by Howard Murad, M.D., FAAD

It’s not a myth—we are definitely comprised of the elements that we eat. These elements are absorbed into the bloodstream and feed every cell. Each month we renew our skin, every six weeks we have a new liver and every three months we have new bones. In order to renew and rebuild these organs and tissues, we need to supply our bodies with the materials that have been lost as a result of constant use, degeneration or aging.

The problem is that we’re not getting enough nutrients to keep our cells fed. The Standard American Diet or SAD (an acronym that is most appropriate) is grossly inadequate and almost devoid of many nutrients. Americans are overfed and undernourished. Adding to the problem, many drugs interfere with the absorption of key nutrients. For example, tetracycline interferes with calcium, magnesium and iron absorption, and many antibiotics interfere with the absorption of the B vitamins, while oral contraceptives and hormones reduce levels of water-soluble vitamins.

It has been well documented in scientific literature that nutrition can play a key role in skin health. In relation to skin disease and aging, the bad news is that poor nutrition can accelerate skin degeneration. The good news, however, is that a healthful diet complete with optimal nutrition can help forestall, prevent, and even reverse skin conditions. Knowing this, it becomes clear that if you add an optimal nutrition plan to every skin care regimen, your clients can literally eat their way to healthier skin while they promote their total well-being.

What to Eat
Nutritionists commonly advise that people “eat a rainbow” of fruits and vegetables every day. Whenever possible, fruits and vegetables should be eaten raw. If they are cooked, they should be steamed to retain nutrients, or else lightly boiled. Even better, waterless cooking in the microwave preserves the most nutrients. While many believe that organic food is best, it may not always be available or cost-effective for everyone. In any case, there are 12 foods that should always be bought organically and there are also 12 foods that don’t have to be bought as organically grown products, says The Environmental Working Group (EWG).

Buy organic:
Peaches
Apples
Sweet bell peppers
Celery
Nectarines
Strawberries
Cherries
Pears
Imported grapes
Spinach
Lettuce
Potatoes

Don’t have to buy organic:
Onions
Avocados
Sweet corn
Pineapples
Mangos
Asparagus
Sweet peas
Kiwi
Bananas
Cabbage
Broccoli
Papaya

In addition to fruits and vegetables, whole grains, lean proteins and healthy fats provide the nutrients the body needs for optimal nutrition. Moreover, adding scientifically formulated dietary supplements to the diet can also be helpful as they offer the nutritional insurance needed to further optimize an individual’s personal nutrition profile. Supplements cannot replace foods, however, especially because we need good sources of fiber like fruits and vegetables. Supplements should only be used to augment the diet.

Inflammation and Cell Water Loss
Whether eaten in food form or taken as a supplement, an “internal skin care” program should incorporate plenty of anti-inflammatory foods and dietary nutrients. As we age, the body develops an ability to react disproportionately to what it perceives as an injury or invasion—either too much or too little. Inflammation is really a sign that the body is attempting to protect itself. It is also a sign of cellular water loss. Inflammation causes cell damage and has been linked to countless conditions from Alzheimer’s disease to diabetes to heart disease, and even wrinkles. When cells are not fully hydrated, they cannot function at optimal levels and this leads to cell damage and aging. Additionally, when cells deteriorate, the immune response does not function well. So, based on this “Water Principle,” the collective idea is to reinforce cellular membranes, prevent cell water loss and encourage the accumulation of intracellular water to ensure that all cells and connective tissues function at their best. But drinking water isn’t the answer—the cells have to be fed. An anti-inflammatory diet will fortify connective tissue, cells and their membranes with the antioxidants, vitamins, minerals and lipids they need for quick healing, resiliency, and supple, youthful skin.

Anti-inflammatory Foods
Anti-inflammatory foods include foods stocked with antioxidants or brightly colored fruits and vegetables, and healthful, EFA-rich protein. In skin cells, such as those found in the stratum corneum, EFAs (essential fatty acids), which are found in cell membranes, actually enhance the immune system as they strengthen the skin’s barrier function. In other words, EFAs play a part in cutaneous immunity. In sum, obtaining a good amount of EFAs through outside sources is essential to total health. In addition, alpha linoleic and gamma linolenic acids are ceaseless inflammation stoppers, as is durian extract and even sulfur.

Alpha-linoleic acid (ALA) works together with antioxidants such as vitamins C and E. It is important for growth, helps to prevent cell damage, and helps the body rid itself of harmful substances. ALA is found in vegetables, beans, fruits, flaxseed oil, canola oil, wheat germ, brewer’s yeast, and walnut oil and raw walnuts.

Gamma linolenic acid (GLA) is an EFA in the omega-6 family that is found primarily in plant-based oils. It is less common than ALA, but can be found in seed oils such as borage, evening primrose, black currant and hemp.

