239. Dr. Shawana Vali: Healing Skin from the Inside Out, Collagen Degradation & Skin Aging

21:03I think in the world we work in, I think the key things that we see is poor sleep. So sleep hygiene, disturbed sleep, not getting into deep restorative sleep. That's causing accelerated aging.

21:15Gary Brecka:I preach about this all the time. And you, exactly, you say it all time your body repairs itself at night growth hormones produced at night happy hormones produced another microbiome the gut microbiome and the skin microbiome is repaired at night right then we've got cortisol we've got stresses daily stresses we have more stresses now than we've ever had we've just mentioned that in the beginning so that's causing accelerated aging your free radical damage your glyconation all the fun stuff that's happening so that's causing us accelerated aging then i always say this to my patients less is more i always say did your grandmother have this like does she have that 14 stage uh skincare routine yeah all right your grandmother had nivea she didn't have eight to 12 steps right exactly so like less is more like sometimes you want to you want to let the body the human organ is so amazing let it do the work god's given it the cells for it to work we just need to tweak it a little bit so my thing is to distill things and remove things a little bit and say no take this away you don't need this right no an antibiotic will only fix the bacterial element in your acne.

22:15Roaccutane will only fix the sebum. It's not going to fix the inflammation. It's not going to fix the scarring. It's not going to fix the cellular turnover. There isn't a one pill for a magic cure. And it's actually educating that patient in that way.

22:28Gary Brecka:Now, where do you fall on sun exposure? Because, you know, I'm... Gary, look at me. Yeah. I'm pale. Come on. I think I've answered your question. I'm a vampire. Well, I hope you're taking vitamin D3 then. Okay, good. You know, I've always been a fan of morning sunlight because there's no UVA and UVB rays. I tell people if they want to get sunlight, first 45 minutes of the day is a great time to just get out. And blue light is less as well, right? Yes, and the blue light is less as well. And, you know, it's the UVA and UVBs that really kind of damage our skin, but it's still okay to be out in sunlight first thing in the morning.

23:03Gary Brecka:I actually make a practice of it. You know, I just expose my skin to sunlight. In the morning, you can tell I don't get a lot of sun. I'm not red and I'm certainly not tan. I'm a white boy like you're a white girl. But so where do you fall on sun exposure? And even more importantly, where do you fall on sunscreen? Because, you know, a lot of sunscreens, I mean, there have been, what, 18 brands or so pulled from the market in the last 12 years for having some kind of indirect cause, either to skin cancer or some kind of other. Carcinogen, yeah. Yeah, carcinogen. So where do you fall in that realm of sun exposure and sunscreen?

23:38Well, the first thing I say to my patients is this skin has to match this skin, which has to match this skin. If you're going to have a Birkin bag here and you're going to go like, Allahu Akbar to the sun, you're going to sit there and get the sun rays in. Birkin bag. You're creating, you're going to cause wrinkling, fine lines, wrinkle, pigmentation. You're going to get that crocodile Birkin you've always wanted. You don't need to be put on a weight. But you're not going to be put on a weight list. Just put a handle on it, yeah. That's what I say. I'm like, are you going to make a Birkin bag out of your decolletage, right?

24:03Gary Brecka:Yeah. So the key thing, the problem with sun is exactly it causes inflammation. It causes a cascade of glycation, oxidative stress, cellular turnover, aging, all the things we've said before, fine lines, wrinkles. It deflates you and can age you. Your skin is like an organ. It holds everything in place. If I'm burning it, it's burning it down. Yes, yeah, burning it is terrible. Literally, it goes down here. The other key thing we need to remember is you mentioned Latinos versus Caucasians or Afro-Caribbeans versus Caucasians. We've got, and I'm Indian-African, by the way, as pale as I am. Indian-African.

24:35Indian-African. Yeah, as pale as I am.

24:36Gary Brecka:Practice in London, live part-time in the Middle East. Everywhere around the world. Yeah, you've got all the bases covered. Basically. But here's the thing, right? I have melanin in me. So if you and I went into the sun, you'd burn quite quickly. I wouldn't. I have a protective melanin in me. So Afro-Caribbean skin, and remember, there's 28 different types of collagen. Wow. So all of us have different types. We have collagen. Well, I'm only aware of nine, but there's 28. So there's one in three that we really work on in aesthetics, that we really up-regulate. That gives you your strength, your volume, the tightness.

25:07And then there's 4, 7, and 14 that work on the anchors between the beauty layer of the skin and the medical layer of the skin to hold it in place. But Afro-Caribbean people have different distribution to Caucasian people. Afro-Caribbean people have more melanin, so they're protected from the sun, whereas you're not. If the UV damages your cells, you get the aging, you get the glycation, you get the fine lines and wrinkles, you get the sunburn. But then on the other hand, Afro-Caribbean skin pigments easily. keloids easily so i think god's been fair to all of us yeah he's been fair in his distribution sun protection is key whether you're indoor outdoor i wear spf all the time and there's different types of spf spf 30 i wear spf 50 um and i also wear sunblock especially in heat like this so you know i do tend to put the sunblock especially on the tips of my nose right zinc oxide base yes i'm a big fan of zinc oxide blocks it completely has the industry come out with something better not yet right are we waiting for it watch and wait right but the non-nano zinc

26:06Gary Brecka:doesn't actually absorb into the bloodstream which i'm a big fan of because you know if you are going to wear sunblock it should be exactly that a sunblock it shouldn't be something that actually passes into the bloodstream and starts our you know to disrupt our hormones and there is a lot of links between different parabens and phthalates and fragrances and and things that that actually do hormone disruptors. Yeah, that are hormone disruptors. And so when you talk about getting into this reticular layer of the skin and actually feeding the fibroblasts or helping the fibroblasts do their job, one of the things I've heard you talk about that I am an enormous fan of are exosomes because these are little vesicles.

