In this special edition of the Integrative Practitioner Podcast, Mark Tager, MD, joins Integrative Practitioner Content Specialist Avery St. Onge for a live interview at the Integrative Healthcare Symposium to discuss specific nutrients and lifestyle interventions that target skin, hair, and nail health.

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Mark Tager, MD, is known for the synergistic and entertaining approach he takes to educating and training his colleagues and consumers. He has trained hundreds of healthcare practitioners to improve their in-person and on camera skills. Clinically, he is most passionate about complementary treatment for chronic conditions, with personalized nutrition as one of the foundations for integrative care. He is currently the Chief Enhancement Office for ChangeWell Inc. He has served as the founding Vice President of Marketing for Reliant Technologies, where he launched the Fraxel® laser and has also served as Chief Marketing Officer for Syneron and as a strategic consultant for Lutronic. He has served as Director of Practice Management for the Miami Cosmetic Surgery conference and Director of Strategic Initiatives for A4M. Along with Dr. Peter Staats, he co-founded The Vagus Nerve Society. Most recently, Dr. Tager created the 40-hour CME course on Personalized Nutrition for Practitioners on behalf of The American Nutrition Association. He is on the faculty of Duke Integrative Medicine. His most recent book is Feed Your Skin Right: Your Personalized Nutrition Plan for Radiant Beauty. The book serves as the basic content for a 10-hr online professional training program called Inside Skin Beauty. He did his medical training at Duke Medical School and Family Practice at the University of Oregon. He lives outside San Diego where he grows impressive tomatoes.


Avery St. Onge: Well, hello everyone and welcome to this special edition of the integrative practitioner podcast live from the Integrative Health Care symposium in New York City. I'm your host Avery St. Onge, integrative practitioners, content specialists. And today I'm joined by Dr. Mark Tager to discuss personalized nutrition for skin health and beauty. 

Welcome, Dr. Tager. Thank you so much for joining us.

Mark Tager, MD: My pleasure to be here.

St. Onge: Do you want to start by just telling us a little bit about yourself?

Dr. Tager: Well, I've got about half of my life in integrative Functional Medicine and the other half and aesthetics. So as one, the team that created the Fraxel laser, which revolutionized how we approach laser skin resurfacing. So to that end, I've been active, I do a lot of writing, I've written a number of books, latest one being feed your skin, right. And that was in response to four questions that I'm always asked. Okay, Dr. tager, what should I eat? What supplements should I take? What topicals Should I put on? And what procedures should I have? And I have one answer? What is it? It depends. So the book is really a way to look at what it depends upon. And the fact is that, you know, there's no other person on this planet, with skin exactly like yours. Even if you had an exact twin. You've been exposed to different mounts of sunlight, pollutants you have eat different foods. So what we try to do is craft an individual skin health and beauty protocol for people.

St. Onge: So how do you evaluate a patient and determine that protocol?

Dr. Tager: Well, it starts off with obviously a history and physical. I think we've got to ask the questions about diet, because what's really important is that I cannot out supplement your crappy diet. You know, a lot of people jump right to supplements and I believe in them. I believe in intelligent supplementation, you have to know why you're taking things. But stepping back versus the history, the physical, you want to look at what drugs people are taking, because there are drug nutrient interactions and drug nutrient depletions. So mainly drug nutrient depletions example 26 million Americans are on a statin. Statins deplete co q 10. What is CO q 10? Necessary for energy, it's the mitochondria need that how does the skin age, the mitochondrial theory of skin aging, fewer mitochondria, they don't work as well. And if you're on a statin that's depleting co Q 10 need that supplementation. And we like to look at nutrigenomics your genetics can dictate a diet that's best for you which nutrients you may be low in because you have a problem with the absorption, the transportation or metabolism of it. And then some of the physiological things that take place in the skin, that how prone you are to glycation or pigments or collagen breakdown. So you take all of that. And you get the lab work, basic labs and these special laboratory developed tests. You put that all together, and you come up with a program. 

St. Onge: Can you tell me more about the key dietary and lifestyle factors that are affecting someone's skin health? 