Durian is another anti-inflammatory food, but we don’t see much of it in the United States. It’s a native plant to Asia that offers a one-two punch to inflammation. Together, the omega-3 EFAs and antioxidants in durian act synergistically as they moderate the induction of inflammatory mediators, decreasing free-radical tissue damage; and inhibit collagen and elastin breakdown from matrix metalloproteinases (MMPs), natural enzymes in skin that degrade the skin matrix.

Early studies have also indicated that sulfur-containing foods like garlic, onions, meat, and cruciferous vegetables can offer anti-inflammatory and detoxifying benefits. Sulfur is found in every living cell in the body and it plays a key role in collagen synthesis.

Special Concerns
While inflammation-abating foods are good for cell health in general, there are some nutrients that are better than others for specific skin conditions.

Acne: Vitamin A helps normalize the production of excess skin cells within the follicles that clog the pore. Vitamins B1, B2, B3 and B6 assist with tissue growth and repair, and zinc helps reduce the inflammation of acne. Antioxidants like grape seed extract also reduce inflammation from acne and free radicals.

Menopausal Skin Issues: Melatonin, in addition to regulating sleep, is a powerful antioxidant that helps protect nuclear and mitochondrial DNA. Glucosamine is the building block for the ingredients needed to heal or repair the dermis, as well as all of the rest of the connective tissue throughout your body. And GABA, which is responsible for the regulation of muscle tone, is also a key nutrient.

Stressed Skin: B vitamins and glucosamine are essential for tissue repair and healing, as is vitamin C, coenzyme Q 10, and pomegranate, which boosts skin’s natural SPF. In addition, oregano an anti-inflammatory herb and curcumin, which comes from turmeric (found in curries), offer cell protective and anti-cancer benefits. Zinc also relieves inflammation and EFAs strengthen skin cell membranes. Lecithin, which is mainly comprised of phosphatidylcholine, is also excellent for stressed or over-processed skin as it is a major component of cellular membranes. Lecithin makes cell membranes strong so intracellular water doesn’t leak.

The ‘Pitcher’ of Health
Stepping away from the traditional idea of a food pyramid, consider the symbolism of a pitcher—a vessel that provides water. The food groups within the pitcher encourage intracellular water as they give the body the nutrients it needs to feed cells for overall health and youthful skin.

Fruits and vegetables form the base of the pitcher. We should eat more of these foods than any other group—3 or more servings a day of fruits and 5 or more servings of vegetables—for example, a small or medium-sized fruit like an apple is one serving and half a cup of chopped vegetable is one serving. Fruits and vegetables are rich in phytochemicals like polyphenols and the healing antioxidants the body needs.

Whole grains (4 to 8 servings daily) would be the next level up in the pitcher. A serving would be one slice of whole grain bread or a third cup of cooked brown rice. Avoid refined grains and carbohydrates (sugars). Whole grains are sources of magnesium and selenium. Magnesium is a mineral used in building bones and releasing energy from muscles. Selenium protects cells from oxidation, and it is also important for a healthy immune system.

Proteins (4 to 6 servings daily) would be the third level up inside the pitcher and this includes omega-3-rich fish, white-meat chicken, eggs, soy foods, fat-free and low-fat dairy products, and beans and provide most of our amino acids. Avoid high-saturated fat meat products and whole-fat dairy foods. A serving would be one medium egg or 3 ounces of fish. Amino acids give the body all the raw materials it needs to build collagen and elastin, the two substances necessary for keeping the dermis and blood vessels firm, strong, and smooth.

Healthy fats should be limited to just 3 to 4 servings a day and are next up within the pitcher. One serving would be a teaspoon of olive oil or alternatively 6 almonds. “Healthy” fats are unsaturated, such as omega-3, -6, and -9 fatty acids, which are found in flaxseed oil, extra-virgin olive oil, canola oil, natural-style nut butters, cold-water fish, and nuts.

Near the top of the pitcher, is space for supplements and water to address any dietary deficiencies.

Bridging the Nutritional Gap
Most people do not even realize that the skin symptom they see in the mirror and fatigue they feel are the result of nutrient deficiencies. We may not know the precise amounts of nutrients that each person’s body needs to close the gap between what’s consumed and what’s missed, but we do know that certain dietary nutrients can counteract inflammation, stress, and neutralize free radicals. It’s important to remember that before there was medicine, there was food.

While not an exhaustive list, the aforementioned nutrients offer an internal route to skin health. The best that we can do is eat well and take supplemental nutrients in amounts that are greater than we can easily consume in the foods we eat, but not so much that we create imbalances or reach toxic levels. These changes can be part of a long-term, inclusive solution, augmenting current topical skin care regimens to improve the look of skin, while at the same time increasing longevity and health down to the cellular level.

