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Skin Anarchy
Lessons in Longevity: Debunking NAD and Cellular Health with Dr. Tiffany Libby of Niagen Bioscience
00:50:02
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- [00:02]
A
Hey, guys. Welcome back to Skin Anarchy. Today's episode is very special because a lot of you have been asking about supplements, especially NAD supplements, and trying to understand their science and understand how does this fit into overall skin health, health in general wellness. And so, as many of you have seen, we've started the entire longevity series, and I think this really ties into longevity overall. So without me ranting too much, I would love to introduce you guys to. Dr. Tiffany Libby is truly an extraordinary dermatologist. She's board certified and has so many accomplishments under her belt. And so I'm so excited, Dr. Libby, to host you and to talk about Neogen Bioscience. So welcome to the show.
- [00:44]
B
Thank you so much for having me.
- [00:46]
A
Yeah, I'm excited to dive in and learn more about you. You know, you have such an impressive background, and I mean, you've really seen this very deep dive level of science, you know, especially from the dermatology side. So I'd really love to get to know more about you and your interest in obviously, dermatology, but then the longevity space as well. If you kind of give us maybe a walk down memory lane a little bit.
- [01:07]
B
Yeah, absolutely. So my current role, I'm the director of Mohs Surgery, which is really a specialized way to remove skin cancer. And I'm a dermatologist specializing in cosmetics and lasers at Brown University Health. So, you know, I really love that I get to do really the procedural side of things, but I'm having very varied conversations with people who are dealing with, you know, high burdens of skin cancer at all aspects of their life. You know, we're seeing patients come in as early as in their 30s, you know, with skin cancer and helping them manage that and then well into their 90s. So something that they, we know will be dealing with chronically and then dealing with, you know, cosmetic patients who have a very different, you know, they're coming in and they don't necessarily need you. Right. They're looking to feel better, to look better and improve and kind of have these conversations, and they want to do it on a holistic level. So I think the longevity space has been very interesting to me. I think when I think about when it first started for me, that interest, I. It kind of brings me back to my childhood. You know, I grew up in a medical household. My dad's a urologist. And from a young age, medicine really felt like home to me. I really saw the responsibility, that desire to constantly be learning, putting in those long hours, and that's was always really deeply fulfilling to Me and figuring out how you can help help your patients in every aspect live long, healthier lives. And then when I was really young, my mother was diagnosed with an acute onset autoimmune disease and she had almost passed from that. So high dose prednisone saved her life, but at a big cost, permanently damaging her adrenal system. And she's lived with these long term consequences since. And yes, she's surviving, but you know, we talk about lifespan and how that differs from health span. Is she really thriving? You know, she kind of put off a lot of these things that she wanted to do later in her life. Enjoying freedom, travel, enjoying being active with us as kids and now with her grandkids, she's not able to do that. So you kind of think about, makes you think about these things earlier on because most of us don't think about longevity when we're young and healthy, right. We think about it when things have happened to us and we're thinking about, oh, how can we dial things back or how can we chase that fountain of youth and what can we be doing now? And I think this is a really exciting time to be in science because we can actually do things and we're learning so much. The space is constantly evolving and there are actionable, actionable things that we could actually incorporate into our lifestyles now.
- [03:38]
A
Yeah, no, it's so fascinating what you're saying, because I think that really kind of hits on, you know, I think a lot of people's interest in longevity. You said it wonderfully, where we don't really think about it. We don't, you know, engage in like, I guess, interventional options, you know, before, early on, especially not in, like in our 30s or even early 40s. And then, you know, all of a sudden something happens and we're like, oh, wait a minute, you know, I need to think about this. So that's very fascinating. Fascinating to me that you brought that up, because I think when I think of any supplement, I think that's where we are. You know What I mean as a supplement industry is that people are coming to this realization and understanding that the body might need some help at this point, you know. And so I guess my question really is for you, like, how do we. I mean, also, I'm curious as also being in healthcare myself, like, how do you manage that expectation with patients right when they come in and they're like, well, now I want to learn all of a sudden about entity supplements or any supplement or anything that they can do to intervene. I mean, where do you think that balance is between like treating someone and then also educating them on these kind of interventions and these kind of like, you know, preventative measures that we could be taking?
