The following blog post is a series of book reviews and recommendations that reflect our mantra "Feel Good About Feeling Good."
Dr. Jeffrey Harmon
Clean: The New Science of Skin by James Hamblin, MD
There is a tendency in skin scare to ere towards the maximalist approach, with more creams, ointments, oils, and moisturizers used more frequently. This is encouraged by the cosmeceuticals industry as well and modern wellness vendors as exemplified by the current trend towards multi-step skin care treatments as popularized by Korean skin care brands. But what if less – much less – is more? And what are the implications of shifting our understanding of clean, healthy skin?
James Hamblin MD, an internal medicine physician turned journalist for The Atlantic Magazine, set out to understand the skin care industry, later broadening his reach to how we conceptualize what is “clean” and how this has changed in society, all through the eyes of cleaning products. He starts with soap. And he starts by explaining why he has not cleaned himself with anything other than water for the past 5 years while researching the book.
The book is a tour de force of history, emphasizing the amazing strides that have come from the development of germ theory and the subsequent mass marketing of soap to the public to achieve a level of cleanliness/sterility that was meant to combat the infectious public health illnesses of the time.
He also dives into the poorly regulated market of cosmeceuticals, concluding that the vast majority of what is placed in skin care products today has no evidence for its effectiveness. He calls into question the actual benefits of all the expensive skin care products people are encouraged to buy. I agree with Dr. Hamblin. Very few ingredients in marketed skin care products have demonstrated significant clinical effectiveness. The industry is filled with half-truths and outright lies. The worst part is that their behavior is legal, simply because it is such a poorly regulated industry.
Dr. Hamblin pivots to the idea that much of our modern skin illnesses can be traced to an imbalance in the bacterial composition of the skin, called the microbiome. The act of exfoliating, washing, moisturizing, and toning the skin is chasing what our body does naturally. He meets individuals who are performing research on introducing bacteria to the skin to treat conditions such as eczema. In the end, he suggests that we are on the verge of a reconceptualization of our understanding of disease of the skin and how to maintain the health of our skin. He emphasizes the preliminary nature of business introducing “pro-biotic” skin care products into the market and suggests that simply embracing our natural propensity to interact with each other and to expose ourselves to “good” bacteria may go a long way in preventing pediatric dermatological illnesses.
We at Harmon Facial Plastic Surgery are not ready to recommend any product or activity mean to introduce bacteria to the skin for the purposes of skin care. However, we strive to provide recommendations that are affordable and effective with the best available evidence. Eat a well-rounded diet, mostly plants, of food free of pesticides and antibiotics. Wear a mineral-based sunscreen of at least an SPF of 30. Exercise, preferably outside. Socialize with your loved ones, safely. Use a simple moisturizer of your choice, which can be inexpensive or not. And consider a retinol and/or Vitamin C serum for photoaging as tolerated. Healthy skin is as much a matter of how we live as it is a matter of what we put on it.
I am Invincible by Norma Kamali
I am Invincible by the famous fashion designer Norma Kamali is a fantastic book option. For those who are unaware, Normal Kamali got her start in a small clothing shop in New York City in the 1970s where she designed clothes inspired by the styles she saw in London in the late 1960s. She went on to design accessible, comfortable, high fashion clothing that evolved through the decades (think puffer coat). She explains her approach to style, which in summary is to have a “uniform.” We here at Harmon Facial Plastic Surgery love this recommendation, as you will see Dr. Harmon in his “uniform” each day: brown loafers or oxfords, relaxed wool or thick cut chinos, a tailored white button down (usually from the wonderful team at Romualdo in Madeira) and his white coat. Now in her 70s, Norma Kamali is also a model for healthy living. This book not only discusses her fascinating personal and professional life, but also her philosophy of health, including her approach to eating a healthy, diverse, and well-balance diet, exercise, and sleep.