Inflammatory Foods and Anti-inflammatory Alternatives
Instead of red meat, eat cold-water fish
Instead of butter, use olive oil
Instead of cheese, try tofu or soy cheese
Instead of snacks loaded with saturated or trans fats, try seeds, nuts, fresh and natural dried fruits (including goji berries)
Instead of foods loaded with simple sugars, such as cookies, candies, cakes, choose fresh fruits and vegetables

Supplements to Take Daily

• Multivitamin and mineral supplement. Select a comprehensive and balanced formula containing all the major vitamins, minerals, and trace minerals;
  select an iron-free formula if you are postmenopausal.
• Antioxidant supplement formula
• High-potency B complex supplement providing all eight essential B vitamins: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5),
  pyridoxine (B6), folic acid (B9), cyanocobalamin (B12), biotin (B7).
• Essential fatty acid supplement providing omega-3 fatty acids. This may be in the form of fish oil, flaxseed oil, or ground flaxseeds
  added to food, or in capsule form. Vegetarians or those not eating fish or taking fish oil supplements should add a micro-algae-derived DHA supplement.
• Lecithin supplement. Use soy lecithin granules sprinkled on or added to foods or a liquid soy lecithin in capsule form.
• Glucosamine
• Calcium supplement for bone health. Most women should take 1000 to 1500 mg of calcium with vitamin D daily, depending on their dietary
  intake of calcium.

You can find all of these formulas separately. However, some supplement formulas, contain virtually all the nutrients you need in easy-to-take daily packages.

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by Howard Murad, M.D., FAAD

Aging Skin. It is a concern for most of us at some point in our life. How do you define aging skin and what works to reduce its effects? There are over 300 theories on skin aging. At least a dozen of them explain why cells decline. Inflammation and free radical damage have been pinpointed as the main culprits in the aging process. No matter what the cause of aging, I like to first look at the three types of aging which I classify as: Intrinsic Aging, Environmental Aging, and Hormonal Aging.

Intrinsic
Intrinsic aging is the natural aging process. It’s the type of aging that occurs whether or not you were exposed to sun, pollution, stress, alcohol or other aging elements. Even if you lived in a cave, your skin and your cells would experience intrinsic aging. Genetics play a key role in this type of aging. If your parents and grandparents aged well, chances are with a healthy lifestyle, you will too.

At about age twenty-five, the skin begins to show signs of intrinsic aging. These subtle skin changes include:

• Reduction in skin firmness as collagen fibers begin to lose their resiliency and become thicker and brittle. Collagen fibers decrease by about 1 percent each year starting at this age.
• Reduction in skin elasticity as elastin fibers become loose and break easily. There are also fewer of them.
• There is a decrease in the water-holding molecules surrounding the collagen and elastin that keeps them pliable and moist.

Environmental Aging
I first introduced the concept of environmental aging back in 1992. At that time, the link between environmental factors and skin aging was rarely discussed.

While the ultraviolet rays from the sun are a direct cause of environmental skin aging, they are not the only cause. Environmental aging is the only form of aging that we can prevent. Stress, nutrition, smoking, alcohol consumption, exposure to pollution and sun are all factors that we can have control over.

Environmental aging can add years to the appearance of the skin, while taking years off the average lifespan. After more than thirty years of observing the lifestyles of my patients, I firmly believe that environmental aging is unnecessary aging.

In addition to the depleted collagen and elastin tissue as seen in intrinsic aging, environmental aging changes include:

• Uneven skin tone called Hyperpigmentation (excess pigment) and Hypopigmentation (lack of pigment). The pigment producing cells become 20 percent less dense every ten years. At the same time there is an increase in melanin production in small areas, this leads to darker age spots and lighter areas or white spots.
• Increased redness due to thinner skin and increased blood vessels. Blood vessels carry nutrients and remove cellular waste from the skin. As they age, they diminish while the remaining become thicker and tend to twist and break.
• There is a decrease in the water holding-molecules that surround the collagen and elastin plus developing skin cells and the stratum corneum cells.

Hormonal aging
To layer onto the natural/intrinsic factors and controllable/environmental factors, the skin also ages as hormones fluctuate. The most notorious of all hormones, is estrogen. As women age, estrogen levels decline, and other hormones such as androgen, can become more dominant, showing a direct result on the skin. In addition to the factors above, hormonal aging signs include:

• Even more thinning of the skin as collagen and elastin fibers become weaker and shrink.
• Increased facial hair and acne breakouts as estrogen levels decline and androgen hormones increase.
• Extreme water loss in the cells and tissue.