- [04:49]
B
Yeah, I mean that's, these are all great points. I feel like there's so much to dive into here. And I think just to wrap up, even on that note, I think it's a systemic problem. Right. Of our U.S. health care system. We're really a treatment based healthcare system. We don't invest much in our preventative healthcare services and we see that in every aspect and how that plays out. You know, where we're more of a specialist dominated healthcare system versus only quarter of our US physicians are in preventative or primary care roles. And we spend, I think less than 10% of our healthcare spending is on prevention. So I think supplement industry is just very interesting because yes, people are coming to it, hopefully to want to get ahead of things, but also because they're looking for a fix. And I have many thoughts on this because I'm always looking at things from a holistic perspective. And I think we, in this, you know, in this world, everyone wants that quick fix. And this is not, there's no, there's no fountain of youth. I think that there's, yes, there are these amazing energy supplements that we're going to get into today. But it's a lot of it are the things that we've known for a long time. Decreasing stress, eating well, exercising, staying active, you know, decreasing that inflammation. So having good sleep. I feel like these are things that we were trying to find ways around that. But I feel like we have to incorporate a lot of those foundational truths and then we can also build on that. So I, you know, just like when I have conversations with my patients, hey, if we're not going to invest in good sunscreen use and be diligent about it and reapply and apply the correct amount, then what, what are we doing having the rest of these conversations and chasing these treatments? You know, so especially when it comes to conditions like melas, have to let them know that there's no real cure. You know, we kind of have to be aggressive with prevention and if you can't promise you will, we will be. Then we don't want to be spending all that money on the treatment side of things. And for nad, this is definitely, you know, a buzzword right now. I'm getting a lot of people asking me about this and we have, you know, we have a, this is already ingrained in what we do in dermatology and I'll get into that as well. But NAD as we know, is, you know, really critical for increasing cellular energy. So, you know, when we're explaining patients, you know, they hear about this, like, can you tell me more about nad? You know, what, what is this? And I kind of explain it as an analogy. You know, I like to use analogies. And I think, I say think about your mitochondria because some people have heard about that mitochondria word, you know, and that's a cellular organelle in all of our working cells, like 99% of our working metabolically active cells, mitochondria is present. And it produces, it's like the powerhouse, the power plant. It keeps the lights on in our cells and it keeps them functioning optimally. It produces cellular energy. So you want to think of it that way, ATP. And in order for that process to occur and, and produce ATP, we need nad. So NAD is really critical to making sure we produce cellular energy. And then another big part is cellular repair, because, you know, things are always happening to us and we're always kind of defending and repairing. So we want to optimize those processes as well. Because when those processes are not optimized, you know, that's when things can go awry and we're not able to fix and, you know, stop some of those negative consequences. So I like to think about NAD that way. And what's fascinating to me is that just like all good things that decline as we age, NAD levels also decline as we age. Actually, they drop by 60 between the ages of 30 and 70. So think about all these cells that require NAD to produce cellular energy. Now they're no longer functioning as optimally as they can be. And that's a big problem. Right. So. So I think that's, you know, and that's one aspect of this whole. How do we optimize our own health? How do we allow our cells to function to the best of their abilities? And these are cells that we're talking about that produce not just collagen, elastin, but, you know, for our skin structure, but also help repair DNA damage at the surface level of our skin. Because, you know, our skin is constantly battling UV radiation that's causing UV induced DNA damage and then that eventually leads to skin cancer. So. Right. There's so much that's happening and it all starts at the cellular level. So I think this is a fascinating time to be able to make changes at the cellular level.
- [09:24]
A
Absolutely. No, I think it's really fascinating, the whole movement around nad. Because I'm not going to lie, at first I was very, very skeptical about it because I come from a very heavy cell biology background. And so for me, when I think about anything going inside of a cell and then acting and then working within that normal cellular machinery, I know there's a lot that needs to happen for that to occur. So, like, that's where I think I get lost in this world of, like, if we supplement our cells, they're going to incorporate that molecule and then utilize it in the normal machinery. So here of like the biotech being utilized by Niagen, that is allowing for NAD to actually be utilized by cells.
- [10:02]
B
So I love that you brought that up because I think as scientists, right, we're always led. We're always, we always lead with skepticism. And that's the way it should be. We should always be like, hey, I don't believe this. I want to make sure, like, convince me that this works, right? And that's sort of how I, you know, even when I was. I told True Niagen, when I started working with them, I was approached by many different supplement companies for hair and pearl, various things, and I said no to them all. Yeah, True, True. Niagen sent me over all of their clinical studies. They've done over 40 human clinical studies there. They have an external research branch that they have a patented nicotinamide riboside. And I'll get into why that is the best way to boost NAD levels. But they have a patented ingredient called Niagen, which is being used independently by Harvard Mayo Clinic by a lot of premier institutions and organizations in order to do research on cardiovascular disease, Alzheimer's, long Covid inflammatory diseases. So they're investing a lot. And their product has been vetted and has been heavily studied in its ability to actually increase NAD levels in the cell. And I think, you know, when we think about nad, then there's other players that people also hear about, like nmn, nr. They're like, what? What is all that? Like, it's Alphabet soup, right? So, and I feel like when you think about nad, I mean, we've heard about it because we've taken Biochem back in our medical school days and Krebs cycle and ATP. But a lot of it's, you know, they just hear nad and they think, I need to get NAD into my body. How do I do that? But that's not the right way to think about it, because nad, as you know, is a large charged molecule that does not enter cellular membranes. So you actually need the precursor to NAD and that precursor, there are multiples of them and the most well studied one is nicotinamide riboside, which is their patented ingredient. True Niagen's patented ingredient, which they call Niagen, that one actually can enter into cells and then has been shown to boost NAD levels and by taking 1000mg daily, has been over three weeks, has been shown to boost those nad levels by 150%. So that's very meaningful. What's interesting is NMN, which is also very buzzy, that needs to be converted to NR before it can enter cells. So it needs an extra step and it also relies on another enzyme in order to be converted to it. So if you have low bioavailability availability of that enzyme, you're not going to get as much of the nr. So NR is really the one that we want to be focused on and that translates into increased NAD levels. And I think you bring up a great point. How do we know what's being told to us is actually happening? And True Niagen has really taken it upon themselves to perform all these clinical studies to demonstrate that not just in vitro, but in vivo, this is being shown.