26:51Gary Brecka:They're about the size of a virus. They're about 1 ,800 the size of a cell. They do penetrate deeply just because of their micron size. Some of them carry high molecular weight, high luluronic acid. Some carry growth factors. So these I'm starting to see slowly. And I think you even have a skincare line that contains exosomes. And why did you choose exosomes? And for somebody that's not familiar with what they are, how do they work in the skin? Why should it be something they consider in a skincare routine? Yeah, so I want to step back a little bit. Yeah, step as far back as you want. You're not in my industry.

27:24You're not someone who's seeking me out. So in terms of acetyl treatments or treating things, you've got virgin and non-virgin. So virgin treatments are things you might be comfortable with. You don't want needles near your face. You don't want anything external put into you. And that could be things like prescription-grade skincare with great formulation, vitamin A, your retinoids, your exosomes, your epigenetic formulations. It could be lasers, ablative, non-ablative lasers. It can be skin tightening modalities, radiofrequency ultrasound. This is all you're comfortable with because you're not putting a needle in your face.

27:54Gary Brecka:Right, and those are looking to do the same thing to provide either micro damage to that layer so that when it repairs, it repairs itself in a healthier way, right? I would probably call that a hormetic stress, like microtrauma, which in a controlled environment done by someone like yourself that understands what they're doing can be a good thing, you know? I also know people that have over derma roller themselves. Scarring and stuff like that. And gotten scarring, yeah, because those needles puncture on the way in, they kind of tear on the way out with a lot of those rollers. Don't do it. Okay, good.

28:27Gary Brecka:Yeah, you know, because Sage and I, when we first started our business, we had a girl working with us, beautiful, early 20s. And she discovered derma rolling. And I'm not kidding you, in three years, she had completely destroyed her skin. It looked absolutely terrible. And she was actually developing these scars. But I want to go back to some of these topicals. I mean, you have a skincare line, but I want to go back to some of these topicals on what exosomes are doing in the skin and why these biologics are. So I'm going to come to the biologics and the formulation in a minute. No, you took a step back.

29:00So let's go. So you've got the virgin-style treatments and then you've got the non-virgin-style treatments. And on the virgin, like you said, it's a controlled inflammation. It upregulates the medical layer of the skin. It tightens you. It cleans up any pigmentation and stuff like that. It works on different modalities. Then you've got non-virgin where we might do intradermal exosomes, where we might inject hyaluronic acid mixed with exosomes, where you might have biologics such as PRF, PRP, your own growth factors. Or you might use biostimulants such as PLLA or calcium hydroxyapatite to regenerate the dermis or even the bone on the periosteal level to tighten you.

29:33So these are non-virgin because I'm using a foreign body into you. So when it came to skincare and skincare formulation, there are only certain things that are licensed at a certain prescription strength that we're allowed to use. But the key thing is here, when you're looking at an ingredient, you want to look at bioavailability. Does this amount actually get to the end point? Or does it go to perspastometalism? Does it just sit on my skin? Does it actually get to that cell we're talking about, the fibroblast, or the melanin, or the carotidin side? What cell does it get to and how much of the bioavailability actually gets there?

30:05And then what does it actually do? What was the outcome of it? And I think that's the key thing. I can name exosomes you. They're exosomia vesicles. You know, I love them. You love them. We love them in longevity medicine intravenously. We love them in our hair, intrascapulates, to get hair growth from the effluvian phase, the shedding phase. You're talking about exosomes. Exosomes, right? We led them into dermal to sell your regeneration and grow, right? But what exosomes and formulations do is they create, they give signals to different cells to give you the output that you want.

30:34Gary Brecka:Wow. So they can take growth factors, DNA, mRNA, RNA, and they can say, okay, produce more collagen. Really? Make more fiberglass. They can literally send this signal to the, wow, that's fantastic. And that's why it's going to be, they're not going anywhere, as you can tell. and that's why it's really important in epigenetic skincare that if you are using exosomic formulation that the bioavailability is actually there. Yeah. Now also the, and by bioavailability, you mean that that exosome is still viable enough to perform its function, right? They're not really living things, but they can also be inert because they're destroyed by heat or what have you.

31:10Or their delivery system is inept, yeah.

31:12Gary Brecka:And I hear the terms collagen, elastin, and fibrin. You know, obviously these are all involved in the scaffolding of the skin, the structure of the skin. For someone that's not familiar, you know, what is the difference between collagen, elastin, and fibrin in the skin? And are there different ways to stimulate each of them? And why are they each important in having youthful looking skin? I think collagen is the main player. Okay. So you've got the building blocks of fibrin, and collagen is actually the main player. It's a protein, right? Yeah, and in the dermis, it's collagen fiber one. About 80 % of your dermis is collagen fiber one, right?

31:48There's one in three, but it's more one than anything. And then fibrin and elastin. Fibrin helps give your fiber in terms of the fibers. So if I stimulate fibrin, you can actually get fibrosis as well. It can go the other way, right? And then elastin is that, you know, that tensile. Do you want it to be loose and relaxed or do you want it to be tight? And you actually want things to bounce back. You want it to be a tensile, but you want it to bounce back. With age, you get the laxity. It's not going back up. So can you remember those days when you used to put on weight and lose weight? Yeah. And the skin never expanded.

