← Biohacking Beauty: The Anti-Aging Skincare Podcast
Biohacking Beauty: The Anti-Aging Skincare Podcast
Dr. Doris Day: Reverse Skin Aging By Fixing Inflammation
01:05:00
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- [00:06]
A
Okay, welcome back to the Biohacking Beauty Podcast and welcome to Dr. Doris Day. It's such a pleasure having you on.
- [00:15]
B
So great to be on with you. Thanks for having me.
- [00:18]
A
Yeah. You know, I want to start with your approach, and that's kind of what. What drew me to have this conversation because you, you blend traditional dermatology and the art of, you know, the science of dermatology and the art of health optimization, wellness internal optimization. So I'm interested as far as, like, what drew you or what realizations you had that set you on the path of balancing the two. Because as I shared with you off air in our first conversation, this is something that I was a little bit shocked that isn't the norm when I came to the United States.
- [00:59]
B
I totally agree with you. I think for me, it's in my blood. I grew up with it. My dad, I think, was the OG holistic doctor. He practiced anesthesiology, but he was really an all round great physician. And even before he would hypnotize, even before he would anesthetize his patients, he would hypnotize them and he found that he needed less anesthesia. But he really lived this life where he used to tell me, even as a little girl, he would say we should all die young at an old age. And when I was little, it didn't mean anything to me. I thought, what a silly thing to say. But as I got older, I understood it better. And he really lived that way. He would say, you exercise for your health and you eat for your weight. So you don't try to eat to lose weight. You don't try to exercise to lose weight. It doesn't work. You exercise for health, and it helps maintain your weight in many ways. But you have to watch what you put in your mouth as well. And they're two completely different things. And every fall, we would go to all the farmers markets and we would collect all the harvest food and he would make amazing harvest stew and really paid attention to spices and supplements and overall nutrition and fruits and vegetables that were in season. So we always ate very healthy and we always ate as a family. So we had the social part of it, we had the health part of it, the exercise part of it, even the intermittent fasting. He would always say, you know, after dinner you don't eat anymore. And we always ate an early dinner. So he had all these things incorporated but never put words to it. And he always cared about appearance even into his 90s. He would care about how he looked and wanted to make sure that when he would go to the hospital to see his patients before he retired, he always wore a suit. He said, the scrubs are for the or. When you see your patients, you have to look appropriate and they have to have confidence in you. And that goes with your attire. So he understood all the different layers. And he didn't so much tell me things as in, this is what I've learned. He practiced it and he lived it, and he taught me by example. And even he would say, you study the textbooks and you have to know what they know now. But that's not how you treat the patient. You have the patient in front of you and they're not a textbook. You have to have confidence. They have to have confidence in you, and you have to understand them if you're really going to help them. And he had such an impact on so many of his patients. I met many of them. I did his billing and his secretarial work when I was in high school. So I really did learn from him in ways, sort of just by hearing his stories about his patients. Him teaching me like we would go to the fish market in the summer, buy fish, and he would dissect it and teach me all the organs. And in the car, we would play car games, we would do the circulatory system. So his idea of fun was medicine. And I just kind of absorbed it through him. And then as I went along in my career, I realized, having done internal medicine before dermatology, that if I told somebody, don't smoke because emphysema and lung cancer, they feel fine now, what do they care? But if you say, don't smoke because your skin will look better, you'll have less lines and your tone will be better, you'll age better, they all quit smoking. When I said, don't eat salt because you'll have a stroke or high blood pressure later, they're like, meh, whatever. But if you say you'll have less puffiness around the eyes, easy peasy, they give up salt or they lower their salt intake. So the advice I give to my patients that will help their skin has such a powerful impact. But then I learned that not only does your skin reflect your health and well being, it affects it. So when I help somebody have healthier skin, I'm also helping them have healthier entire body, healthier mind, healthier body, healthier organs, and a longer lifespan. So the skin to me is such an important, powerful organ, not just for vanity and for appearance, but it tells so many stories and the impact it has on your health and longevity and well being is really powerful.
- [05:07]
A
I love it. And there's a study. I talk a lot when I give talks because I think it drives this. You know, a lot of times people expect, you know, a skincare company to come and say, hey, you should really, you know, look better and this is what you should do. But when I give talks, a lot of the times I'm trying to bridge the gap. Exactly to your point, to bridge the gap of the skin as it relates to overall body aging. And there is a beautiful study that came out of Lisbon, University of Lisbon, where it shows that senescent cells or zombie cells or, you know, rogue cells in your skin hijack the skin brain axis, and they actually inflame your brain, then drive inflammation throughout the body. So this is a small example, but it's a very poignant example as far as, like, this enormous organ and how it then relates to other, other parts of your body.
- [06:02]
B
And there was a study more recently even done by Dr. Saranya Wiles at the Mayo Clinic, and she showed that when she lowered inflammation in the skin, they also lowered systemic inflammation. So we're learning more and more about when you do something to the skin, it affects you internally. But the first book that I wrote, which was now 30 years ago on acne, was called 100 Questions and Answers about Acne. It was this company that wrote a series of books on 100 questions and answers about everything. And I did the acne one. Back then, we used to use antibiotics for everybody, and that was the norm. You do doxycycline for a few months, start them on a retinoid benzoyl, peroxide, and then they stop the antibiotics, continue the topicals, and that keeps them clear. Now, I've given up 99% of my antibiotics, but back then we would say food. We don't have any data that food affects your skin or your acne. If you feel like a food bothers you, then don't eat it. But, you know, we don't have science to back it. It's exactly backwards. What you put in your mouth, what goes to your gut, how you eat, how you stress, how you think all of that affects your skin and your breakouts. So I've gone 180 degrees around that. And now I spend so much time speaking with my patient about the food, their diet, how they manage stress. I'm not saying don't have stress. We're always going to have stress. You should have stress. Like when you grow, when you get better at things, you go through stress, but it's how you manage the stress. Things are not the end of the world. They're puzzles, they're challenges. They're things that you have to put into perspective and say, I'll get through this, I'll be okay. I've gotten here, I'll get there. And it's how you plan it in your head and how you give it the space where you look at it as a challenge and a puzzle, but not as something that is going to be life or death or the end of the world.