- [12:55]
A
Right. That's very fascinating. And that's, that's really why I asked you, because. Exactly. You know, there's so many brands right now. I mean, literally NAD came out and everybody had a supplement. You know what I mean? It was like everybody, everywhere you look, and it's like for the longest time, like, like I said earlier, like, I was just kind of like overwhelmed, you know, as both a consumer and also from the healthcare side, I was like, this doesn't even make sense, you know, like, what are we doing? I'm sure a lot of people agree your mind goes to toxicity, right? It goes towards the other side of things. Because if you put things in your body that are not made like, you know, what you're explaining is very, very. That's rare to see that in a supplement brand, you know, But I'm talking about the. When people don't do that homework and they just give you these supplements and then you're flooding your body with it. That there's a whole other side for all of our listeners, which is the toxic toxicology side. And that's very, very important to understand. And, and so when you guys are shopping, like, these are the kind of things you should really hone in on, you know, because there can be a lot of damage that can happen.
- [13:54]
B
You are so right. Because even as a physician, I mean, I'm Thinking about it from like a skincare perspective, patients come in, what should I buy? That they're overwhelmed. What they see on the skincare aisles, right, there's tons of stuff out there they don't know. But this is even more critical. This is what you're putting into your body. And this is, as I'm sure you have a very widely educated base here. But the supplement industry is not regulated. So we don't know those claims. What they're saying is, in their formulation, you don't know if that's true. We don't know if there's extra stuff in there. We don't know what the percentage of that is. And that's really frightening for consumers. And that's why I was always very hesitant to get involved in any supplement space. But what I really come to love about this company, True Niagen, is that they've taken that very seriously. They recognize that there's very little regulation, not even by the government's fault. They don't even have the ability to provide this kind of oversight because the industry is so large, they can't even do this kind of independent testing. What True Niagen has done is they've taken it into their own hands and you can go into their website and you can see they've tested, they've done independent testing of some of the competitors, brands and their own, and they done third party testing just to say, hey, we love that second opinion. We're like, hey, let's get more testing, let's vet. And the more evidence we see, the more we can trust. We want to be able to trust what we're using, just like we want to be able to trust our doctors when they're telling us, you know, advice. We want to be able to trust that what we're taking is doing what it's actually saying it's going to do. So I really respect that. You know, the company takes it seriously and unfortunately has to spend funds of its own in order to help police the arena, if you will. Because shockingly, they found that many of those supplements, like you said, don't carry the amounts or don't even. Can sometimes even contain the ingredients that they're stating they contain on their box.
- [15:40]
A
Yeah, no, I mean, I'm glad they're doing that though. Honestly. I think that's, that's important to set an example in this industry with that, because at the end of the day, and this is generally my opinion about supplements, is like, if you're going to make a supplement, you need to put the, the money behind testing it, you know, like, you got to do that, because if you don't, then you're exactly what you're saying. Like, the FDA is not doing anything about this stuff. You know, there's a lot of doctors right now. I, I saw one very, very famous. You like, you know, podcaster. He's a, he's a physician and he was talk, you know, he believes more in the pharmaceutical industry than he does the supplement industry. And I see that point. But at the same time, there's an argument to be made where it's like, well, the FDA is not doing jack about this. You know what I mean? They're not coming out and saying, we're going to regulate it. So at the end of the day, what do you do? You're still going to have products, but you have to put some responsibility on those brands and say, okay, you're coming out with a product now test it and show us that you tested it. You know, show us the data. And the fact that, you know, true. Niagen is saying that, yes, we are testing our product. You know, we're not going to just be out here and not give you that information. That's huge. I think that goes a very, very long way and it sets a really good example for this industry. So, yeah, yeah, I really feel like.
- [16:51]
B
Even with, I, Me too, because I think with skincare, you know, again, there's also so many brands out there and I think the ones I feel responsibility when I am working with brands on advisory side or promoting it or recommending it to patients even, you know, for me, it's something. Is this something I would use? Is it something that I know is going to help or at least I can help them understand how much it will help, you know, so. And that's really helpful when they've done those studies and we're not talking about like, you know, patient satisfaction studies or like on 10 patients, you know, we're talking about real studies where they're doing things that they can actually measure. Is it actually increasing the skin moisture content? Is it actually increasing these essential skin barrier lipids and, you know, so we want to know, have actual metrics that are objective.
- [17:34]
A
Yeah, well, let's dive into that because I want to. A lot of our audience, obviously, we want to learn most about skin health, you know, and like that. So you, you just mentioned a coup just now. But, like, overall, what are the actual, like, results that we can expect if we're using an NAD supplement regularly and sticking to it?