Dr. Tager: Sure. The SAD diet, standard American diet, what is it? It's high in these unrefined sugar 125 pounds a year. And why is that important? That's important because of glycation. So when you take sugar, and it binds on to proteins, so when it binds on to collagen, it renders the collagen more brittle, less soluble. And I just learned this recently, the half life of collagen in the skin is 10 years. So half of your collagen is turning over in your skin in 10 years. So if you are gleich cating In other words, that sugar is attaching to the collagen, making it more brittle. You get the fine lines and the cross hatching in the face. So that's one piece certainly The amount of fat that people take in refined carbohydrates, I think we've learned a lot more with the importance of the essential fatty acids. And they're important because you want to have a healthy balance between the Omega sixes and the Omega threes. Almost everyone would do better with omega threes. And that's important in the skin, because think of the Omega threes as the mortar between the skin cells. So just as we have leaky gut, we have leaky skin, and leaky skin. The the, the essential fatty acids are critical for keeping those cells tight, and not letting water evaporate and not letting harmful things in.

St. Onge: You've already started to answer this question. But based on your evaluation of the patient, how do you then design their treatment protocol specific to them?

Dr. Tager: To start, you hope and pray that they're going to take your dietary advice. And that's the hardest thing. And if they don't take it all the way, at least they make some minor improvements. You know, one of the five things that will often ask people to do a dietary recall or keep it three day dietary record, and what's that's therapeutic, because if you ask someone, we're gonna write down everything you eat for the next three days, they come in, and it looks pretty good, you know, they start spending time and attention. So the first is trying to get people to really follow the dietary advice. On top of that, you're really thinking about trying to get people to exercise and manage their stress, those who are the exercise part is pleased just move your body, you know, get 34567 10,000 steps in a day, it's as simple as walking. Now, as people age, you really need to spend time and attention on your muscle mass, because you know, your muscles are burning these, these calories. They're responsible for so much more than that, as well. And then they sent hormone signals to the brain, these Myo kinds. So I think, you know, resistance training is particularly important as you age really important. So move your body resistance, training, flexibility, little yoga, good stuff. We all need to do more more stretching, particularly when you sit all day and those hamstrings get tight, pulls the back out. So those are some of the lifestyle things and stress is a whole nother topic. I think that for people, probably the biggest thing is to realize what's important, what's not important, what's controllable, and what's not controllable, and you need to really pay attention to what's important and controllable. But it's a hardest thing for people who lay awake at night and they're in bed and their minds are turning over stuff, that may not be important, and they certainly can't do anything about it until 11 o'clock at night. So it's the learning to let go. I think this is part of the physiology of the parasympathetic nervous system, you can learn to calm your restless mind, you can learn to relax your body, sometimes vagus nerve and non invasive Vagus Nerve Stimulation helps for that. One of the things I've co founded is the vagus within a nerve society. And we do a lot of that information, providing information on how do you get more parasympathetic tone more, you know, we live in this wired world. I mean, we're just stuffs coming at us all day long. And what happens is it takes so much energy to respond to all of this. So most people don't do a very good job replenishing their energy. And that's the role of the parasympathetic system. Biggest thing breathing. Nice. For breathing, belly breathing, breathe in soft belly. I personally like the 478 technique. You're in for four, hold for seven, out for eight. If you do that, two three times. sinks into your body. So I think those are the lifestyle pieces.

St. Onge: Yeah. I mean, when it comes to skin health in particular, I feel like people are looking for instant gratification. And so when you tell them like, oh, just eat a perfect diet. Forget your stress and exercise. It's, first of all, that's hard to do, but also they're not going to see immediate results. So how do you have those conversations with patients?

