Mini Pause #7: Great Skin Health Inside & Out

How to Make Your Skin Health a Priority–One Habit at a Time

TL,DR (too long, didn’t read)

We lose collagen and elastin at a rate of one percent per year, and over time, we often see more wrinkles, poor elasticity, and decreased hydration of the skin. Supplementation and a proper skincare routine can help to reverse the skin aging process.

I’ve outlined best practices in food, lifestyle, supplements, and skin routines in today’s newsletter. The links throughout take you right to the science behind this information.

WHY

As we age, many of us notice changes in skin quality. Dull skin, fine lines, and a loss of elasticity are among the most common grievances in women during perimenopause and menopause.

While fillers and injectables are certainly options, I would put them second in line after a few items well within your control–your nutrition (or your internal health), your exercise habits, and your skin routine (external topicals). All of these can address wrinkles, elasticity, and hydration both from the inside out and outside in.

While you likely won’t see immediate results, when done consistently, you may see a noticeable difference in your skin in about three months.

I’ve made a personal goal to have my best skin ever this year, and it has become such an interesting rabbit hole to go down!

WHAT

Fine Lines & Wrinkles
The facial muscles are a group of about 20 flat skeletal muscles lying underneath the skin of the face and scalp. Most of them originate from the bones or fibrous structures of the skull and radiate to insert on the skin. This is a unique feature of facial muscles–a direct insertion point to the skin.

Other skeletal muscles typically originate from and insert into bone. The insertion directly into the skin is what allows for the face to move.

Years of facial expression start to show up at perpendicular angles to the muscle fibres. For example, the infamous “11” lines in between the eyebrows are exactly perpendicular to the muscle fibres of the procerus muscle. This muscle originates off the nasal bone and then flares upwards and inserts into the skin of the forehead. It is involved in furrowing or depressing the medial part (inside part) of the eyebrow.

This is in part due to wear and tear, but also an accumulation of oxidative stress, and a decrease in collagen and elastin production. As we age, this can look like a one- to two-percent loss per year.

Elasticity
It’s well known that collagen hydrolysate has several positive biological actions in the body, such as acting as an antioxidant, an antihypertensive, and being involved in lipid-lowering activities, and reparative actions in damaged skin.

Collagen is super interesting because it has a dual action in the skin where it first provides the building block components for collagen and elastin to be synthesized in the body. It then binds to dermal receptors to stimulate the synthesis of collagen and elastin as well as hyaluronic acid.

I think collagen is the heavyweight champ of skin supplements.

Hydration
Drink more water–YES! We all have to do this.

I typically aim to drink 3-4 litres daily. Most days, I settle on 2.5 to 3 litres. One thing that helps me is flavoring the water. I often add cucumbers and blueberries to a big jug. This little action makes the water feel more special.

Another component of hydration is your ability to hold onto that hydration. This is where you might find an electrolyte helpful.

Electrolytes, including sodium, potassium, and chloride, are minerals that carry an electric charge when they dissolve in water. Sodium is a cation with a positive charge (Na2+), while chloride is an anion with a negative charge (Cl2-). Other common electrolytes include phosphorus, calcium, and magnesium.

Electrolytes are involved in:

  • transporting nutrients to cells,
  • transporting waste out of cells,
  • proper function of nerves, heart, brain, and muscles,
  • pH balance, and
  • fluid balance.

Hormones
While hot flashes are often ascribed to “typical” menopausal symptoms, declining levels of estrogen can have devastating effects on our skin and hair.

Decreased estrogen levels in perimenopause and menopause can look like:

  • skin dryness and itchiness (pruritus),
  • skin thinning and atrophy,
  • wrinkles and sagging,
  • poor wound healing, and
  • reduced vascularity of the skin.

Many women find that using topical estradiol on the face and décolletage area improves the appearance of the skin. This topical application does not act systemically when applied only to the face. However, you must discuss this use with your primary healthcare provider and consider your individual risk factors.

HOW

LIFESTYLE INPUTS
Generally, consuming darker-colored foods like blueberries, blackberries, pomegranates, cherries, raspberries, etc., are great for skin health as they contain polyphenols that love your skin. Salmon, avocados, nuts, and seeds are good foods to be consuming often for their healthy fats.

Resistance Training: In researching for this newsletter, I was delighted to discover that resistance training also positively contributes to healthy skin by reducing circulating inflammation, increasing skin turnover rates, and by thickening the dermal matrix.

  • This is great for women in their 40s and beyond! Why? Because the tendency is for our skin to get thinner with declining collagen and estrogen levels.