The NEW Anti-Ager
No matter what the cause of aging, the depletion of water in the cells and in the tissue is the common denominator. This leads to my discovery that water is the anti-aging ingredient of the 21st century! But, it’s not the water you drink; it’s the water you keep – this is what I call The Cellular Water Principle.

If you are like most people, you mistakenly believe that drinking eight, ten, or even twelve glasses of water a day is the best way to hydrate your body and keep your skin healthy. Unfortunately, the main result of that fluid intake is frequent trips to the bathroom.

When it comes to reaping the healthful benefits of water, it’s not the quantity we consume but the quality of our cell’s ability to utilize this essential component that counts. Without an adequate water supply, the skin cells disintegrate, structures that support the skin become stiff and lose flexibility, and skin layers become thin and flat. The result? Visible signs of aging, including wrinkles, age spots, and fine lines.

The Cellular Water Principle is not about drinking water; it is about getting water into the cells and keeping it there so that every cell can function at full capacity.

Next to oxygen, water is the most important substance you need, and almost everything we know about aging tells us that the decline in function over the years is a direct result of water loss. To give you a visual, think of an infant. At birth, a baby’s body weight is about 75 percent water; it’s plump, smooth and resilient. As age takes it toll, we lose the ability to hold on to that water. Our skin becomes thin, dry and rough as the water content drops to an average of about 50 percent for adult females, 60 percent for males. Holding onto the water is the secret to keeping cells youthful.

The Missing Link
Inflammation and free radical damage have maintained their status in the headlines as the main causes of aging. Some of the worlds leading scientists have been unraveling the mystery of how these forces cause your body – and your skin – to destruct. Not only are inflammation and free radicals inextricable linked to wrinkles and the aging process in general, they are important players in chronic diseases from diabetes to arthritis to cancer. But as important as these factors are, they still have the same net effect; destruction of the cells or tissue causing water loss.

Quick Fix
During my over thirty years of practice I have seen over 50,000 patients. Many of them come to me as the signs of aging set in. Their mission – to stop the results of aging skin with an injection or a facelift. While I believe that surgical procedures can provide wonderful results, I always educate my patients on the fact that these procedures do not improve the quality of the skin. The skin can be lifted and pulled back, yet you still have the same skin. You can freeze the muscle or plump up a wrinkle with fillers, but you have not made the skin healthier. My answer is to put the water back into the tissue with using a method that combines both topical and internal factors.

The Cellular Water Principle – Topically
You can increase the water content in your skin by using treatments that contain these ingredients:

• Exfoliators such as enzymes, AHAs, BHAs, to remove non-functioning skin cells
• Natural Moisture Factors such as Sodium PCA and Hyaluronic Acid that absorb water
• Ceramides and Essential Fatty Acids, such as Evening Primrose Oil, Avocado Oil, Linoleic Acid protect the skin’s barrier function and help prevent water loss
• Antioxidants such as Vitamin C, Pomegranate Extract, Grape Seed Extract, and Green Tea, to protect from damaging free radicals
• Anti-inflammatory agents such as Licorice Extract, Zinc, Cucumber, and other botanicals to reduce inflammation

The Cellular Water Principle – Internally
I have always believed in the importance of supplements and their role in skin health. As the first to pioneer the use of Internal Skincare® back in 1995, I have scientific proof, through independent studies that you can reduce wrinkles, increase elasticity, clear acne, increase sun protection and reduce cellulite with specific supplement formulas.

To optimize the water content in the cells internally, recommend daily intake of these key nutrients:

• Glucosamine increases connective tissue so it can absorb more water
• Phosphatidylcholine to maintain cell walls
• Lecithin to build cell membranes
• Antioxidants including Vitamins C & E, Grape Seed Extract, and Coenzyme Q10 to fight free radicals
• Anti-inflammatory agents such as Zinc and Licorice Extract, and soothing botanicals to reduce inflammation
• Essential Fatty Acids lock in moisture in the cells
• Amino Acids which are the building blocks for collagen and elastin

When taken in the right combination, you can increase the water content of your cells and reduce wrinkles by 34 percent, increase elasticity by 18 percent, in just five weeks.

Synopsis
Incorporating The Cellular Water Principle may be summarized in two ways:

1. Put it on – Keep it in: On the outside you need to trap the water into your skin. This starts with cleansing. Leave the surface of the skin slightly damp, and then apply moisturizer that contains ingredients that attract water such as Hyaluronic Acid or Sodium PCA, and ingredient that lock in water, such as Ceramides.
2. Drink it – Keep it: On the inside, drink water and hold it in by taking Glucosamine. (Glucosamine produces Hyaluronic Acid, which attracts up to 1,000 times its weight in water). Then you maintain the water you drink by taking Essential Fatty Acids, such as Flaxseed, Olive Oil and Fish Oils.