Dr. Tager: For, you know immediate results, I can do a Fraxel laser treatment on a patient, and you will have beautiful glowing skin that regenerates. And it will continue to improve over 456 months as you remodel and rebuild new collagen. The way by the way, the way collagen works is when you heat the dermis, or sometimes when you put a micro needle in there, you're breaking up the collagen with heat it denature. So it shortens and unwinds and it becomes a scaffold on which we create new collagen. So that's called collagen remodeling. And that process, you know, you need, you need your amino acids. For that you need vitamin C, you need iron, you need copper. So it's not just one thing. So what I've found is that there are some things that work immediately you can do micro needling, I mean, you will see a an improvement there. There are topicals that work over weeks. Now they don't work immediately. So it's are you in just for the short game in the long game? Now the thing is, when you I would sit with someone to ascertain their motivations. You know, it's, I've got to look great for this wedding. Well, fine, we can do that. But if you want to really build on beauty, you then you have to turn to Inside Out approach.

St. Onge: And why do you find it important to address something like skin health? Like how does skin health reflected the rest of your overall health?

Dr. Tager: Yes, the answer is yes, it reflects your overall health. But what's important about that is, skin is the biggest look, it's the biggest motivator in a lot of ways. I mean, if if I were to sit with someone and say, you know you're eating all this sugar, you're like eating and that's why your hemoglobin a one C is seven and a half. You gotta cut it out. Okay, I'll try doc, if you say this is responsible, to a great extent, for your skin, gut getting old and the loss of luster and the cross hatching and wrinkles around your mouth. You've got a motivated patient. So you have to realize that this this beauty motivation is fundamentally ingrained in all of our societies since the beginning of time. We're seeing a lot of men, I mean, certainly the men's aesthetic movement now is gone crazy. So in many practices for dermatology, aesthetic practices, 40% of the patients are men. So that's sort of come down. So I think it's just a powerful motivator. And it's also something you see every day. I mean, you don't see the workings of your liver necessarily. You don't know how your guts really do. But you know, how your skin's doing. It's an instant barometer for a lot of people. 

St. Onge: And what are the supplements that you are using? 

Dr. Tager: It depends. Again, we talked about the importance of intelligence supplementation. So I think a good multivitamin is a place to start. I think essential fatty acids are omega threes are just that they're essential. Vitamin D is also very important for the skin. I mean, we know that that 92% of Americans don't get the estimated average requirement don't meet that estimated average requirement for vitamin D, which is very significant. Vitamin D plays an important role in skin health. And particularly the other day, it happens in Southern California, you've got all this sunblock on you. So you, you just don't make vitamin D from the skin because you're you've got 50 on and you've got hats and things like that. So I think that's important. And then moving on from that. I think you need to choose your antioxidants, certainly, and there's lots of favorites that people have. I mean, if you go to a conference like this, everyone has a favorite antioxidant. Certainly Vitamin C is critical. The other ones that have good data behind them are Pycnogenol and and then we've got poly pine bark and ferns and polypodium leucotomos. Spent a long day. That's another one. I'm a big fan of Astra Xanten as an antioxidant, and the reason for that is spending time in the Pacific Northwest Portland, Oregon, the old days, those salmon had to get upstream and they did it by eating all those krill and get that red algae. And they got a lot of power from that. So I'm a big believer in esta Xanthine. Above and beyond that you want to make sure your minerals are fine. I mean zinc certainly. Well let's look at x Mi Yeah, acne is either in adolescence or in menopausal women, Berry or menopause. It's a perfect storm, a high fat diet with a lot of dairy changing hormones, and low zinc. It's a perfect storm. It's a perfect storm for acne. So I always like to see what the zinc levels are and patients with acne, I think that's really an important one as well. That's so getting your minerals, right. And then now you've got the basics. So what else might you need? You know, hair, skin and nails? I mean, are you going to take a formulation? For it's too late for me, as you can see, but no, it's with silica with some of the other key ingredients, some of the adaptogens because stress is such a big part of things do you want to reach for a supplement with Rhodiola or ashwagandha? I think the adaptogens particularly, you know, I think that's particularly important. With women around menopause who are just not sleeping, they have estrogen, you have to think whether you have estrogen dominance, which is what happens during menopause, even though you get a you get a fall in, in estrogen, it's about 35%. But the Fallen progesterone is 75%. So during menopause, there is relative estrogen dominance, and this is often the cause for many of the symptoms. And so cruciferous vegetables, most notably dem die in DeLisle, methane is just essentially cruciferous vegetables chopped up and extracted the active ingredients. That's a wonderful supplement, I think and you need to sleep. Otherwise, you know, you have your issues with your cortisol. Certainly. Yeah,

St. Onge: I mean, particularly with acne, I feel like I mean, I've watched my friends go through this just, it feels completely out of your control. Like, they've tried going off dairy, they've tried all these things, and they're still just have acne and it won't go away. And it feels like the only solution is something like Accutane. What, how do you address a patient like that?