- [07:53]
A
Yes. Because actually in your brain these are stored. These are processed in completely different areas in your brain. If you feel that stress has been forced upon you or it's what we call like elective stress. Right. The stress that you have undertaken, let's say they are actually perceived as completely different challenges, completely different inputs to your brain.
- [08:13]
B
The cortisol level changes based on that and that affects your skin. So I spend a lot of time talking about holistic things that people can do about supplements. But what's really interesting is that a lot of times people really just want a quick fix. They appreciate the information, but then they're like, okay, but what are you going to do? And I'm like, yes, I'm going to give you a whole routine and a regimen. But attacking it this way and addressing the whole root cause of it is going to give you longer lasting results. But it's also an effort. And sometimes getting people to want to engage in that effort because you know you're comfortable with what you're doing many times, even if it's not quite so positive for you, even if it's destructive, because it's just the path you're on. So helping people break the path that they're on and recognizing that there's a better and in the long run, easier, happier way to go, that can take some work and some time. But we get there. And I always tell my patients, I don't want you to just look better, I want you to be better. And when we get to the root cause of things, you look better because you are better. And that has a lasting impact.
- [09:24]
A
Wow. For sure. You know, on the flip side of that, in your experience, what is a myth that you feel still persists as it relates to skin aging or anti aging? What do you see still? That is a misconception that we can't seem to weed out?
- [09:44]
B
Well, one is I can't seem to weed out the idea that you still, you need to reapply sunscreen. So people think If I put it on in the morning, I'm done. That's one, two is they think that after a certain age, it doesn't matter how much sun you get anymore, that the damage is all done. When that's not true, you can still repair. It's harder as you get older, but you can still repair. And another myth that's really disconcerting that I've been working hard for literally 20 years to try to fix, and now it's starting to pick up steam because a lot of people are, we're on the same page and we're giving each other courage. Is the idea that menopause hormone therapy, people think it's dangerous, but it's actually really very. Not just safe, but life saving and skin saving. So talking about affecting the root cause, a lot of times it comes down to your estrogen, progesterone and testosterone balance. And helping women understand that estrogen is not a carcinogenic. And balancing out your hormones can help your skin and your hair in very, very powerful ways.
- [10:47]
A
I'm wondering, this is kind of besides the point, but I'm wondering right now, within the, I would say the longevity HRT discussion around men is that, you know, the paradigm until now was, hey, you should kind of wait until things really go haywire or kind of really go off course, and then you should engage in hormone replacement therapy or whatever that is. Right now the paradigm is shifting, saying, hey, if you're suboptimal, that's when there is not enough oil in your system, as they say.
- [11:21]
B
Exactly.
- [11:23]
A
Does that apply also for women?
- [11:26]
B
The data shows the earlier you start, the better and the more benefits you get overall. Another myth that's really tough is fighting the idea that it's surgical or it's non surgical in terms of the approach. And the reality is that it needs to be both in many cases. But even if you do a surgical approach, you still need the non surgical benefits. You still need skin care, you still need devices, you still need neuromodulators, you still need fillers. And that combination is, is the answer. So it's not that you can just go in and get a little filler and solve all your problems. Sometimes you need to improve skin quality and then you need a device that helps with that. Sometimes you do need a little bit of filler. And if you get a facelift, you'll look pulled and smoother, but you still look deflated because you need volume. And a facelift may reposition and they can put in some fat, but it doesn't Often last. You still need volume. So I often tell my patients that I'll get you ready for surgery, but we need to do these non surgical approaches too.
- [12:29]
A
That's fantastic. And what I think is a very refreshing approach is kind of what you alluded to as part of it, which is what I tried to trademark and failed, by the way, is prejuvenation is the idea of the surgeon or the derm, the aesthetic derm, whatever that is, is indeed the artist. But you are the canvas. Right. The better you respond, the better the artist is. If you're going to try to paint on a rock or you're going to try to paint on a. Whatever the best canvas is, it's going to be a completely different scenario. Right. So you are responsible for your results in many cases.
- [13:10]
B
Absolutely. But the problem with the prejuvenation is people come in and they want things that they don't need and they think it's preventative. So preventative and prejuvenation is different at different ages. So if you're super young, it's really just good skincare. But I have people who come in in their 20s and they have perfect faces and no lines and appropriate movements and they want to already start with treatments because they say, well, I don't want to get wrinkles later. But the reality is that isn't how it works. So it's really understanding the movement. But the one thing that I find, and I'm doing more in my practice, is a device called Softwave Early. So that is one thing that I think is true prejuvenation, because. And my daughter, who just turned 34 last week, has been doing it for two years and she's now a dermatology resident and very skeptical of everything. But the idea is it builds collagen and it doesn't melt fat and it doesn't cause scarring under the skin. So that's true prejuvenation, because it works with skincare, works with sun protection to help keep your collagen healthy. And that's something I just have them do once a year for people who want to do a treatment. You can do a little micro needling, but only if you have acne. If you have perfect skin, I don't want to break it. So I'm not going to do microneedling in those cases. Same thing with Botox, same thing with filler, that it's not a toy to play with. You don't do things because you think, I can just try it out. You have to really understand what's Moving the skin, how the skin is aging, what your genetics are. And if you're not having the healthy diet, the exercise, the good skin care, doing those things won't save you from early aging. You have to do all those things and then the treatments are the icing on the cake.
- [14:58]
A
That's a very interesting approach. So a lot of the times in this podcast, we are very weary of recommending non ablative, non invasive devices. We were very outspoken, for example, against radio frequency microneedling.
- [15:15]
B
And agree with you.
- [15:16]
A
And by the way, when it was not cool, now with the fda, it's cool, right? The FDA just released a warning. So one of the things that I encourage, both in our company and when I talk with other people such as yourself, I love the idea of someone having a different opinion. So I would love for you to explain to me and to people who listen, within which parameters would softwave be? Maybe you would like to explain what softwave is, but also within which parameters would it be not risky? Would it create collagen that is not fibrotic? How do we approach that? But maybe start. Let's talk about what it is.