As the famous Nobel Prize winner, Albert Szent-Gyorgi von Nagyrapolt wrote, “Discovery is seeing what everybody has seen, and thinking what nobody else has thought.”

Water. It’s the Anti-Ager of the 21st Century.

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by Howard Murad, M.D., FAAD

Cultural Stress is a new type of stress that is superimposed on the normal stresses of everyday life. From the advent of the digital revolution in the 1980s, to increased population and affluence, to the world-changing events on September 11, 2001, to chronic economic concerns, to the compulsion to send an endless stream of texts or to update our network of friends and family on Facebook and Twitter, many of life’s stressors have taken a more prominent and invasive position in our daily lives.

Technology is not entirely to blame for Cultural Stress, but the “freedom” to work and communicate anywhere, anytime, 24 hours a day, keeps America the land of the constantly “logged-on” workforce. Americans work longer hours than nearly anyone in the developed world – even the Japanese. For many professionals, the 40-hour workweek is history. Sixty to eighty hour workweeks are now the norm.

As a result of this pursuit to stay ahead, people experience extreme levels of on-the-job stress. According to data from the National Institute for Occupational Safety and Health, 40% of workers find their jobs stressful and 75% of people surveyed believe their jobs are more stressful now than a generation ago. Nearly 3.5 million Americans spend an hour and a half or more getting to and from work as they are pushed farther away from work in search of more affordable housing. Commuters are filling 4 a.m. trains into major cities and restaurants that opened for breakfast at 6 a.m. are opening earlier to accommodate the bleary-eyed workforce.

Americans in Isolation
Cultural Stress, whether caused by fear, overwork or too many options causing conflict in decision-making, ultimately leads to isolation. I believe isolation to be one of the most prominent diseases in today’s world. Studies have shown that to reduce isolation, people need to have regular physical and social contact, which reduces Cultural Stress and leads to happier, healthier lives.

World events have driven many Americans to isolate themselves, thus increasing depression and suicide. The CDC reported that the suicide rate among middle-aged Americans has reached its highest point in 25 years. Research indicates that Americans have fewer close friends than prior generations reported. Longer hours, lengthier commutes and the substitution of Internet contacts verses real-life connections contribute to the breakdown of social networks.

It Starts Early
Cultural Stress starts young, and while parents may not like to hear this, they are the ones who initiate it in their children. New parents are often anxious about getting their child into the best preschool. In fact, it’s common for unborn children to be placed on a preschool wait list. The next focus is on ensuring that the child is enrolled in all the right extracurricular activities – from preschool through high school. This cycle puts pressure on children to excel at a very young age, while placing a burden on the parents to make more money to pay for the education and extracurricular activities.

This scenario coupled with our society’s increasing affluence has a far-reaching domino effect. In order to make more money to pay for all the activities we are involved in, we are working longer hours. The more money we make, the more things we buy, and this phenomenon extends well beyond possessions. As we have become a more informed society, we are more aware of the endless possibilities available to us in the form of clubs, lifestyles, diets and leisure activities, to name just a few. All of this has put a great strain on our health and well-being, especially because the vast majority of Americans are barely keeping up.

Nutrition, Sleep, Depression and Exercise
Our busy, on-the-go lives have created yet another problem. We have no time to cook at home, so we have grown accustomed to eating out and as a nation we are consuming more processed foods than ever, and more foods that are fried, high in sugar, saturated fats and calories. We are eating less fruits and vegetables and this reduces the amount of antioxidants we consume. The result is high BMI (body mass index) readings and glycation, which makes us more susceptible to diabetes and increases the risk of cardiovascular disease.

Cultural stress is also keeping us up at night. Our national sleep deficit has resulted in an astounding nearly 50 million prescriptions for sleep aids and billions in coffee sales. Americans sleep less than people in any industrialized country. Sleeplessness has been associated with increased risk for illnesses such as colon cancer, breast cancer, heart disease and diabetes. The same sleep deficit that makes us unhealthy and also reduces our ability to be creative and productive.

To help maintain mental and physical health we need to eat complex carbohydrates from whole grains, fruits and vegetables, and good fats, especially omega-3 fatty acids. These not only encourage water to be attracted to the cells, but are also a component of the cell membrane. The Standard American Diet or SAD (an acronym that is most appropriate) is almost devoid of omega-3s. The University of Pittsburgh reported that high levels of omega-3 fatty acids like those found in coldwater fish, flaxseeds, olive oil and raw walnuts lessened bouts of depression as they built more grey matter in “depression” areas of the brain.