- [17:53]
B
I think it Depends, like what kind of NAD supplement, first of all. Right, so I think what we've sort of alluded to here is that they're not all created equal. And, you know, I think NAD is so buzzy that NR kind of gets lost in that. But really, nr, the Niagen, which is the patented nr, is going to be that precursor you're looking for to boost those NAD levels. And it'll depend on the amount that you're taking. So if you're taking 100 milligrams daily over three weeks, you'll increase your levels by around 20 some percent. That's what the studies show. A thousand milligrams will increase it by 150. And really the maximum daily you can take recommended is 2000. But what's also exciting is the brand just launched a true Niagen beauty supplement and that one is 100 milligrams. So it's meant to be as like a booster to be added with, you know, one of the other main products like the age better or the clinical strength, which age better, is 300 milligrams. Clinical strength is 500 milligram capsules. And it's meant to specifically have these skin healthy ingredients like astaxanthin, which, you know, has potent antioxidant and anti inflammatory capabilities. It's a carotenoid and it helps to reduce oxidative stress and inflammation and has measurably been shown to help improve skin moisture content and skin elasticity. It also is formulated with biotin, hyaluronic acid, grapeseed extract, vitamin E as well. So these are all ingredients that are helpful to support optimal skin barrier health, help improve skin elasticity and collagen production. So, you know, I think this is, it's great sort of thinking about beauty from within. You know, we are off. It's meant to complement your skincare routine, meant to complement everything else that you're doing. But I always like this layered approach. You know, when you can tackle something from multiple aspects, you know that you're going to come to that solution more quickly and more effectively.
- [19:57]
A
Yeah, no, I love that and I. That's actually, that's solid. I mean, those are some of the major things we're looking for when it comes to just, I guess as consumers, you know, wanting more resilient skin. Right. And so I think that's huge. And, you know, I want to ask you this from the longevity side as well, because we are hearing so much about mitochondria these days. You had brought it up briefly, you know, earlier and the whole idea of mitochondrial health, I think, is finally and rightfully so, taking, you know, center stage. And so when it comes to the mitochondria, what is it that you think consumers should understand about true mitochondrial health? Longevity, resilience. Like, what is it that matters when it comes to that? And how does NR play a role?
- [20:40]
B
Yeah, so mitochondria, these are the cellular engines of our cells. So when we think of our skin, you know, I know we, we recognize our skin is such a dynamic organ. It is really the only special super specialized organ that is sort of constantly defending. It's our interface with the outside world, you know, so it is constantly protecting us from all the external ag we know. Well, UV radiation, which is responsible for 90% signs of skin aging. Right. So your brown spots, wrinkles and loss of radiance and sagging of skin. So it's responsible for 90% of those signs of photo aging, and it's responsible for 89% of. It's 80 to 90% of skin cancer. So our skin is highly dynamic organ, and there are a lot of different processes happening in it from skin regeneration, skin cell turnover, DNA repair processes, producing collagen and elastin, producing all of those ceramides, those barrier lipids, all of those, you know, those healthy fats, the lipids in our skin barrier that help keep moisture content in and prevent dryness and help keep that microbiome stable. So there's a lot of things that are happening in the skin, and all of them are mitochondria dependent, meaning that they're depending on these mitochondria to be functioning optimally. So if the mitochondria is not producing enough cellular energy because NAD levels are dropping, then all of those functions, as we can see, will decrease. And I think, you know, we're always floating in beauty that we lose 1% of. Starting in our mid-20s, we lose 1% of collagen in our skin per year. When women hit menopause, you know, we start losing even more than that. That kind of number jumps up to 2% per year. And you know that. But sebum production decreases, and that means skin is drier and the skin barrier health is now weakened and is no longer functioning as, as optimally as it can be. So there are a lot of things that are decreasing in the skin that are happening as a result of just aging and internal processes, let alone all the UV radiation that's sort of bombarding us and creating this constant battleground, if you will, on, on the skin. And we're relying on our cells to be able to defend and sort of take up these free radicals. You know, we want these antioxidants, we want all of these processes to be functioning in unison to help, you know, keep all this damage at bay. But unfortunately, you know, these processes start declining because, you know, we have less cellular energy feeding it. And I think what's important is all of these things that we see downstream can actually be helped by an interesting. This almost like a singular pathway, you know, that's upstream and helps with prevention and is really tied to so many of these processes that are critical in maintaining not just skin barrier health, but, you know, reducing risk of developing skin cancer in the future and reducing signs of the photo aging.
- [23:43]
A
That's so interesting. I mean, I find that to be so fascinating on so many fronts because there's. I mean, I think at the end of the day, when it comes to longevity, most people, I think they assume that we're just talking about, like, reversing damage or, like, you know, like, how can I, like, kind of take things, like, in the opposite direction, Right? But then when you think about true preventative measures, like, you're really actually priming yourself to age better, you know, and to really, like, do better as you keep going forward, you know. And so I think that's a whole, like, mind shift, you know, that needs to take place, I guess, when we're approaching these kind of, like, interventions, because, I don't know, like, longevity is interesting for me, you know, right now, the whole space, like, I think people are divided in the way that we view it and the way that we like what we expect, I guess you could say, from it. So whether it's a supplement or, you know, you had brought up skincare earlier. Even the longevity skincare that I'm seeing pop up, you know, all over the place. It becomes this idea or this hurdle of setting, like, true patient expectations around this stuff, you know, and. And figuring out, like, what can you rightfully expect? And, like, when it comes to your mitochondria, you're not going to reverse what's already happened. I mean, I think that's the thing that I. I get very stuck on that because I think a lot of the people, even the ones that chime into our podcast and our emails, they're always asking about, how can I reverse the damage, how can I reverse this? How can I make things go back to how it was when I was 20? And it's like, you can't. There's no way to do that. So, you know, that's why I asked you about that is, you know, why does mitochondrial health matter? But no, I, I want to actually ask you more about a little, go a little deeper into biomarkers because you can't talk about longe without talking about biomarkers. And I think right now with all of those independent companies that are out, like, I know Function Health does this, there's so many that are tracking almost every biomarker that you can think of, you know, through blood. And so what are your thoughts on that in terms of like, just biomarker studies and, you know, I guess how it ties into what Trigon is doing and, and what we should know as patients, as consumers about what, what we can really rightfully or, you know, I guess logically interpret from these kind of like, you know, tracking or this kind of like, you know, looking into our health like constantly, like, what should we really be looking at?