32:19Right. Or you used to, I don't know, if you, you know, if you're body training weight and you debulk. Yeah, yeah.

32:24Gary Brecka:You would either get, you know, lots of guys would get those stretch marks around their shoulders and their pecs and stuff because the muscle grew too fast. Exactly. Yeah. So I just say to patients, after the age of 35, be very careful of weight gain and loss or muscle gain and muscle loss. because after the age of 35, you've got significant fiberglass degradation and your fibrin and elastin is not as strong as it used to be. So it doesn't bounce back. Whereas your collagen, you can keep upregulating it with different treatments that I have. Most modalities in my industry work on collagen fibers 1 and 3.

32:58We don't really concentrate on fibrin and elastin.

33:01Gary Brecka:Okay. So fibrin and elastin, they're going to be, they're being lost at a rate that's commiserate with aging, but the collagen can make up for that because you're going to increase this protein. So what are some of the ways that you increase collagen in the skin? And then I want to get into some of the topical modalities that people use because I believe some of these are short-term benefit for long-term loss. You know, people are borrowing from their future, if you will, too much burning of the skin, scraping of the skin. And maybe you get this youthful rebound. Temporarily. Temporarily. But then you're literally borrowing from your future.

33:39You know, my wife has friends like this that were just laser and dermabrasion and microneedling freaks.

33:48Gary Brecka:And skin looked great for a period of time, and now it really looks terrible, and it's hard to get it back. If you want protein to build lean muscle, but without the caloric impact or need to cut, you need Perfect Amino. It's pure essential amino acids, the building blocks of proteins in a precise form and ratio that allows for near 100 % utilization in building lean muscle and no caloric impact. So we build protein six times as much as whey, but without the excess body fat we normally get during bulking. This is the new era of protein supplementation, and it's real. If you want to build lean muscle without having to cut, you need Perfect Amino.

34:27Gary Brecka:Now let's get back to the Ultimate Human podcast. I think the first thing you said about me was the inside. Yeah. So for me, I don't diagnose collagen degradation because it doesn't present like that. You're presenting with adrenal fatigue or you're presenting with other features, right? And then it's a byproduct of the stress that you're going through. Yeah. So I'm not focused on collagen, collagen, collagen. I'm focused on getting the inside correct first. I love that. So if we've got adrenal fatigue, then I'm working on that. Is it NAD? Is it peptide program? Can I move the needle? What do you find some ways that people recover from adrenal fatigue?

35:02Gary Brecka:Because we do see women whose cortisol is floored out. Yeah. They're just not producing cortisol. I've been out twice in my career. Have you really? Yeah, I've had significant burnout twice in my career. So how did you get your cortisol back? Yeah, so I've been completely floored. I was easily dominant with adrenal fatigue. Oh, dude, the worst. I had to go through rewiring myself. I had to do my routine NADs. I had to turn around. I went on peptide programs. I didn't just go on ACTH 139 and the adrenal fatigue ones. I went on SEMAC and SELAN as well to optimize my mood and cognitive resilience.

35:32Oh, SELANQ. Yeah, yeah. So I went on those.

35:34Gary Brecka:And the anti-anxiolytic, that's a peptide. Yeah. So I went on those. And then I went on a microdose on estrogen as well. Wow, okay. But now I'm coming to perimenopause, so I'm now changing that up a little bit. So we work on the inside first before I'd work on the outside of your collagen degradation. On the outside, like I've said before, it's always virgin or non-virgin tools. What are you happy with? in my industry everything is inflammation based it's me causing microtrauma right to upregulate the cells to wake them up so it's either that but there's a new area of medicine which we spoke about in the saudi conference called regenerative aesthetics love that's where your biologics come in that's where your exosomes are coming in that's where things like polynucleotides are coming in that's where profilo is coming in that's where your biostimulants have now come back again they used to be out of a fadish fashion because like calcium hydroxyapatite or plla used to grow your face uncontrolled by a stimulation so you'd get that look and you're like no no i haven't had any treatment i promise you for two years it's still growing still going but they've changed the mechanism of action they've told us to inject much deeper and over dilute and you know they've changed the molecule right so they've worked on it's changed the mechanism of action so we've got different modalities now in terms of regenerative aesthetics and cellular regeneration that are not focused on just micro trauma but work on a biological front on the front end on the outside but also on the inside we've got regenerative modalities such as your exosomes, your mesenchymal stem cells, such as your peptides, or just natural things like therapeutic plasma exchange or EBU, IV ozone.

37:00I love that you're saying all these things.

37:02Gary Brecka:That's great because, you know, these toxins build up not just in our bloodstream but in our tissues. Our skin is also a secondary route of waste elimination. Lots of waste is sort of excreted through the skin. And if you're full of toxins, they're going to come out that way. You know. And what happens? Do you remember the days when, I don't, you must do intermittent fasting. You must be a prior. You did 24 hour fasting from what I remember. 24, 72 sometimes. You're like a legend in fasting. And you notice that your skin just glows. Oh, it's unbelievable. The whites of your eyes, they're bright.

37:33Gary Brecka:And your skin changes in three days. Yeah. You know, which is fascinating to me. And that's why sometimes I say to patients, you know, you can't get access to me, but you can get access to my knowledge. You can go on intermittent fasting. You can go into autophagy. Your body can start repairing it. so it can start reducing the inflammation on the inside, your skin will start glowing and repairing itself. Yes. You can do a detoxification, remove all these creams that you're putting in for the next seven days, and you'll notice that your skin barrier function will start waking up again. Wow. And your skin will start repairing itself.

