Ep 90 - The Rogue Pharmacist: Rejuvenating, Regenerating Retinol

0:00:03.9 Tracy Donley: Welcome, everybody, to ASCP and The Rogue Pharmacist Benjamin Knight Fuchs. In each episode, we will explore how ingredients, chemicals and the environment can have a positive and negative effect on our skin. I'm Tracy Donley, Executive Director of ASCP. And joining me today and co-hosting is Maggie Staszcuk, our very own education specialist. Hi, Maggie. 

 

0:00:28.5 Maggie Staszcuk: Hi, Tracy. 

 

0:00:29.7 TD: Okay, question for you today. So, do you use retinol in your daily skin routine?  

 

0:00:37.0 MS: I have to say I don't. I'm a little bit afraid of it, that introductory period with the redness and the peeling. I don't know if I wanna face it. 

 

0:00:44.6 TD: And you're an esthetician. 

 

0:00:45.8 MS: I know. 

 

0:00:46.5 TD: How old are you? And can I ask that?  

 

0:00:48.0 MS: I'm not sure that I wanna say that on the podcast. 

 

0:00:49.4 TD: Oh, I can't ask that. Okay. Well, all I can say is I use that retinol. And maybe it's just out of desperation 'cause I'm old. But anyhow. Well, guys, we may learn something new today and change Maggie's opinion. We're gonna be discussing rejuvenating, regenerating retinol. That's right, retinol. Hey Ben, how's it going?  

 

0:01:10.6 Ben Fuchs: Hey, Maggie. Hey, Tracy. Good to see you. 

 

0:01:12.6 TD: Welcome, Ben. I'm excited to discuss this topic. I hear most people should be using some form of retinol, right?  

 

0:01:18.4 BF: Heck yeah. You go to the gym, right?  

 

0:01:20.3 TD: Yeah. 

 

0:01:20.6 BF: Maggie?  

 

0:01:21.1 MS: Yeah. 

 

0:01:21.4 BF: Maggie, you go to the gym, right?  

 

0:01:23.3 TD: She's like winking right now. 

 

0:01:25.7 BF: We talked about vitamin C, and vitamin C is your skin's best friend. But whenever anybody asks me about what's the most important thing they could put on their skin, I got get a tough time between retinol and vitamin C and also alpha hydroxy acids. I consider those to be the, and minerals, to be the big four things you put on your skin. So while vitamin A or retinol may not be as multifunctional, perhaps, and as benign as vitamin C, it's so darn important. In fact, in the world of pharmacy for many years, it was the only thing that you could get that was FDA-approved and indicated for anti-aging. In fact, that's where... Obviously, that's where I first learned about on the importance of not retinol but retinoic acid. I'll tell you what I mean by that here in a second. In the pharmacy setting, and we studied a lot. We studied vitamin A a lot. Vitamin A is not really a vitamin. Do you guys know this?  

 

0:02:13.9 TD: I did not know that. 

 

0:02:14.6 BF: It's not really a vitamin. It's colloquially referred to as a vitamin, and of course now it's even more than colloquially referred to as a vitamin. Most people call it a vitamin. But technically it's a hormone. And that makes it very interesting in the sense that vitamins help. Vitamins assist chemistry. Chemistry will not proceed without a vitamin present, without vitamins present. And so vitamins have a helping effect, but hormones have an activating effect. They actually turn things on in the case of vitamin A as well as vitamin D. These are two things that we call vitamins that are really hormones. They sit inside a receptor on a cell. I think we talked about this before, the nature of receptors. They sit inside the receptor and they activate chemistry. They turn things on, which makes them much more fundamental than a vitamin. And the fact that you can actually upregulate chemistry by taking something that's called a vitamin that you get at a health food store is really phenomenal. That you could actually get hormonal benefits from something that's so readily available really makes vitamin A one of the most valuable of all the nutritional supplements and one of the most important nutritional supplements that we can take orally. 

