This Is Why 99% of Skin Conditions Don't Heal — And What Dermatologists Won't Tell You with Dr. Mamina Turegano

Mark Hyman, MD

Full Transcript

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Dr. Mark Hyman
You said that muscle building is one of the best ways... It's a non skin care intervention for healthier skin in midlife. Can you kind of unpack that?

Dr. Mamina Turegano
There is a study that was really interesting about women in their kind of midlife age range. They compared them doing aerobic exercise to strength training. The participants who were strength training actually had a thicker dermis. You know, so dermis is where our collagen sits. When you're strength training, you're increasing insulin sensitivity and then that kind of takes a load off of your cells.

You're you're decreasing inflammation as well. Your mitochondria are optimally functioning. When your cells in the dermis are affected by that, they're gonna work better. They're gonna build more collagen.

Dr. Mark Hyman
Hey, everybody. I got some really exciting news. The doctor Hyman show is a finalist for two SIGNAL awards this year. Now first nomination is for the best live podcast for my conversation with Halle Berry at Eudaimonia where we had an incredible discussion about menopause, women's health, and why we completely need to rethink how to support women through this stage of life. We're also nominated for my thought leadership for my conversation with doctors Michael O'Koon and Ray Dorsey about the alarming rise of Parkinson's disease and what the latest science is teaching us about the connection between the gut and the brain, environmental toxins, and a whole bunch more.

And I'm really proud of both these conversations, and now we need your help. Please help me. Voting is open through October 15. Just head to vote.signalaward.com and vote for the doctor Hyman show. And as always, thank you for listening, for watching, for sharing these conversations, and being part of this community.

We couldn't do it without you. Ramina, welcome to the podcast.

Dr. Mamina Turegano
Thank you so much for having me.

Dr. Mark Hyman
You know, I've never had a dermatologist on. I'm very excited about this because when I started practicing functional medicine thirty years ago and treating people's health issues, I would notice that their skin would get better by improving their nutrition, by optimizing their gut flora, by helping them get rid of toxins, by dealing with, you know, food sensitivities. And it was quite it was quite amazing to me how things that were really chronic persistent conditions, like dermatitis issues like eczema, psoriasis, acne, rosacea, like a lot of the bread and butter stuff Yeah. Just people have. It doesn't go away.

Yeah. And it has to be man... It has to be managed. It has to be treated with medication. It's Mhmm.

And, you know, traditional dermatology is at least the way I learned it because I'm a family doctor. I learned dermatology. Yeah. You know, basic dermatology. I do basic stuff.

Was to put lotions, potions, gels, salves, creams, whatever you could put on the top to actually fix the problem, whether it was steroids or antibiotics or any fungal or whatever the thing was. Mhmm. If it's wet, dry, if it's dry, wetted, whatever, like,

Dr. Mamina Turegano
the Right. Right. Yeah. That... That's how...

With how they would teach that.

Dr. Mark Hyman
And I came to quickly understand when I started practicing functional medicine was that the skin health is really coming from the inside out. Yes. If you have sun damage. Yes. If you, you know, do things that harm your skin from the outside, it can be an issue.

But a lot of skin health and the treatment of chronic skin conditions, which a lot of people suffer from, is from the inside out. And it's dealing with the foundational things of nutrition, of gut health, of optimizing nutrient status. And so I think that I I kinda wanna get into, you know, how you came into this field from a traditional dermatologist and sort of had this awakening that... And and I know you kinda were sort of a little bit open to this because your mother's Japanese, and you learned about eastern medicine. How how you really kind of flipped the switch and said, oh, maybe there's a different way to approach these chronic dermatological conditions that cause so much suffering.

Yeah. So tell us how you kind of started to kind of understand that there was a different way of thinking about it, and let's sort of unpack some of the basic foundations of integrative functional dermatology.

Dr. Mamina Turegano
So like you mentioned, my mother's Japanese. So just from a young age, I've been exposed to alternative approaches to healing instead of just, you know, suppressing symptoms with, you know, an over the counter medicine or prescription medicine. My mom would incorporate modalities to really get to the root cause or what I would think. And so it just kept me... You know you know, gave me an open mind.

And when it came to applying to medical school, I was like, do I wanna go to a naturopathic medical school versus, like, an allopathic conventional medical school? And I was so torn. And I decided, you know, if I went the conventional route and got my MD, I could always practice, you know, holistic forms of medicine, functional medicine, with that background. And Which

Dr. Mark Hyman
kinda same happened to me. I was gonna study Chinese medicine. Was like, yeah. You know, like, I think about an MD behind my neck. I can do more stuff and be more big big

Dr. Mamina Turegano
papa. And, oh my gosh. And as you know, like, when you're in med school and residency, I just feel like I just got sucked into this vacuum. I was basically just trying to survive, like, just studying all the time, not

Dr. Mark Hyman
sleeping. Brainwashing.

Dr. Mamina Turegano
Yeah. It really is. It's it's so ironic, like, just the health, like, stress that we put our bodies through with medical residency and medical school. And so I definitely experienced a lot of health issues just going through all that. And and, really, there's...

Derm residency, even though derm is kind of a fun, more... You know, people think it's like a a fun field. It's not as... Some people don't take it as seriously as, like, you know, thoracic surgery, but but it's such a hard residency. There's such a learning curve because there's so much to learn in derm residency that you don't learn in medical school.

And so I just kind of got sucked into that and went into conventional private practice, but I was always so interested in taking a holistic approach. Like, I was president of an integrated medicine interest group during med school. And as I was practicing, you know, as you mentioned, we we put a lot of... We focus a lot on skin, like topical treatments. We do a lot of systemic treatments as well, but so much of it revolves around suppressing inflammation.

Dr. Mark Hyman
Well, steroids. You can use oral

Dr. Mamina Turegano
steroids, but

Dr. Mark Hyman
that's that's another some pretty serious

Dr. Mamina Turegano
steroids. It's it's

Dr. Mark Hyman
Like using a nuclear bomb.

Dr. Mamina Turegano
It's So Yeah. It's leaving you guys a nuclear bomb.

Dr. Mark Hyman
You know?

Dr. Mamina Turegano
And long term use, there's so many issues that come with that. But, also, even, like, biologics too, which are... They're they're safer than steroids, but there are also a lot of ramifications with biologic use.

Dr. Mark Hyman
And biologics, just to interrupt you for a second, is basically this class of drugs that is suppresses your immune system.

Dr. Mamina Turegano
Yes.

Dr. Mark Hyman
And and, you know, generally works well and doesn't have as much side effects, but does increase the risk of cancer and also lowers your immune system function so you're more likely to get serious infections.

Dr. Mamina Turegano
Yeah. More so with the anti TNF class, the newer classes. They're becoming more specific so they are more safe. But still, yeah, it's the premise of they're all suppressing your immune system. And it's just like, let's just shut up the immune system so that you can live in peace.

But what I've noticed just practicing more and more is that it's not really getting to the root cause. Like, I'm so grateful for these treatments because it makes people more comfortable. It makes them survive their day to day, but it's not really getting to the root cause.

Dr. Mark Hyman
So how do you then think about approaching dermatology now from this new set of lenses and perspectives that you have about how skin health is really from the inside out? It's a systemic problem, not just a skin problem. Your skin is a reflection of what's happening in the rest of your Mhmm. So how do you think about that? How do you approach these patients who come in with these really intractable conditions that, you know, require basically a sledgehammer?

We use sledgehammers in medicine.

Dr. Mamina Turegano
I know we do.

Dr. Mark Hyman
And it's just... No. There's a different approach.

Dr. Mamina Turegano
So when somebody comes in, obviously, take a thorough medical history, look at their background. But I also go beyond that and look at what they're eating, how they're sleeping, what the stress is like in their life, what hormonal changes they could be going through. Are they going through menopause? What are their environmental exposures? Are they traveling a lot?

What kind of environment are they living in? And, you know, what are their... What's their exercise habit like? So really taking all of that into consideration and taking that into account before I come up with a treatment plan for them.

Dr. Mark Hyman
So what tend to be the root causes that you're you're seeing, like, clinically in practice? Like, what are the things that are coming up over and over again that you're like, oh, I didn't learn this in residency or medical school, but this is actually something that is real that when I change this thing, it works.

Dr. Mamina Turegano
I would say gut and hormones are, like, the two biggest things that we see when it comes to a lot of the the major skin issues, whether it's acne, eczema, psoriasis, rosacea, hair loss even too. You know, we're not really addressing those in conventional dermatology. We have a lot of wonderful treatments, like I said, to suppress the symptoms. We have a lot of things that can help acne, whether it's spironolactone or isotretinoin, but, you know, it's not really healing the underlying triggers.

Dr. Mark Hyman
Yeah. It's true. Like, I I find that, you know, you start with nutrition in the gut Mhmm. And then you kind of work on optimizing that, and then you kind of see what's left over. And then, you know, there are other things that might be playing a role.

Like Mhmm. You said hormones, we'll get into that. Mhmm. Mitochondria, we'll get into that. Exercise, we'll get into that.

Dr. Mamina Turegano
Yeah. Insulin sensitivity.

Dr. Mark Hyman
Insulin resistance, which is a big thing for skin health, which people don't realize, which is affecting to some degree ninety plus percent of Americans. You know, function health with our diagnostics, we we measure insulin on everybody, which is not something most doctors check. And, you know, we're looking at the reference range from Quest, which is 18 or above is abnormal. I mean, really optimal is probably less than five. I mean, I'm three, two to three.

