Aging Skin & Rejuvenation: Insights from Dr. Jennifer Goldwasser

In a recent Medicine 3.0 episode, Dr. Catherine Isaac welcomed back dermatologist Dr. Jennifer Goldwasser to discuss aging skin and rejuvenation strategies. This informative conversation covered everything from basic skin care to advanced treatments, offering valuable insights for anyone looking to maintain healthy skin as they age.

Understanding Skin Changes with Age

Dr. Goldwasser explains that as we age, our skin undergoes numerous changes:

• Mottled, non-uniform coloration
• Increased laxity
• Development of wrinkles
• Growth of various skin spots

Sun exposure is the primary culprit behind these changes. Dr. Goldwasser suggests comparing protected skin (like the underside of your arm) with frequently exposed areas to see the dramatic difference sun damage causes. Another telling sign of sun damage in elderly individuals is "senile purpura" - red-purple blotches that appear on sun-exposed skin due to deteriorated connective tissue.

The Subtraction-First Approach

Rather than immediately adding products, Dr. Goldwasser advocates for a "subtraction-first" approach to skin care:

1. Eliminate harmful habits:
   • Tobacco use (smoking, vaping)
   • Excessive alcohol consumption
   • Recreational drugs
   • Sun exposure
   • Ultra-processed and animal-based foods
2. Add beneficial practices:
   • Plant-based diet rich in phytonutrients and antioxidants
   • Simple, targeted skin care routine

Essential Skin Care Elements

1. Gentle Cleansing

Dr. Goldwasser recommends gentle cleansers like Dove sensitive skin products or La Roche Posay's hydrating cleanser. She warns against products with strong fragrances, dyes, or exfoliating particles, especially for aging skin which becomes thinner and more sensitive.

2. Proper Moisturizing

• Choose the right vehicle: Creams (oil-based) are better for aging skin than lotions (water-based)
• Look for jar packaging rather than pump tops for richer products
• Recommendations: Vanicream, La Roche-Posay Lipicar, CeraVe or Cetaphil in jars
• For extremely dry areas, Dr. Goldwasser surprisingly recommends Crisco shortening as an effective, non-irritating option

3. Sun Protection

Sun protection remains crucial even as we age, as UV damage continues to accumulate.

Managing Common Skin Conditions

Seborrheic Dermatitis

Often mistaken for dry skin, seborrheic dermatitis (dandruff) requires:

• Regular, vigorous cleansing
• Products containing pyrithione zinc (like Head & Shoulders)
• For facial involvement: washing twice daily, once with anti-dandruff shampoo and once with facial cleanser

Dr. Goldwasser notes that seborrheic dermatitis is common in babies and aging adults, particularly those with neurological conditions like Parkinson's disease or those experiencing immunosuppression.

Anti-Aging Treatments

Over-the-Counter Options

1. Retinols: Derived from vitamin A, these are the most potent OTC anti-aging ingredients
   • Benefits: Reduce fine lines, improve skin texture
   • Limitations: Can be irritating and sun-sensitizing
2. Vitamin C:
   • Benefits: Stimulates collagen production, acts as an antioxidant
   • Limitations: Unstable in formulations, effective products are costly
3. Other Options:
   • Peptides
   • Hyaluronic acid for moisture
   • Niacinamide for inflammation

Prescription Treatments

Tretinoin (prescription retinoid):

• Apply a pea-sized amount at night
• Wait at least 20 minutes after washing
• Avoid sensitive areas (upper eyelids, lips)
• May need to start gradually (every other day) or seasonally
• Most effective for fine lines, less so for deep wrinkles or skin laxity