 

0:03:22.1 BF: Now, the thing about that makes vitamin A so fascinating... In general, it's a building substance, it turns things on, has a lot of specific benefits. It's important for your immune system. It's important for bone development. It's important for the eyes. But if you wanna lump all of these things that vitamin A does, it helps us cope with the world. It makes us more resilient in the face of all the assaults that occur in the environment. And so vitamin A is a very important building substance. In fact, for the immune system, when there's a viral infection, a measles infection in a third world country, the World Health Organization will send them vitamin A because vitamin A is that important for helping build the immune system. And these days everybody wants to build an immune system, so vitamin A taken orally can be very valuable. But here's where vitamin A for estheticians and for folks who want skin, here's where vitamin A is so darn helpful. Remember, the skin is a barrier to water, right? So it doesn't really... Water-soluble ingredients don't really penetrate through the skin very effectively. Vitamin A is fat-soluble. Vitamin A makes it through the skin surface really effectively. And not only that, but vitamin A can actually make its way to the dermis and to the lower levels of the epidermis where the viable cells are. 

 

0:04:28.0 BF: And this effect that vitamin A has when it interacts with cells is a genetic effect. It turns on genes. It turns on the genes that help the cell cope. Specifically for the skin, it turns on the genes that stimulate collagen production as well as hyaluronic acid production. It turns on the genes that make your skin beautiful. It turns on the genes that help you improve... That help improve wound healing. Vitamin A turns on the fibroblast, stimulates the production of connective tissue, via this kind of receptor mechanism where it sits in the receptor of the fibroblast. But it does more than that. So that's great right there. It turns on the production of collagen and hyaluronic acid, gives you a nice fat dermis. But more than that, vitamin A is a normalizing vitamin. By normalization that means it helps cells grow if they're not growing, or it helps cells not grow if they're growing too fast. In the skin, the cells that grow and divide are called keratinocytes, those are called skin cells. They start their life at the bottom of the epidermis, at the basal layer, and they migrate their way up to the very top to the stratum corneum. And this journey upwards, which we call transit time, is about four to eight weeks. 

 

0:05:35.3 BF: Technically, the process is called differentiation. It's called differentiation because the cells take on a different shape, and each shape tells the shape above it what's happening. These different shapes are communicating to each other so that when the shapes are switching really fast, there are systems in place that will slow things down. When the shapes are shifting too slow, there are systems in place that will speed it up. Vitamin A is the communication molecule that tells the cells whether they should be going faster or they should be going slower. And there's many skin diseases that are caused by cells that are dividing too fast. For example, acne. It's a classic example. And guess what? Vitamin A is the main treatment for acne. Eczema is when cells aren't growing fast enough, and vitamin A is a treatment for acne... Or for eczema. 

 

0:06:22.1 TD: So on that same note, if someone is... Potentially has skin cancer... 

 

0:06:25.9 BF: Heck yes. 

 

0:06:26.7 TD: You would like them to probably take vitamin A, right? 'Cause they're gonna slow down that zombie cell. 

 

0:06:31.3 BF: You are... And vitamin A deficiency can actually cause actinic keratosis and various skin cancers. So yes indeed, vitamin A is used to treat cancers, it's used as chemotherapy for lung cancer. It's plain old vitamin A. Or actually, I think it's maybe a drug version of vitamin A. But in any case, it's leveraging, this differentiation stabilizing ability that vitamin A has. So not only does it have a benefit for the fibroblast, for turning on the production of connective tissue, giving you a nice fat dermis, but it has epithelial benefits as well, in terms of stabilizing the growth of the keratinocyte for acne especially, and it's a treatment of choice for dealing with acne, but also for eczema and also for psoriasis. Now, there's another thing that vitamin A does that, this is what Maggie was alluding to, and a lot of people say this as well, because vitamin A stimulates, it turns things on, if the skin is not quite ready to be stimulated, it's not gonna handle vitamin A as effectively. So what you wanna do if you can't use vitamin A is you wanna use supplements that stabilize and strengthen your skin, and those are most importantly gonna be fats. Essential fatty acids particularly, and also a fatty plant nutrient called beta-sitosterol. And between beta-sitosterol and omega fats, especially omega-3 fats, you can really do a lot... Get a lot of benefits for strengthening the skin so that you can use topical vitamin A. 

