that’s combined with a vitamin C product or a new type peptide, a peptide plus vitamin C, plus annatto, we get a really great synergy. So two things to think about here. The synergy of the ingredients and the synergy of inside out meeting outside in.

Evelyne: So Mark, we’ve talked about vitamin E, vitamin C, we talked about the importance of the microbiome, we talked about fish oils for barrier function. What are some other areas that are important for skin health related to supplementation?

Mark Tager: Well, one of the largest ones is hormones. And the importance of balancing hormones … There’s a dramatic shift in the skin and metabolism that takes place. And in the increase in vasomotor symptoms and the hot sweats and the flashes and all of that goes together. And so we see particularly in the perimenopausal period, menopause, this dramatic loss of skin volume, of connective tissue and elastin. And this is one of the real drivers for women in that period of time. And one of the things that we can do in addition to all of these topicals that we talked about and keeping metabolism high and getting muscle stimulation and exercise, is the importance of getting hormones balanced. And one of the simplest ways is to look at that period of time in which we have estrogen dominance. So we have this fall in estrogen, but it is not as great a precipitous fall as the fall in progesterone. So we get a relative imbalance. The cruciferous vegetables are really great for that. This is where broccoli and maca and other vegetables are really important.

And it’s hard to get enough of the DIM. One of the key ingredients into the body without getting a concentrate. So I think many women can benefit from that supplement. It’s also important during that period of time to help shift estrogen metabolism away towards the good pathway 3-hydroxy in a way from the pathways that can move it towards more cancer inducing hormones.

Evelyne: I also would love to ask you … You mentioned peptides, and I think you were talking about topical peptides. Can you talk about some of the research there?

Mark Tager: One of the questions I’m often asked is, what do I smear on my skin? What do I put on my skin? And there’s the basics. You’ve got to have good sunblock, good protection. For that, you’re going to lean into the titanium and zinc. You want to have a good hydration moisturization product. If your skin tolerates it, you really want to get a retinol. Increase that skin turnover. But now increasingly … Certainly vitamin C and some other things will penetrate the skin. This is where we’re seeing the science evolve. We’re seeing novel peptides that are able to get in the skin penetrate, and we’re able to show that this can improve collagen and elastin. One of them that comes out of Europe is called PeptiYouth, and it was AI discovered. One of the fascinating things is they’re able to take information, run it through AI and find the right formulation, the right molecule, the right configuration of a molecule, the right ingredient that works well in the skin. So this PeptiYouth is great.

And we always think about synergy. Whenever you think about topical, it’s not just one thing. It’s that with let’s say an Annatto tocotrienols with some vitamin C and maybe some other ingredients. So that’s a very exciting area. Then the other area of growth is exosomes. Hard to know what you’re getting. Not well regulated. It’s a bit of the wild west right now. But there are some of the more reputable companies are producing some very interesting molecules there.

And there’s so much trial and error here for a patient. I will go to my wife’s side of the bathroom and I’ll open that cabinet and I will see thousands of dollars worth of topicals. You shift it up. Sometimes it works for a while, stops working and you move to something else or you find some staples.

Evelyne: Well, Mark, thank you so much. We’ve covered a lot today. And what I really took away from this conversation is that even though we spoke about supplements for beauty from the inside out, the framework that you use to speak to practitioners to have them speak to their patients, I think can really benefit anybody who recommends supplements. So thank you for that.

Mark Tager: My pleasure.

Evelyne: I just have three more questions for you that we ask every guest on the show. The first is, what is something you’ve changed your mind about through all of your years of practice?

Mark Tager: Collagen. I think it has benefit. I think these bioactive collagen peptides, I used to pooh-pooh them, but I’ve come around to believing in them.

Evelyne: What are your three favorite supplements that you take?

Mark Tager: Again, what’s my favorite doesn’t need to be your favorite because I take them for some very specific reasons. I am a big fan of Astaxanthin. I am a big fan of Omega-3s, and most recently I am a big fan of Magnesium L Threonate. And those three seem to work for me well.

Evelyne: Awesome. And the last question, and you answered one of them already, but what are your favorite health practices that keep you resilient and balanced? I know you said you’re seven hours of sleep. What else?

Mark Tager: I spend a lot of time working on harnessing the power of my parasympathetic nervous system. So many people that we see in clinical practice are wired and tired and they have sympathetic dominance. So I will use my Truvega or my gammaCore device to reset my parasympathetic system. I will deep breathe. Every night before I go to bed. I do four, seven, eight breathing. In for four, hold for seven out through my mouth for eight. I think that’s a powerful resetter of the nervous system. And I really try to focus on spending the most attention on things that are important and controllable and letting go of all the other stuff. That has been the major challenge of life because we want to grab on and do things and fix things and be involved. And sometimes you just have to let things go and let them flow. So that’s the way that works.

Evelyne: I love that. Thank you so much, Mark. It’s been a pleasure talking with you today. It’s just a pleasure knowing you. So thank you very much. And thank you for tuning into Conversations for Health today. Check out the show notes for resources from today’s conversation. Please share this podcast with your colleagues. Follow rate or leave a review wherever you listen. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht dedicated to engaging discussions with industry experts exploring evidence-based, cutting edge research and practical tips.