The Blue Zones Solution: Eating and Living Like the World’s Healthiest People by Dan Buettner and How to Eat: All Your Food and Diet Questions Answered by Mark Bittman and David L. Katz MD
Though wildly different in style and structure, the information these books communicate reinforces each other.
The Blue Zones Solution: Eating and Living Like the World’s Healthiest People by Dan Buettner reviews the data gathered and lessons learned while studying populations of people throughout the world with a relatively large number of centenarians, or individuals who live to be at least one hundred. This research started as an assignment by The National Geographic Society. Located in Greece, Italy, Japan, Costa Rica, and Southern California, Mr. Buettner labeled these communities “blue zones.” He derived the following 9 “lessons in longevity” from these communities:
1. Live in a physical environment that constantly and passively encourages movement
2. Live with a purpose beyond employment
3. Identify time to relax and wind down
4. Stop eating when your stomach is 80% full
5. Eat a primarily plant-based diet with little meat
6. Appropriate/moderate wine drinking
7. Create a social circle that supports healthy behaviors
8. Attend faith-based or other community services weekly
9. Place family first and keep parents/grandparents nearby
Mr. Buettner highlights some of the healthy foods that are commonly consumed by each of the above communities, explaining their health benefits and how the macronutrients and micronutrients in these foods relate to each other despite the diets varying between the communities. He not only emphasizes the importance of what foods are eaten but also how the acts of acquiring, preparing, presenting, and consuming food are performed and respected as a significant daily event in the lives of these individuals. He moves on to discuss case examples of communities who changed their health by adopting behaviors like those adopted by blue zone communities, including small towns in Iowa.
The book then moves on to present concrete ways we all can adopt “blue zones behaviors” to improve our health. These include moving our diet to a primarily plant-based diet with minimal dairy and meat as a small side dish or garnish eaten infrequently. Mr. Buettner emphasizes the importance of treating the act of preparing and consuming food as sacred and something that should be shared with family and/or friends in a distraction-free environment. He summarizes the dietary example of blue zones communities with an easy-to-understand list of 4 foods to always have available and 4 foods to avoid completely, such as sugar sweetened beverages, salty snacks, processed meats, and packaged sweets.
Mr. Buettner recommends “de-conveniencing” the home to encourage more physical activity as a baseline behavior. His suggestions include using more non-mechanized appliances and a push lawnmower. He makes concrete recommendations for organizing the kitchen and bedroom to maximize health. Finally, he includes easy-to-follow recipes inspired by the meals consumed by members of blue zones communities that reflect the recommendations made earlier in the book.
Mark Bittman and Dr. David Katz go into more detail about the science of nutrition in How to Eat: All Your Food and Diet Questions Answered than Mr. Buettner, including some of the misunderstandings and controversies associated with the field of nutrition. Not only does this book reference blue zones but Dan Buettner references some of Mark Bittman’s recipes in The Blue Zones Solution. How to Eat is written as a long Frequently Asked Questions session that also feels like a back-and-forth conversation between two knowledgeable friends. Mr. Bittman and Dr. Katz demonstrate a wonderful ability to cut through the confusion about various fad diets and otherwise heavily restricted diets that have caused many to unwisely exclude broad categories of food. The idea of the relative benefit of individual foods is brought up frequently. For example, there is controversy as to whether dairy products should be a component of a maximally health diet. Mr. Bittman and Dr. Katz explain that, with every food, it really depends on what you are replacing that food with. For example, they explain that if an egg is replacing bacon for breakfast, then it may be good. However, if an egg is replacing plain yogurt with muesli and berries then it may not be good. How to Eat reinforces the stories in The Blue Zones Solution and fleshes out the reasons why the interventions made by Mr. Buettner in communities throughout the United States have been effective in improving population health in those communities.
We at Harmon Facial Plastic Surgery are not dieticians. The nutrition recommendations provided in the above books do not necessarily reflect the opinion of Harmon Facial Plastic Surgery.
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