The research that confirms the state of our *skin* determines the state of our *health*

0:03Hi, I'm Sophie and this is Age Well with Dr Sophie Shotter, a space devoted to all things health, wellness and longevity. Because for me, ageing well is about looking and feeling like the best possible version of ourselves, inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research, sifting fact from fiction. I'll also be talking to all kinds of trusted experts tapping into their knowledge, along with bringing you conversations from a range of interesting women and men, finding out how they age well. So this is my show. Welcome along. And as always, thank you so much for listening.

0:46Dr Sophie Shotter:I am really looking forward to this episode, Sophie, because we've had a little chat about it off the air and it seems super, super interesting. Might be a little bit controversial for people, but this episode is all about new and emerging evidence, I guess not so new evidence, that reveals inflamed or prematurely aged skin isn't just an aesthetic consideration, it's actually a potential risk factor for future disease. And this really is fascinating, so please tell us more. In other words, how our skin looks on the outside is actually a potential indicator of our health on the inside. And there's really credible science here.

1:23As you say, it's emerging evidence, but it does seem to be significant. The data we have so far, and we'll link everything in the show notes, suggests that damaged or inflamed skin isn't merely a cosmetic issue, but a significant risk factor for systemic disease. I'll try and simplify it all as much as possible. Certain skin signs can indicate various inflammation-related illnesses, including things like cardiovascular disease, diabetes, and even neurodegenerative conditions. So think about the fact that unhealthy skin, which may, for example, have more cellular senescence going on, releases certain chemicals, and these are inflammatory chemicals, into the bloodstream.

2:06They then wash around your body and cause damage to other tissues, including some of your internal organs. And that's what these studies are all about, because what we're starting to see is that when this moves from what we see on the surface of the skin to inflammation affecting internal organs or our whole system, so our body, these chemicals can then do harm to other organs, even organs that might seem entirely unrelated like the heart and the brain. So the result on these organs is then an accelerated ageing process with higher risk of developing various health conditions. So far, scientists have linked aged or diseased skin to the onset of cardiovascular disease, type 2 diabetes, cognitive impairment, osteoporosis, Alzheimer's, Parkinson's.

2:56So all of this upends previous thinking that lines and wrinkles are just a sign of aging caused by sun exposure, genetics and lifestyle. It goes beyond that to suggest that these things have an impact on how we age. So it isn't just about how our skin looks being about vanity, it's thinking about your skin as your body's biggest organ and the impact that the health of that has on your overall health. And what's also interesting is how this evidence suggests that we can think of skin not just as a signal but actually as a trigger. So having healthier skin, making your skin healthier, either through, preferably through protection in the first place, but if not, then through treatment can help protect you from various age-related diseases.

3:45Dr Sophie Shotter:Gosh, that's such a huge, huge thing for people to consider because as you say, most of us think about this purely in terms of aesthetics. So, all right, should we run through some of the research super quickly? Sure, but it isn't just one study. It's actually multiple studies and all of them reinforce the same core message. Firstly, we've got research from both the University of California and the Jitchi Medical Institute in Japan, and both of these have concluded that sun-damaged or inflamed or damaged skin is a risk factor for almost every single age-related disease from Parkinson's to type 2 diabetes, which is obviously a big statement.

4:23The Californian and Japanese studies are also backed up by a study in Toronto, which found that 99 % of people who look at least 10 years older than their chronological age have got corresponding health issues. And all of this research has its roots in something called the Baltimore Longitudinal Study, which considers the effects of aging on our overall physical and cognitive health, and has found that how youthful a person looks is actually a strong indicator of their internal health. Again, this confirms what many experts have started to suspect, that our skin isn't just this indicator of our chronological age or our lifestyle, but it's a really powerful mirror that reflects the state of our internal health.

5:03Dr Sophie Shotter:And I know that you have been talking about this for a very, very long time now. So compromised skin is not only a sign of age-related disease, but could also potentially cause it, i.e. compromised skin, for want of a better phrase, could be a possible trigger. Yeah, exactly. And this is where it gets really even more interesting because while those of us in the industry have been watching these studies play out and it was previously thought that the skin was simply a visible tally of lifestyle damage that we've accumulated. It seems that the reverse is true in that if we allow our skin to become damaged, this will actually cause inflammation and cellular damage.

5:42So again, our skin doesn't just offer clues to our physical well-being, but the research indicates that wrinkles, dry skin, sunspots could also potentially cause that internal premature aging on a cellular level. So we now have this direct evidence that taking care of the skin externally reduces not just how the wrinkles look, for example, but also releases the inflammatory mediators that are released by the skin. And then according to some studies may even help to prevent things like dementia.

