The Wisdom of Menopause

by Christiane Northrup

  ~ USE A SUNSCREEN EVERY DAY ON YOUR FACE, NECK, AND HANDS. Make a habit of putting sunscreen with an SPF of 15 or higher on your face, neck, and hands every morning except during the brief early-morning or late-afternoon “sun bath” that I advocate for optimal vitamin D levels. (See chapter 12.) There’s been a lot of concern lately about sunscreen products having exaggerated SPF claims and, even more troubling, potentially hazardous in-gredients. The Environmental Working Group (EWG) rates sunscreens annually and posts an annual guide on its website (www.ewg.org). Currently, EWG’s top-rated products all contain either zinc or titanium; none contain oxybenzone or vitamin A. Of particular concern is retinyl palmitate, a derivative of vitamin A that’s been linked to higher rates of skin cancer when applied to the skin in the presence of sunlight. EWG estimates that more than 40 percent of all sunscreens available in this country contain this ingredient.

  ~ MOISTURIZE. If your AHA, antioxidant, or sunscreen formula is not in a moisturizing base, then finish off your daily skin care regimen with a light moisturizer for day and a richer formula for the evening. This helps much-needed moisture remain in your skin cells, keeping them plumped up.

  Exfoliants and Antioxidants

  FRUIT ACIDS: Alpha hydroxy acids (AHAs) and other fruit acids do double duty as exfoliants and antioxidants, boosting the effectiveness of the other antioxidants in your skin care preparation. As exfoliants, they work in three ways: (1) they help dissolve the “glue” that holds dead skin cells together, thus resulting in easier removal, so new and plumper cells can rise to the surface; (2) they increase the hydration of the skin through increasing the production of glycosaminoglycans (GAGs), which are present in the interstices of the collagen matrix, thus boosting the amount of moisture in skin and reducing fine lines and wrinkles;4 and (3) they encourage the repair of elastin and collagen in the skin and even help thicken it a bit.

  Commercial products usually contain from 5 to 10 percent fruit acids, concentrations that are low enough and safe enough for all skin types and tones. It’s always best, however, to test any product first, either on the inner part of your elbow or just under your jawline. If your skin is sensitive, start with a 5 percent product. If you can tolerate that, gradually work up to a 10 to 12 percent product. You may experience a slight stinging with some products until you get used to them. Higher-strength AHAs (up to 70 percent) are used to lighten the skin or cause a deeper peel and should be used only by professional estheticians or doctors.

  Fruit acids help normalize your skin whether it’s dry or oily. If it’s oily, they remove the top dead layer of cells, thus allowing oil to flow out of the follicle more easily so that it can be removed without stripping away essential moisture. If your skin is dry, fruit acids remove the dry dead layer and stimulate cell renewal.

  It usually takes about two weeks before you’ll notice a difference in your skin with regular use of a fruit acid. They can reduce wrinkles and improve roughness, sallowness, and hyperpigmentation at concentrations as low as 5 to 8 percent.5 Most people start by using AHAs only at night, but once you know they work for you, you can apply them twice per day.

  As antioxidants, fruit acids can also alleviate some of the freeradical damage that results from exposure to sunlight and pollutants in the air.

  ANTIOXIDANT VITAMINS AND HERBS: An ever-growing number of natural plants, vitamins, and herbs have been found to help the skin resist free-radical damage and inflammation when applied directly. Many can also help reverse the aging process. The effect of antioxidants is synergistic, and they work best when used in combinations.6 For example, vitamin C and vitamin E suppress the skin’s sunburn reaction well when used together.7

  Differing types of antioxidants exert their antioxidant effects through different pathways. Those that are known as nonenzymatic antioxidants (e.g., vitamins C and E) get depleted as they scavenge free radicals. Therefore they must be replenished regularly, especially under conditions where the free-radical burden is high, such as being under heavy emotional stress or outdoors in the wind and sun. This is why it’s best to apply at least one product in the morning for protection during the day, and another at night that is designed to replenish moisture as well as fight free-radical damage. A good antioxidant skin care regimen will improve skin circulation, decrease edema and puffiness (including under the eyes), decrease fine lines and wrinkles, possibly help shrink large pores, and also decrease ruddiness and restore a healthy, natural glow to the skin.