- [16:04]
B
Okay, so softwave is the energy is ultrasound. So that exists on the market. But what makes softwave different? And I have the other devices. I have microneedling rf, I have other ultrasound devices, and I have thermogenal therapy. I have everything. But what got me to softwave, and the reason why it's my favorite product is a few things. One is it's one of the things that I do that patients consistently come and they say, this really works. And I'm floored by that. Like, I try to underestimate things that I'm very careful with patient selection, but the science of it. So when I'm looking at a device, cause I buy everything in my office, I don't work for any company. And when I'm looking at buying a device, I'm thinking, I'm gonna look my patients in the eye and say, do this. I recommend this for you. Okay. So I need to know, one, that it's safe and two, that it works for the safety. The way that this is delivered, it's synchronous parallel layers of ultrasound. It doesn't go below the skin, it goes into the skin. There's no fibrosis. They know this from biopsies. There's no scarring, there's no fat melting. But I think the reason that it works so well and why people are so happy is because what it's doing in the skin to Build collagen without fibrosis. It's pure collagen building because of the temperature it gets to. And the way the cooling works within it is that you get a tightening and a lifting and an improved skin texture. So I mean, I've had seven of them because I do it every six months and I've been doing it for a few years. But the difference that you see in the skin really quickly, like within two weeks you start to see it. Within a month people start to notice. And now they have an eye and a body handpiece. I was really floored and how well it worked. And the thing is, I don't do it in my office. My associate does it, but it's going all day long because people come in and they ask for more and they send their friends in. So I worry about fibrosis, I worry about fat melting. Now I don't have the Morpheus RF microneedling. I never personally wanted to adopt that technology because I had seen so many problems with it. But when I do RF microneedling, I never go beyond a millimeter and a half. And if you're at that level, even for acne scars, there's good studies that show that's all you need to go to get the benefit of collagen improvement without creating fibrosis or scarring. And I do that treatment myself. I won't delegate it to anybody. So I think it's the picking the right patients, doing the right pre care and post care. Now I helped co found a new company called Rapalogics. And this I think you'll be really interested in on the biohacking side. So we had access to this library of molecules that originally belonged to Novartis. They're analogs of rapamycin, so they're selective MTORC1 inhibitors. And it got bought by Cambrian Biopharma. And then we created this sub company called Rapalogics. And we had access to select out a few of those molecules to have exclusive use for skin. So we got the new Inkey label, we got everything done. Raised money, like millions of dollars. Did the basic science research show there's no systemic effects? The molecule is called RLX201. So for your listeners, I'm sure you've talked about rapamycin in the past. So rapamycin is used as an FDA approved drug to help prevent kidney transplant rejection. But it's really big in the longevity biohacking space. But the problem with rapamycin, if you compound it and use it as a cream and is it blocks two pathways. One is called mtorc1, one is mtorc2. So the torque1 pathway you don't want to block, you want to block only the torque 1 pathway, not the torque 2, because one has cell turnover and that is accelerating aging in a way. The Torc 2 is a cell repair. So these are analogs of rapamycin that are selective torque 1 inhibitors that help with cell repair. And we took skin explants to 56 year old fibroblasts, which are the cells that make collagen and elastin in the skin. We treated it with the RLX201 and retinoids. And what we found is those 56 year old fibroblasts reverted to 23 year old fibroblasts. So they aged backwards so beautifully. And the amount of production they had was incredible. Then we took the same cells and we treated it just with the retinoids to see the retinoids were doing the effect, not the rlx. And the cells made fibroblasts, but they had increased senescence. So what happens is whether you're getting sun exposure or stressing or doing a laser treatment or microneedling RF or any treatment, you're hyperstimulating. You're asking those fibroblasts to produce more collagen, but they will. But they're going to get exhausted and their mitochondria will get exhausted and you have accelerated senescence. So this molecule is helping their recovery. So they can produce without becoming exhausted, because once they go into senescence, they're no longer useful. And then you have to count on those stem cell reserves, but your stem cell reserves run out. So this way you can preserve your stem cell reserves. So when you're in your 60s and 70s, you can still make new collagen. Because I see all the time that I have women in their 60s and 70s who come in for laser resurfacing and other things. When they had a facelift, they got that done and they said they had horrible downtime. But they didn't see any improvement in their skin because the fibroblasts weren't there to produce new collagen. So now we can help with that production. So when you combine it with exosomes or growth factors or other stimulators, now you can have that hyper stimulation with proper repair, greater longevity of the fibroblast. And we saw also excellent elastin production, which is really hard to do. So elastin production. So it's the difference. Now in terms of my approach is I really am interested in longevity and health span. And when it comes to the skin, this molecule I think is going to be ultimately as big as retinoic acid in terms of skin longevity.
- [22:20]
A
I agree, I agree. Few fun anecdotes. We also are working with Cambrium, but that's on a. It's going to take a long time, but it's really cool. And one of the best things that they do is use AI and big data in order to simulate very large cohorts of data.
- [22:40]
B
We're doing that too. Yes.
- [22:41]
A
Really cool.
- [22:42]
B
Yeah.
- [22:46]
A
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- [24:37]
B
Yes, I used those. Yep.
- [24:38]
A
And showed a reduction of 40% in senescent cells. That's why we went down the path of developing our own platelet derived exosomes. It's a really cool convergence that we have right here talking about basically the two complexes of mammalian target of rapamycin, which is mtor. Normally what needs to happen with the, I would say like old school rapamycin is that you had to do a few things. First of all, you had to kind of undulate your consumption and that is because Although you are targeting both mechanisms, both structures, they don't respond in the same rate. So you do get some of those results when you're getting prescribed, either obviously wrap up topical rapamycin or you're taking it orally. The problem is, is that the second thing you need to do is to be really careful as far as introduced injury to the skin, inflammation, et cetera, because you are, as you mentioned, you're inhibiting the skin's ability to respond to damage.
- [25:47]
B
Absolutely.