Professional Procedures

1. Botox:
   • Temporarily paralyzes muscles to reduce expression lines
   • Generally safe with effects lasting 3-4 months
   • Best for forehead lines and "11 lines" between brows
2. Fillers:
   • Typically hyaluronic acid-based (Restylane, Juvederm)
   • Best for deeper lines around the mouth
   • Duration varies based on product
3. Lasers and Energy Devices:
   • Can address pigmentation, visible vessels, and redness
   • Newer technologies like radiofrequency microneedling can stimulate collagen and tighten skin
4. Surgical Options:
   • Most effective for significant laxity
   • Eyelid surgery (blepharoplasty) offers good value and high satisfaction

Emerging Treatments

While Dr. Goldwasser finds radiofrequency microneedling promising, she cautions against jumping on trends without sufficient evidence:

• Red light therapy: Limited scientific support
• Topical estrogen: Insufficient safety and efficacy data

Key Takeaways

1. Protect skin from sun damage at every age
2. Simplify your routine - less is often more
3. Choose products appropriate for your skin's changing needs
4. Adjust skin care seasonally and as you age
5. Consider the risk-benefit ratio before trying trendy treatments

The podcast emphasizes that good skin care requires adapting to our body's changing needs with age, replacing dated routines, and focusing on evidence-based approaches rather than marketing claims.

Timestamps:

‍00:00 - Introduction

‍02:39 - Effects of sun exposure on skin aging

‍05:39 - The subtraction approach to skincare

‍09:01 - Gentle cleansers and proper product selection

‍11:57 - Understanding seborrheic dermatitis

‍16:57 - Menopause and skin changes

‍23:36 - Types of moisturizers and proper application

‍32:21 - Effective skincare ingredients

‍37:14 - Anti-aging ingredients: retinols and vitamin C

‍44:21 - How to properly apply tretinoin

‍53:13 - Benefits of tretinoin for aging skin

‍57:44 - Botox, fillers and other cosmetic procedures

‍1:04:36 - Innovative treatments in dermatology1:12:27 - Conclusion and preview of future episodes

Food Environment and Meal Prep: Driving Nutrition Success

In this episode of Medicine 3.0, host Kelly interviews Bionic Health Advisor Anna Simmons to discuss practical nutrition strategies that can help anyone achieve their health goals. They dive into the differences between meal prepping and batch cooking, how to optimize your food environment, and provide actionable tips for grocery shopping and maintaining consistency despite busy schedules.

Topics Covered

• Meal prep vs. batch prep techniques and benefits
• Food environment optimization
• Creating sustainable nutrition plans
• Grocery shopping strategies
• Solutions for busy schedules
• Protein distribution throughout the day
• Beginner-friendly approaches to meal planning

Main Takeaways

The Power of Preparation

Both Kelly and Anna emphasize that preparation is key to nutritional success. Whether you choose meal prepping (preparing complete, portioned meals) or batch prepping (cooking larger quantities of individual ingredients), the upfront time investment significantly reduces daily decision-making and cooking time throughout the week.

"Preparation decreases decision fatigue. Throughout the week, you don't have to decide what you want to eat. It's already prepared for you. You know you have a healthy option to reach for." - Anna

Optimize Your Food Environment

Small changes to your kitchen and food storage can have substantial impacts on your nutrition:

• Replace candy bowls with fruit on counters
• Store less healthy options in opaque containers or away from eye-level
• Position colorful fruits and vegetables prominently in your fridge

Strategic Protein Distribution

Rather than following the typical American pattern of minimal protein at breakfast and excess at dinner, both advisors recommend distributing protein more evenly throughout the day. Aiming for approximately 30 grams of protein at each meal can help with muscle maintenance, satiety, and energy levels.