  The following is a list of some of the best-studied antioxidants, though there are certainly more.

  VITAMIN C: Research has shown that in the proper form, vitamin C, a powerful and ubiquitous antioxidant, can restore a smooth surface and youthful glow to aging skin. Data from the NHANES I study mentioned earlier showed that women who got plenty of vitamin C in their diet were less likely to get wrinkles.8 This is but one aspect of the very well-documented role vitamin C plays in protecting virtually every organ in our bodies from the effects of aging. In the skin, this vitamin is essential for the production and repair of collagen. It also helps heal inflammation because it blocks the production of some of the inflammatory chemicals.

  The problem with using natural vitamin C topically is that it’s very acidic, which is irritating to the skin. It is also water soluble and breaks down rapidly, losing its potency within twenty-four hours. That’s why most products containing conventional vitamin C aren’t effective. But when vitamin C is combined with substances that render it more bioavailable, it becomes nonacidic while maintaining its antioxidant and collagen-enhancing properties. Vitamin C that is rendered absorbable by the cells can penetrate the thin membrane that encases a cell, and it offers maximum protection against free radicals in the place they do the most damage—the outer membrane of the cell. Studies have shown that vitamin C in fat-soluble form is absorbed much more quickly and achieves levels in the skin that are ten times higher than natural vitamin C (ascorbic acid). Vitamin C in the form of such substances as tetrahexyl decyl ascorbate is stable and can be added to creams and lotions, where it will keep its potency for months.

  Vitamin C creams help heal sunburn. And because fat-soluble vitamin C compounds help stimulate the growth of fibroblasts, the cells that help produce collagen and elastin in human skin, it has been shown to help reduce fine lines and wrinkles, firm skin that is sagging because of damaged collagen, and heal inflamed or irritated skin. It also gives skin a healthy glow. (See Resources.)

  TOCOTRIENOLS AND VITAMIN E: Up until very recently, scientists felt that the tocopherols, particularly d-alpha tocopherol, were the most potent part of the vitamin E complex, and the alpha tocopherols have been widely used in cosmetics and other products for over thirty years. Alpha tocopherol is often used in cosmetics in its ester form on the assumption that a process known as enzymatic hydrolysis in the skin will restore it to an active form. But this isn’t the case because, in the stratum corneum of the skin, where vitamin E’s antioxidant defenses are most needed, there is only very limited enzymatic activity necessary to change the ester into the right form. The result is that many of these vitamin E products remain largely inactive.

  The ideal form of topical vitamin E is a natural blend of the tocopherols and the tocotrienols (another part of the vitamin E complex). The tocotrienols inhibit peroxide formation—a measure of free-radical damage—much more efficiently than alpha tocopherol, and they’re better at increasing the levels of the various skin enzymes that help protect the skin from ultraviolet damage. In fact, research suggests that the tocotrienols are forty to fifty times more powerful than other forms of vitamin E.9 This relatively new type of high-potency vitamin E is made using a special extraction process on rice bran oil or palm fruit oil. The resulting liquid can easily be mixed into creams, lotions, shampoos, or other cosmetics. Topical tocotrienols can help dry, damaged hair, severely dry skin, and brittle fingernails. Look for the words high-potency E or HPE on the label to be sure you’re getting the right products.

 
; When applied topically, both tocotrienols and tocopherols rapidly penetrate the skin and become most concentrated in the superficial stratum corneum layer, right where the threat of UV damage is the greatest.10 Vitamin E, like vitamin C, has also been found to inhibit collagenase enzymes, which break down collagen following UV exposure. (For more information about tocotrienols and skin care, visit the website of dermatologist Randall Wilkinson, M.D., creator of the Trienelle skin care line, at www.trienelle.com.)