Dr. Tager: Well, I have to make sure, first of all, that they really are staying off dairy products, that they really are staying off the fats that they are doing a plant mainly a plant centric diet, with lots of phytonutrients in it, that will crowd out a lot of things. So that's the first thing when when people tell you, it's like, I'm a vegetarian. Yeah, but I also eat little fish, and every so often a little chicken, and well, they're not vegetarian. So, you know, the point is, people don't actually really monitor very well, what they're doing. So you really do start with diet. And then you have to dress torma hormones, certainly, I mean, your friends are probably in an age where, where they're young enough. I mean, I can, I can pause, simply go ahead and take, by the way, a young man who's going to the gym all the time, and doing a lot of whey protein, and we can give him you know, very little zinc, a lot of whey protein, a lot of testosterone, perfect prescription for for acne. So I think you've got to consider hormones, you've got to consider diet strongly. You know, obviously, there are topical regimens that can be helpful for the exfoliation. You also have to look at the microbiome. And particularly. So when you look at acne, there's a change in the ratio between proprio and X, you know, back bacteria in the in the gut, it's normally it's normally about two and a half to one. On acne patients. It's about nine to one. So there's a change in the gut ratio. And what happens is, if you had to do anything, you would support a bacteria called akkermansia. akkermansia is responsible for the creation of acetate. The bugs in our gut, create short chain fatty acids. These are used for lots of things for your brain for your skin for GLP. One, they create these as building blocks. Now the butyrate that we talked about very often stays in the gut. That's to heal the gut. So you got the bugs, bugs are making butyrate butyrate stays to heal the lining of and maintain the lining of the gut. acetate goes more assuming appropriate goes more to the liver. But acetate goes into the circulation and makes its way to the skin. And we need to get that acetate in the skin to affect the skin microbiome. Okay, so many things affect the skin microbiome, but acetate will do that. So if you have a high fiber diet, I mean, first thing I would do is high fiber, high fiber, high fiber, fermented kimchi, sauerkraut, you got to feed your gut bacteria, right? If you want great skin. I mean, you just have to do that. And so you want to see the akkermansia. That's there, one of the commensal bacteria that we call the O GZ. You know, the original gang. But that's, that's important. And we're just learning more and more about that the relationship between the gut microbiome and the skin microbiome.

St. Onge: Do you consider probiotics?

Dr. Tager: Yes, yes, I think, folks, but we still don't really know what the absolute right blend is. We've got the, you know, half a dozen that are common, you'll see them. And that seems to be good enough, as long but I also have to have the fiber in your diet. You gotta go first to the foods, lots of fiber. And then you add the probiotics. I mean, obviously, there's other things you can do for gut health. You know, there's a lot of prescriptive lot of regimens that practitioners have, but that's the simplest part.

St. Onge: Yeah, that makes sense. Well, those were really all the questions I had. Before I let you go, do you have anything else you'd like to add?

Dr. Tager: Yeah, just and this on the fact that what if what you see on the outside is what's on the inside. I think the quality of your thoughts and your beliefs, what you say to yourself, how you go out in the world and give and share with others. Whether you choose to focus on anger, and divisiveness Are you choose to focus on gratitude, love and well-being that is reflected in your face and your skin? So I lead with that one.

St. Onge: So, try to be nice and then you'll have good skin? 

Dr. Tager: Yeah, you're more likely. By the way, don't smoke, easy on the alcohol, eat a lot of plants. Be nice and kind and it will reflect in your face.

St. Onge: Well, that's a good way to end. Thank you, Dr. Tager, for joining me today. 

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Editor's Note: Transcripts are auto-generated.