38:02If you remove all the things that you use for your acne and stuff like that, leave it alone for a few weeks, your skin will wake up.

38:08Gary Brecka:Yeah. And you won't break out as much. Stopping. Even if you don't come and see me. Yeah. You know, it's funny. I have one teenager now, but I have one that just recently turned 21. Both of them struggled severely with acne. One went on a very short course of Accutane. We took him right off. But one of the interesting things, much to your point, was in both of their cases, when we applied the less is more theory, not over scrubbing their face, not always using these facial cleansers. and a lot of those are benzoyl peroxide and all those pads. Acids. And yeah, the acids. You know, I found that it really inflamed the skin.

38:50Gary Brecka:They would go from having acne to really red and inflamed acne. You could tell the skin was super, super irritated. But in both of their cases, both my youngest son and my youngest daughter, their skin changed dramatically when we started skipping days washing it, when they just used warm water, when they actually didn't use any, and they had a little bit of sun exposure, not a lot, but just a mild amount of sun exposure, it actually really started. And we focused on hydration and good nutrition. And internal. Yeah, internal. It really started to change them. Well, my wife, who's been very public about this, just recently went through menopause.

39:32Gary Brecka:And on the way in, we noticed dramatic changes, mood, emotion, typical hot flashes, but also to her skin almost overnight. Yeah. And, you know, I've been deep down the rabbit hole of female hormones and their relationship to, you know, estrogen's relationship to skin elasticity. You know, and when these hormones floor out, the skin very rapidly loses its elasticity. But what was fascinating is after hormone therapy, her skin bounced right back. It was unbelievable. I mean, I think menopause is like, if you could sort of design the perfect torture chamber for a woman, you know, it's like weight gain, water retention, loss of skin elasticity, no libido, sleep disruption, brain fog, and mood swings.

40:25Gary Brecka:There you go. And by the way, we're going to toss in a little frozen shoulder. Cognitive decline. Cognitive decline. And we're going to maybe toss in some frozen shoulder just to really complicate things. Oh, and carpal tunnel as well, yeah. Exactly. Fun times. And, you know, as we really, I mean, when I got this test back on her, which is called a Dutch test, it really gave me so much insight into how so much could go so wrong so fast because these things floored out. And I really would implore women to really, if you're very menopausal, you're going through menopause, you know, get a functional medicine doctor to do a hormonal evaluation on you.

41:01So what have you seen with hormone replacement therapy

41:05Gary Brecka:in men and women and having effects on their skin. Yeah. So men, again, never come for, I look tired. I've got folds, wrinkles. Can you fix that? They don't come. Men come. My wife sent me to get refreshed. Yeah. That's it. So men never come to me because I've got wrinkles on my face or folds here. Yeah, we're fine with it. You're quite chilled, Frank. You throw some Juergens, you know, 299 CBS lotion on. I just borrow her moisturizer. I'm like, I don't care what I pull on my face. but it's the wife that pushes the man it's so true and then when you take the history from and like i said we always do inside out and then i'll find out you're wide and tired you're running on empty you're not sleeping you've got loss of libido you've got middle abdominal weight gain you don't have that drive that you used to have i'm like okay let's do a testosterone test we've got a little bit of testosterone deficiency are we in andropause do we even have adrenal fatigue on top are we just in andropause right so what happens in men is that the testosterone declines over a long time right and then with the collagen and with in terms of skin you notice you get the bony resorption so you get loss of definition of your jawline you said yeah that sharp jawline you used to have right you also get folds and wrinkles in your face that doesn't really bother you because you know men should look like they've lived right right it doesn't really bother you but you look a bit weathered right you might get recession of your hairline and you get the middle abdominal weight gain and like men again are always metric driven if i change you on the inside outside is five minutes you're like done yeah goodbye i'm off right and and and i've got different modalities again is it virgin non-virgin do i stick to just peptides do i stick to ibid simple stuff do i do tp ubi all that kind of fun stuff or do i go on testosterone replacement are you ready for that yeah my women will literally take the pencil and they will consult themselves i need this tighten i've got this mole i've got this i literally woke up this morning and this is a classic line in perimenopause i woke up this morning and my like my jowls were here they weren't there yesterday and they're suddenly down here yeah i suddenly look like i've aged 10 years overnight this is what happened to sage so women they'll take their pencil and they'll mark it all and i just sit back and relax and you know i check my my my whatsapps because i feel like i've been here before yeah i'm like here's your charge for the consultation yeah you've diagnosed yourself but the good thing about women is they'll tell you everything and the picture's a lot easier and they're very transparent.

43:27So the picture's a lot easier. So again, on the inside, are they sleeping? What's their mood like? So we can diagnose perimenopause just on clinical symptomology, like you mentioned with those symptoms. And they already have that in clinical because they've spoken to their friends. We talk to each other all day long. Oh yeah, yeah. Women just, they're flat out with their friends.

43:44Gary Brecka:And they'll come in. Yeah, they'll come in and go, I'm perimenopausal, right? And you're like, you're 38. I'm perimenopausal. It starts early in Dr. Vali. Did you not know? You're like, okay, no, not a problem. It starts early as 38. Yeah, yeah, yeah. Did you not know? I was like, okay, cool, not a problem. Estrogen decline in women just happens overnight over the cliff. Right. And it just drops by 30%, 40 % overnight. Collagen degradation happens. Fine lines, wrinkles, open pores, owing nose. More inflamed conditions. So say you had moderate rosacea. You just drank a glass of wine in your 30s.