Cardio: Tomato-faced cardio bunnies rejoice! Regular cardio is going to be wonderful for improving circulation to the face, which allows the blood to deliver nutrients to the skin.

  • Cardio also helps to increase mitochondrial function of the skin cells and reduce circulatory inflammation factors.

Red Light Therapy: This has been one of the interventions (above resistance training and regular cardio) with which I have noticed the biggest difference.

  • Research shows that red light therapy, or photobiomodulation, improves the enhancement of mitochondrial adenosine triphosphate (ATP) production, cell signaling and growth factor synthesis, and the reduction of oxidative stress.
  • I invested in the BON CHARGE Red Light Face Mask and the Red Light Neck & Chest Mask and I use them daily in the morning when I check my emails. This is a simple habit stack! I always check my emails at my desk, so it’s an ideal time for me to pop these on while I organize my inbox.

Supplements: Collagen Supplementation: A daily scoop of hydrolyzed collagen has been shown to augment the effects of aging including poor elasticity, fine lines and wrinkles, and skin hydration. I add a heaping scoop of Equip Foods collagen or mindbodygreen collagen to my morning water as I’m heading to the gym.

Vitamin D: Vitamin D is well known for improving many hallmarks of skin aging. Here are a few good things that it does:

  • prevents DNA damage,
  • stimulates DNA repair mechanisms,
  • regulates keratinocyte proliferation (keratinocytes produce keratin and make up 90 percent of your epidermal cells), and
  • regulates mighty antioxidative responses.

I love the mindbodygreen Vitamin D3/K2 supplements. I take 4000 IU in the spring and summertime, and pump it up to 6000 IU in the wintertime.

Electrolytes: I use LMNT, a salt-based electrolyte, daily with hot water. My current favorite is Chocolate Caramel. My regular rotation includes Watermelon, Grapefruit, and Raspberry.

OUTSIDE INPUTS
I have incorporated these steps into my skincare routine following a conversation with my friend Dr. Tony Youn on the Better! podcast at the start of this year. This cadence included Dr. Youn’s routine essentials for better skin through topicals:

Morning Skin Routine: 1. Cleanser, 2. Vitamin C or antioxidant serum, 3. Sunscreen

Evening Skin Routine: 1. Cleanser, 2. Retinoid, 3. Moisturizer

I am also becoming interested in peptides and stem cells and their ability to help rejuvenate the skin. Coming up:

  • Dr. Adeel Khan will be a guest on the podcast to discuss regenerative medicine through stem cells and peptides (not just for skin, but aging in general).
  • I’m visiting his clinic to have some peptide treatments done on my skin and can’t wait to share the results with you!
  • And, I’m already knee-deep in stem cell and peptide research and will have a special Mini Pause newsletter on this topic.

NOW

You may have some of these foundations already in place like eating good fats, or resistance training.

I want you to pick only one item from the HOW section that you want to incorporate into your existing skin routine. One of the best ways to make it “stick” is to pair it with something you are already doing. For example:

  • I put collagen into water I am already taking to the gym.
  • I use my red light face mask when I am seated and already checking my emails in the morning.

Habit stacking is an efficient way to make a small–and significant change–to your routine that won’t be overwhelming. This way the new habit is not an extra step, it is blending into an existing one.

YOUR TURN!

What are your skincare questions? Which one of these steps are you going to try? Let me know at support@drstephanieestima.com.

Discover Beauty That Fits Your Style

When I find something awesome that makes a difference in my health, I want to share it with my Bettys. So, if you vist the items I’ve shared in today’s newsletter, here are discount codes for you to use. I hope you love these products as much as I do!

  • Equip Foods collagen; use code DRSTEPHANIE
  • mindbodygreen collagen; use code DRSTEPHANIE
  • mindbodygreen vitamin D3/K2; use code DRSTEPHANIE
  • LMNT electrolytes; direct link to free sample pack with purchase
  • OneSkin peptide skincare (cleanser, sunscreen, moisturizer); use code DRSTEPHANIE
  • Timeline Skin Health serum; use code ESTIMASKIN
  • BON CHARGE red light masks; use code DRSTEPHANIE
  • Bonus! In a previous Mini Pause issue, I mentioned my love affair with Rose Best Skin Ever and Rose Glow Serum by Living Libations. They are both divine in a bottle! The link auto-applies a discount at checkout.

Question of the Week

Q: What about fibre?

From the Bettyverse: Thank you, Gabi, for asking for more about this topic!

I have a question related to the comment about fibre. There seems to be so much conflicting information about whether we need fibre at all. For instance, I hear of the carnivore diet being good for autoimmune issues and as long as you have enough dietary fat (not too much, not too little) you will have normal bowel movements. But I’ve also heard that women benefit from fibre to rid the body of excess estrogen.