According to the National Institute of Mental Health, in any one-year period 9.5% of the population or about 20.9 million American adults, suffer from a mood disorder. Perhaps the best alternative to prescription drugs is exercise. Exercise conditions the body and allows it to detoxify quickly ridding the body of stress byproducts such as cortisol, which is known to impact the immune system. Aside from exercise being an outlet for anger and depression, it reduces boredom and is sometimes referred to as “moving meditation.” It helps many with problem solving as it offers time for reflection. It also increases self-esteem and offers social support. Exercise reduces muscle tension, releases healing endorphins and helps with relaxation and sleep. Finally, exercise makes us more fit to combat Cultural Stress and disease.

Emotions Tied to Skin
Dermatologists have long recognized neuropsychological connections between the appearance of the skin, perception of beauty and health. Anxiety and cultural stressors trigger cellular water loss through perspiration. The skin may flare up with acne or eczema in stressful situations. Recent evidence links the central nervous system and the skin revealing specific communication molecules that originate in both systems. For centuries, ancient medical practices and cultures have appreciated the connections between mind and body in wellness and disease, yet conventional medicine still trivializes this complex set of relationships. The role of modern medicine is so focused on acute disease that we forget to ask ourselves, “What is true health?” In my opinion, being truly healthy does not only mean the body is free of diabetes, cancer or other afflictions—being healthy also involves a passion for life, a true connection with others and an overall positive “sense of self.”

Cultural Stress and Skin
Cultural Stress can cause an outpouring of adrenaline, cortisol and other stress-related hormones that contribute to damaged cell walls which in turn, allows the precious water that keeps them functioning to escape. The water loss has a myriad of effects. It causes our cells and connective tissue to break down, which prevents our heart, lungs, brain and other organs from functioning at optimal levels – all of which become apparent when you look at the skin. Stress induced water loss also contributes to common skin problems – acne, rosacea and even premature signs of aging.

We can encourage more water in the cells and reduce Cultural Stress if we address the body with a comprehensive care program based upon Inclusive Health®. This approach takes all external, internal and emotional factors into account.

1. Topical Care – as the largest organ of the body, the skin is extremely responsive to products applied topically. Appropriate skincare regimen and professional spa treatments will address skincare concerns ranging from acne to wrinkles, while also preventing future damage.
2. Internal Care – we can only address cell health in the top 20% of the skin, the epidermis, with topical care. The cells in the remaining 80%, the dermis, must be addressed internally through diet and supplementation. A diet rich in raw fruits and vegetables and healthy fats such as those found in raw nuts and olive oil will promote the body to create healthy, hydrated cells. Dietary supplements provide the body with a constant supply of essential nutrients that serve as the building blocks of strong healthy cells.
3. Emotional Care – maintain connections with others; discover a passion such as painting or dancing. Reducing isolation promotes a healthy sense of self. Seek out the nurturing power of touch through facials and massage.

Tips for Reducing Cultural Stress

• The first step in reducing Cultural Stress is to determine its sources. Once the sources are identified, develop a plan of action to reduce their impact.
• Practice being mindful: Take some time each day to meditate or be quiet and enjoy the simple rhythms of life.
• If you are stuck in traffic and late for an appointment, accept the fact that you can’t control the situation. One thing you can control is how you react to these situations. Try to make the best of it. Why have a bad day when you can have a good day?
• Exercise regularly: Go for a walk, do yoga or take an exercise class. Being physically active, even for just a few minutes can make a difference in the way you feel.
• Nourish your body for optimum health: Make it a habit to avoid the Standard America Diet. Get foods that encourage and increase the water content in your body – a diet full of whole grains, fresh fruit and vegetables, good fats and proteins. Take a nutritional supplement to fill the nutritional gaps in your diet.
• Get a good night’s sleep: Americans sleep less than people in any industrialized country in the world. You need seven to nine hours of sleep every night to fully restore the body. Don’t lose sleep; find the time to recharge your body at night so you have the energy to face the challenges that come up every day.

Connecting the Dots
It’s easy to tell people to relax or to be good to themselves, but when stress is so pervasive that there’s no hiding from or avoiding it, it takes effort to unplug. The reality is that our lives will become even more hectic as time goes on and we will continue to push our children and ourselves to capacity until we wear out. As Americans, it’s not easy to unlearn the need to be on the go, but when it comes to mental and physical health, a day, week or month of complete relaxation may be just what the doctor orders. Everything in moderation is the key and this includes the things that contribute to Cultural Stress. The goal is to reduce Cultural Stress while enjoying the simple pleasures of life.

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by Howard Murad, M.D., FAAD

It’s human nature to reevaluate the way things are done. Think about fashion, food and design. These industries are constantly evolving, borrowing from what’s been done in the past, improving methods and products for the future. It’s no different in the spa industry where the basic facial, before there were AHAs, included just the minimum steps. It’s true that American spas got their start with methods and products from Europe, however, the changing landscape of our country, the entrepreneurship of U.S. business and the ingenuity of today’s scientific researchers have pulled the skin care and spa industry in a very different direction than from where it started. What’s certain is that where we are today will likely evolve in the years to come.