  COENZYME Q10, OR UBIQUINONE: This powerful antioxidant is essential for the health of the entire cardiovascular system because of its ability to help cellular mitochondria produce energy. But it also functions as an antioxidant and helps inhibit collagenase.11 In one German study there was a 23 percent reduction in fine lines on the face when a cream containing coenzyme Q10 was used topically.12 Creams with coenzyme Q10 are readily available in natural food and other stores.

  TURMERIC EXTRACT: This ingredient commonly found in curry has powerful antioxidant and anti-inflammatory properties that give the skin a more youthful appearance. (Hindu brides in India traditionally rub this Ayurvedic spice on their bodies for this reason.) Until recently, it couldn’t be used in skin cream because of its strong scent and its skin-staining pigment. Research from two studies presented at the 2010 meeting of the American Academy of Dermatology revealed that a new moisturizing cream containing purified turmeric extract (which is white instead of orange) significantly improved the appearance of facial spots, fine lines, and wrinkles.13 Skin care lines that contain at least some products with turmeric include DDF (see www.ddfskincare.com), Juara (see www.juaraskincare.com), and Vicco (see www.viccolabs.com).

  MELATONIN: Melatonin is best known for its effect on sleep and diurnal cycles, but it’s also a potent antioxidant. Topical application of melatonin has been demonstrated to inhibit UV-induced redness, thus having a powerful anti-inflammatory effect.14

  PROANTHOCYANIDINS AND CATECHINS: Polyphenolic compounds are found in a variety of plants and have many beneficial effects in humans. For example, the polyphenols in green tea are what give it its beneficial effect on the lining of blood vessels. Proanthocyanidins and catechins found in grape seeds, grape pips, green tea, green apples, and other sources have substantial antioxidant activity.15

  Other Skin-Enhancing Substances

  MICROCOLLAGEN PENTAPEPTIDES: Fibroblasts are the cells that produce collagen in skin. These cells produce less collagen with age for reasons that aren’t clear. We do know that they haven’t lost the ability because when aging fibroblasts are placed in cell culture and stimulated by growth factors, they can produce significant quantities of collagen.16

  One of the factors that stimulates fibroblasts to produce collagen is a small segment of the collagen molecule itself, known as a pentapeptide fragment.17 Researchers have found that it is an effective stimulator of both collagen and fibronectin synthesis—both of which are important components of the interstitial matrix around skin cells.18

  Testing of this pentapeptide (3 percent concentration) on a panel of thirty-five subjects for a period of six months demonstrated significant to highly significant changes over a placebo cream as well as a commercial 5 percent vitamin C product.19

  LIPOSOMES: Liposomes are small, membrane-covered sacs approximately three hundred times smaller than the human cell that are very useful for penetrating the effective barrier that the skin provides for protection. They consist of a lecithin-based lipid membrane surrounding specific contents that the cells need. When applied to the skin, the structural similarity of the liposome to the cells, as well as its small size, allows it to penetrate readily into the various levels of the skin.

  When it hits skin cells, the membrane of the liposome fuses into the cell membrane, discharging its contents into the cytoplasm of the cell over the course of six to eight hours. Lipsomal delivery systems thus dramatically increase the effectiveness of any active ingredient in a skin care formulation, making it approximately ten times more effective than when applied without the liposomal delivery system.20

  How to Evaluate a Skin Care Formulation

  The newest skin care ingredients are so effective that they belong to an entirely new category that has been dubbed “cosmeceuticals,” given the fact that they have pharmacologic effects on the structure and function of skin. The FDA regards these products as cosmetics and they are regulated as such.

  There are two things to consider about this as a result. The first one is that cosmetics manufacturers aren’t allowed to make any claims (whether or not they are true) about a product or ingredient’s ability to make permanent changes in the skin. This very much limits the ability of a manufacturer to provide consumers with independent referenced material about the action of a product or its ingredients.