You know, someone who's 66, who's healthy, who's fit, who's like, metabolically okay, because I know what to do. That's kind of optimal. Yeah. But we're seeing even at the reference range of Quest, sixty five percent of members of our over half a million members have high insulin levels

Dr. Mamina Turegano
Oh, god.

Dr. Mark Hyman
And have inflammation. You know, you're probably familiar with Nicholas Perricone.

Dr. Mamina Turegano
Mhmm.

Dr. Mark Hyman
And he wrote the Wrinkle Cure way back And it was all about, like, inflammation and oxidative stress. And and so the question is, like, what is causing this inflammation? What is causing all this damage? And it's it's things that we can actually identify. So Yeah.

Diagnostically, how do you think about approaching these these patients with these chronic illnesses? What are you what are you testing? What are you looking for? How do you sort of do an essential differential diagnosis, but based on a a a new set of of lenses that you're looking through?

Dr. Mamina Turegano
There's people who come in wanting to, you know, help their skin with wrinkles and, like, kind of coming in for antiaging treatments. So that's a separate kind of diagnostic approach. But for people coming in with chronic inflammatory issues, whether it's acne, psoriasis, eczema, I do think that it's really important to look at their gut health, and I will often collaborate with other functional medicine doctors or naturopathic doctors to do gut testing and really do a thorough examination. Is there yeast overgrowth? Is there an imbalance somewhere there?

We do know that there are higher rates of SIBO in rosacea. Like, that's been established, higher rates of Helicobacter pylori. Mhmm. And Yeah. You know, we see that in in acne as well.

Really looking at that and targeting those things if if they show signs

Dr. Mark Hyman
Even fungal overgrowth for rosacea.

Dr. Mamina Turegano
Oh, fungal overgrowth. Definitely. When people come in with acne, another thing I really like to look at is their insulin sensitivity or their resistance, testing their insulin level, and even looking at the ratio of insulin to their fasting glucose, I think, gives even a more accurate picture of what's going on with their insulin sensitivity. And, yeah, the... In terms of testing, those are the main things.

And like I said, if we need to do more extensive testing like Dutch test to look at their hormones more closely, I will include, you know, another, you know, collaborative physician who who has more experience than that. But I do think that patients get frustrated, and they're like, just wanna know why I have this. They're they're grateful for medications, but they're like, if I stop it, then it comes right back. So it's it's it's not really solving, you know, the deep issue.

Dr. Mark Hyman
I also find that checking gluten sensitivity and antibodies to gluten is a big one, especially for certain conditions, whether it's psoriasis or... There's a lot of data that gluten can be a player.

Dr. Mamina Turegano
Yes. Yes. There... Yeah. Even, like, in non celiac patients, gluten can be a player in certain forms of psoriasis, because some people with psoriasis can test positive for those antibodies.

And for those patients, I do tell them to stay away from gluten. And then, like, some random other, like, dermatitis flares, we can see gluten sensitivity.

Dr. Mark Hyman
And acne is another one. Acne is a big one. You know? You mentioned insulin resistance, but again, like, you know, when you have high insulin, in women particularly, it can cause high testosterone and then sugar. So sugar is a big factor in causing acne.

People don't realize that.

Dr. Mamina Turegano
Oh, huge. Yeah. Sugar and dairy.

Dr. Mark Hyman
And dairy. Dairy is another one. And I personally have that. If I have dairy, like, especially if it's like a American, you know, regular dairy, but it's not... Or a two or regenerative or whatever, or sheep or goat Mhmm.

I get pimples. I'm like... It's like clockwork. Yeah. If I eat much dairy, I get pimples.

Mhmm. Mhmm. So it... You know, and I see this in my patients. So dairy and sugar...

And you think about the acne industry. I mean, it's

Dr. Mamina Turegano
huge. Well, it's huge. And, like, if you talk to, you know, like, my partner who'd been practicing for forty years, she said we did not see this much adult acne that... I mean, teenage acne has been around for a while, but adult acne has been rising in the last few decades. And it's like...

It just makes you wonder what else is going on in our environment. Yes. I think that agricultural practices have changed, like what we're feeding cows and, like, that could be affecting milk, the meat, all of, like, the other endocrine disrupting chemicals that could be out there.

Dr. Mark Hyman
Glyphosate destroys microbiome. Yeah.

Dr. Mamina Turegano
I mean, we're seeing more acne alongside, like, more rates of hypothyroidism, more hair loss, more infertility. Like, there's something going on in our environment that's that's affecting our whole endocrine system, I think, because these are all hormone based, a lot of it. Yeah. And, like, I also have my other theories. Like, I do think that we live in a more stressed environment too.

Stress is so huge when it comes to acne, as well as, you know, all these other inflammatory skin issues that we see. Stress can, you know, increase cortisol. So cortisol just sends a whole cascade of signals, including just, like, increased inflammation in our skin, increased... It makes our sebum more sticky. So, like, we get more acne from that too.

And... Yeah. So so we see that. And and and I'm I'm telling people to stop drinking coffee, but sometimes I do think that it can... If people drink too much caffeine or consume too much, that can artificially increase, like, their stress response in their bodies too.

So that's something I also talk about with patients. I'm like, what's your sleep like? How much caffeine are you consuming? I I sort of go in there as well.

Dr. Mark Hyman
Yeah. I don't know if you kind of adhere to this theory, but a lot of these skin conditions are inflammatory.

Dr. Mamina Turegano
Oh, yeah. Yeah. Inflammation, I would say, the base for everything.

Dr. Mark Hyman
Yeah. And so typically in medicine, we use anti inflammatories or immune suppressants or steroids basically to calm inflammation down. Yeah. But rather than going to the root of, like, why is there inflammation? So could you could you share a little bit about, like, your experience with some of these things and and what you've seen?

Dr. Mamina Turegano
When it comes to, you know, I'm just trying to think of, like, patient examples. I had a patient with terrible acne, and she had all these side effects to the conventional treatments, spironolactone and isotretinoin. She would respond to them, but she kept on getting like, she... Like, so spironolactone can affect your periods, and she was not having her periods, which which wasn't the problem, but she was also just getting a little bit too dehydrated from it. Like, it was causing her heart to race.

Dr. Mark Hyman
That's a... It's kind of a diuretic that also blocks testosterone so it can help with acne. Yeah.

Dr. Mamina Turegano
Yeah. And then with isotretinoin, she was getting joint pain. So we were working with a functional medicine doctor, and she did some gut microbiome testing on her and saw that she did have yeast overgrowth and and fixed her fixed her yeast, but she also did some hormonal testing as well and gave her certain supplements to just help kinda with the hormone balancing. Mhmm. And her skin cleared.

She didn't need any conventional treatments Yeah. Which I was thrilled about, honestly. Yeah. And... Yeah.

And then, you know, when when I talk about... When when patients come in, like, psoriasis too. So with psoriasis, I find that these patients have so many other issues going on. They have cardiovascular issues like metabolic syndrome.

Dr. Mark Hyman
Mhmm.

Dr. Mamina Turegano
So... And then prediabetic. They have hypothyroidism. They have low vitamin D. There...

It... It's like a full picture with with psoriasis. So so I I try to also do other workup. I I do look at their thyroid. I do look at their lipids and their vitamin D and and make sure that we're addressing all of those things.

They're usually sleep deprived. I find that a lot of people who do, like, night shifts where their circadian rhythm is completely flipped upside down, that really sets off psoriasis. It sets off a lot of inflammatory skin issues, but we do see circadian rhythm disruption being a huge one with psoriasis.

Dr. Mark Hyman
I've seen a lot of psoriasis patients, and I find it's one of the slam dunks of functional medicine. And even though it's such a, like, called the heartbreak of psoriasis. It's like, you know, and the things that I found were gluten are really top of the list. Anybody who's got that, I get checked for sure. Mhmm.

Mhmm. Gut issues and pretty leaky gut and food sensitivities on top of that, and and and also overgrowth of yeast, which is a common one. And then heavy metals, are kind of often overlooked. And so Yeah. If you kind of dig around on those, usually you can find a way through.

You need to find a good practitioner like you or a functional medicine doctor to do because it's not something that traditional doctors even think about.

Dr. Mamina Turegano
They don't. I know. And I wish... There's a lot of, like, people... I don't know.

I feel like there's lot of controversy out there on, like, doing some of these forms of testing. But but to me, we we can't... We don't have all the answers with the conventional testing. And so... Yeah.

I I know I really appreciate, like, your mission to to really bring about these other forms of how do we find out the root cause of these patients, whether it is with heavy metals or gut microbiome testing?

Dr. Mark Hyman
And the truth is there's not a lot of research money going towards these modalities of nutrition, of gut health, of things that are really kind of not long term treatments. Because think about it. Like, if you if you get someone on a drug for, you know, acne like a a retinoid Mhmm. I mean, they're kinda on it. So it's like, it's great for the drug company.

Like... But if you treat someone and they get better and they're off everything, not so good. So there's not a lot of incentives for doing the foundational things. It doesn't mean that because there's a lack of, like, large double blind randomized controlled trials that it doesn't work. I would say the absence of evidence is not the evidence of absence.

Mhmm. And I think, you know, as a clinician, I'm observing things over and over like you are.

Dr. Mamina Turegano
Mhmm.

Dr. Mark Hyman
And I'm seeing that, you know, there's a there there. And yes, we need more research, and thank God the the Medicare, the Center for Medicare and Medicaid Innovation put up a $100,000,000 to study chronic diseases using functional medicine and lifestyle medicine, which is amazing. There's... There is some things happening, but we... That's just...

That doesn't mean we can't already just take advantage of these things, because they're generally low cost or low risk, and they're very safe to do. Changing your diet, changing your lifestyle Right. Exercising, taking a few supplements. Let's talk about nutrition and the skin. What...