6:15Dr Sophie Shotter:Wow, so powerful. I was thinking, It seems that increasingly the world of science is looking at more and more different ways to measure our health and longevity. So it used to be simply taking blood, for example. But on your podcast, we've talked about looking at the oral microbiome, looking at the vaginal microbiome, the seminal microbiome, the various tests we can do from saliva-based genetic testing to poop-based gut health testing. And now it seems that one of the easiest indicators is simply to look at our skin. Yeah, apparently so. And looking at all of the studies combined, it really does seem that our skin could be used to predict a number of seemingly unconnected factors, from bone density to the risk of developing neurodegenerative diseases and even cardiovascular disease.

7:02Dr Sophie Shotter:And the big message has always been sun damage causes skin ageing. So does this mean that aged skin might be less a sign of sun damage and more a sign of internal inflammation? and if so, does this mean that SPF is less important? No, absolutely not. Sun care and SPF are still critical. The sun's UVB rays damage the skin's surface and its UVA rays go much deeper. And both of these can cause those signs of ageing, the cellular senescence, and that can lead to this systemic inflammation. So UV light is responsible for over 80 % of what we see in terms of visible skin changes. And in fact, according to some experts, If you spent your whole life indoors with the curtains drawn and no UV light, you might not see significant changes to your skin until you reach your 80s.

7:52So all of this reinforces the fact that sun exposure is indeed aging and potentially causes that internal inflammation if you allow yourself to burn or go red. So despite the fact that going SPF free has become something of a talking point, the research underlines the importance of keeping the skin calm and uninflamed. Actually, should we talk about this trend of going SPF-free? Yes, this is still an extremely worrying trend on socials with so-called influencers encouraging people to ditch sunscreen in favour of natural alternatives, like mayonnaise, believe it or not, or going without any protection whatsoever.

8:28Bear in mind, this is usually from self-proclaimed wellness experts who have zero medical training. Generally, the justification is that SPF has toxic ingredients. I do need to be clear that there are some ingredients that I would avoid. So, for example, oxybenzone is one of the most commonly used ingredients in some chemical SPFs, but it's very easily absorbed by the skin and enters the bloodstream and can then disrupt hormones. Personally, I'd also avoid SPF products with retinol palmitate, which is a vitamin A derivative, mainly because that can make you more photosensitive. But my point is this, don't throw the baby out with the bathwater.

9:04Do your research and by all means, look at the ingredients. And if you're in any way concerned, then just choose a great mineral sunscreen over a chemical sunscreen. And if you want the lowdown on everything SPF, scroll back. I think it's two years or so, April 2024. And you can listen to my full episode on sunscreen, including the many things that people don't realize. Two other quick things. I do absolutely agree with many experts that getting some SPF free first morning light is a good thing. And this is to do with the incredible health benefits of some of the sun's infrared rays. This has been really well documented and I've got no issue with that again, assuming that you're not going red or pink or inflamed.

9:44But here we're talking about that very early sunrise light. Once the day has properly started, wear sunscreen. Also, another one of the arguments is that skin cancer is a relatively new phenomenon and for hundreds of years our ancestors have been living and working outdoors and they didn't get skin cancer. This is blatantly untrue. Our ancestors did get skin cancer and it's not a new phenomenon. It's simply that we now know more about the impact that sun damage can have and we have better, faster ways of communicating that and better ways of tracking it in populations. Back in the Middle Ages, there was no public messaging, no social media platforms and no conversation around health and wellness.

10:24But the fact is that there's over 2 ,000 melanoma skin cancer deaths in the UK every year. and melanoma skin cancer is the 20th most common cause of cancer death in the UK, accounting for 1 % of all cancer deaths. Equally worrying, skin cancer cases are expected to double in the next 10 years and estimates suggest that one in four people are at risk of getting skin cancer in their lifetime. Bear in mind, we're really fortunate to have access to lots of extremely effective SPF products which when used properly will help to protect skin against damage from the sun's harmful rays and can mitigate things such as sunburn, pigmentation, sunspots and skin cancer and ultimately help to save lives.

11:05So I hope I've been clear, but yep, wear your sunscreen.

11:10Dr Sophie Shotter:Very clear. Right. So back to the research. What can we do then other than, as you say, wear sunscreen? I think this is a three-pronged approach. So one, prevent with sunscreen. Going back to our original theme of keeping the skin calm and reducing inflammation because inflammation is a precursor of age-related disease, there is evidence that sun cream can prevent most of the inflammation that occurs when the skin isn't exposed to the sun. In fact, in one early study, those who wore a broad spectrum sunscreen every day for four and a half years didn't show any signs of further skin aging during this period.

11:46Two is skincare, and this is all about keeping the skin calm, well-nourished, and using appropriate active ingredients. Obviously, there's a lot of cult skincare out there but ultimately we can go back to basics so the old favorite ingredients do work think about humectants like glycerol hyaluronic acid and lipids and these will really help to support a healthy barrier and then you might want to add in targeted things like acids or peptides or retinoids to actually target signs of aging if you have them in terms of other ingredients have a scroll back and listen to our episode with Mark Birch-Machin and his interest and expertise is in the role that various lifestyle stressors play in skin aging and specifically again focused on the role of sunlight.