My personal issue is inflammation of my joints. (For context, I’m 45, perimenopause (regular cycles, low progesterone/ estrogen dominant), and have been healthy keto for five years. I manage everything through diet and appropriate supplements. )

Could you say more about whether we “need” fibre and why? And the place of plant-free/fibre-free diets like carnivore?

WHAT THE SCIENCE SAYS

This is a multilayered question and I will try to address all of it succinctly.

I guess the short answer here is, you–need fibre. Full stop. I don’t care if the carnivore community says it isn’t important. That is inconsistent with the robust amount of literature and clinical outcomes that say otherwise.

A staggering amount of evidence demonstrates that fibre consumption reduces heart disease and cancer. (Another meta-analysis review here.) fibre has an unwavering and amazing ability to reduce LDL cholesterol. Many studies have demonstrably shown a 20-25% reduction in LDL cholesterol levels with adequate fibre intake.

In cancer risk, more fibre consumption has best shown a reduction in colorectal cancer by about 20%, as well as other cancers we care about like ovarian and breast cancers. Fibre plays a role in the estrobolome (the area of the gut dedicated to processing estrogen) and does help to bind to and get rid of estrogens.

KEY POINT

If you are going to eat a lot of meat, it is probably a good idea to pair it with a lot of fruit and veg.

Typically, individuals who eat high amounts of meat often miss out on the opportunity to consume foods with fibre. That does drive up the risk for heart disease and cancer over the long term.Vegan ideology might be tempted to conclude that it is meat consumption that drives heart disease and cancer. Hear me on this: it’s the lack of fibre consumption in individuals who consume meat that drives up cancer risk.

Clinically, this is where we need to think with a little bit of nuance.

SHORT-TERM VS. LONG-TERM BEHAVIOR

Going carnivore for a year, in the grand scheme of your 85+ year life doesn’t affect health outcomes. Just like if you have elevated LDL cholesterol levels for one year in the context of 85 years of healthy LDL cholesterol levels also doesn’t marginally affect outcomes. What is far more important is the chronic elevation of LDL over many decades that drives up the risk for these multifactorial diseases.

Imagine it another way. Remember when you were a silly, naive teenager and did dumb stuff with your friends because you thought you were invincible? While the activities you engaged in (and compounds you ingested) were probably really bad for you at the time, they aren’t going to be predictive of health for your entire life. It was a year, or two (or five) of doing dumb stuff. And then you came to your senses and corrected your behavior.

Now, before you send me a message about why I am hating on carnivore and how great the carnivore diet was for you–I get it! I, too, have used carnivore interventions in autoimmune patients with great success. The big idea I am trying to convey is that the intervention, while it worked in the short term, is designed to be transient. It doesn’t last forever.

Because the diet you need when you are sick is not the same one you need when you are well.

YOUR TURN!

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

Mini Pause #2: How Cold Plunge Benefits Women

Welcome to the The Mini Pause!

This is your weekly roundup of the BEST actionable steps for women 40+ who want to gain control of their hormones during perimenopause and menopause.

Last week we looked at oats and how they can be effectively used as a pre-workout fuel. If you missed it, you can read it here.

Cold Plunge: Is It The Same for Women?

TL,DR (too long, didn’t read)

Cold plunges are a great tool for recovering from muscle soreness post-exercise and there is some evidence it may help with the appearance of cellulite. There are a few considerations for women to keep in mind if you are jumping on this ‘cool’ trend (see what I did there?). Irrespective of the temperature, you want to stay in the water until you start shivering. Interestingly, women may not need to cold plunge at extreme cold temperatures to reap the benefits on metabolism and immune function.

WHY

Cold plunging has myriad benefits and one of the ways it shines is as a recovery tool. When you submerge yourself in cold water, it triggers several physiological responses in your body, such as:

  • constricting blood vessels,
  • reducing inflammation (which helps with muscle recovery), and
  • reducing swelling.

Anyone with an autoimmune condition or an arthritide like osteoarthritis knows how “hot” joints and tissues can get during a flareup and how welcome the cold can be. Women who run hot in the luteal phase of the cycle, or those who suffer from hot flashes, also may find cold plunging a welcome relief and a help with thermoregulation.

Cold plunging aids muscle recovery. This is incredibly important if you lift weights!

  • In the short term, cold plunges help with recovery from high-intensity exercise and endurance activities.
  • In the long term, it helps with muscle strength, muscle power, and even jump performance.