44:11Now in your 40s, you're noticing broken capillaries. Yes. Broken skin thickening. You've got pores. Your face looks a little bit grubbier. The solveness is there. It doesn't look as bright as it used to be. Yes. So you're noticing changes that you didn't see before. Your skin's thinner. the ceramides have gone because the estrogen drives the ceramides the ceramides have gone so you're feeling dry everywhere you've got hair thinning so this is what's happening and then suddenly you're getting the middle abdominal weight gain you are not eating at all but you're still putting on weight yes retaining water you're retaining water so women will come in and again it's do you want to say the virgiline or non-virgiline some of my women are still not hrt ready they're not identical hormone replacement ready either so i have to still i just have to use the tools i have whether it's peptides nads whatever it is just to optimize their mood get them to sleep with a delta sleep induced peptide what is it that i can do in a natural way that they're comfortable with yeah right and on the outside it's easy i've got loads of modalities to thicken their skin tighten their skin you know do they want to buy a stimulant to lift on the bony level so they have jawline definition back do you want do they want an ablative laser with exosomes to continue regeneration yes but if i can convince them to go on biodentical hormone replacement therapy or HRT a lot of women are now going on it much younger because of positive outcomes I think

45:24Gary Brecka:so many women are suffering unnecessarily because they have this fear of getting on a bioidentical hormone therapy and I've seen miracles happen for women that are suffering overnight my wife being one of them and I'm a big fan and I've been deep down the rabbit hole in the research and some of the studies that linked you know hormone therapy to breast cancer actually debunked that link in the very same study just after it was carried on for a longer period of time i think it was the women's health initiative was the big one that really got a lot of uh it's been debunked right yeah it's been debunked by the women's health initiative um so you know if you if you are listening to this podcast and you're one of those women you know don't be scared of seeing a functional medicine doctor and getting on bioidentical hormone i would say go on it yeah yeah because it can be so um you've mentioned peptides a number of times what are some of your favorites for skin i mean like the ghkcu copper peptides do you like bbc what are your what are your go-tos?

46:14Gary Brecka:So I don't really, I don't use peptides for the skin because I've got so many different modalities already. Gotcha. So I don't really need to use peptides. I've got better things that can work for it. Okay. But GHKCU is a popular one. Thymorosin beta is a popular one. You can do subdermal injections or you can just microneedle it in. It's up to you how you want to take it. For me, I use peptides for the internal stuff. Yes. I don't use peptides for skin. I don't use peptides for hair either. I use exosomes for hair because the cellular regeneration is much stronger. So the outcome is there for my patients because if I promise you something I don't deliver, game over.

46:47Again, I'm the worst doctor in the world. Especially in dermatology. Yeah, yeah, I'm the worst doctor in the world. So your reputation matters, but also you have to do good by the patient. So I have to say these are the modalities you've got. If it was my hair and my hair follicle, this is what I would use.

47:00Gary Brecka:So I want to talk about the new breed skin technology. Tell me about that. How are you using that for your clients? So for me, like I've always mentioned, and probably for you as well, bioavailability is important, formulation is important. And one thing I didn't understand, I'm a practicing doctor. Yes. I'm a derm, I'm a practicing doctor. But what I didn't understand is how one skincare brand can work on all of us the same way. I couldn't agree with you more. We're eight or nine billion different types of people. If we're doing personalized medicine, why are we not doing a personalized approach?

47:28So then when I was looking at formulation, I'm like, what do I like in practice that is prescription grade strength? And can I get it over the counter? So I was like, okay, most of the skin products sit on the beauty layer. So it's not even going where we need it to go.

47:41Gary Brecka:Right. How do I get my 12 favorite ingredients to go to the medical layer of the skin without you needing a prescription? Yes. And then how does it treat open pores, oiliness, fine lines, wrinkles, pigmentation, rosacea, acne, all common things we suffer from, right? Inflammation. But it works on you differently to me because we're different ages. We're different sexes. We have different skin conditions. Right. So then I wanted an epigenetic formulation. So I took the 12 prescription-grade actives. I shrink wrapped it in Japanese technology. I spent about seven years in lab and formulation and clinical trials and studies.

48:17And we proved that it goes to medical level of skin, the reticulodermis.

48:20Gary Brecka:Wow. And it upregulates your fibroblasts or your melanin or your inflammatory cytokines or whatever it needs to differently to mine. Wow. So if my problem is pigmentation and yours is rosacea, it acts on you differently to me. Wow. Regardless of gender, heritage, age. By using cell signaling or something. Cell signaling, epigenetics, formulation, that kind of thing. Wow. So we've done that in our Painted Molecule Biometric Adaptive Complex 12. So that's in our adaptive skincare. Okay. And that's why you call it adaptive skincare. Adaptive, because it adapts to you. Okay. And then the reason why we call it Newbreed Skin Technology is because I wanted something fun, you know, like Rihanna Fenty.

48:54I wanted something fun. I wanted to be just as cool. Yeah.