Smart Grocery Shopping

Before even beginning to meal prep, having a grocery strategy sets you up for success:

• Create a shopping list based on planned meals
• Shop the perimeter of the store for nutrient-dense options
• Take inventory of your fridge and pantry before shopping
• Be flexible with ingredients if certain items don't look fresh

Freezer as Your Friend

For busy individuals, the freezer becomes an essential tool:

• Freeze pre-portioned meals for busy weeks
• Prepare freezer-ready smoothie packs
• Stock up on frozen vegetables and fruits, which are often flash-frozen at peak ripeness
• Make breakfast burritos or sandwiches that can be quickly reheated

Progress Isn't Linear

Both advisors emphasize that nutritional progress doesn't follow a straight line. There will be weeks when meal prepping isn't possible, and that's okay. What matters is returning to consistent habits:

"Progress is not linear. You may have seen a graph in the past where there's what people think progress is and then what it actually is and it's just squiggly lines all over." - Kelly

Start Small and Simple

For beginners, Anna recommends:

• Keep recipes simple rather than attempting complex dishes
• Focus on spices, seasonings, and sauces for variety
• Start with small, achievable goals like improving just breakfast
• Break down larger nutrition goals into manageable steps
• Consider working with a coach or knowledgeable friend for accountability

About the Experts

Anna Simmons has been a Bionic Health Advisor for two years, coming from a background in human development at UNC Chapel Hill with certifications in personal training, nutrition coaching, and health coaching. Her personal passion for strength training and nutrition developed during college and intensified during the COVID pandemic.

Kelly Joniak  is also a Bionic Health Advisor that has previously been featured on the Medicine 3.0 Podcast. She competes in Olympic weightlifting and brings both personal and professional expertise to the conversation about nutrition planning.

Timestamps

Meet Anna Simmons (00:01-01:40)
The Bionic Experience (01:40-02:48)
Meal Prep vs. Batch Prep (03:20-05:10)
Pros and Cons (05:55-09:20)
Food Environment (10:05-12:43)
Nutrition Recommendations (12:43-19:52)
Grocery Shopping Strategies (19:52-24:39)
Making Progress (24:39-27:20)
Solutions for Busy Schedules (27:20-31:57)
Final Thoughts (31:57-34:38)

Beyond Traditional Cardiology: Inside Bionic Health's Advanced Vascular Module

Cardiovascular disease remains the leading cause of death globally, yet traditional healthcare often takes a reactive rather than preventive approach. At Bionic Health, we're changing this paradigm with our comprehensive Vascular Module, designed to identify cardiovascular risk factors years—even decades—before they manifest as clinical problems.

In a recent podcast conversation between Bionic Advisor Kelly Joniak and physician Dr. Catherine Isaac, we explored the science and strategy behind our vascular assessments. Here's what makes our approach different.

Beyond Basic Cholesterol Testing

Most primary care visits include a standard lipid panel measuring total cholesterol, HDL, LDL, and triglycerides. While these metrics provide baseline information, they tell only part of the story. Our Vascular Module includes advanced biomarkers that offer deeper insights:

• Apolipoprotein B (ApoB): This carrier protein reflects the actual number of LDL particles circulating in your bloodstream. Dr. Isaac explains, "APO-B is a reflection of how many LDL cholesterol particles are migrating through your bloodstream... the more congested it is, the greater likelihood that particles will embed in the arterial wall."
• Lipoprotein(a): This genetically determined particle increases plaque buildup risk approximately sixfold. "Those particles are six times more likely to promote plaque buildup," notes Dr. Isaac.
• Inflammatory Markers: We measure high-sensitivity CRP, IL-6, and homocysteine levels, which can indicate cardiovascular inflammation.

Seeing What's Actually Happening in Your Arteries

Rather than relying solely on blood tests, we use advanced imaging to visualize arterial health directly:

• Coronary Artery Calcium (CAC) Scoring: This non-invasive CT scan quantifies calcified plaque in the coronary arteries, providing a concrete measure of existing disease.
• Coronary CT Angiogram: For some members, this more detailed scan using contrast dye visualizes both calcified and soft plaque, offering comprehensive assessment of arterial narrowing.

"Atherosclerosis is a lifelong process that takes decades to develop," Dr. Isaac points out. "When plaque is initially laid down, it's soft. But over time, as your body remodels it, it calcifies and hardens."