- [25:59]
B
This is fascinating because I've always been a strong believer of you don't test unless you can do something about it, you know, and if you're going to test, you know, you have to be prepared to interpret those tests and help guide on what to do next next. So I think that right now we're kind of outpacing, we're being able to test all these, you know, we can all these biomarkers and we can link them to different things. They may be correlated with certain diseases or certain disease pathways or inflammation. But I think we still need a lot more studies before we're making, you know, major clinical decisions on what we should be taking or how we should be intervening. So I think, you know, it's great that there's such a large focus on this and that it's such an evolving space. But, you know, I'm sort of someone who likes to wait to see more evidence on how to incorporate this into clinical practice. And I think it sometimes can be a little dangerous when consumers just have access to the ability to get all these tests and then they don't know what to do with that information. You know, just like when sometimes we have patients who are, they're released in their portal their imaging results or their biopsy results, and they get them before you do, and they don't know how to interpret, you know, some of the side, the footnotes of the pathology and they're calling you frantically. So I think it can sometimes create more false hope or more stress or chaos. So I think there's still a lot more that we need to tease out in this field. I think it's fantastic that we can measure and, but we need to have a better, you know, more robust studies to not just correlate, but really show that it's really causing these diseases. So I think it's like the big thing is correlation, not cause or causation, not just correlation. Right. So I think that there needs to be a lot more research done in this area, but it's an exciting space for sure.
- [27:47]
A
Yeah, no, I, I think that what you said is so like on point and I, and I've been very much like trying to like put this out there. I, I wrote about this, I think a few months ago on LinkedIn and I got a couple of comments on there that were a little hateful, I think, because people were like, well, you know, because the whole idea of biomarkers, you know what I mean? It's like exactly what we were talking about here is like biomarkers matter when you know what they mean. But there's literally out there right now that's going to be able to interpret, okay, over six months you tracked xyz. What does that mean for you? You know, what does that mean? Yeah, like, and also like if you already have certain things you're dealing with, if you have comorbidities, you're all, I mean, everything will change, you know, based on what you're already combating, your body's already working on. And so it's going to be different for everybody. And there is no framework at play right now that's going to help you interpret any of that. So for all of the people that are or, you know, looking at their aura ring readings every day and you know, just like crazy stuff. I'm like, it doesn't, I don't know, it just, it feels like you're putting the cart before the horse when it comes to this, you know, and so.
- [28:53]
B
I mean, isn't this, isn't this the theme though? It's like so much like think about all the images we get flooded with daily, all the news, all the, all the headlines that we get flooded with. There's so much data out there, it's almost like you don't even know how to interpret it. You don't even, it's almost more anxiety provoking having all of this information. Right. But I think the key is knowing what to do with it. I don't know if we know exactly any how to interpret it all yet. So I would be hesitant to just put too much weight on what some of those tests may be showing until there's more information and we want studies that are going to get rid of the confounders. Right. Because there's some people have a lot of different comorbidities on a lot of different medications or taking a lot of supplements. You want to be able to isolate that. That biomarker is really doing that really is something that's going to cause xyz. We don't need it to be something that, oh, you know, it has been seen higher in people with xyz. We want to know, is it really going to cause it?
- [29:48]
A
Right, exactly. And also, like, you know, not everything needs to be labeled as a biomarker. Like, there are just certain things that are present in your body and they fluctuate literally second by second, minute by minute. And that doesn't mean it's a biomarker. It just means it's there.
- [30:04]
B
It's very true. It's testing is a, a point in time. And I think that's, that's really critical. And sometimes people jump to conclusions based on that point in time. And that can also be dangerous. For example, if you're doing imaging and you didn't have a baseline that could be interpreted very differently, you know, as a sign of growth or something that has been stable. And sometimes labs can be erroneous. So I think we have to take everything, like you said, with a little bit of skepticism and wait and really make sure that there's robust science behind it before we take it as, you know, the end all be all.
- [30:38]
A
I agree. Have you, you know, you brought up imaging? I want to just ask, have you seen the. Or have you had patients that have come to you and been like, I put my results into CHAT GPT and it told me like, like people are doing that. Apparently they're putting like radiographs into like CHAT GPT.
- [30:54]
B
Wow.
- [30:54]
A
Yeah. Yeah.