48:58Gary Brecka:Well, you are pretty cool. I mean, look at your boots. Those are cool. I got styled. Yeah. And then on the other side, devices, over-the-counter devices. So, you know, your LED mass, your microcurrent devices, you know, does it actually lift and tighten? Right. How do I get my hands on you over the counter without you having to come to me? So I was like, well, microcurrent only goes to the beauty layer and the dermis. It doesn't go to the muscle. It doesn't go to the bone. It doesn't go to where we restructure. We age from the bone. Do you remember grandma used to have these big, wide eyes? And now they're like tiny, beady, rhomboidy.

49:33And like the cartilage of the nose is growing and the ears are growing. and the jawlines move forward or backwards, but the eyes are beady. That's your skull resorbing as you age.

49:42Gary Brecka:Wow. So we age from the skull, and everything else slips off. Wow. And that's why you get the fat pads coming here. Never really thought about it that way. Yeah, and then the balloon deflates. The skin deflates, so it doesn't hold it as much. So you've got the periosteum, the skull resorbing, and the balloon resorbing. So in between, everything slips. Right. So I wanted a technology that doesn't need a transducer gel, that doesn't need, you don't need to be like, use my creams yeah it doesn't need a current it doesn't and i don't need to be you might not like my cream so don't yeah don't use my creams right but it's also i wanted you to be able to take a technology that goes to the bone and it lifts and contours it goes to the fat pads and repositions them that goes to the lymph nodes and decongest you that goes to the frontalis muscle here and releases tension and gets rid of headache or goes to the massages and your teeth grinding intention it releases it so this is called transons more called oscillations it's vibration technology so everyone's like oh you're based on a sex toy i'm like no we did clinical studies and we made different sonic wave patterns to go to different anatomical planes to give you different outputs so we made cutis which gives you the perfect bone structure but each sonic wave pattern gives you different outputs what does this look like like a handheld device yes a handheld device it looks a little bit like a sex toy oh it does but it's in a really cool charging case.

51:00Most women are not scared of those.

51:02Gary Brecka:Let's just be honest. But it's in beautiful colors. It's like your Hermes orange and your bone. Can you use it in public? You can use it in public and no one's going to say anything to you. Okay, good. They'll be like, that looks cool. Yeah, that's cool. She just whipped that thing out on a bus. Awesome. Exactly. On the plane, you're de-puffing. It's great. You know, I'm all about optimizing performance. And lately I've been using the ion weighted vest during my workouts and it's been a game changer. It isn't your average weighted vest. It's designed to fit like a second skin, activating your core, improving blood flow, and even helping you with recovery while you train.

51:34Gary Brecka:What I love most is that the weight is perfectly distributed. It doesn't pull on your shoulders or throw off your alignment. Whether I'm doing strength training or cardio or just taking a walk, I'm burning more calories, building muscle, and pushing my endurance even further. If you're serious about leveling up your training and unlocking your full potential, check out the ion weighted vest at iongear.com that's a i o n gear.com and you can use code ultimate for 10 off and start training smarter today now let's get back to the ultimate human podcast but actually but what it actually does is studies show that it changes the cells there's no point it's not temporary with use you can re-educate it's like going to the gym and the muscle right so it reposition re-educates your cells so what you've got is some it's a horseshoe shade and it's got a connecting wire and some people really putting force in it so the connecting wire breaks you're like dude it's not going to give you a facelift just like calm down with the tension let the device do its own work right lifts and contours your face repositions a fat pack it can relieve tension it can de-puff your pace depending on the protocol and is this um is it using microcurrent or is it using sound wave what is it using sonic wave sonic wave and And it's called trans-anatomical, so each anatomical plane, oscillation technology.

52:49Gary Brecka:Ah, so you know that different tissues respond to different wavelengths. So muscles are going to respond differently than connective tissue, than bone. So you actually provide different wavelengths to stimulate those different areas. And we base the muscle. I've never really heard of somebody starting with skin care from the bone out, but that really makes a lot of sense. I never really thought about, you know, skull resorption because you are having osteopenia, osteoporosis. These are demineralization of the bone. Why would you not have it in the skull? It makes perfect sense. But it's just like when we assess you in the face and you want contouring or anything like that.

53:25Some people want their lips done or they want their cheeks done, something like that. The first thing someone looks at is your eyes. Next thing is your teeth. Fix that first. Forget your lips. Forget your cheeks. No one's looking at them.

53:37Gary Brecka:So true. So it's understanding. And the reason why we went in and out is because of the journey that we've both been on. We understand internally what's happening pathophysiologically and histopathologically on each cell that we can now understand what happens on the outside. Yeah. And so is this used in conjunction with a skincare routine? Because I have seen as many as 14 steps in a skincare routine. And I'm like, how can anyone stick to that kind of program where you literally have 14 things? You have an enzyme cleanser, then you have a cleanser, then you have a You have dermatology. What do you call it?

54:12Gary Brecka:What's the sandy things? Microdermabrasion. Microdermabrasion. Exfoliation. That's the word I was looking for. Exfoliation. Then you have something you put on right after that. Then you have a toner. So what does a good basic skincare routine look like for you? Okay, so let's go back to basics. Yeah, let's go back to basics. Regardless of gender, and I always do this, regardless of gender, heritage, age, regardless of the 21-year-old sitting in the room, the 16-year-old sitting in the room, then there's me, there's you, right? 30s, 40s, 50s, whatever it is. Regardless of gender and ethnicity, something's going on in our skin for all of us, the same thing.