- [25:48]
A
So by only, by, by only targeting the first structure, you are eliminating basically all of the good and none of the bad.
- [26:00]
B
Right, Exactly.
- [26:01]
A
You don't need to worry or to formulate an impossible formula to which it gives all the results that you want. But people need to adhere to some very, by the way, individual, but also very weird form of application of products. One of the worst thing you can do to a skincare product is asking people to go on and off and create a weird regimen.
- [26:25]
B
Absolutely, absolutely. That's why compounded rapamycin is dangerous. You will destroy your skin barrier. But this, because it's a selective torque 1 inhibitor, you're getting all the repair, all the good and not the bad. And we have skin biopsies, we're doing really good human studies besides the basic science studies. So we know everything about this molecule and what it's doing and how it's working and, and it just makes everything else you do work better, but without the safety issues. So we have, in our studies, we have patients use, or the candidates using it twice a day and no issues at all. And not only that, it doesn't pill like you need to have a luxury because, you know, with skincare, like you can have the best product, but if it doesn't feel good and if people don't like using it, they're not going to use it. This is one where people come back, I'm going to send you some, and they're just like, this feels so good. I love using it. I look forward to it. It's really kind of such an interesting product to create something from scratch at this level. I've helped companies build brands and build products, but not from a molecule. And being able to work on the whole formula and the botanicals that go in it, it's really quite special. So now we're at the launch, but it's a big deal.
- [27:43]
A
It hadn't launched yet.
- [27:44]
B
It just. We're doing a scientific launch, so we have it in a few practices. But in January we'll do a big launch. But now we're just. It's literally been out for two weeks.
- [27:54]
A
And this is over the counter. People will be able to buy it.
- [27:57]
B
From your doctor, from your doctor, not anywhere. Because there's still a story to it. I think when you're talking about longevity and you're telling somebody you're going to use this, but you're not changing anything else, you're just going to put it on first and then use all your other products. It's a lot to ask. It's the same idea is that you're saying, well, take your magnesium and vitamin D because you don't want to get osteoporosis later. People can wrap their heads around that. But skin longevity, you want to see a result. The one place where we saw results really fast that sort of surprised us was the arms. So we had people put it on one arm, not both arms. In my office, I did a survey study. So we're doing a formal study with biopsies and blinded everything. But I just did one where people kept the products they're using and added this on their face and neck. And one arm.
- [28:45]
A
Yeah.
- [28:45]
B
And the place where they could see the fastest difference is the arm. They would say it's like two different arms now. My arm got better so fast. And that is an area where women, when they hit their 60s and 70s, that crepiness on the arm drives them crazy. And I just wanted to know it didn't irritate or bother anyone, but they saw such a difference. And I would ideally mix it with a retinoid.
- [29:06]
A
Yeah, I mean, the business of retinoids for the body, in my opinion is that's one of the areas that if companies want to create a unique product and kind of be early to market, if you would. I think there's still a lot of room there.
- [29:21]
B
Agree. I have. I made one in my line because I have my own thing and I made an incredible retinoid that has vitamin C, a little bit of salicylic acid and peptides. And the, the glide is not, is not silicone. It's just so luxurious. But I use that with the req and it makes such a difference on the arms. But I agree with you. I needed a body retinol. But again, remember, if you're using a retinol, especially if it's a prescription strength, you're hyperstimulating those fibroblasts and you are wearing them out. So you need for them to recover. So I started pulsing and again, exactly what you said. What's the hardest thing to do is say, tell somebody, use this on and off. So now you don't have to pulse it anymore. You can get the benefits of long term use of retinoic acid without promoting senescence of the fibroblasts.
- [30:10]
A
Amazing.
- [30:11]
B
And that's a conversation you can't have. People get really upset when you can say retinoic acid is great, but it could be accelerating aging. Nobody wants to hear that. They're like, what do you mean? This is the greatest thing ever. And it is.
- [30:24]
A
I agree. First of all, is retinol is vitamin A one of the best things by the way? Not only for your, for your skin. Now we know it again, we're talking about senescent cells. Adequate amount of consumption of it shows reduction of senescent cells even in the brain. So there is, there is again best thing since sliced bread. The problem is, is the introduction of again of excess inflammation through that process. And a lot of people think that their retinization, like the initial part where they're using the retinol and they're getting a little red or irritated or anything like that, has something to do with their end results of skin rejuvenation. These are actually two separate, completely separate processes. These just happen alongside each other and by the same product. So one of the things that were a challenge for us, for example, when we introduced a professional peel that right now people can get from a professional and it was pretty medium strength glycolic acid. But we've introduced copper peptides into that.
- [31:25]
B
Beautiful. So smart.
- [31:27]
A
We have an encapsulation system that allows that to happen. People didn't peel or they peeled, you know, significantly smart. But the estheticians went, I know people don't peel, it doesn't work.
- [31:39]
B
I know.
- [31:39]
A
So I think this is such an intragen, I think that product, the MTOR1 Selective Inhibitor. Yes, selective inhibitor product would be such an interesting case study in the adoption of longevity as part of the story of skin appearance or health. I'm interested.
- [32:06]
B
I know it's really fascinating, but what you say is so interesting too because I do a lot of CO2 laser in my office. But now I pre treat with the req with the RLX 201 and I pre treat with, I have them do a carboxy mask which is like hyperbaric oxygen the day before and then on top I use the exosomes, the platelet derived exosomes and I use a copper mask right over it. And they don't have the weeping, oozing misery and they're Ready to go at five to seven days. And sometimes they're like, wait, this isn't the experience I had before. Are you sure it's working? Am I going to get the results? And they're so shocked that not only do they get the results, but the results are better with less suffering and less downtime, because I tell them that the laser is not the main event. And I think for you, you'd say that about your peel. The main event is what you're introducing into the skin and how you're driving that repair process. So I'm introducing nutrients into the skin. I'm driving repair and healing. But you don't need the suffering to get there, necessarily, or as much suffering to get there. So I think in a way we're doing the same thing. I'm just using a device and you're using chemicals. But it's what you introduce that makes all the difference in the end result, which is beautiful, but without the suffering or as much.