Tell me your philosophy around what should be, like, a healthy skin diet, and also, like, what do you use when you start to treat these chronic issues like psoriasis or eczema or acne or so forth?

Dr. Mamina Turegano
Yeah. When it comes to a healthy skin diet, most of the evidence comes back to a Mediterranean based diet. Basically, I would just call it, like, a well balanced diet. So adequate protein, adequate healthy fats, low sugar, adequate fiber. I think fiber is also an underrated thing.

We're seeing definitely low fiber correlate with a lot of issues a lot with acne. But, anyway, so so though... That's the basic premise. But we also wanna make sure that we're adding, like, adequate nutrients, vitamin c, polyphenol rich foods, or supplements. But but I would say foods would be the the best route if you can do it Mhmm.

And other flavonoids as well as, like, carotenoids are huge as well, whether it's, like, beta carotene or astaxanthin. So foods rich in those ingredients. I... It's tough because I I try not to be overly restrictive with patients. I feel like it ends up backfiring.

Mhmm. But I'm like, if we can at least make the goal of making it more balanced, you know, making sure you're having your fruits and vegetables. I know that sounds so cliche, but doing that and making sure you're having adequate fiber, healthy fats, minimizing the processed foods, minimizing the sugar Mhmm. That's where we have the most evidence.

Dr. Mark Hyman
Those are foundational principles for general health... Skin health.

Dr. Mamina Turegano
Mhmm.

Dr. Mark Hyman
But then when it comes to people with chronic conditions, like, I I find that elimination diets can be a great place to start. Yes. Basic gluten, dairy, sugar, processed food. It's like... It just makes such

Dr. Mamina Turegano
a difference. Where we have the most evidence for acne, it's it's dairy and with sugar. When it comes to dairy, it's more so skim milk than it is whole milk, but but the evidence is pretty compelling for really all forms of dairy. Mhmm. And then when it comes to...

And then and then increasing fiber too. We... We're seeing that lack of fiber is also contributing to acne.

Dr. Mark Hyman
And affects the microbiome.

Dr. Mamina Turegano
Yep. Exactly. Yep. And then there's also this idea where if you're not, you know, regular with your bowel movements, it can cause a buildup of, like, certain hormone metabolites as well that could potentially contribute to acne. So something to think about when it comes to psoriasis.

Most evidence, like I mentioned, is Mediterranean diet, healthy fats. I try to supplement with omega threes and vitamin d. And then gluten, it's interesting from what I learned is that if if they do have a sensitivity to gluten with, like, certain antibody testing, then I would definitely have them go gluten free. I'm not as adamant about it if they're negative with those tests.

Dr. Mark Hyman
It's... I find it's worth trying because there's, you there's two parts of your immune system as as obviously you know. But for people listening, there's the one that's forming antibodies, which we can test for, and there's the one that doesn't form antibodies, which is the ancient immune system or the innate immune system that doesn't form antibodies. And there's a there's a good body of literature that a lot of people react to gluten from the innate immune system, which is not measurable. So I find it often like a good...

You know, just as a good kind of test for, like, two or three weeks Yeah. And not forever. And then and then you see. What... Like, are there foundational nutrients you recommend for the skin?

You mentioned omega threes, vitamin d.

Dr. Mamina Turegano
I keep it pretty basic. Omega threes, healthy fats in general, whether it's, you know, avocado, nuts, fish. I mean, not all the time, but, you know, kind of the... You know, incorporating the ones that are smaller. Like, I like sardines.

Dr. Mark Hyman
I mean,

Dr. Mamina Turegano
if you get wild caught salmon, great. And then when it comes to other things to incorporate more fiber, so that's just vegetables in general, fruits in general. But there's really not, like, one specific thing. You know, I meant... Like I mentioned, carotenoids.

I tell people, really try to eat the rainbow, and I know you've, like, mentioned this too, for for... In general, for, like, for skin issues. But, there's not like, oh, if you eat more of this specific food, you're gonna you're gonna get

Dr. Mark Hyman
Yeah.

Dr. Mamina Turegano
All better.

Dr. Mark Hyman
Yeah. Well, Nick... Nicole's parent was talking about, like, wild salmon. I think the omega threes are so big. I find that if I would say, like, what is the one clearly, like, clinically effective skin nutrient that I've used over and over again for skin, hair, and nails, it's omega threes.

If someone's low in omega threes and at function health, we test everybody for the omega index. And, you know, you just wanna be over 8%, and most people are not. Most people are quite low. And so, you know, we don't get a lot of, you know, wild animals or wild plants or wild food, which is where typically these omega threes are. So I think it's important to supplement.

Talk about how hormones play a role in skin and how... I know you've talked a lot about sort of female health and reproductive health and some of the things that happen on menopause. Like, tell us about how how you help think... Women think about their skin health. Yeah.

And then and then we will get into the aging and that, like, how... Because I think we've been talking clinically about what are the health pathologies, let's say, which are diseases of the skin. But then we're gonna get into, like, just how do you make sure your skin ages well. Yeah. And that's that's sort of topic two we'll get to, but I I wanna sort of sort of just talk about sort of hormonal dysregulation.

Because you did mention gut and hormones as key drivers of skin dysfunction.

Dr. Mamina Turegano
Huge. Yeah. There's different types of hormones. There's estrogen, progesterone, testosterone, the sex hormones. And then there's also thyroid hormone, which plays a big role with a lot of skin issues, and then insulin Mhmm.

Being another hormone. So

Dr. Mark Hyman
Mhmm. I

Dr. Mamina Turegano
I see all of those playing a role with how we age and how that can contribute to inflammation in our skin. So, I mean, just to kinda touch on each of them, when we see thyroid issues, we see more dry skin. We see brittle nails. We see more hair loss.

Dr. Mark Hyman
Mhmm.

Dr. Mamina Turegano
We see... Yeah. Just, like, decreased wound healing time, just like the circulation's not as robust. So so, you know, when I see those issues, anytime somebody comes in with hair loss, I always check thyroid. When it comes to insulin, we talked about acne.

So insulin resistance, see more so in acne. We can also see it in psoriasis. It can also contribute to accelerated aging, so that's something we'd like to look into. And then when it comes to the sex hormones, you mentioned menopause. So, you know, we have a drastic drop in estrogen, when...

In, like, within the first five years of menopause. And estrogen is huge when it comes to just overall skin health. It plays a role... And testosterone as well. Testosterone goes down too, and I'll talk about what the benefits are.

But but with estrogen, it's... It activates fibroblast activity. These are the cells that help build collagen. So that's that's how, you know, collagen production goes down. It also contributes to increased, like, hydration in the skin, whether it's increased hyaluronic acid or just increased, lipid production in our cells.

So so our skin barrier becomes altered. Our skin becomes more dry when we have less estrogen. And it also plays a role in, like, the thickness of our skin. So we have what's called epidermal atrophy. And that's where you get, like, that kind of that crepey skin, kind of in that post menopausal period.

So estrogen plays a really big role with that. Works alongside progesterone. And then, like, testosterone. Testosterone's really huge when it... And the androgens in general when it comes to, like, oil production.

And so that plays a role with skin barrier dysfunction. That's why we always see dry, itchy people as they get older. Everyone just gets more dry.

Dr. Mark Hyman
So are you a fan of hormone replacement therapy for women?

Dr. Mamina Turegano
I am a big fan. I think it does wonders for your skin.

Dr. Mark Hyman
Yeah. And how how good is the how good is the data on that?

Dr. Mamina Turegano
We haven't really... There... I don't think there's, like, been a lot of amazing studies that are dedicated to looking at skin health, and I would love for there to be more. It's more just... It's kind of a side effect that we've been seeing.

Dr. Mark Hyman
So you basically clinically observed this. And and and I think it's true. I think women do notice that, and I think, you know, like you say, these hormones are really playing a role. So you've talked about insulin resistance, you've talked about thyroid dysfunction, then you've talked about sex hormones all playing a role. So I think I think, you know, getting your hormones tuned up is super important.

And as... Particularly women, as they go through perimenopause and menopause, there's so many things that start to happen. They get more insulin resistant, their thyroids often go wacky, their sex hormones are going wacky, and everything's gonna... And then there... Of course, their stress hormones are going wacky because they're in the middle of this Yeah.

Generation with older parents and younger teenage kids and, you know, careers. And it's like... It's kind of a soup of of dysfunctional hormones Mhmm. Of insulin, thyroid, sex hormones, and cortisol and stress hormones. So I think I think that that that's often not really well addressed with traditional medicine, but there's ways to look at these things.

There's ways to understand where you are. There's ways to work to optimize your health with these both with, you know, hormone replacement therapy, but also lifestyle, diet, and so forth. Let's sort of get into skin aging, because I think it's a sort of a separate topic that I want to dive into. But I just... Before we do that, just want to close on this first bit by saying that if you have a skin issue, if you have psoriasis, or eczema, or rosacea or acne, which are the most common ones that I forget any that I forget any.

Yeah. Yeah. And these are the bread and butter.

Dr. Mamina Turegano
Right? The bread and butter of one three.

Dr. Mark Hyman
These are things that have solutions that you're not necessarily hearing from your regular dermatologist, that a functional medicine approach, integrated medicine approach can really help solve. And sometimes it takes a minute to figure it out, to unpack it, to be a detective, but it's it's worth going into that route. Mhmm. And sometimes it does mean modifying your life a little bit. Like, sometimes you can't eat gluten.