54:45There's only two things that are happening that we're synonymously feeling the same. We all have fibroblast degradation from the age of 20s, early 20s. Your collagen, elastin, your hyaluronic acid, your gags are all going down. So that gives you fine lines, wrinkles, open pores, oiliness. Then all of us, regardless of ethnicity, have some form of pigmentation. So in me, it's going to be brown, and you're going to be pinky, purpley or vascular. So fair hair, fair skin, pinky, purpley, vascular. Brown hair, darker skin types, brown. So if I'm only just treating those two things, I'm going to, together with that, I'm going to give you the perfect canvas.

55:19So that's just two creams. Okay. Obviously, they're my creams, but they're just two creams with my patented formulation. But if I was going to say to you that you're not going to bother with my skincare and you're going to go and use two, three products, the only thing I would say to you is use an SPF, use a beta-glucan-based serum. Beta-glucan-based. And I'd actually say to you, wash your face with water. Yeah, that's what I would say to you. And if you can tolerate a retin-A or retinol or something vitamin A derivative-based, because that's the strongest ingredient, has a massive amount of studies.

55:50There isn't anything that's been studied more in our industry.

55:52Gary Brecka:In retin - Yeah, retin-A, retinol, retinal, whichever one you can tolerate, right? Once a week, twice a week, just to upregulate the fiberglass. Ah, okay. And that's it. That's all I would start with. Really? So washing your face with water, applying one of these creams. So just wash and then apply the cream. There's not a multi-step. You're not a big believer in taking those abrasive things and scrubbing off the layers of the skin. You just gave me the stories of not just your kids, but also one of your ex-employees or colleagues. Oh, yeah. She derma-rolled herself. It was terrible. I mean, she started at 24 by the time she was 20.

56:26Gary Brecka:Last time we saw her, she was 27, maybe 28 years old. and there was a noticeable, you know, scarring on her skin and she was actually going for laser to try to correct what she had over. They said less is more. Because once you've damaged certain cells, you know when you've got the stretch marks, you're like, I'm getting muscle, right? We can't get it back together. We can't get these borders back together. Have you ever seen anyone fix stretch marks properly? Even if we do CO2 blazer, if we do carboxytherapy, even if you've got exosomes in there. Right, you can lighten them a little bit. You can change the pigmentation, but that's about it.

56:57And you can bring the borders slightly together, but it doesn't go back to nubar skin. No. So once you've damaged certain skin, it's really hard to bring back.

57:05Gary Brecka:Yeah. So you've got to be careful. And that's why I talk about the Birkin bag. This skin is thin. The skin under the eye is super thin. The skin around this area is thin and the neck's skin is thin. These are the areas you don't want to damage. Yeah, very true. So are there any different, I mean, are there any topical modalities that you think are a great practice? Are there any particular lasers that you're a huge fan of? Because I know there's CO2 lasers, there's ablation lasers, there's class one, class two lasers. There's so much that when you walk into most cosmetic clinics, you can get paralysis of analysis.

57:39Gary Brecka:You can also get lost in the programs that they're trying to offer you without really having a fundamental understanding of, okay, which one of these is going to borrow from my future? Which one of these is actually going to give me real skin regeneration? And changes. Yeah, and real changes. So I would go back to basics again. and I would say, let's first put you on a skin, prescription-grade skin program. Let's re-educate the cells. You've had your skin your whole life. It's not going to happen overnight. It's going to take me three to four months to give you good skin. And I always promise you 70 % improvement and we aim for 90.

58:10Gary Brecka:Wow. So what we do is we re-educate. We might resurface you. We might use a partial ablative, not full ablative. A full ablative laser such as CO2, I'd only do my 40s up. Okay. Post like a facelift or something like that. but I do a non-ablative laser such as Fraxel, which is less damage, but I'd combine it with exosomes for regeneration, right? How would you apply the exosomes? Intervenously or topically? No, topically or interdermally, right? Okay. One or the other. And then, because that will cause cellular regeneration. Okay. So you either do microneedling, like your colleague did, prescription microneedling, or you can do a partial laser such as a Fraxel, which is a baby laser, right?

58:47But not an ablative, fully ablative. Fraxel is a light laser, right? It's a light. It's not ablative. It's a lighter version, not a CO2. You don't need that yet. Okay. And then what happens, we put you in a prescription-grade skin program, just creams, the next six to eight weeks. Morning and evening, two minutes in the morning, a couple of minutes in the evening. You yourself, within four weeks, you're not wearing as much makeup. Pores have gone away. The skin feels tighter. Because we're working on the reticulodermis. We're getting your cells to start behaving again and start upregulating to regenerate again.

59:15Right? Yeah. And if you need another, if you need another booster, we might do another booster. And the first phase of the skin changing, It takes skin cells six to eight weeks, the caritonocytes, eight weeks to change their behavior from up to 12. So the first eight weeks I call transformation. The second phase, and this is the most important phase, I call permanence. We want your skin to permanently behave like that for six to eight weeks. And in this program, we increase the actives. We might increase the dose of the retinate. We might increase the dose of the prescription-grade actives, and they're just creams.

59:45By the end of it, you have perfect skin.

59:48Gary Brecka:Wow. You turn around and you continue it. And say you started with inflammatory acne, you had some scarring, you had some breakouts. I say to you, you know what? In three to four months, you're going to have, you're going to tell me off and you're going to complain about one or two spots. It's like your whole face. Because literally, if you can go on a cellular level and retrain the cells slowly, rather than attacking them and blasting them, because you don't want to borrow from your future in your own words. Yes. You want to re-educate them slowly and you want them to behave in that way for the rest of their lives.

1:00:15And that's the key thing. Slow and steady wins the race.