- [33:29]
A
First of all, we have to send you. I want to send you the vampire exosomes in it and one of our cult products, one of the products that made us famous, which is called the hyperbaric mask, which mimics the activation of pathways that you would have in a hyperbaric chamber. And normally we blow people's minds, but I wonder. But I do want to. So we're having a very, very interesting discussion, but exactly like retinization and cellular turnover, we have a side discussion that we are not. That we're not stepping on. And I really want us to discuss that, which is the introduction of inflammation to the skin and what happens when the skin. What happens later on. So the first question, the question I had prepared, but we somehow are going around it is we've talked right now a lot about introduction of inflammation and the body's response to inflammation. But it is a silent ager. It is something that the body keeps a toll as a famous. The body keeps the score. As the famous book goes. Let's talk about how it actually is experienced by the skin. Inflammation.
- [34:44]
B
We need some inflammation, because inflammation serves a purpose. The problem is chronic and extended inflammation and the production of reactive oxygen species and matrix metalloprotein activation. That's going to accelerate aging in the skin and even cancer. So and the number one cause is going to be from UV rays. And if you. That's why we protect. And the more pigment you have, the better you can mitigate that. But the reality is every skin type does experience some inflammation. Every skin type builds heat and toxicity from excess exposure. It's a real problem.
- [35:25]
A
It's funny because a lot of the time I say inflammation is not the problem. Inflammation is needed. It's natural. Unresolved inflammation is the issue.
- [35:34]
B
Right.
- [35:34]
A
You need to.
- [35:35]
B
Exactly, right, yeah, That's. That's perfectly put. It's unresolved inflammation and inflammation that goes beyond the body's ability to immediately handle it. So you need that basis because it helps knock out cancer and other things. So if you had no inflammation, it would be detrimental and deadly. But. But most of us don't have that problem. I mean, I can think about it with salt. Like, you know, most people don't have the problem of not getting enough salt in their diet. The problem is you need salt. You can't live without salt. But too much salt is the problem. And most people end up at too much, except for me. One time I went to the doctor and he said, you didn't have enough salt? And I was like, yes, yeah. And then I added some salt in. But for most people, it's. It's too much. Right, but same with inflammation. Same.
- [36:22]
A
Yeah. There is a study. So there's always, by the way, like, just a side note, there's always like this pendulum that goes, that goes back and forth in the salt discussion. And it doesn't help that in 2024, there was a study that came out and said, you know, autopsies, et cetera, show that people that basically, like a low sodium in your blood would predict, like, low mortality rate. And it really kind of reshuffles all the time. The discussion.
- [36:50]
B
The problem is, is that just like with everything we're talking about is people go to all or none with everything. It's. The reality is it's not salt alone. It's. It's salt along with other minerals and other electrolytes. It's your overall balance. Even when they talk about creatine and, and, and omega 3s and they, they go to like, it extended or people died faster. The reality is, what are those things doing? Like, when you talk about copper, it's because, you know the Krebs cycle, you know the biochemistry of why, why you didn't pick Copper randomly. You know what copper does for wound healing, and you picked it for a reason. So the idea that someone's going to pick an Omega 3 and not look at the vitamin D or the, the diet and the fat content or the other foods in the, in the diet that are going to complement or help Omega 3 do its job, even with cholesterol, we just go Good, bad. LDL is not bad. It's how it's processed, what it's carrying, where it goes, what else is in your diet, what else you're doing. So there's so many elements to it, but we want to simplify it in the skin. We had the same argument online, on social media about buccal fat removal. It became like, everybody gets buccal fat removal. And then, oh my God, it's the worst thing that's aging. The reality is some people need it a lot, some people need a little bit, some people need none. There's no one size fits all with any of this. But with science, we tend to unfortunately look for sensational headlines and all or none things that are going to get attention but not sort of tell the whole story or the context. And I spend a lot of time reading entire studies, looking at the charts and the data, and I realize that there's so many studies that are so misleading because of the way that they use statistics or the way that they chose to put their data out there. And then people just read the headline, the abstract and the conclusion, and they don't actually look at the data to see that it doesn't make sense. And this is why hormone therapy became so demonized, is that people didn't read the data, they just listened to the headlines and then they came out with the wrong answer. And so many women were harmed.
- [39:01]
A
Wonderful. First of all, two things that I am taking from it. First of all, one thing that I'm reminded of from the last thing that you said, that there is a huge company, that company, by the way, did such a good push of marketing that actually got acquired by not only Nestle, but then got L' Oreal to invest $66 million in it.
- [39:21]
B
Wow.
- [39:22]
A
And they took a postbiotic and they've basically published know the positive results of the study, which happened in the middle and by the end the results were null, but no one cares anymore. And they got, you know, pick your favorite, really pick your favorite health oriented podcaster. They got them to talk about it and talking about it to this day. And obviously these podcasters, they read maybe the end or something like that. Move on.
- [39:51]
B
Oh, they don't even read. It's the researchers for them that read. I mean, they get the talking points. I know, it's so discouraging. It's really, it's very discouraging. That's why I go and I read everything myself. And I actually read it for internal medicine too. I read it for like the Watchman for heart for afib, I read all the studies on that. I try to read and do exams on as much in internal medicine as I can because it keeps me thinking critically. And my dad always told me to not trust what you read, that you have to, you have to question everything in the textbook. That's the one thing also my dad really taught me. And my dad was a very go with the flow guy, but when it came to medicine, he was not. And he said, you have to question everything in the textbooks. Don't believe a single thing, always be skeptical, always ask questions, always be curious.
- [40:38]
A
Absolutely. The second thing it reminds me, and this is for me by the way, this is something that it's a mirror to how I make decisions around supplements. You mentioned creatine and omega 3s, both of those. I am a person that says, oh, is our five grams of creatine good? Let me take 30. First of all, thankfully I cannot physically. But, but recently there has been a. Obviously not, honestly not peer reviewed, but there has been a publication saying, hey, creatine out of China, which most companies, even the biggest ones source from there may have heavy metals there and especially one that is called DHT and dcd which are both like extremely, extremely harmful. And obviously when we talk about. So really if people want to look for a brand called like for, for a label called creapure that's out of Germany, but really I tried to find companies using Korea pure, very difficult to find. The second is obviously omega 3s. Even if you get them from the best source, the way that they're handled shipping, you're going to get some that are rancid.