- [30:56]
B
I wonder. I mean, we did some work on AI and just how, how good ChatGPT was at answering dermatologic board examinations. We used it for how could it generate representation of. Accurate representation of surgeons. And like, there are a lot of biases and problems there, you know. So I'm curious in the radiographic, I'm sure there's been studies that will examine how well it can detect anomalies compared to radiologists. I would assume that, you know, it probably does pick up on a good number of findings. And yeah, like, major, I would never rely. Lie. You know, that's like the whole ethical component of AI. Who's liable for this? You know, in terms of the read. And these are the things that we still, like, where the technology outpaces the clinical implications and the ethics behind it all. You know, I, I'm not surprised that ChatGPT might be able to diagnose from a radiograph certain things, but they also might miss other things too. You know, what's interesting is there's an interesting study that looked at just using these LLMs, just trying to determine if a biopsy was malignant or not. And it was performing very well. And then they realized that, wow, a lot of the biopsy images that were taken, the ones that had rulers in them or were marked with it, you know, rulers were ones that were more highly suspicious to the physician. So it started picking up on, oh, ones with rulers are going to be ones that are more, more likely to be malignant. Like that's not the right clue you want, you know, so, so there are things like that where you have to make sure that the interpretability is representative, you know, and that the thought, the algorithm that it's using to generate the output is one that's been checked a bit. And that's a problem with AI. A lot of it's still like black box. You don't know exactly how it's arriving to its conclusion. Yeah. So, I mean, I'm sure that, you know, I'm not surprised that people are doing that. They're using it for so many different things. And I feel like before we used to laugh @, oh, Dr. Google that, you know, patients coming in. Well, I, look, I talked to Dr. Google and this is what I found out. Can you now, it's, now it's a whole other.
- [33:04]
A
Beast. Yeah, yeah, it is. Because, I mean, I've seen it. I think, I think a lot of people, not just like the obviously imaging is like, in my opinion, that's a huge problem if you're putting your, your imaging results in there, but then even like taking a picture of your face, you know, or like something going on, like from the dermatology side, especially like if you have a rash or if you have some sort of lesion that's popped up or something. Right. Something's different. You put it into charge. It has no way, I mean, I don't, I don't think it would be able to do it. Maybe like there's a chance, but that it can't replace you. Going to a phys, like physically going to a dermatologist or an actual physician and having them look at it. And I think that's where a lot of times, like I, I, I've seen this a lot, people are literally arguing for it, you know, and they're saying, well, no chat. GPT told me that this is what's going on. And it's exactly that same situation of like Google, you know. So, yeah, I just find it to be very interesting, the time we're in right now with all.
- [33:59]
B
That. It's a very interesting space because, yeah, I think that we are seeing that it can perform sometimes better than physicians in diagnosing some of these conditions. But, I mean, there are studies that show that. And, you know, I feel like if that's the case, then, you know, we. There's ways we can leverage that. You know, maybe you can use it as a triage tool. You know, if you're get like, there's a huge shortage of dermatologists, especially in rural areas, and can you get this technology out so at least it can be used as sort of a triage tool so you can escalate the severity of this case of being seen, you know, so that the. The patient can be like, you know, in your clinic that next week versus something that can really wait months. And so I think that there is utility there. But I think, as we know, even when Covid hit and we had teledermatology was huge and, you know, translated very well into like, psychiatry and even pediatrics. We thought it would translate very well into dermatology, but it didn't. Actually. It's very hard to do a full body skin exam via telermatology. And, you know, I mean, it's very hard to diagnose something without examining with a dermatoscope or touching it and feeling it and getting, you know, so there was actually, we realized a lot more nuance there, and that might not necessarily be picked up from just a sheer.
- [35:22]
A
Image. Right, right. No, it's a. It's really fascinating, dermatology. I think that's why for me personally, it fascinates me because it is a field that it does require that actual human component, you know, of like a real. A person seeing you physically. I. I believe it does. I mean, I think at the end of the day, yeah, you can do certain things that are maybe like, you know, a little bit. They'll point you in the right direction. You know, maybe you can go to your dermatologist with a few questions written down, but you need somebody to look at your skin, you know, and you need them to actually evaluate even something like rosacea. You know, so many people chime into our comments and DMs about, Hey, I have rosacea. I have, like, how do you know you have rosacea? How do you know? How do you know you have, you know, like, I don't know, whatever it is that you're, I mean, you, if you haven't seen a dermot term, like, where is the proof that you have it? So that's where I, I get a little worried, you know, for consumers and patients because we want to really put that again, cart before the horse without really doing our deep dive, you know, and going to a.
- [36:21]
B
Professional. So I think sometimes some, some early stories, you might want to rule out lupus. So I think. Yeah, yeah. So very critical to make sure that, you know, you aren't just writing something off just because you've double checked it with.
- [36:34]
A
ChatGPT. Right, right, exactly. No, I want to, actually, I want to circle back because, you know, speaking of true, Niagen, I have a few other questions because you spoke about how this is bioavailable. You know, this is more bioavailable. And speaking of bioavailability, I mean, the question comes up about time frames, right? In terms of when can people rightfully expect to see some sort of a difference or maybe, you know, what, what do we tell ourselves in that category of like, well, this is when I should start seeing some results. Is, do you, is there like a marker that has been set yet in terms of like timeline or what are your thoughts on.