Sometimes you can't eat dairy. Sometimes you have to fix your gut. Sometimes you... Like, there's things you have to do.

Dr. Mamina Turegano
It takes work, which is why I think so many people don't do it too.

Dr. Mark Hyman
Yeah. Yeah. But but the other alternative is just to be miserable.

Dr. Mamina Turegano
Exactly. No. No. No. For sure.

For sure. Yeah.

Dr. Mark Hyman
I had quite an amazing patient. I'll just tell you quickly about psoriatic arthritis, which is like an advanced form of psoriasis that affects the joints.

Dr. Mamina Turegano
So hard.

Dr. Mark Hyman
And it's a tough condition. At Cleveland Clinic, we did a we did a study where we took our patients in our center for functional medicine. We're treated by the functional medicine doctors who had psoriasis or rheumatoid arthritis, comparing it to the rheumatology patients in the rheumatology department, which is rated number one in the world for rheumatology at Cleveland Clinic. So these people know what they're doing. They're really good.

And they're training and they... And the fellow looked at our data. We didn't analyze the data. They looked at our data. They used all their traditional rating scales that they have in medicine for rheumatology.

Dr. Mamina Turegano
Uh-huh.

Dr. Mark Hyman
And we did better across the board in outcomes. Were using functional medicine, not using drugs compared to them using all the drugs.

Dr. Mamina Turegano
Doing the usual things, looking at their gut

Dr. Mark Hyman
The gut health, nutrition. Yeah. Everything. Elimination diet. The usual stuff.

And it was like... I think it was shocking to them, but it was, like, obvious to me. I had a patient who was a psoriatic arthritis patient who had multiple other issues. She had pre diabetes, she had migraines, she had depression, she had irritable bowel, she had reflux, and obviously psoriasis, and arthritis. And she was taking Stelera, is a very expensive immune suppressing drug, and she was taking a bunch of other drugs like her neurologist, and her psychiatrist, and her gastroenterologist, and her endocrinologist, for her diabetes, and her pre diabetes, and her migraines, her...

You know, and they're all like, these are the best doctors in the world, and they are giving them the best treatments for their... But they're all treating like a like a blind man and an elephant. And I'm like, what is the common denominator in this patient? It's inflammation. All these migraines are inflammation, prediabetes inflammation, irritable bowel inflammation, reflux inflammation, joint pain inflammation, actually psoriasis and skin inflammation.

And I said, look, I don't... Know. She has severe bloating and severe, like, reflux and all these symptoms. Think you have SIBO, which is bacterial overgrowth in the gut. I think you probably also have fungal overgrowth given how many antibiotics or steroids you've been on.

And so I basically gave her an unabsorbed antibiotic, rifaximin, and I gave her an antifungal. Not typical treatments for psoriasis. No. And I gave her some probiotics and vitamin d and fish oil, think probably a little zinc or something, and not a lot. And then I put her off gluten, dairy, sugar, processed food.

I basically put her on my ten day detox diet, which essentially is an elimination diet to get sort of all the potential triggers for short term. She came back six weeks later, and she said, I'm better. Like, I have no psoriasis, no arthritis. I stopped all my meds. I said, I didn't tell you to stop your meds.

She said, well, I know, but I felt better. No migraines. No prediabetes. She lost 20 pounds. No more reflux.

No more irritable bowel. And no more depression. And depression is also inflammation, right, in the brain. And so I was like, this is this is an example of a way that, you know, traditional medicine misses the boat. Mhmm.

Like, they just kind of don't understand how to think about the problem. And that by using these other sort of filters to see the same symptoms and the same diseases, we see a different set of issues that are going on. And it's almost like we put on special glasses, like you put on infrared or night vision glasses, and you're like, oh, I see what's going on. And then she, you know, she... But but this is not, oh, it's an anecdote or whatever, and I'm like, yeah.

I I had done this for thirty years, and I can tell you there's hundreds and hundreds, if not thousands of patients across the spectrum of different diseases that have responded this way, and not everybody responds to everything. And sometimes it's a puzzle, and like I had a patient with eczema, couldn't get better, and I... Then I figured out it was mercury. But it's just... It's it's really about being persistent.

So if you're listening out there and you have these issues, don't give up. There's a way forward. You might have to change your lifestyle, but it works. Let's get into let's get into aging. What's happening in terms of, like, skin as we age?

Like, what goes wrong, and how do we how do we improve? Do you see some people, like, who look like a 100 when they're 45, and people who are, like, 90 who look amazing?

Dr. Mamina Turegano
Oh, yeah. There's different things happening at the different layers of our skin, and I'll just, like, briefly touch on it. So, you know, the top layer of the epidermis, as we get older, our cellular turnover gets more sluggish. It slows down. So that contributes to just kinda more dull, uneven skin.

And I think of that phrase, like, smooth as a baby's butt because, literally, like, babies, their skin cell turnover is every two weeks. As adults, it's every four weeks. But then, like I said, as we get older, it just becomes more sluggish. So so that's what creates, like, the buildup of dry skin and, like, uneven skin tone. So there's that.

And then, you know, we have our melanocytes, which sit at the base of our epidermis, and these are the cells that produce pigment. And their activity just becomes more, like, unpredictable. Like, some just poop out. They're like, I'm just gonna, like, release all this pigment. And we get, like, more sunspots and, like, uneven pigmentation as we get older as well.

And then we're also, you know, producing lipids, and we have sebaceous glands that are living in the dermis, but then they get released into the epidermis. And lipids are also responsible, like I mentioned earlier, for keeping our skin hydrated, keeping our skin barrier intact. So as we get older, we get more dry skin. And then below the epidermis, we have the dermis. And the...

Probably the biggest component is collagen, which sits in the dermis. And, I mean, there's other components, elastin, hyaluronic acid, or what we call glycosaminoglycans, which are these sugar molecules like hyaluronic acid that sort of, like, live between the collagen fibers and support the collagen and elastin. And as we get older, collagen. We get more disorganized collagen and elastin, and that contributes to wrinkles that we see. And that's a natural part of aging, but there are certainly things that accelerate that, which we can talk about.

Below the dermis is the subdermis or the subcutaneous fat, which, you know, as we get older, fat decreases as well. And then below that is bone. As we get older, like, our bone our bone starts resorbing and, like... Yeah. Yeah.

We we have decreased bone structure. So, like, I think of it like a mattress. You know? Like, the mattress cover is, like, our epidermis, and then the springs are, like, your dermis, and then the actual bed frame is your is your, you know, your bone structure that's supporting everything. And so so we need all of that to look like a very appealing bed.

Dr. Mark Hyman
From your perspective, given what you know with functional intuitive dermatology, how do you think about skin differently with aging? How do you how do you help people take care of their skin differently with nutrition, lifestyle, gut, supplements? I know. And the skin care. Because Yeah.

And think suck does matter.

Dr. Mamina Turegano
But does matter. And, yeah, if you were to ask a conventional dermatologist, there, you know, there are a lot of things that we have so much evidence for, decades of evidence topically that can help your skin, whether it's retinoids, sun protection. There's other things like vitamin C, like topical antioxidants.

Dr. Mark Hyman
Yeah.

Dr. Mamina Turegano
But but there are also things that we can do internally that really help our cellular activity repair the cells. And like you mentioned, nutrition, stress, sleep, other, like, environmental, like, stressors. I mean, we know that UV is huge, but whether it's pollution or, like, under... Like, other, like, endocrine disrupting, you know, chemicals, these all come together. And then also just being sedentary too.

These all just come together and accelerate aging. Oh, sorry. I forgot to mention cigarette smoke. I mean, a lot of people I feel like are not smoking cigarettes as much these days. People still do, but cigarette smoke is

Dr. Mark Hyman
huge. Do.

Dr. Mamina Turegano
And Asia Yeah. Very common there. But, yeah, cigarettes and alcohol definitely just create more inflammation.

Dr. Mark Hyman
Okay. So cigarettes, I think people understand if you smoke, you look kinda haggard and you get wrinkles fast. And if you wanna wrinkle and age quickly, definitely smoke. But alcohol, I I I don't think people know. Can you talk about alcohol and skin?

Dr. Mamina Turegano
Yeah. Alcohol can accelerate skin aging. So our bodies are exposed to a a variety of different toxins, but our liver, thankfully, is there to help stop, or to help just kinda decrease that toxic burden. But when that burden accumulates, if our liver is stressed or distracted by things like alcohol or potentially other medications, then that toxic burden can increase and and increase stress on our cells, what we call, like, oxidative stress, and that causes cells to not function as well. So when it comes to collagen, we're not building collagen.

Inflammation from oxidative stress can also break down collagen more quickly without

Dr. Mark Hyman
So so Nicholas Pericom was right. Oxidative stress and inflammation are a key to skin breakdown and aging down. Yeah. Co cure. So so you mentioned collagen a few times.

Mhmm. People hear about collagen, and they take collagen

Dr. Mamina Turegano
Right. Yeah.

Dr. Mark Hyman
Supplements. Is that a thing? Like, is there data on it? Or is it just Yeah. Is it just window dressing?

Like, what is actually going on with the

Dr. Mamina Turegano
Yeah.

Dr. Mark Hyman
Whole industry? Because, you know, people think, oh, I'm taking collagen. I'm getting collagen. Is that actually happening?

Dr. Mamina Turegano
I know. It's it's not a straightforward answer. I would say overall, yes. I think that there's enough data to support collagen consumption. But, you know, a lot of the data that is pretty compelling is industry backed, so you kind of have to take that with a grain of salt.