- [41:55]
B
Yeah, I know.
- [41:56]
A
So in both of those cases, this is a reminder for me that a little goes a long way and I shouldn't be the prototypical biohacker male that says let me take 100 times more than the recommended dose.
- [42:13]
B
Actually, you know what isn't it should. What should solidify that for you too is that now that we have all these things that we add to our lasers, I use less energy and I get better results. Like with your peel, you find that you can now because you're driving the healing, you can actually possibly even change the concentration of the glycolic acid and still get the results. Because all you really need to do is deliver that copper more efficiently, create a little bit of the chemistry, the, the, the enzymatic process, but deliver that copper and you'll have the results. So I think, yes, I'm, I'm not. If a little is good, a lot is better. I am one because I. Because I see people doing that in dermatology all the time is like if you put in five units, put in 10. And the reality is, I think if you put in the right amount, you get the results you want. And I'm. I'm actually a. A less is enough or the right amount is the right amount person. So I'm careful that way. I also want to know what could go wrong before I do something and what I would do about it so that I can feel confident that I'm doing the right thing for the patient. So I would want to know. If you take a lot of, like, if you take a lot of vitamin A, it actually can cause a lot of problems. So. And creatine, you have to be careful. I mean, if you don't have proper kidney function, you have to be a little bit careful. But mostly it's just a protein.
- [43:34]
A
Yes. Yes. I love it. Let's take a quick break from this episode to discuss skincare that makes big promises but delivers small results. We know how tiring it can be. Yungoos isn't playing that game. This is longevity science for your skin, where breakthrough ingredients meet real results. For example, our bio barrier formula features LPC6, an antioxidant that's 20 times more powerful than vitamin C. We're talking triple action defense against every type of free radical that ages your skin. And our revolutionary spermidine serums, the first skincare products to harness this cellular powerhouse that literally triggers your skin's red renewal process. Every Yungoose product targets aging at the molecular epigenetic level. NAD precursors that restore cellular energy. Peptides that rebuild collagen, bioidentical compounds that reinforce your skin's natural defenses. This isn't surface level skincare. This is your skin's biological reset. Whether you're dealing with dryness, signs of aging, or just want skin that actually looks as good as you feel, Young Goose has cracked the code on what your skin really needs. If you're ready to experience what happens when you're when science meets skincare, check out the Yungoos link in the show notes or go to yungoos.com because your skin deserves this. The future, not just another cream. By the way, we are for the listeners and for you too. We are still in subject one out of like five, but I want to again diverge and I really want your input on a few things because one of the things that we are lucky to have you is that you have differing opinions. As I said to My personal opinions, but also to the opinions of the more of the holistic kind of skew that we have to this podcast. So I want to hear your opinions around fillers because many people who use our products and listen to this podcast use it in spite of the fact or listen in spite of the fact that with poo poo fillers, et cetera, they would still get them. Obviously, neuromodulators is a different issue, which I think is less controversial. But recently there is controversy around perception, deviation around fillers, migration and encapsulation within fillers. So I wanted to hear how you approach it. Who would you recommend fillers to, what you feel should be a concern or what is not a concern?
- [46:42]
B
I love the question and I love that we have differing opinions, but I think you'll agree with me by the time I'm done. Okay, so I'm never cavalier about doing a filler. I don't think everybody needs a filler. I have more people that I say don't do filler than I say do filler. The right candidate selection is really important. And before you get to the filler, the single most important thing you do is an assessment, is you have to be able to analyze the person's face, understand their symmetry, their balance, their architecture, the aging, their position at rest, their position when they animate, their position on command, their movement on command, and what the overall balance is of their face. This involves touching their face, feeling the different areas. How strong are their masseters, how strong is their jawline, what's the position of their chin? What is their orbital bone? Are their eyes sunken? And the eyes are always the rate limiting factor in whether or not filler is going to help and whether or not filler is appropriate. Because as you age the bone that surrounds the eye, it's called the orbital bone. This bone shrinks as your skeleton gets smaller. And when the bone shrinks, the hole gets bigger because it's surrounding a hole, your eye will fall in, your brow gets heavier and it drops from above. So now your eye is smaller because it's sunk in a little bit and the brow dropped. If you put filler below because they think they're hollow, you're gonna push the lid up from below, make their eyes smaller still, and then they feel their cheek is deflated. You put filler in their cheek. Now they have big cheeks, small, squinty eyes, low brows. They look totally bizarre. That's not how you do filler.
- [48:22]
A
Pick your favorite Hollywood star that looks like this.
- [48:26]
B
Now, I know this Is true. And it gives it a bad name. So the way fillers are done properly is you understand the different fillers we have, what the structure and the rheology, what the chemistry and the mechanical action is of that filler, both when you inject it and as it ages over time. And you're going to use something a little bit more structural, not to lift, but to create balance and to shape the face and restore it. You're not trying to make somebody look younger. You're trying to help them look healthy and youthful. So I call it anchoring and blending. So you have anchor points, the apex of the cheek, the gonial angle, the corner of your jaw, the chin, the base of the nose. These are anchoring points of the face that need to balance. They're limited by the eyes. You can't over build them. And then you blend. The mistake people make where you get either overfill, doughy, look, perception, drift, all those things is when you just try to fill every hole and erase every line. Fillers are not line erasers. Lines and wrinkles don't make people look old. I never do it to fill a line. I do it to create balance. So let's say somebody has upper lip lines most of the time. If you look at someone who has upper lip lines, they have one of a few problems. One is they can have a big overbite. Two is all women. As we age, our chin shrinks and recedes. This bone, the mandible, will shrink and the chin recedes. So now your chin is set back. Your upper teeth and lip hangs over the lower lip. Every time you close your mouth, you pucker a little bit, which makes upper lip lines. The worst thing you do is fill the lines. Now all you've done is you've made that protrude more and you've added weight. The lines are gone, but they look worse. You have to balance the chin and the lower lip so the lips sit better. Then you can add a very soft filler to blend that area without adding bulk or weight. And sometimes add in a laser to smooth. Add in good skin care to build the collagen and improve the skin quality. Now you look youthful, balanced, restored and more beautiful. And no facelift will fix that because if you are missing volume and overall balance, you need a filler to help that. And now we have bio stimulatory products like Sculptrin Radiesse that. All they do is they help stimulate collagen from underneath. When you do that with good skincare devices and lasers on Top now with really no added volume, you have thicker, healthier, more youthful skin, and you look more youthful. So there's a lot you can do if you respect anatomy, if you respect the aging process, if you understand how different fillers work. You use the right product in the right place, and you don't try to get one to do everything because you have it in your hand and you have some left. So I'll just put it somewhere. You don't do that. You say, nope, that's not the right product for this area. And you really respect that. Fillers have limits, and sometimes you need to look to other sources to solve the issue or just say, we can't do it with just filler.