- [37:12]
B
That? I think this varies for everyone because everyone starts with a different baseline. I think what they've been able to show is the percent that NAD levels get boosted by in what timeframe? So within three weeks you should start to see that or cellularly, you know, on that level, your NAD levels will be boosted by 150% if you're thousand milligram daily dose. I think that translates differently into what people see. I will give a personal anecdote because when I started working with the company, I wanted to take the supplements first myself just to, you know, just to obviously try it out and make sure it wasn't something that really interacted with me. And I felt really good about using personally and recommending to others. And a few months ago I was looking, I was reading, you know, something and I was looking at, I have a piece of hair hanging over my forehead and, and the distal end was gray, but then the proximal 2 inches was black. My hair is black. And I said, that's interesting. Usually it's the other way around. You know, your hair's not growing in gray. And I thought, what did I do differently over two months? Because usually you know, when you see telogen effluvium, something happens, and three months later, hair falls out. Right after pregnancy or after severe illness or surgery, like, what did I do? Like two months ago, I'm like, oh my goodness. I started taking Truniagen. And I'm someone. I don't really take other medications. I don't. I wasn't changed. There wasn't meaning something meaningful changing in my life at that time. So I thought, oh, this. That's very interesting. I shared it with the company and they told me that, you know, just anecdotally they've had a lot of people notice significant improvements in their hair growth. The density, I thought that was fascinating, which kind of makes sense. If you're optimizing your hair follicle function, you're able to produce, you know, in the melanocytes within your hair follicles. Right. If it's getting to that, that level, you're going to have more full hair, maybe less grays, maybe more density. So I thought that was very interesting. And then another one that it translated for me personally was I went to get my hair colored and I've been going to the same girl for three years now. And she said, what, what are you. What kind of shampoo are you using? Or what are you using in your hair because your hair is so thick? She said, I've had to. She usually mixes one bowl of color for my hair. She had to mix two and a half. Yeah, that was how. And she was. I. I thought that was so fascinating because I'm like, I didn't even really notice. I haven't, I've been so busy, I haven't been paying attention and I usually wear my hair up. But I thought that was interesting. So I think it manifests differently for everyone. I've talked to others too, and you know, they may say that they feel more energized. You know, I feel like as a mom of three and constantly working, very busy, I can't tell if I feel more energized. My energy levels are always pretty low. But, you know, I could use more energy. But, you know, I've note, I've heard that as well anecdotally, but I think those are, again, like you said, many. Those are things that it would be great to be formally studied. And I think they're actively doing that now. They're looking into how and with measurable outcomes, you know, with trichoscopy, can they actually see that the hair density that, that it's actually materializing versus just Anecdotally, it's great to hear anecdotes from people and like my personal story. But we want to know on, on a larger scale, how is this going to translate for.
- [40:22]
A
People? Right. That's really fascinating that you notice such a difference. That's huge. That's.
- [40:27]
B
Huge. I'm so.
- [40:27]
A
Happy. Yeah, I bet. I mean, it's really cool because, I mean, especially now everyone is on a glp, I feel like, you know, and so they're losing to compare and, you know, that's, that's really cool. That's really.
- [40:39]
B
Cool. That is.
- [40:40]
A
True. Yeah. Now I'm curious though. You know, we talked so much about diagnostics. I have to ask you if there was one ideal diagnostic, you know, modality or some sort of a tool for longevity, especially when it comes to the skin, something that isn't already, you know, we don't have it, what would you want that to be? Like, what in your ideal world? Like, what would that look.
- [41:00]
B
Like? I'm like thinking, I mean, I think there's so many things I would think about outside of just this for skin longevity. But I, you know, I, when you, when you bring that up, I feel like people are really interested in testing right now. Like, what can we test? You know. Yeah. I think that there are these interesting machines out that you can take a picture and you can see your percentage, your level of photo damage. I can give you your skin age. You know, it can give you how much pigmentation or wrinkles or bacteria you have on your face. I can kind of quantify that for you real time. It'd be interesting if we're talking about cellular level, if there was some diagnostic tool that could also maybe real time measure, you know, some of those cellular NAD levels or how optimally those skin cells are functioning. You know, maybe it's something where you can see that areas that are more photo exposed are really running low on NAD levels or, you know, and you might realize that, okay, I need to be boosting it or either internally or, you know, know. I don't think it's confidential anymore. I did ask the brand if I could share because they, they have a new innovation that's going to be launching soon, but it's called a nano cloud. So it's basically how do we get this NR directly to the skin? And you would love this because as a, you know, chemist and with your, your science background, NR is not water soluble. It's, it will disintegrate basically in water. It's not stable in an aqueous solution. So that was really problematic because everything comes in a serum or a cream and how do you make it stable? And they really, you know, they don't want to just put a claim on there and send out a product that you know that by the time you get it, the NR levels are not going to be non existent. So they formulated a dry product, a powderized, essentially, you know, form of nr and then the packet is formulated with like hyaluronic acid, ceramides and other good things. And you can add a serum then and it will activate, it turns into a serum, like it kind of dissolves into your palms within a few seconds and then you can apply it directly to skin. So I find that fascinating because, you know, I thought I would have gone to this earlier, but from a dermatologic standpoint, we've known for years and we've had studies on this already that nicotinamide, which is an NAD precursor, we give this in high risk in cancer patients because studies show that taking nicotinamide 500 milligrams twice daily can help reduce your future risk of developing non melanoma skin cancers. So your basal cell squamous cell carcinomas by 23%. So, and a recent study out of JAMA Derm that looked at a ton of VA patients also corroborated this. They said they found a 14% risk reduction, but they also found that that risk reduction was higher when you took it after your first diagnosis of skin cancer. So it's like earlier interventions, even better, better. And the reasoning behind it, the mechanism of action, is because it's improving your skin's ability to repair DNA. So your, your skin that's constantly being barraged by the UV radiation that's causing DNA mutations that eventually down the road lead to skin cancer. Now those repair processes are activated, they're optimized, they're able to, you know, tag that DNA that needs to be repaired, able to get rid of the antioxidants and I'm sorry, able to get rid of the free radicals. So the, so those antioxidant powers are working. So I think that that's really fascinating that we've kind of already been using it in that way orally as a supplement. And that's very commonly recommended throughout, in my field, in most surgery and dermatologic oncology for patients who have had at least one skin.