12:33I was really interested to hear his views on niacinamide as a powerhouse ingredient and I think generally that was a good episode to help everyone learn how the skin ages in terms of the role of telomeres, senescence, ATP and mitochondrial DNA. I'm not going to go into all of it again now but do have a listen as this might be a good sister episode for you to listen to I think anyone suffering with skin redness or inflammation do think about a range such as media beauty and have a listen to our recent episode with Tina the founder because she's been doing really interesting work on the microbiome and increasingly I do think this is key to having calm and healthy skin and of course there's lots of in-clinic treatments that we can also do to help keep the skin healthy.

13:17Dr Sophie Shotter:But even if people have a smaller budget, as you say, even just a simple moisturiser can help. In fact, we have direct evidence that a simple moisturiser does reduce inflammation. And believe it or not, that may even help prevent dementia. Dehydrated skin is basically less effective as a barrier between the outside world and our internal bodies. So when the skin is dry and flaky, its usual job of keeping out infectious agents, environmental toxins and allergies, while also keeping in moisture, becomes significantly more challenging. For example, in one study, a team of researchers asked older volunteers to apply a topical moisturiser twice a day for one month.

13:57And compared to older participants who hadn't received any treatment, the subject's skin was significantly restored with lower levels of three different classes of inflammatory molecules. So in case anyone's actually interested, I think experts believe that decreased levels of something called the stratum corneum, which is kind of the outer layer of the epidermis, is a major contribution to, or major contributor to inflamed and unhealthy skin. Okay.

14:25Dr Sophie Shotter:And what's the third thing in your three-pronged approach? Lifestyle. All the stuff that we already know and talk about, Fi, avoiding ultra-processed food and alcohol, avoiding stress, not that you can avoid all stress but bad stress, not smoking, taking care of your gut health, even something as simple as drinking plenty of good filtered water, though the evidence here when it comes to drinking water to support skin is a bit less cut and dried. Some studies suggest there isn't any real support for this, while others claim it can help. It also hasn't been directly studied as a way to prevent inflammation or related diseases, but overall I'd say that drinking good clean water is a huge positive along with many other lifestyle factors that we've covered on the show including strategic supplementation if needed whether that's a good quality collagen do remember again i've done a full collagen explainer from over two years ago now or some of the newer evidence-based supplements that i know you and i take many of which we feature on my supplements episode yeah and your collagen episode is still one of your most listened to popular episode.

15:30Dr Sophie Shotter:So please do go back and listen to that. It was one of your first. And you say that the science on all of this is still emerging. Yes, but it's become a reasonably big area of study. And some of these are quite long-term pieces of research. In fact, I'll just mention the idea of inflamaging, which sounds like a new term, but I've actually traced its roots back to a year 2000 group of scientists at the University of Bologna in Italy, who suggested it as a new way to think about aging. So the theory is that in a young, healthy person, the immune system is routinely deployed to patch up any damage and shoo away any baddies or infections.

16:07But as we get older, or when we're in poor health, these inflammatory responses can pass a certain threshold and then go into overdrive, releasing chemicals that actually do the opposite. So they rampage around the body, destroy healthy cells and mutate our DNA. And this is what the Italian scientists called inflammation, this simmering backdrop of inflammation that accompanies the aging process. And their research concurs with the other studies I've mentioned that wrinkly, diseased or damaged skin becomes part of this system of inflammation, releasing this chemical of cocktails, and that leads to further damage and inflammation.

16:43And we do know that chronologically aged skin exhibits higher levels of a whole panel of inflammatory cytokines and chemokines. And bear in mind that these inflammatory cytokines and chemokines then degrade collagen and elastin and cause further skin thinning, wrinkles and reduced elasticity. They also disrupt the skin barrier, increasing water loss and making it more open to infection. And all of this is further compounded by those zombie senescent cells in the skin created by natural aging or UV damage that then release their own inflammatory cocktail.

17:16Dr Sophie Shotter:So it sounds like the perfect storm. Yeah and in terms of what we know this is just the beginning but as our body's largest organ it's clear that the skin can have a profound impact on our internal health and I think people often forget that skin is another organ of the body and that's the key message I want to get across in this episode. Skin care isn't just vanity and your skin is another organ. So please do look after it. Do you know what? It sounds so silly. I know that my skin's an organ, but I had never, ever thought about it ever in this way. And it makes total sense because if we could see inside other organs and they were inflamed or wrinkled, we'd worry.

17:56Dr Sophie Shotter:So why are we not thinking about that with our skin? So interesting. So, so interesting. Sophie, thank you so much for explaining all of this. Really, really useful. Thank you, Fee. and that ends this week's podcast if you want to find out more about me and my work or maybe book a consultation head to dr sophie shotter.com and you can find me on socials at dr sophie shotter and again thank you so much for listening

18:40Thank you.