Personalized Treatment Through Deeper Testing

One of the most valuable components of our Vascular Module is the Cholesterol Balance Test, which determines whether a member predominantly produces cholesterol internally or absorbs it from the intestine. This distinction directly informs treatment approaches:

• High Absorbers: May respond better to medications like ezetimibe that block intestinal cholesterol absorption.
• High Producers: Typically see significant benefits from statins, which inhibit internal cholesterol production.

Additionally, our Fatty Acid Balance Test measures the ratio of omega-3 to other fats in red blood cell membranes. "An ideal omega-3 index would be greater than eight," explains Dr. Isaac. "Most people eating an American diet have a very low omega-3 index because they're not getting significant sources of fish."

Moving Beyond Fear-Based Medicine

Dr. Isaac addresses common misconceptions about cardiovascular interventions, particularly statins. "One of the big components of my job is dispelling myths around statins. A lot of people reflexively balk at the idea of having to take a medication on a daily basis."

By using personalized data rather than one-size-fits-all approaches, we can make informed recommendations that balance risk and benefit for each individual.

The Hierarchy of Cardiovascular Interventions

While we employ advanced testing and personalized medicine, we emphasize that the foundation of cardiovascular health remains lifestyle-focused:

1. Food First Approach: We recommend the "800-gram diet"—consuming approximately six cups of fruits and vegetables daily. "Eating more fruits and vegetables is associated with lower blood pressure, lower cardiovascular risk, lower risk of diabetes, lower risk of cancers, lower risk of all-cause mortality," says Dr. Isaac.
2. Regular Physical Activity: Consistent cardiovascular exercise significantly improves vascular health markers.
3. Targeted Medications When Appropriate: For those with elevated risk profiles, evidence-based medications can dramatically reduce risk. "A person with an extremely strict diet can reduce their LDL cholesterol by approximately 20 to 25 percent," notes Dr. Isaac. "But with statins, we can dramatically drop people's LDL cholesterol and ApoB by 30 to 40 percent."
4. Targeted Supplementation: Supplements like omega-3s can fine-tune a cardiovascular approach, but they're the "cherry on top" rather than the foundation.

The Bionic Difference: Proactive, Not Reactive

Perhaps most importantly, our Vascular Module embodies our core philosophy: identify and address health issues before they become problems.

"Coming from traditional medicine, we were really playing catch-up more of the time than being proactive," reflects Dr. Isaac. "I get a lot of gratification out of taking care of our members, identifying disease earlier than we would have normally identified it using the traditional approach."

By combining advanced diagnostics, personalized interventions, and evidence-based lifestyle modifications, we're redefining what vascular health assessment can be—and helping our members live longer, healthier lives in the process.

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Key Timestamps:

00:00 - Introduction and welcome with Kelly Joniak and Dr. Catherine Isaac

00:46 - Overview of the vascular module and baseline evaluation

03:05 - Explanation of lipid panel testing (cholesterol, triglycerides, HDL, LDL)

04:25 - Deep dive on Apolipoprotein B (ApoB) and its significance

05:32 - Lipoprotein(a) explained and how it affects plaque buildup

07:30 - Discussion on lab work timing and what blood tests actually show

09:59 - Coronary artery calcium scoring and how it works

12:32 - Explanation of plaque formation and calcification process

15:16 - Lifestyle recommendations based on risk factors

17:37 - When medications are appropriate for higher-risk patients

19:59 - Cholesterol balance testing and personalized treatment approaches

21:29 - Addressing myths about statin medications

23:04 - Inflammatory markers and their role in cardiovascular assessment

25:21 - Omega-3 index testing and supplement recommendations

27:36 - The importance of lifestyle fundamentals over supplements alone

30:06 - Closing thoughts on proactive vs. reactive healthcare approaches

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Interested in learning more about Bionic Health's approach to cardiovascular wellness? Listen to the full podcast episode with Dr. Catherine Isaac or contact us to schedule a consultation.

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