- [51:37]
A
I love that answer. And if, you know, speaking to a plastic surgeon, obviously, you know, it's now trendy, whether it is Cameron Chestnut, Amir Kharam, whoever we've, we've spoken to and then got those responses, what one would say has, hey, I'm open up, opening up that tissue. I see fibrosis, I see encapsulation, and I see lack of blood supply. This is because of the product. This is the product. What I'm seeing is the product, period. Don't tell me, you know, stories about negligence. What are they missing in the picture that, that what needs to be, no pun intended, filled in here for them to get a full picture of what was going on there.
- [52:22]
B
I think sometimes that can happen, but I don't necessarily think that's a problem. Like if you have fillers underneath and even if there is some fibrosis. But the skin looks great. Like my sculpture. Patients are my happiest patients. Their skin is beautiful. And I've been doing sculpture for 20 years. I was doing it for HIV patients before it was for. For aesthetic patients. Yes, exactly. And Sculptra is a beautiful product. People love it. I'm just starting a clinical trial on it now with biopsies. So we're going to start measuring some proteins in the skin and fibrosis. So we're going to have data and it's going to be published. So we're just starting it. We're just actually just signed the other yesterday, as a matter of fact, Tuesday to. To finish the paperwork to start recruiting patients for that. So we'll start injecting in January, but we'll. But the company is at least trying to get data on this because they're saying things, but who knows? Then there's also technique. And just think, the person who goes for plastic surgery and you look at the Patients that they see, most of them look like they've had filler. Most of them are overfilled or had problems with filler. What percentage of people who've had filler go for plastic surgery? What percentage of patients who've had filler, who look great, who don't get plastic surgery, don't have those issues? So, yeah, I guess it could happen, and that's fine. But I don't think that it means that it always happens. I don't think that it means that it's a problem. If it happens and you have so much blood supply in your skin, if you're not seeing surface changes of blood supply issues, then. And the skin looks great and the person looks great and their body's healing great and they're not needing to do anything else. I don't. I don't see why it matters. Like, there's so many things that you can look at. You can get an MRI and find out you have a little cyst on your kidney, or you have this or you have that, but you don't have any problems. The kidney's functioning perfectly, your body looks great. Who cares? But I'm not saying that, but I do think you have to be careful. And I have so many patients who come in and they have too much filler and filler in the wrong place and filler in the wrong way, and it looks wrong. There's a thing called the uncanny valley where you start to look off in balance and it's uncomfortable and it detracts from beauty. This can happen from a facelift. This can happen from fillers. It can happen from many things. But I will tell you, to the plastic surgeon side and why, I mean, I haven't had a facelift. I'm in my 60s. I'm hoping to not have one, but if I need one, eventually I'll probably go to somebody. But I see a lot of times after plastic surgery, there's a lot of fat atrophy in the preauricular area, the area in front of the ears. And there's nothing like radiesse, hyper dilute radiesse or sculpture to restore that area because they are putting tension on the skin and they are affecting blood flow. You can do hyperbaric oxygen. You can do a lot of things around their surgeries. And I'm a big fan of Cameron Chestnut. I disagree with him on the filler thing, but I think. I mean, I'm in awe of his lifestyle. Like, this guy is a perfect human. Like, it's crazy how amazing he is. And how he lives his life and his supplements and his exercise routine. I just watch and I'm exhausted. But he. I mean, he does live.
- [55:38]
A
It's also a fantastic human being, which I totally.
- [55:41]
B
Oh, he's such a nice person and so smart. He's so smart. I respect him. And that's why it's even more troubling to me that he says those things. And he says them so emphatically, as if it's an all or none. But, you know, I disagree. But I adore him and I think he's smart.
- [55:58]
A
Yeah, I love that disagreement. And again, obviously, when, you know, to really sum it up, if you're a hammer, everything looks like a nail, right? So if that's your focus, then whatever detracts from your focus is a negative. And I get that.
- [56:14]
B
But, you know, one thing I tell everybody is as important when you do the analysis of knowing what you can do is to know what you can't do. So there's things that I know I can't do, and I tell the patients that, too. So I agree. If you have a hammer, everything looks like a nail. But it shouldn't be that way. It should be that. I send people out for plastic surgery all the time because I know that not everything I do is going to solve what bothers them, and I want them to get the results they want. But I also know that surgery does not solve problems that I can solve. So I tell them, after surgery, you're going to still need me and we're going to do these other things.
- [56:51]
A
I love it. And from what I hear from you or what I, you know, looking at from your point of view, you need a. You need a responsible human being consulting and obviously treating you. That's number one, experienced, responsible and, and, and sane and not. Understands anatomy, understand anatomy, understands bias as well, understands that. Their own, Their own bias as well. Because at the end of the day, I don't want to get into the amount of C sections we have in the United States. I think there's so many examples of bias and medical treatment. However, that could be also applied to plastic surgery where there is no responsibility. There is. There is, you know, less experience or however you want to call that or less sure of a hand over there. And things cannot look great or also could impede blood flow, et cetera, on that part of the aisle, quite literally as well. Right.