Another benefit of cold plunging is its stimulatory effects on metabolism. While you are in the cold tub and immediately afterward as your body brings your core temperature back to normal, you will burn more calories to heat up. Cold plunging liberates stored triglycerides from your fat depots and uses them for energy as you are trying to warm up.

Now — a word of caution — some online influencers have claimed this is the “single best way to get fat off your body.” This is simply not true. We are all subject to the laws of energy consumption irrespective of whether we cold plunge or not! And frankly, I’d argue that building muscle tissue is the single best way to burn fat.

I’ve estimated using this calculator that I burn about 35 calories while in the cold plunge. Using this estimate, a 35-calorie burn (and then a bit extra to bring your core temperature back up) is going to burn about 3.6 lbs on an annual basis.

In aggregate, this can contribute to fat loss when calories are controlled in your diet.

And finally, cellulite. While harmless, it’s often the reason women don’t wear the short shorts, the short sleeves, or the bikinis. While I think life is too short NOT wear what you love, there’s some emerging evidence that cold plunging can help with the appearance of cellulite.

WHAT

For those of you wanting to better understand the science of cold plunges, the process by which cold plunges impact metabolism is by activating brown fat.

When brown fat is activated, it generates heat by disrupting energy production. The technical term is called “uncoupling” oxidative phosphorylation. This uncoupling is being driven by Uncoupling Protein 1 (UCP1), which is present in the mitochondria of brown fat cells. UCP1 uncouples (or disrupts) the electron transport chain from creating ATP, causing the energy produced through cellular respiration to be dissipated as heat rather than used for ATP generation.

When heat is being created, your brown fat utilizes stored triglycerides as a fuel source. It breaks down triglycerides into fatty acids and glycerol. Then, those are transported to mitochondria to be oxidized for heat production. This process results in the release of energy in the form of heat and the consumption of stored fat.

For cellulite, during a cold plunge the cold temperature is absorbed by the fibrous connective tissue, leading to the collagen being more soluble. This solubilization promotes the removal of the tight, non-elastic network that often contributes to the appearance of cellulite. As a result, the skin’s pitted texture diminishes, creating a smoother and more even complexion. The activation of fibroblasts in response to collagen solubilization stimulates the production of new, more elastic collagen and further enhances the skin’s overall quality.

So at what temperature do you set your cold plunge and how long do you have to stay in to get these benefits? Like most things, there are sex differences when it comes to cold response.

Generally speaking, women are more intolerant to cold than men:

  • Women get colder faster
  • Women start shivering at higher temperatures
  • The neurotransmitter and immune benefits seem to be slightly lower for women. That doesn’t mean you don’t receive a benefit — it just means your response is smaller than what occurs in men.)

Where you are in your cycle also affects your tolerance to cold temperatures and how long you can be in cold water immersion.

  • Generally, women tend to run warmer in the luteal phase of the cycle — from ovulation through to the first day of your period. Cold plunging may be a welcome relief during this time.
  • In the follicular phase (bleed week through to ovulation), you’re typically more resilient to stressors. This can be a good time to play with longer plunges or colder temperatures.

HOW

Here are a few ways you can incorporate cold plunges as a recovery tool. I’ve outlined strategies at different price points for you to consider:

Cold Shower: This where my cold plunging journey started. I would take my regular shower and then the last minute, I would turn off the heat and stand in the freezing water for a minute. I may or may not have been screaming, crying, or both.

Ice Bag Baths: The next step in my cold plunge evolution was my bathtub. I would fill it up with cold water then top it off with ice from the gas station to get it extra cold. This was a better solution for a while. I could immerse myself in the water completely rather than being limited to the size of my shower nozzle. Over time, I did find the trip to the gas station cumbersome, and it was hard to control the exact temperature this way. If I over did it with the ice, I had to wait for the water to warm up.

Coldture Cold/Hot Tub: I invested in a cold tub when I knew it was a recovery practice I wanted to do several times a week for help with muscle recovery from my training sessions. I know I sound like a broken record, but in perimenopause, it’s all about the recovery!

For those of you wondering, I purchased the Coldture Classic tub with chiller. I decided on this tub because:

  • The tub is portable and I can move it outdoors in the summer if I want.
  • The tub DOUBLES as a hot tub! The temperature range on the chiller goes from 3C- 40C or 37F to 104F.
  • I can turn it on and off from my phone.
  • The chiller gets the exact temperature.
  • The two-step filtration system keeps my water clean.

There are other cold plunge options without a chiller. I went with this because I like to have control over the temperature. (If you decide to check out Coldture, use code DRSTEPHANIE to get a discount.)