1:00:18Gary Brecka:I totally agree with that. is there anything that you know of to actually increase the density of these fibroblasts? Yeah. So the neocollagenesis, most modalities are based on something called neocollagenesis, i.e. new collagen formation, right? And what we call it, it's a fibroblast upregulator that increases the density of the fibroblast. Perfect. If we're increasing the density of the fibroblast, we're increasing everything else. And what increases the density? So it depends. is that we can do inflammatory-based modalities or we can do biologics or we can do virgin or non-virgin or we can just do prescription-grade ingredients.

1:00:55It just depends what you're comfortable with.

1:00:57Gary Brecka:That's phenomenal. And then just whining things out, I won't take you deep down the rabbit hole of peptides, but I'm a huge fan of peptides and we use them internally for lots of things. What do you use? BPC157 for wound healing and repair, something called TB500 for wound healing and repair. So like post-surgical recovery, anytime someone has like a knee, hip, shoulder, rotator cuff injury, low back, especially if it's chronic and persistent. You do a sub-cup. Yeah, you can do it sub-Q. BBC is probably one of the few peptides that's tolerated well orally because it's a gastric peptide. But we find the combination of those two works really well.

1:01:35Gary Brecka:GHKCU, copper peptide, NAD. I know you're a fan of NAD too. 50 milligrams a day in sub-Q injection or a transdermal patch. which in full disclosure, I'm a partner in a peptide manufacturer called Peptual by Visalius Lab Sciences. And I chose these guys because they manufacture in a CGMP certified lab. They don't source ingredients from China and the peptides really work. A lot of the over-counter peptides have all kinds of nasty things in them, heavy metals, fillers, binders. And very often they're not even peptides. And it's hard for a consumer to know because, I mean, how are you going to evaluate whether or not this white capsule is, you know, rice bran or a peptide other than by the fact that it either worked for you or didn't work.

1:02:25Gary Brecka:But, you know, not being a dermatologist, but having seen the, I would say, the greatest shift in what we see by treating the inside, showing up on the outside is when we balance hormones. you know you see a noticeable youthful appearance in both men and women that get their hormones balanced you know when their estrogen dominant or progesterone is deficient or the cortisol is floored out or like you said stress and inflammation has just uh fatigued their adrenals um you know we see it you you you see it in the skin they just look and feel tired um and in a few weeks you know, they seem to really, really bounce back.

1:03:11So Dr.

1:03:11Gary Brecka:Valli, I, first of all, I'm so appreciative that you came on the podcast. And it's so interesting that we saw each other in Saudi and that we're here in the Middle East. I think this is one of the most fascinating regions of the world because they are growing so fast. And they're so hungry as well. So hungry. Yeah. And they're innovating and they're, it's like they want the brightest minds. They want the best food. They want the most educated population. They, you know, they're really thirsty for knowledge in this area of longevity, anti-aging. You must be a very popular human being walking around here.

1:03:48Gary Brecka:I saw you get mobbed after your talk. You got mobbed too. We both got mobbed. Yeah, we sure did. So I wind down all of my podcasts before we go into the VIP and we have some questions from my VIP community by asking all my guests the same question. What does it mean to you to be an ultimate human? For me? For me, I'm perimenopause at the moment. So for me - Full disclosure going on there. Yeah, full disclosure. If you ask me in two weeks' time, it would be a different answer, right? So for me at the moment - And you might be angry. Yeah, I might be completely different. For me, it's just contentment.

1:04:24For me, the ultimate human, because I've got access to everything. And you're like, you're on a peptide stacking program, I'm on a peptide stacking program. I have access to everything. As soon as I see the first red flag, of like i mean cause of overdrive i know what to do so i'm quite privileged in the industry to have that access yeah so for me at the moment it's just contentment i want to get to that phase where the highs are high but i don't feel it high and the lows are low but i don't feel them low i'm just streamlining and you know just getting through like content and happy yeah what what will be

1:04:51Gary Brecka:will be and what won't be won't be yeah you know i think i think there's a lot of genius in that you know um letting go of the things that we can't control yeah you know i've i've focused a lot on that as I've gotten older or more mature, whatever you want to call it, you know, frustrating yourself with the things that you have no control over is just, that's only on you, you know? But getting frustrated about the things you can control, it's, you know, a little different, but with so often things just knock us off our stride during the day that we have zero control over. You know, I don't get frustrated in traffic anymore.

1:05:27Yeah.

1:05:27Gary Brecka:I'm just like, well, that's what it is. Yeah. You know, so I'm going to be late. I feel like, especially because you're an entrepreneur like me, we go through such high highs and we go through such low lows that you have to get to a point where you're just like nothing. Our emotion is so tied to our outside environment. How well did this meeting go? How bad did that meeting go? What are they saying about you on social media? Was I validated? Was I not? Yeah. It is. And that's why I say I'm perimenopausal at the moment. So ask me on another day. I'll give you a different answer. Yeah, I know. It depends on my cognitive resilience.

1:05:57Gary Brecka:All right, Dr. Valli, we're going to go into the VIP room. And for those of you that are interested in becoming a VIP, you can head over to the ultimatehuman.com forward slash VIP. This is the community that I am pouring myself into. We do private podcasts. We do live Q &As. I have a Gary AI in there that you can ask anything to. You can feed it your labs. You can feed it your genetic testing. You can ask it questions about supplementation, diet, lifestyle, travel hacks, anything you'd like. I think you'll find it fascinating to interact with the Gary AI. But for the rest of you guys, until next time, that's just science.

1:06:29Thank you.