- [44:46]
A
Cancer. Wow, that's really fascinating. That's really fascinating. I mean, I would be interested to see like long term studies on that, using something like that, like a topical application I know there are some, some skincare products right now that are saying, you know, we're, we have nad or whatever in there, but I mean I haven't seen any data yet from them, you know, like from these like different skincare brands. That's very.
- [45:07]
B
Fascinating. Yeah, I think that's where I was interested to learn that it was not stable in an aqueous solution in a water based. Because most all the serums, all moisturizers, those are water based formulations. And if it's not stable then I'm assuming that these, you know, some of these other brands may not be making accurate claims. You know that that's where I would be.
- [45:28]
A
Skeptical. Right, right. I, I think it's, I mean I've been skeptical the whole.
- [45:33]
B
Time. It's always good to be skeptical. I like, I like that's my baseline usually.
- [45:38]
A
Too. Yeah, I know it's hard, it's hard in the longevity space. It's hard not to be. I mean I think you have to be skeptical because yeah, a lot of this stuff is cellular biology stuff, you know, and it's very, very complex chemist, obviously chemistry, but the biology and physiology is very important to understand. I think for a lot of the people, all of you listening out there, you guys always, you guys do have your finger on that pulse of like what is coming out and like what is new in this space from the obviously like skin care side. But also I know a lot of you chime in about supplements and anything else and it's important for us, I think all to understand that there just isn't like we might know theoretical science but then applying that science and translating it into a way that is going to actually benefit you. We're not there yet for most it of things like we're just not. And, and so anybody over claiming, like I always try to tell our listeners this, like you can't, you got to really dig in, you know, you got to dig in, you got to do your homework because people overclaim and that's marketing. That's an entire field, you know, of business is marketing. So you know, when you're buying things, you got to really see like where are the scientists, where are the doctors and all of this and who, who are they backing? Because that's usually going to kind of guide you in that right direction. So that's my little caveat for our listeners, you.
- [46:53]
B
Know. Oh yeah, for sure. Which is this is why I feel like I'm so proud that like really the only brand I've been aligned with from a Supplement, in the supplement industry because of how robust and how, and how seriously they take it. You know, they are basically saying, we recognize that the industry is not regulated. We recognize there are a lot of products out there that do not do what they claim and do not contain what they claim and we are going to be different. You know, so I, I think that's, you have to have good quality and you have to have good trust and you're doing that by increasing your transparency. So I think they're kind of hitting, you know, hitting a home run on that. But I agree, this industry is so large and it's impossible to regulate, so it's not even by anyone's fault. It's really quite impossible. So you're right to remain vigilant and kind of remain skeptical and don't sort of, you know, believe all the hype until you've sort of done a deeper dive into it and demand the clinical studies and sort of, you know, I guess this is, you know, this is why I commend you for having a podcast like this because you are, you know, I'm doing this on a day to day, patient by patient basis. But you're reaching a lot more people and people who are interested in these topics and you're able to spread the word and. Yeah, so I think that's really, you know, wonderful that you're, that you're able to educate on this.
- [48:10]
A
Level. Thank you so much. That means a lot. And I, I think for me, I mean, it means a lot that you're backing a brand because obviously, like, you have so much experience in your field and you know, you are a leader in your field. And that's why I said what I said. If you, if you guys are shopping for anything, especially in the supplement realm, look to the medical community, you know, look to them and ask are they backing it? You know, so if you see somebody like Dr. Libby, you know, like promoting it, or you know, like somebody with credentials that has done like put their life into a field, you know, and has, has really like understood it on such a multifactorial level and they're able to say, I believe in this and I think this makes sense, that's when you can have a little bit of peace of mind there, you know, and that's what I do. You know, whenever I'm shopping, I'm always looking for the doctors, I'm always looking for the specialists and seeing where they align because that will guide my purchasing decisions as a consumer. And so I really advocate for that. But thank you so much, Dr. Libby. This has been so wonderful chat with you and so enlightening. I've learned so much from you during this conversation. So thank you so.
- [49:15]
B
Much. Thank you so much for having me. I really enjoyed it. Thank.