Anecdotally, I do see I do see a lot of improvement in patients who do take collagen peptides. And, yeah, just because you take collagen peptide doesn't mean that that collagen goes to your skin. It's more so that the collagen peptides can send signals to help your body build better collagen.

Dr. Mark Hyman
But

Dr. Mamina Turegano
I also advise patients, you... I'd rather you also get better sleep, get sun protection, decrease the stress in your life, strength train. I would rather... Like, have that all dialed in before you're incorporating collagen peptides. I don't think it's, like, the easy switch to just add collagen peptides.

Dr. Mark Hyman
You can't eat crap and be stressed and not sleep and just take a bunch of collagen supplements and think you're fine.

Dr. Mamina Turegano
Yeah. Exactly. The short answer is yes. I do think

Dr. Mark Hyman
You think they're helpful?

Dr. Mamina Turegano
I'm on team collagen.

Dr. Mark Hyman
Okay. Great. Amazing. I think that's helpful. I think I've always wondered because I I...

You I think they're they're good in the gut, and they can be a gut. But I always wonder, do they get really absorbed and used properly? But the other thing sort of we didn't really get into yet was sort of the the the sun. And, you know, I think UV radiation.

Dr. Mamina Turegano
And

Dr. Mark Hyman
then, you know, when you get a sunburn, that's because the sun's creating oxidative stress and inflammation and damaging the skin, and that's why you get it sunburned. Yep. And that and that creates lasting damage.

Dr. Mamina Turegano
Mhmm.

Dr. Mark Hyman
How how does that work? And and and and what happens in the mitochondria in the skin? Because we didn't really talk about mitochondria, which are basically little energy powerhouses in the cells, but they are also key to skin health. And and can you kind of tie that together or how all that connects?

Dr. Mamina Turegano
UV radiation is probably the number one extrinsic factor that contributes to skin aging.

Dr. Mark Hyman
So beauty from the outside in, but also sun from the outside in.

Dr. Mamina Turegano
Sun from

Dr. Mark Hyman
the outside. But inside inside out and outside Yeah.

Dr. Mamina Turegano
I mean, yeah, we know genetics plays a role. And all these other things, sleep, stress, nutrition, exercise, these all play a role. But but we... But by far, it's... And smoking too.

But by far, it's it's UV radiation. And, yes, as you mentioned, it increases oxidative stress in our cells. Basically, it's it's causing, like, a localized stress response within our cells, and it's causing DNA damage. And, you know, it's all fine because if you're healthy, we have the DNA repair mechanisms in place that go in and, like, repair that DNA. We have, like, the antioxidants that fight those free radicals, those unstable molecules from oxidative stress.

And, you know, we can repair and heal from that. But with enough hits, your body's like, okay. Like Yeah. We've done enough. And that's why you see those con...

The consequences of just prolonged and, like, just chronic sun exposure come out later in life because it's like your body has already done so much to try to combat that that it just comes out later in life. And so when you have this oxidative stress within your cells from UV radiation, it affects the function of the organelles and mainly mitochondria. The mitochondria... I mean, as we age, mitochondrial function does decline. But but stressors like UV, UV radiation definitely accelerates the, the mitochondrial dysfunction within the cell.

So when you're a powerhouse of the cell, the mitochondria aren't working as well, then that cell itself will create more oxidative stress to your body. And and, like, your body just has a harder time, like, fighting it. Like, it... It's almost winning. And then...

So when your cells aren't working well in the skin, you get more collagen breakdown. Like, those are... Like, the fibroblasts, which are the cells that make the collagen, yeah, don't work well. And then, yeah, it just continues. And then, like, your epidermis, the keratinocytes at top layer of your scalp.

There... I mean, our skin's a dynamic living breathing organ. You know, we think the skin's just there to, like, make you look good, but, no, it's doing so much. It's it's... Our cells are constantly regenerating.

We're building things. So when you have that mitochondrial dysfunction, which, like, in addition to UV radiation, could be from a bunch of other things. But, when you have that, then, yeah, that's that's where you can see a lot of cellular aging and then skin aging from that.

Dr. Mark Hyman
Something people don't really talk about is, like, say, you know, skin health related to mitochondrial health Mhmm. And how much energy it takes to have a healthy skin. As we age, you said the mitochondria become more injured and damaged just because of aging itself, because of insulin resistance, because of generalized inflammation in the body, because of sun damage, because of poor diets, because of all these reasons that we we accelerate mitochondrial injury. And it doesn't just affect the energy in in the cells in our tissues and organs, but in our in our brain, but also our skin. And I think some people don't really realize, and that I would love you to talk about this process of sort of how do we how do we take care of our mitochondria, and how do we think about, like, the repair and regeneration, renewal of mitochondria.

There's a concept in medicine called autophagy, which means cellular cleanup, essentially means self eating. Mhmm. Like, at night when we sleep, our bodies will gobble up with lysosomes, all these old parts, and recycle them. But also the mitochondria have a process like that too Yeah. Called mitophagy.

So can you talk about mitophagy and and skin, and how that all connects, and and how accumulating damaged mitochondria leads to more skin aging and how to use mitophagy to help clear and fix that for healthy skin aging?

Dr. Mamina Turegano
Yeah. There's there's... And there's multiple ways to address mitophagy. So, yes, mitophagy is what you said. It it helps clear out that kind of the damaged mitochondria that mitochondria that aren't functioning because they're really just, like, taking up space, and then the cells aren't working as well.

So to optimize mitophagy, we wanna decrease the stress in the cell, the oxidative stress in the cell. So doing things like, you know, decreasing processed foods, those can, you know, add to the stress in the cell, decrease UV radiation. And that's a whole another topic because I know the sun is important too.

Dr. Mark Hyman
Vitamin d.

Dr. Mamina Turegano
Vitamin d, all of that. But there's a way to do it responsibly. But... Yes. But but minimizing, like, chronic UV exposure.

So there's that. There's nutrition. Actually, you know, sleeping adequately. Sleep is when we're doing so much repair Mhmm. Not only, you know, within our within our skin cells, but, like, our whole body.

So so important. And then stress... Minimizing stress. Stress contributes to more oxidative stress literally within our cells, so minimizing that. I know we've talked about strength training.

When it comes to to exercising, we know it's nourishing ourselves, like, with the circulation, but it's also, you know, improving things like insulin sensitivity. And when you when you have just all these other markers functioning better than... Unless... And you have less inflammation, your your mitochondria are gonna work better. So by minimizing all these things And

Dr. Mark Hyman
also increases the number and and the

Dr. Mamina Turegano
Yeah. The number

Dr. Mark Hyman
of function of mitochondria for exercise.

Dr. Mamina Turegano
Oh, yeah. Yeah. Yeah. I know. Exercise, I think, is, like, so amazing for mitochondria.

And and there's also supplements that you can take too. Like, it's it's... We live in a toxic world, so it's hard to to really combat all of these stressors with our bodies. I mean, yes, we we we do have We

Dr. Mark Hyman
need the foundations, but supplements help.

Dr. Mamina Turegano
Foundations, but supplements do help. And things that are anti inflammatory are helpful. I mentioned... You know, we talked about omega threes for a while. And then, you know, vitamin D supplementation can also help with that oxidative stress too, actually.

And, and then I'm also a fan of things like urolithin a, where it really does target mitophagy directly. And you you can get some endogenous urolithin a, like, you know, it's a byproduct of, like, things like walnuts and pomegranates from your gut. But but I do think that oral supplementation, can definitely benefit everyone, because it's like only forty percent of people can actually create their own, like, urolithin A. So, and urolithin A, we know helps with mitophagy within your cells. And, I mean, there's there's oral versions.

There's topical versions, but that's something that I would certainly consider. I would also consider things like, you know, just polyphenols, whether it's through foods or through supplements. You know, there's decent data with EDCG, which is from green tea Yeah. As well as, like, like, cocoa flavanols. And then we...

I mentioned carotenoids earlier, which include things like astaxanthin and beta carotene. These all help kinda reduce that oxidative stress burden within your cells, which then will in turn help with mitophagy.

Dr. Mark Hyman
Well, astaxanthin is is something that's in salmon because it's from the algae, and it's like what the what the salmon eat that mixes them orange.

Dr. Mamina Turegano
They mix them orange. Right. Right. I know some people

Dr. Mark Hyman
It's like carrots. It's like the same thing.

Dr. Mamina Turegano
Carrots. I know there's this trend with young people. It's called, like, tan maxing, and they, like, are consuming all these, like, carrots and dastazanthin supplements so they could, like, look

Dr. Mark Hyman
I I did that once. I I wasn't intentionally. I'd say, carrot juice was good for me. So I'm way back when they're... And I was drinking carrot juice every day, and I was like, wow.

I'm like orange. Or orange. Yeah. It was crazy. I I wanna double click on your own.

For people listening, it's what we call a postbiotic. So when you eat certain compounds, and these are polyphenols, it can be pomegranate, green tea, cranberry, walnuts, whatever, Your bacteria, if you have the right bacteria, will process that and create metabolites. And some of those metabolites have beneficial effects. So, you know, people understand that probably a third or half of the metabolites in their bloodstream are from their gut microbiome. They're not they're not made by your cells.

They're made by these bacteria that are producing all these molecules. And when you have bad bugs, they're producing bad crap. And they're producing... When they have good bugs, they're producing these beneficial things. Mhmm.

Mhmm. And so urolithinase, like you said, most people don't have microbiome because... I mean, I I give talks, and I'm like, who here has never taken an antibiotic in the room of a thousand people? Like, nobody will raise their hand. We're like Right.

Think once somebody raised their hand out of a thousand people, oh, I never treat antibiotics. I felt like it's not very common. I mean, all of us have had antibiotic. We kind of kill off the bugs, and so it's really important to help to support that... Those bugs.