  Second, the labeling requirements for cosmetics do not require the manufacturer to disclose the amounts or percentages of ingredients, although all ingredients must be listed on the label. What that means is that the consumer doesn’t know whether a product actually contains an ingredient in any meaningful quantity (i.e., the quantity and percentage that clinical studies have shown to be effective). Labeling regulations require that ingredients be listed in descending order, from greatest to the least, for those ingredients constituting 1 percent or more of the total weight. Ingredients making up less than 1 percent of the total may be listed in any order. The label, therefore, is of limited usefulness in determining the concentration of ingredients that may be highly effective at low concentrations. A product containing 1 percent melatonin, for example, would be indistinguishable from a product containing .001 percent. A product might only contain a few molecules of an effective ingredient that will maximize marketing but minimize effectiveness! Therefore the consumer is forced to rely upon independent reviews of the scientific literature or independent reviews of individual products. In the Resources section, I have endeavored to steer you to some products that I know are effective, both from personal experience and from my review of the science supporting them.

  Also, be aware that the cosmetics industry still puts things such as lead in lipsticks and other makeup products. Though people are waking up to the ill effects of chemicals in skin creams, it’s important to check ingredients. Good databases include CosmeticsInfo.org (www.cosmeticsinfo.org) as well as Skin Deep (www.cosmeticsdatabase.com), an online safety guide for cosmetics and personal care products maintained by the Environmental Working Group that covers nearly 64,000 products from more than 1,800 companies.

  The Preservative Dilemma

  The law requires that skin care products be preserved in order to prevent bacterial or fungal overgrowth, which is known to be dangerous. (There have been cases of blindness from mascara that was contaminated with pseudomonas bacteria.) Most companies accomplish this by adding traditional chemical preservatives known as parabens and formaldehyde-releasing chemicals. (Check product labels for the following: DMDM hydantoin, diazolidinyl urea, quaternium-15, benzalkonium chloride, benzalkonium bromide, chlorhexidine, cetylpyridinium chloride, or thimerosal.) Though preservatives are effective and give products a long shelf life, they themselves aren’t entirely safe—especially when used on the skin over many years.

  Some are found in very low levels in nature. Generally more than one paraben preservative is used to give broader germ-killing power. Parabens can cause skin irritation and contact sensitization over time. They may also act as environmental toxins that accumulate in tissue, including the breast. Further studies are necessary to evaluate how much risk is associated with longtime use of parabens and formaldehyde-releasing preservatives.

  You may also see claims made for “natural preservatives.” These products often use essential oils such as tea tree oil or grapefruit seed oil. These “natural preservatives” do not lend themselves to variations in formulas needed to produce an entire line of products; in other words, they have limited use and at times their effectiveness as a preservative or antimicrobial agent is questionable. It’s prude
nt to consider using products that don’t contain potentially harmful preservatives whenever possible to decrease one’s total lifetime exposure to these common chemicals. (See Resources.)

  Skin Care by Prescription Only

  If you follow the insulin-normalizing diet I recommend in chapter 7 and institute the skin care regimen I’ve outlined above, including a good antioxidant product with at least two or three of the antioxidants listed, then you probably won’t need anything else for your skin. Nevertheless, it’s worth knowing about the popular prescription skin care medications that are available. There are two basic kinds: retinoic acid derivatives and hormone-containing products.

  RETINOIC ACID DERIVATIVES: Retin-A, Retin-A Micro, and Renova are all prescription medications derived from retinoic acid, a form of vitamin A that helps prevent or reduce fine lines and wrinkles, reverse sun damage, and heal acne.

  These substances are powerful antioxidants, and regular use of retinoic acid as prescribed by a physician can result in reduction of fine lines and wrinkles, stimulate blood flow to the skin, even out pigmentation, and help prevent wrinkles and lines from forming in the first place.

  But retinoic acid is not for everyone. Side effects include redness, dryness, itchiness, and increased sun sensitivity. It takes anywhere from two to six months to notice a real difference if you’re not taking any other steps to improve your complexion, and you must be absolutely committed to rigorous sunscreen use.

  I personally used a form of Retin-A prescribed for many women before I discovered other, more effective skin care products. Though the Retin-A worked and was nonirritating, it resulted in excessive flakiness of my skin, which I’d sometimes notice on my cheeks and jawline at the worst possible time—usually looking into the mirror just before leaving for a speaking engagement! Not all women have this effect, but I find I get much better results with the topical and systemic antioxidant program I now use.