Today’s spas would largely be unrecognizable from those in the 1980s. In a nutshell, the American spa has gone from an exclusive venue where treatments were more pampering, to an inclusive one where treatments are custom-designed and therapeutic. Along the way, we’ve seen therapies come and go, and come again—sometimes tweaked, sometimes renamed. We’ve also witnessed an explosion in the number of medispas in our nation. With this explosion, many have asked if the holistic approach disappeared. The answer, simply, is “no”—it has just evolved into an advanced, inclusive health care approach, which will be the wave of the future in U.S. spas, medispas and medical facilities.

Where Did We Start? To understand the inclusive health care approach, we have to step back and see the pattern from where we came. Briefly, the pampering spa of the 1980s was an imported model from Europe. Treatments used French, German or Italian cosmetics, methods were less therapeutic and the exclusive environment catered to the wealthy. Fast-forwarding to the 1990s, U.S. spas became holistic centers. Many spa owners decided to strike out on their own to venture down a path rarely taken in the Western world. The holistic movement argued that long-term solutions could never be achieved without finding and treating a root cause. This movement was in defiance of the medical world, which has its therapies based more on systemic drug therapy. Thus, there was a gradual progression down the well-being path in the 1990s—a path replete with alternative therapies and saturated with Asian philosophies.

All the while, a large portion of the industry remained ever focused on medical esthetics. Slowly, acceptance of the spa environment and esthetics practitioners occurred in the medical world. Doctors began partnering with estheticians and bodywork professionals to augment waning revenues, which the decrepit U.S. health care system helped shrink. But adding skin care and holistic services to their invoices did more than just pad revenues. Clients and patients were asking for more and experiencing real results. The spa environment offered the softness and caring service so absent from traditional medical care. And holistic treatments from the alternative world and Far East satisfied the growing natural movement. As a result of these trends, which overlapped and intermingled, the skin care and spa industry gave birth to its newest creation: the medispa.

What Changed? Through their partnerships with spa pros, cosmetic physicians in the medispa were introduced to a multidisciplinary strategy of treatment where each professional worked toward wellness, within the confines of their respective specialty. Often, the protocols were under the direction of a physician, and while the packages aimed at being therapeutic, in many cases, they were heavy on the medical side. In addition, there was a lack of synergy across specialties: the left hand didn’t know what the right hand was doing. Packages were a mishmash of therapies that sometimes made no sense or could be counterintuitive to the patient/client’s goals. Some overbearing physicians caused resentment among the medispa staff members, who felt there should be more of a partnership or yin and yang in treating clients/patients. All of this started to change as time went on. A shift in the physician-dominated spa model began to occur because consumers demanded less invasive or non-invasive medical procedures.

Moving away from invasive procedures, an increase in the collaboration between specialties occurred, and new systems and protocols that integrated other fields were discovered. The physician’s leading role became diluted. At the same time, the practice of integrative medicine proved to be incomplete. Fundamentally, integrative medicine could not work because it is flawed as it allows for only some therapies to integrate or “come in.” Integrated modes of treatment are often secondary to and not as good as primary medical care. As such, there still remained a great disconnect among healthcare and spa professionals and the very patients and clients they treated.

What is Inclusive Health? To address the across-the-board disconnect, an inclusive system of care had to be introduced to U.S. spas. Now practiced in some medispa facilities across the nation, inclusive health care involves a team of professionals who partner with the client/patient to achieve long-lasting cosmetic goals and total wellness.

After a thorough examination of a patient’s health, internally, externally and emotionally, a mutually agreed upon goal is discussed with the client and a treatment protocol is outlined with the input from all medispa staff members, which could include a physician, lifestyle practitioners, estheticians, body workers, etc. Each participant, including the patient/client shares an equal responsibility in achieving the common goal(s). For organization’s sake, inclusive health programs are subdivided into categories such as: external care (facials, skin care, cosmetic surgery), internal care (nutrition, supplements, medication), and emotional care (relaxation spa services, stress-reduction, psychoanalysis, support groups).