But also, like, you you you can actually take a supplement, your luthinase supplement. And it's Mhmm. It's something that actually I use every day. Thank you. Mostly from from from a metabolic function, from brain function, from a muscle function, from my autophagy.

I don't think about it for my skin so much, but now I do. And and I think there's a lot of data on it. And one of the things it also does seems to do is reduce inflammation. So it can reduce CRP. It helps with all these benefits.

So I I think it's one of those supplements that has a lot of research, and I I think, you know, there's there's millions and millions of dollars of research on this, which is not typical for most products. So I think... I'm impressed by it. It's in... Published in the Journal of American Medical Association, major It's not like

Dr. Mamina Turegano
Yeah.

Dr. Mark Hyman
In some supplement journal somewhere. It's... This is good science. Yeah. So I I think I think this phenomena of of taking care of your mitochondria as a concept is really important.

Like, you're only as healthy as your mitochondria, and as... And and when you age, your mitochondria decline and function declines. And a lot of the things that we know for healthy aging, whether it's, you know, overnight, like, twelve to fourteen hour fasts, or whether it's exercise, or whether it's, you know, your 11 a, these are all things that help your mitochondria function better. So I think it's so it's so important.

Dr. Mamina Turegano
And, like, with urine... Lithium a too, there's... I learned that you have to be cautious too with which products have your lithium a. Like, there's really just, like, that one, like, Mitopure that has the, like, the properly studied amount or, like, the accurate amount of urolithinate? Because, like, if you look at some other brands, they've been studied, like, with third party testing where it doesn't actually show, like, the adequate

Dr. Mark Hyman
Yeah. The the dose. The dose. Yeah. Yeah.

If you take one milligram of aspirin, it's not gonna do I agree. I I I have been a big fan of TimeLine Nutrition, and might appear for a long time. I've taken it for a long time. Think that's why they're one of the sponsors of my show, and I think you need to be transparent about it. I think it it...

You know, yes, they're they're sponsoring the podcast, but also, like, I I looked at the science, and you have, and I mean, you know, it it makes sense, and it and it's it's valid science, and it it... It's impressive compared compared to a lot of other products people take. Yeah. It's it's impressive. When when someone has skin aging, is there a way to kind of reverse it, or is it...

Is the damage already done?

Dr. Mamina Turegano
The... There... There's definitely ways to modify your cellular function. It... I don't know if you're you're gonna be 100%, you know, reversible.

But, like, you know, if somebody comes in, they're 70, we're not gonna make them look like they're 25. But there's Really? Yeah. I know it. Right?

But I'm

Dr. Mark Hyman
66. I was hoping for a miracle here.

Dr. Mamina Turegano
I definitely think that we can, for sure, optimize cellular function, you know, regardless of how old you are.

Dr. Mark Hyman
And one one of the things that sort of ties a little bit into... And I wonder if it ties into this mitochondria is is this exercise. And Mhmm. You said that muscle building is one of the best ways. It's a non skincare intervention for healthier skin in midlife.

And I don't really understand how strength training would affect the skin. Can you kinda unpack that for us?

Dr. Mamina Turegano
I know. Yeah. I'm basing that off of... There is a study that was really interesting. It was a small study.

It was, like, 60 or so participants. They were mid, women in their kind of midlife age range. And they compared them doing aerobic exercise to strength training, and they both showed improvement with, like, hydration and barrier function in the skin. But they act... So...

And they... They're measuring, you know, different layers of the skin. The the participants who were who were strength training actually had a thicker dermis. You know? So dermis is where our collagen sits.

And I think that it makes sense, you know, when you are... You know, when you're strength training... And I've heard you talk about this before. You're increasing you're increasing insulin sensitivity, and then that kinda takes a load off of your cells. You're you're decreasing inflammation as well.

Your mitochondria are optimally functioning. And when your cells in the dermis are affected by that, they're gonna work better. They're gonna build more collagen. So I I... To me, it makes sense.

I I would like to see more studies, but but I do really appreciate that.

Dr. Mark Hyman
I've kind of... On my face, obviously, I've had a lot of sun damage. And... But I I noticed, like, I'm 66, and I look at my skin, the elasticity, my body, it it it don't really have a lot of skin aging. Mhmm.

I mean, I noticed it's a little bit thinner in some some ways, but, you know, I've been eating well my whole life. I've been, you know, exercising my whole life. I've been trying to... I mean, stress is what I think, but I know I've been taking, you know, basic nutritional supplements. And I...

And I'm just, like, kind of amazed at, you know, what what you can do if you actually take care of yourself and you you do the right things. And it's it's something I think it's good to start early. Yeah. But, also, you can start at any age and and slow the process down. And and I'm curious, like, from your perspective, like, what are the highest value interventions for people listening?

Like, what are the things that, you know, for for skin longevity? Like, what are the highest target?

Dr. Mamina Turegano
The highest value. Yeah. So, yeah, I know we we wanna talk about how... What we can do from the inside out, but I do have to say sun protection is probably the biggest thing you can do.

Dr. Mark Hyman
The sunblock?

Dr. Mamina Turegano
Yeah. Sunscreen, and, like, when you're outside, you know, try to minimize the time you're in... You're outside during, like, those peak UV hours, which is, like, between 10AM and 2PM, wearing some protective clothing, hats. Those all play a role.

Dr. Mark Hyman
Now Like, you need UV blocking clothes, or

Dr. Mamina Turegano
is a But but, like, but sunscreen's not 100% gonna gonna block out all your

Dr. Mark Hyman
UV rays. Can you get us, like, sun damage through your clothes, like, a mask?

Dr. Mamina Turegano
Oh, yeah. Yeah. Yeah. UV can still penetrate clothes. Not as, you know...

It's still a form of protection, but but UPF material does a much better job at, like, blocking out UV rays. So, just some things to consider. And I know that we... You know, also, I just wanna take into consideration the fact the sun is really important too. Right?

Like, for vitamin D absorption, metabolism, as well as, like, circadian rhythm regulation.

Dr. Mark Hyman
Your eyes.

Dr. Mamina Turegano
Yeah. Definitely. Like, getting that sun early in the morning. But I think that you can still do all those things. You can go outside, wear sunscreen.

Don't try to... Don't try... Try not to bake outside for prolonged periods of time. That's where we that's where we see a lot of the skin cancer. And, you know, with melanoma, it's for people who have that intermittent prolonged exposure.

So it's interesting.

Dr. Mark Hyman
When you go to The Bahamas for a holiday, you'll lay on the beach all day for seven days.

Dr. Mamina Turegano
Exactly. For men, the most common location for melanoma is the back, and for women, it's the legs. But those aren't areas that are seeing the sun every day. But for, like, those intermittent bursts of sun exposure, like going to The Bahamas and you're just getting, like, burned on your back, that plays a bigger role with melanoma development. Whereas the non melanoma skin cancers, like basal cell carcinoma or squamous cell carcinoma, those are from just, like, chronic daily sun exposure that just build up over time.

But all of that can contribute to skin cancer, development as well as accelerated aging.

Dr. Mark Hyman
But not not all melanomas are skin sun exposure related. Are they, are they?

Dr. Mamina Turegano
Well, yeah, you're right. Not all. Because we can see melanoma between the toes. We could see anal melanoma.

Dr. Mark Hyman
That's what I mean.

Dr. Mamina Turegano
Yeah. So there's other components too. And what's interesting too, we have studies to show that low vitamin d can can make melanoma... Like, can put you higher at risk for melanoma, which is kind of ironic. Right?

Because we say stay out of the sun to to, you know, to prevent melanoma. Yeah. So it's it's about finding that healthy balance. Yeah. Vitamin D is is important for melanoma prevention too.

And, you know, we we always talk about supplementation and trying to get vitamin D through food, but, like I said, you you can still go outside. Just gotta do it responsibly. But I'm sorry. To answer

Dr. Mark Hyman
your question,

Dr. Mamina Turegano
the highest impact is sun protection.

Dr. Mark Hyman
Sun protection.

Dr. Mamina Turegano
It is. And it's... I mean, we have studies to show that it plays the biggest role, probably about 80%, and when it comes to skin aging. There's genetics, but then, you know, there's other factors too. So smoking, we talked about.

Thankfully, you know, I think people aren't smoking as much. They... People still do smoke, of course, but that's huge. Like, when they look at identical twin studies and, like, they see the twin who's out in the sun and smokes, drastic difference. So that...

And then when we talk about nutrition, so sugar can accelerate aging. I've heard you talk about advanced glycation end products or AGEs. Yeah. This is when sugar... You know, when you have more sugar that can bind to your collagen fibers, and that can make your collagen more brittle and, like, break down more easily and, like, not remodel as well.

Yeah. So sugar is huge. And then, of of course, if you have insulin resistance from sugar, that's gonna create more inflammation and further aggravate, you know, collagen breakdown. Try to, like, minimize processed foods as well, but most of our data is with sugar. And then when it comes to what to add, we we touched on this briefly, but just, like, just nutrient dense foods, foods full of polyphenols.

I just say, like, just colorful foods, you know, like vitamin c, your citrus, your your bell pepper, like the berries, just things that are full of polyphenols is important. And then, yeah. And we talked about carotenoids too, whether it's... Oh, and also lycopene, beta carotene, as well as astaxanthin. And then sleep is huge.

We do have some good data to show that poor sleep, circadian rhythm disruption, that can all accelerate aging. Stress is huge, and stress is, like, harder to quantify just because... You know? Like, what is stress? Like, we all deal with so much stress.