- [57:51]
B
But I don't extend it out to everybody. I just say, this is something that I see.
- [57:56]
A
I love it and I love the discussion here. So listen, we have so much that we could cover.
- [58:04]
B
I know I talk, I can talk for sure.
- [58:08]
A
But I mean, we've definitely. I mean, we should do it again. We'll try to do something again. But let's talk about maybe to end this. Let's talk about some practical tips from your experience. If someone wanted to start just an internal upgrade to improve, obviously skin, but their entire body from the inside out, what would you tell them to do? First?
- [58:33]
B
From internal, I would say my number one would be sleep. I would say try to go to bed at the same time every night, wake up at the same time every morning. I would be a competitive sleeper. Like, try to get seven to eight hours a night, which is the average. I'm really religious about my sleep. And I take magnesium glycinate and an L threonate at bedtime every night with a little apigenin sometimes and my hormones. But I watch my sleep. I make sure I get enough REM and deep sleep. So I have the oura ring and it tells me. And I have the hume band and I have my watch. I have like all these things and I measure how they go against each other. They don't give me stress. They actually make me happy because I, I can. And I match it with how I feel. So one is sleep. Two is hydration. Make sure you're. You're well hydrated because your skin has hyaluronic acid in it. Naturally, 60% of your body's hyaluronic acid is in your skin, whether or not we inject it. And the more water you have, you're.
- [59:28]
A
Saying it can be more artificially, just a little bit.
- [59:31]
B
And then the third is protein. As you get older, make sure that you, you have enough protein. And there are studies that show that resistance training builds collagen in your skin. So the workouts matter. And as you get older, cardio is still important, unfortunately. I like cardio. I don't love weight training, but I'm doing it. But resistance training is really critical. So internally I would say. And vitamin D, I think, is critical. Vitamin D with vitamin K is really, really important for skin and hair. So some supplements are important. I do think a good Omega 3 that's not rancid is also important. And I also take nmn, nmr. That's helpful. N acetylcysteine. I have a glutathione spray. There's a couple things, but basically it's a few supplements, a very low sugar. Try to eliminate as much sugar as you can in your diet. So I Say less crap and then intermittent fasting if you can do it. It's not as important as you get older but a 13 hour fast basic is a good thing.
- [60:29]
A
And do you still follow your dad's type? Kind of like a schedule where you would eat earlier dinner and not eat anything after.
- [60:37]
B
I often stop eating at about 2.
- [60:39]
A
Interesting.
- [60:40]
B
Yeah, I'm not a night eater.
- [60:42]
A
Okay. How do you personally approach skincare? Do you have routines or ritual you follow like you're tried and true?
- [60:49]
B
I'm human so I'm not perfect with my skincare and I sometimes will eat crap in my diet but I'm trying really hard and I'm better. But I would say I'm always testing new products, I'm always trying things. My basic is have a clean palate. So cleansing is the most important step in your routine. Not over cleansing, not over scrubbing, but getting makeup off at the end of the day and not going to bed without washing your face in the morning. You could just rinse with water and then I have been using the RLX, the req@ night, my molecule and my retinoid and moisturizer in the morning. I'll do moisturizer, sunscreen. If I'm feeling more motivated I'll put on a serum or something. I'm testing but I can be in a hurry in the morning. But definitely a good moisturizer and on the body too. I will do my body retinol and I will do a good moisturizer and I leave it in the shower and I have a really nice foot cream that I put on my feet before I go to bed because my husband knows if I'm ever incapacitated he has to moisturize my feet. I just don't like.
- [61:49]
A
Nice. So in Anastasia, my wife, the co founder of Young Goose, when she was pregnant I used to massage her feet every day and she says that that's the only reason she's going to get pregnant again.
- [62:00]
B
Exactly. You see this is well also you make very cute kids so that your 2 year old is adorable. So I think at least 4 more. Tell your wife let's go. You have to keep massaging.
- [62:09]
A
Yes, let's go.
- [62:10]
B
Yeah. Two is a good age to have the next one.
- [62:13]
A
Yes. And you know there is a new study showing that women who have kids later, they enjoy more longevity. So there you go. Last is what's one thing you wish every patient knew about their skin?
- [62:26]
B
It's an open question that it is healing and recovering and it's never too late to Help your skin look its best. I have patients who are in their 80s or 90s and they go, yeah, I don't know, I'm going to give up at some point. And I'm like, why? It's like we can keep going with. It doesn't have to be treatments but it can be skincare. My mom is 93 and she still likes her skincare. She loves all of it. So it's never. You're never too old to want to still look beautiful. And beauty can be more beautiful with age. I think every decade should be your most beautiful best.
- [63:04]
A
I couldn't agree more. I couldn't agree more. And people are starting to discover it too. That's a trend now to say, hey, wherever I am now, 30, 40, 50, this is. I really feel my most beautiful self. And I think that's lovely.
- [63:17]
B
Yes.
- [63:17]
A
Dr. Doris Day, this has been amazing. Where can people follow you? Obviously you have a show on Sirius XM social media. Where can people find out more if they want?
- [63:30]
B
It's super easy. I'm DrDorrisDay on everything. Instagram, Twitter, Facebook. It's my website. Dr. DorisDay. Dr. DorisDay.
- [63:39]
A
And how can they kind of follow the trajectory of RLX to what's the RLX?
- [63:47]
B
201. The product is called REQ, Rapalogix Health R A P A L O g I x health.com is the. Or rapalogix.com either one is the website. So there's. We're building out the website but there's a lot of really good information up already and we'll have a lot more on it to come. So the building the product was almost easier than building the marketing.
- [64:12]
A
Wait until. Never mind, we'll talk. I know anyway, as I say, you know, it's easier to charge it. It's shorter to charge a Tesla to 80% than to the. Between 80 to 100%. But thank you very much. We'll have everything in the show notes and we hope to have you back here. It was incredible.
- [64:33]
B
Thank you. Thanks for having me. This was so much fun.
- [64:36]
A
Yeah. Thank you everyone.
- [64:37]
B
Bye Sam.