I have the temperature set at 13C / 55F and I’m in there for 11 minutes, or until I start shivering. Depending on where I am in my cycle, this can be anywhere from 8 to 12 minutes. As I continue to build out cold tolerance, these numbers will change.

The main point is this: irrespective of your method or duration of cold water immersion — you want to stay in the water until you evoke a shivering response.

NOW

Choose your cold adventure (cold shower, ice bath in your bathtub, or cold plunge) and ignore the voice in your head telling you to avoid discomfort. That’s where all the growth, grit, and resilience happens!

Research on women and cold plunging is almost non-existent (surprise, surprise), but here are a few general guidelines for you to follow. Also, let your intuition guide you.

  • Aim for 10-12 minutes per week to start. If you are plunging 3x/week, that will be anywhere from 3 minutes to 4 minutes per session. Stay in until you elicit a shiver response.
  • Aim for the temperature to be 10C-16C / 50F-60F to start.
  • Towel off when you get out, and if time allows, don’t get dressed right away. Let your natural shivering response warm you back up. Truthfully, I’m only able to do this on weekends when I have a bit more time. I usually find my shiver response to last anywhere from about 15-30 minutes after the cold.
  • Note where you are in your cycle (if you’re still regular). You might find cold plunging a welcome relief in your luteal phase. That’s when you tend to run hotter and your tolerance for longer sessions is lower. During follicular phase plunges, the water may feel relatively colder, and you may be able to tolerate longer sessions.

Question of the Week

Q: I’m in menopause and my cholesterol and blood sugar have both gotten worse. Why?

 

Excellent question!  Let’s tuck into it.

EVALUATING

Menopause, from a strictly hormonal perspective, can and should be viewed as an estrogen deficiency. Estrogen has a direct effect on our lipids by directly acting on the liver to reduce total cholesterol, to reduce LDL cholesterol, and to increase HDL cholesterol.

In menopause and in perimenopause you have marked changes in estrogen levels. This means that in an environment of reduced estrogens, total cholesterol and LDL cholesterol will rise, and HDL cholesterol will lower. And the jump is significant — most women will see a 10-15% rise in their lipid levels in their post-menopausal years.

In my podcast with Ben Bikman, he called women “metabolic superheroes” prior to menopause because of of this lipid-balancing effect estrogen has. Once you’re menopausal and not taking hormonal replacement therapy, you can absolutely see a rise in total cholesterol and thereby increase your risk for cardiovascular and cerebrovascular disease. In fact, the female risk of cardiovascular disease in women who are 10 years into menopause tends to square off with the risk in men!

Our blood glucose similarly has a similar fate through a different path — your muscle. Skeletal muscle is the largest organ in the body by weight and is one of the primary regulators of glucose balance and homeostasis. Skeletal muscle is responsible for 80% (not a typo) of the glucose that circulates post meal.

As you age, the muscle desensitizes to the insulin signal from the pancreas, which has a net result of increased circulating blood glucose. Now, pair this with menopause, where you have a lower concentration of anabolic hormones like estrogen and testosterone, and this insulin insensitivity is amplified.

NEXT STEPS

The good news here is that you can always do something about it.

Women with a healthy weight and normal to high muscle mass are much less likely to experience the glucose dysregulation and dyslipidemia I described above. Maintaining or building your lean muscle tissue can be achieved through dietary or mechanical means.

Consuming protein (at a minimum of 1g/lb of body weight) is ideal for stimulating muscle growth. (There’s a lot more to say about what kind of protein, dosing of protein, and % of protein targets in the diet. Look for that in a future newsletter.)

Mechanical stimulation is what you might have guessed — regular resistance training! You have to give the muscle a reason to grow! Lift weight as heavy as you can with as close to perfect form as you can.

I will be diving into far more detail on form and type of exercises in coming newsletters and podcast episodes. I have spent the better part of 30 years mastering this and, as you might imagine, have a lot to say about it!

Nutrition plays a role here too — specifically your fibre consumption. Women who consume 25-35g per day will positively impact cholesterol levels, and can offset excessive weight gain.

YOUR TURN!

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

What I Recommend: LMNT

Healthy hydration isn’t just about drinking water. It’s about water AND electrolytes. You lose both water and sodium when you sweat. Both need to be replaced to prevent muscle cramps, headaches, and energy dips. This is especially true in winter, when your hydration needs actually rise.

I’m loving the new LMNT limited-edition Chocolate Medley for hot drinks. All three flavors, Chocolate Mint, Chocolate Chai, and Chocolate Raspberry taste great on their own or swirled into my favorite recipes. And the Chocolate Caramel rounds out the hot-drink flavors.

Visit drinklmnt.com/drestima to receive a free LMNT Sample Pack with any order.