So, but, you know, just a matter of incorporating stress decreasing modalities into your life. And then exercise, we have data to show that that helps with skin collagen production. Those would... And, yeah, minimizing pollution. I would say those are, like, the the biggest levers, with sun protection being the biggest one.

And then we also have a ton of evidence when it... When... If you just put it in a vacuum. Like, if it's just... If you're just focusing on skin, topical retinoids, we have decades of studies to show the impact of topical retinoids for skin health.

Dr. Mark Hyman
It's got vitamin A derivative.

Dr. Mamina Turegano
Vitamin A derivative. Yeah. So the the most popular example is retinol, which you can get over the counter. Then there's a prescription retinoid, which is tretinoin. The brand name is Retin A.

Those are the most common forms. There's retinal, retinaldehyde, there's tazarec, sertine, adapalene. There's a lot. But, anyways, there's a lot of studies to show that that really helps with collagen remodeling. And then topical antioxidants, vitamin c being the most studied example shows.

So after sunscreen, we like retinoids and vitamin c.

Dr. Mark Hyman
So put vitamin c and ret... And retinoids on your skin.

Dr. Mamina Turegano
Correct. Yeah. Yeah. Vitamin c in the morning because that works alongside sunscreen to help with, like, the oxidative stress from the sun as well as pollution. Then And retinoids at night to really contribute to that repair process when you're sleeping.

Dr. Mark Hyman
K. I need I need to up my game here because I... I've been focusing on, you know, my exercise and diet. And skin care, like, you know, I'm a guy. I don't really get...

Care.

Dr. Mamina Turegano
But, I mean, if you wanna, like... For overall longevity, you gotta do all the exercise and diet. Like, that's gonna be better for

Dr. Mark Hyman
overall health. I'm curious about, like, you know, I, you know, I I don't want my skin to age faster than it needs to. And it sounds like simple things. Simple and retinoid. And you can do the retinol over the counter.

Dr. Mamina Turegano
You do retinol over the counter.

Dr. Mark Hyman
That's strong enough? Or

Dr. Mamina Turegano
Yeah. For a lot of people, it is. And the thing is it's just slower acting. Tretinoin is faster acting. Retinol has to get converted.

It has to go through a couple stages before it gets converted to tretinoin.

Dr. Mark Hyman
So

Dr. Mamina Turegano
tretinoin works faster. It has a higher irritation potential, so people who have sensitive skin or are just starting out, we do recommend something like a retinol. Yeah. And and I would say we have the most evidence behind that. I know TimeLine has their topical...

Like, you could do topical urolithin A Yeah. Which we do have some studies to show that that can help with wrinkle reduction as well as increasing hydration and barrier repair in the skin.

Dr. Mark Hyman
Mhmm.

Dr. Mamina Turegano
And so, yeah, something else to think about too. There's some supportive ingredients in those products. Like, there's topical niacinamide. We do have some nice data with topical niacinamide for barrier repair and wrinkles too, as well as, you know, things like hyaluronic acid, ceramides. These are, like, nice hydrating ingredients.

Dr. Mark Hyman
Great. And it's it's a it's a good list. It's a good list of how to

Dr. Mamina Turegano
keep you...

Dr. Mark Hyman
Get healthy. Now people are talking about... I just kind of briefly wanna kinda dive into this, but people are talking about a lot of these sort of newer therapies, whether it's exosomes, peptides Yeah. Growth factors, NAD products, red light therapy. Can you kind of...

Is it hype? Is it science? Like, what... What's the eighty twenty on this stuff?

Dr. Mamina Turegano
Yeah. I know. People talk about those a lot. I would say don't do that unless you're already doing sunscreen, retinoids, vitamin C. But...

Yes.

Dr. Mark Hyman
Grocery. Lifestyle.

Dr. Mamina Turegano
And all the lifestyle things that we talked about. But... Yeah. Let's... I just talk about peptides because so many people...

That word is just so popular, mainly because of the injectable peptides. But because the injectable peptides have become so popular, topical peptides is just gaining so much more buzz, but they've been around for decades too. And there are a bunch of different types of topical peptides. Some are better than others, but in general, I am definitely a fan. I think it's so easy to incorporate peptides into your routine.

There's a lot of moisturizers that incorporate it, a lot of serums that already have it. There's even some in some sunscreens. But, basically, they send signals to your cells to build more collagen, or they send signals to your cells to increase hydration. So definitely all about peptides.

Dr. Mark Hyman
Topically or, like, injectables? Because, like, g h k c u is a thing a lot of women are using for their skin.

Dr. Mamina Turegano
And Right. Right.

Dr. Mark Hyman
Is that is that, like, legit? Or

Dr. Mamina Turegano
I'm sure it it helps, but as of now, we don't have the evidence or, like, the safety measures in place to fully recommend it. Yeah. Like, yeah. So I'll say that. But we do have topical GHKCU, the topical, the copper peptides, which we definitely have good evidence for.

I mean, not as good as retinoids for sure, but that helps with collagen recycling and rebuilding. So incorporating copper peptides is wonderful into your routine as well as some other, like, hydrating peptides and collagen building peptides. And there's also, like, neuromodulating peptides. So some people like to call it, like, Botox in a bottle because, you know, Botox essentially, like, paralyzes your muscles, so you're not creating those deeper contractions. Super mild form of that with these neuropeptides, for people who are, like, Botox averse.

It doesn't compare to Botox. But, anyways, so that's peptides. It... Depending on the peptide, you could do a lot of different functions in the skin. Then there's growth factors you mentioned.

Growth factors are also signaling molecules that I think we do have some pretty decent evidence for. Growth factors are pretty large molecules. So so just because you're putting growth factors on your skin does not necessarily mean it's penetrating the skin and doing its thing. So I would say you have to make sure you get the right growth factors. Not all of them are equal, but we...

I do like them. And then there's PDRN, which has gained a lot of buzz because of the whole K beauty, Korean beauty kind

Dr. Mark Hyman
of What is PDRN?

Dr. Mamina Turegano
So PDRN stands for polydeoxyribonucleotide, and it's derived from salmon sperm.

Dr. Mark Hyman
Okay.

Dr. Mamina Turegano
And most of the data is with PDRN injections into the skin. We we know that it helps with collagen remodeling when it when it gets into the dermal layer. It helps with wound healing. Topical PDRN, we have some evidence for its efficacy, but doesn't compare as much to the injectables. But I I I like it.

I think it's a wonderful ingredient to have in your moisturizer. So and we're seeing

Dr. Mark Hyman
more of Salmon sperm.

Dr. Mamina Turegano
Let's talk about Salmon sperm facials is what we're calling it.

Dr. Mark Hyman
Love that. What about things like exosomes and stem cells? Like, people are injecting those in their face topically.

Dr. Mamina Turegano
Once again, it's one of those areas where it's a little bit controversial because we do still need more safety data. I think it's still kind of the wild, wild west with that. There are a lot of products out there that have topical exosomes in them, and they are lovely and they seem to work. But whether or not the exosomes are doing anything or what exactly they're doing, it's hard to say because it's so hard to stabilize exosomes at room temperature. Like, they need to be, like, frozen Right.

At a negative temperature.

Dr. Mark Hyman
I wonder among these creams. Or

Dr. Mamina Turegano
Yeah. And and, also, it's like, what exosomes are the best? Like umbilical cord exosomes or, like, mesenchymal exosomes from bone marrow or, like

Dr. Mark Hyman
because that

Dr. Mamina Turegano
Yeah. Yeah. There's different kinds, and that kinda goes along with stem cells too. You know, which ones are the best? So I think we still have more to come with that, but I think it's promising.

Dr. Mark Hyman
I I I know you've been a dermatologist for a long time. I can't tell how old you are. I wanna know your skin routine.

Dr. Mamina Turegano
Wait. Wait. Should I have you guess how old I am?

Dr. Mark Hyman
I kinda would say, like, maybe late thirties.

Dr. Mamina Turegano
Mhmm. Yeah. I'm 43.

Dr. Mark Hyman
Yeah.

Dr. Mamina Turegano
So that... I'll I'll take that. Thank you. But... Yeah.

So, you know, I mentioned the topical skincare regimen. I definitely, for a while, have been incorporating sunscreen. I didn't for most of my twenties, and it wasn't until I started during residency where I was like, oh, okay. I guess I should do this. So I do sunscreen.

I do some type of retinoid at night. By the way, you can't use retinoid when you're pregnant. And then, I do vitamin C in the morning. But I do. I use I use serums and and moisturizers that incorporate peptides and or growth factors.

I do use a product with PDRN and copper peptides. I use a serum that has a neuromodulating peptide to help soften my lines.

Dr. Mark Hyman
Do these things stack? You just put one on after the other?

Dr. Mamina Turegano
So... Okay. You... So it's so funny because I I hate overwhelming people because there's so much noise out there in the skincare world. So what I tell people is really the bay...

The foundational skincare regimen is a cleanser because, like, washing your face is important too. It's kind of underrated. Like, the buildup of pollution. Like, all that stuff during the day, like, that accelerates skin aging. Those are...

That creates oxidative stress on your skin. So washing your face is so important. And then moisturizing because, once again, because of the elements, our skin barrier is disrupted. Our our keratinocytes are working hard to repair the barrier. And, like, if there's stress on our skin, it needs help.

So moisturizer is important and then sunscreen. So those are the three minimal things to do. And then after that, a retinoid and vitamin c. And then if that's well established, then you can incorporate another serum that might have, like, peptides or growth factors. And then, like, just find a good moisturizer that has all the fun things, that has growth factors and peptides too.