Take, for example, a client/patient with severe acne. In an inclusive health care environment, the treatment would begin with a thorough, physical and clinical evaluation with lab tests to reveal lifestyle, nutrition, stress levels and hormonal balance, and blood composition. From there, an esthetician might begin enzyme facials and assign a home care regimen to complement in-house procedures. A physician could then work on acne scarring with medical solutions if needed. A nutritionist could administer a recommended immunity-boosting diet to fortify cellular health and healing as well as supplements. A massage therapist could offer body services to reduce stress. A psychiatrist or support group may help with the mentally debilitating aspect of acne and acne scarring. A makeup artist could offer makeup application tips on covering up blemishes as they heal. And if the acne is related to a medical issue such as polycystic ovarian syndrome, and excess weight is an issue, exercise physiology professionals may assist in weight loss goals, while an endocrinologist could prescribe the appropriate care for any concomitant, underlying medical issues.

Scientific study has brought us to where we are today and consumers have pushed the industry to honor their requests for better and longer-lasting results. As more has been learned about the human body and mind, a full story has begun to appear (but we still have much to discover). We’ve learned a great deal, down to the body’s miniscule cellular components. What these tiny parts tell us is that everything is connected, from what we feel to what we eat, our lifestyles, our sleeping habits … all body parts including muscles, blood vessels and connective tissue rely on each other, all organs are connected, and all cells work together. Making changes in internal health and emotional composition, in addition to therapeutic esthetics, produces profound results in patients and on their skin.

In sum, today’s inclusive health care environment aims at being noninvasive, goes beyond the holistic approach and includes nutrition, hormone therapy, exercise physiology, psychological health, etc., in addition to medical treatments, spa services and therapeutic skin care. Collectively, the result is optimum health and beauty that lasts.

A Comparison to Overseas Spas Inclusive health is truly an American creation with roots in European and Asian philosophies. While international concepts have been imported to the U.S. spa industry, they’ve also been adapted for the needs and demands of the American clientele. Interestingly, Europe is now looking at America for cues on how to become more relevant to European consumers. European spas have historically been based on treatments that use natural resources and incorporate some medical care, but not to the extent of being whole-health, inclusive care centers, such as those found in the United States now. While European spas have traditionally focused on a comprehensive approach to therapeutic stays that may last for weeks, the newest trend is to offer shorter daylong packages that provide the cosmetic aspect of inclusive care, which marries health services to esthetic treatments for total well-being. All things considered, there are still many differences between U.S. and foreign spas.

The biggest difference between U.S. spas and those in Europe—other than the lax attitude (according to American standards) toward nudity—is water therapies and the use of oils. Water services still remain a tough sell in most American spas and are largely absent in medispas. In the U.S., water does not form the foundation for all other treatments as it does overseas. Oils, because of their feel, are generally not used as often in the U.S. either as cleanliness-obsessed Americans are broadly adverse to greasy-feeling skin.

Long ago in Europe, health, wellness and beauty, surrounded the use of balneotherapy including drinking natural spring water. Still today in Europe, it is widely acknowledged that water therapies have a “noticeable effect on motor skills, skin, mental health, and other conditions.” As such, the water features are much more elaborate and form the core of a spa-goer’s therapies. For example, in France, the birthplace of thalassotherapy, bathing in sea minerals is believed to keep infection at bay, promote pain relief, assist in the rejuvenation of skin cells, and promote a healthy exchange of minerals and toxins between the blood and water.

But things are beginning to merge. For example, in Germany, in addition to skin care treatments, there are spa treatments for cardiovascular disease, musculo-skeletal illnesses, rheumatic diseases, gynecological problems, disorders of the nervous system, psychosomatic fatigue, general infirmity and convalescence. Russia has a similar feel where each guest undergoes a medical evaluation, receives prescriptions if needed, and a treatment schedule of walks and massages for relaxation and health benefits. However, during an average three-week stay at a Russian spa, days are still structured around meals and mineral waters, be it drinking them or bathing in them.

In Italy, where spa visits date back to ancient Rome, today’s services have evolved with the inclusive approach. Interestingly, the fastest-growing area in Italian spas is anti-aging and cosmetic procedures. A spa stay may include a guest evaluation that focuses on biological age and everything from health history to emotional countenance, stress levels to memory, skin and body composition, in addition to flexibility. A team of experts then outlines a list of health services (mind and body) in addition to external treatments from microdermabrasion to massage, filler injections to mud therapy and bathing with vegetable, mineral or marine extracts.

Total Care Like the aforementioned overseas spa industries, the face of the U.S. spa market is continually changing. A look back offers us a glimpse of just how much. Holism is not dead. Along with countless other therapies and methods, it has simply been reborn as inclusive health care, a revolutionary strategy that will ultimately help make people as healthy as they can be inside and out. Inclusive health care can foster wellness, encourage skin health and thwart aging on every front—externally, internally and emotionally. In this new era of the skin and spa industry, health and beauty in the United States have become synonymous. Taking notes from our successes, it’s ironic that spas overseas—from which we derive our foundation—are now looking to America for the next thing: spa protocols to treat the mind, skin, body and spirit—inclusively.

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