Dr. Mark Hyman
Yeah. That's good. I mean, just kind of in a brief aside, because I think this is an issue for for for me, I think, about this, which is what's in the skincare products besides the active ingredients, and are those harmful? And I had a I had a patient once who used sunblock all the time.

Dr. Mamina Turegano
Mhmm.

Dr. Mark Hyman
When I checked her urine, she had extremely high levels of parabens, where... Which is a plastic Mhmm. Like a petrochemical toxin that they use in these compounds.

Dr. Mamina Turegano
Mhmm.

Dr. Mark Hyman
So are you fixing one thing and hurting another thing? And how do you Yeah. How do you manage that? And and and what do you think of the Skin Deep database from Environmental Working Group that kind of grades skin care products based on levels of toxins in them?

Dr. Mamina Turegano
I respect the fact that something like this exists out there. I do take it with a grain of salt because the data that's in the EWG database is from studies where there are usually, like, insanely almost impractical doses, insanely high amounts of these products or ingredients that are used on, like, animal models. And we can see issues in animal models, whether it's endocrine disrupting issues, potentially cancer. You know? And and it's it's hard to extrapolate that to human data for a lot of these things, for things like parabens and, like, even, like, some of these chemical sunscreens too.

And and so I think, like, theoretically, it seems scary. Like, oh my god. When it's given an insanely high doses to animals, like, we should not do that. We shouldn't use it as humans. But I wouldn't...

You know, if people have been using a lot of these products, I wouldn't freak out. Like, just because somebody has a bunch of parabens in their urine, the question is, okay. What... But what exactly, like, what is... How is that manifesting in their skin?

Dr. Mark Hyman
I mean, my my philosophy... And maybe this is right or wrong. I don't know. But if you wouldn't eat it, don't put it on your skin because everything you put on your skin gets absorbed through your skin.

Dr. Mamina Turegano
Okay. So I have something to say to that. I have something to say to that because our skin is all... Honestly, our skin does serve as a great barrier. Like, it's...

One of the functions of the skin is to protect our our body from, like, the outside elements, from pathogens, from irritants, and all those things. So there is an element of really good barrier protection on the skin. But the other thing I wanna add too is that not necessarily everything you eat is good for your skin.

Dr. Mark Hyman
This is true.

Dr. Mamina Turegano
Like lemon. Like, lemon will destroy your skin.

Dr. Mark Hyman
Really? Yes. Lemon juice. Lemon

Dr. Mamina Turegano
can... Yeah. Lemon can cause, like, irritation from the acids in the skin. I mean, we have stomach acids that can that can deal with

Dr. Mark Hyman
putting lemon on your skin or eating lemon?

Dr. Mamina Turegano
So eating lemon is good.

Dr. Mark Hyman
Oh, yeah.

Dr. Mamina Turegano
No. Putting lemon on your skin

Dr. Mark Hyman
is not good. I wouldn't do that. Yeah.

Dr. Mamina Turegano
Yeah. So so so so

Dr. Mark Hyman
there's like enough.

Dr. Mamina Turegano
So so... But...

Dr. Mark Hyman
Don't wanna put chili peppers on your face.

Dr. Mamina Turegano
Exactly. Exactly. But... No. But I I I do appreciate you saying that.

Like, we have to be... You know, if we can eat it, like, then, you know, it... It's potentially safe for our skin. But I I also want people to know that our skin is there to protect us too. And, like, a lot of these things usually just penetrate to the...

Through the epidermis, not really getting to our vasculature. Of course, there's things that get into our vasculature as well, but our skin, I would give it more credit. It really does do a good job at keeping a lot of the things out. I'll say I'll say that, but but, yes, there are definitely things that that can get absorbed that aren't.

Dr. Mark Hyman
I mean, because I always wonder about it. Because then as a doctor, I'm like, when you... Someone comes to the emergency room and they have heart attack, you put nitroglycerin paste on their chest once

Dr. Mamina Turegano
a while.

Dr. Mark Hyman
Or there's topical estrogen. Topical hormones. You've got, you know, all these topical drugs that we deliver through the skin, whether it's fentanyl patches or... Like, it's it's it's a known thing.

Dr. Mamina Turegano
It is a known thing. Yes.

Dr. Mark Hyman
So, like, it's not like they don't get through.

Dr. Mamina Turegano
No. For sure. And there's certain vehicles that deliver these things more effectively than others. So so it's it's a matter of, like, what the product is. But...

Yeah. No. For sure. Like, things definitely can get absorbed too.

Dr. Mark Hyman
So if you have a choice between something that doesn't have a lot of bad, you know, industrial ingredients in it versus something that does, would you choose the one that doesn't, or you don't care?

Dr. Mamina Turegano
Of course, I would wanna look at the safety data behind it too, but but I would try to minimize, like, anything that has this, like, toxic burden to the skin for sure. Yeah.

Dr. Mark Hyman
Okay. Good. I I guess Yeah. Yeah. No.

I think you're right. There's probably not enough data. Like, what happens when you put all these things on? But, like, just, like, at a high level, like, I wonder if anybody's in the studies to see if you put this stuff on your skin and measure the blood levels or urine level of these compounds. Has anybody done that work?

Dr. Mamina Turegano
Yeah. I mean, I think that that some of it has been looked at too. Like, we we do see higher absorption with chemical sunscreens in our bloodstream.

Dr. Mark Hyman
Is it better to use mineral sunscreen then?

Dr. Mamina Turegano
So... Yeah. I mean, if if that sort of freaks you out, then yes. I would use mineral sunscreen. The FDA kind of put that in the category of generally recognized as safe, whereas the chemical sunscreen is is not in that category, mainly because you do have extensive systemic absorption with it.

Whether or not that does anything is is just still up for debate. So

Dr. Mark Hyman
Wait. Are you saying that the FDA says that that these chemical sunscreens are not generally recognized as safe?

Dr. Mamina Turegano
That's right.

Dr. Mark Hyman
Wow.

Dr. Mamina Turegano
But there's a new one that just came out this past year that is con... There's... It's BEMT parcel shield. It's another name for it. That is...

A it's chemical sunscreen that is lumped with generally recognized as safe. But... Yeah. No. We need some work with the chemical sunscreens.

But but I have to tell people, they're still effective. They're still overall safe. We don't have the human data to show that it does anything, but it does absorb more into your bloodstream. Bloodstream.

Dr. Mark Hyman
This is such a great conversation. Are you up for a few rapid fire questions? Let's do it. Okay. So what's the biggest driver of premature skin aging?

Dr. Mamina Turegano
UV radiation.

Dr. Mark Hyman
Sun. Okay.

Dr. Mamina Turegano
Yeah. The sun.

Dr. Mark Hyman
Can you take aged skin and actually improve it or not?

Dr. Mamina Turegano
Can... Yes. You can. There's hope. There's hope.

Dr. Mark Hyman
What matters more for skin health? Is it in longevity? Skin care or exercise?

Dr. Mamina Turegano
It depends on what your goals are. If you wanna live longer, I would say exercise. If you want your skin to look smooth and wrinkle free, skin care.

Dr. Mark Hyman
How about mitochondria? How important

Dr. Mamina Turegano
are they?

Dr. Mark Hyman
Skin at 1%.

Dr. Mamina Turegano
Yeah. Mitochondria? Oh, at least a nine. At least a nine. Okay.

Because there's a lot of other factors that also contribute to aging too. It's not just mitochondria. We we need And

Dr. Mark Hyman
and urolithin A is the data there or no?

Dr. Mamina Turegano
Urolithin A is... Yeah. I would say we have really good data with urolithin A.

Dr. Mark Hyman
Amazing. Okay. And then what's the most overrated antiaging skincare trend?

Dr. Mamina Turegano
Okay. So there's, like, products that

Dr. Mark Hyman
are TikTok trend, or should people be like, wait.

Dr. Mamina Turegano
Oh, wait. There's a couple of things. Like, a lot of people are into, like, beef tallow, and they think that that protects their skin from the sun. It's... No.

It does not. It's an okay moisturizer, but it's not anything miraculous. We have a lot better moisturizers out there.

Dr. Mark Hyman
Beef fat on your skin, not a thing.

Dr. Mamina Turegano
It's it's... Yeah. It's it's

Dr. Mark Hyman
I don't quite know if just... Coconut oil is like

Dr. Mamina Turegano
Coconut oil can be helpful. It it is comedogenic, so be careful if you're acne prone. But but, beef tallow is also comedogenic as well. But people think it's like a miracle cure, and it's not.

Dr. Mark Hyman
Amazing. Okay. Wow. Well, thank you so much, for your insights, your work, your your advocacy, because there aren't enough, I would say, integrated functional dermatologists out there. Yeah.

There really aren't. And I had the privilege of learning from some of the OG ones, you know, back in the day. And and I think that, you know, if you're listening to this, you know, there's really two issues. One is healthy skin aging, and two is skin conditions. Mhmm.

Mhmm. And there's a lot to do about both of them. Yeah. And hopefully, you know, we can really, help people to understand what they can do. Tell us where people can learn more about you, find you, learn about your work.

Dr. Mamina Turegano
I am very active on social media. My handle is, doctor dot Mamina, d r dot m a m I n a, on Instagram, TikTok, and YouTube. I have a website, doctormamina.com. And if you're also interested in prescription skincare, I'm a cofounder with other derms for prescription skincare service called DermClick.

Dr. Mark Hyman
Amazing. DermClick. Alright. Well, so good to meet you and have you on the podcast, and thanks for your work.

Dr. Mamina Turegano
Thank you so much for having me.

Dr. Mark Hyman
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