 

0:07:51.6 TD: So are you recommending that we would orally take these omega-3 Omega-3s?  

 

0:07:55.0 BF: Not only that, you should treat your skin sensitivity if you can't use retinol as diagnostic, as a diagnostic tool that tells you, "Hey, I may need to be strengthening my skin here." There may be an issue with fats, and ironically, or interestingly, as women get older, they don't process their fats as effectively. And so if the older women are the ones who need the retinol and the retinoic acid, and remind me to tell you about the differences between all these three, 'cause they're very interesting, it's the older women especially who need this, that are the ones that are avoiding it because of that issue. So for older women especially I would say... And by older, I'm not saying old. 

 

0:08:33.5 TD: You're saying like me, right? Is that what you're saying?  

 

0:08:35.4 BF: No, I'm not... 

 

0:08:35.6 TD: You're looking right at me, Ben. 

 

0:08:36.6 BF: No, I was not looking at you. 

 

0:08:37.3 TD: I can see you. 

 

0:08:37.7 BF: I was not. And we start to get older, like in their 40s and 50s, perimenopausal especially, and certainly menopausal, you definitely wanna start working on fat metabolism and making sure you take in your fats. In fact, we talked earlier about vitamin C and connective tissue, well, vitamin A is also important for connective tissue and vitamin A is very important for osteoporosis. So while we're talking a lot about the important... In our culture anyway, we talk a lot about the importance of calcium for bones and for connective tissue, bones are connective tissue, vitamin A and vitamin C are really important for bone health, as important as they are important for the skin. 

 

0:09:15.4 BF: One of the things that vitamin A will do, retinol or retinoic acid will do, because it's stimulating the movement, it's speeding up transit time for the movement of the basal cell up to the stratum corneum, sloughing off will occur, and this kind of peeling will occur, and this is what a lot of people experience, not that it's a peeling ingredient necessarily, but if there's a lot of stratum corneum... A lot of corneocytes on the stratum corneum, a lot of dead cells, when people first start using retinoic acid or retinol, they'll notice a really dramatic peeling effect. That peeling effect, doesn't always occur, and as you get used to... Your skin gets used to a regular application of retinol or retinoic acid, it will tend to become less and less pronounced, but that peeling effect in turn has a stimulating effect on new keratinocytes and improves the movement upwards and what that does, is two very important things for the skin. Number one, it can help lighten the skin and it can have... Has a great de-pigmentizing effect. In fact, I consider retinol to be way better than hydroquinone for lightening the skin. 

 

0:10:15.0 TD: Also for hyperpigmentation?  

 

0:10:16.2 BF: For hyperpigmentation. 

 

0:10:17.1 TD: Oh, that's great. 

 

0:10:17.9 BF: And, this is really cool. This... Picture in your mind's eye, how it's speeding up the movement of cells from the bottom to the top, it's moving everything up. If you have a mosquito bite or if you have a spider bite, it will speed up the removal of the toxins of the mosquito bite or the bug bite. 

 

0:10:33.3 MS: That's super cool. 

 

0:10:34.2 BF: Isn't that super cool? So you can... We use our... My retinal formulations as a mosquito bite treatment. 

 

0:10:41.3 MS: How does somebody phase into starting to use a retinol product?  

 

0:10:44.5 BF: Okay, so that's a great question. There's five forms of vitamin C that are available, but there's three main forms. The three main forms are the carrier form, that's the way vitamin A is carried through the body, and that's the kind you'll find in most nutritional supplements, and it's the kind you'll find in most over-the-counter products that don't really feature... Don't really talk a lot about vitamin A. Has some vitamin A benefits on the skin but not a lot, and that's called retinyl palmitate. And you'll see that in most over-the-counter products. Not really therapeutic or esthetician strength products, and that's the weakest form. 

 

0:11:15.9 TD: Are they still gonna call it retinol in those products?  

 

0:11:17.9 BF: They're called retinyl palmitate. 

 

0:11:18.2 TD: Okay. 

 

0:11:18.3 BF: Okay? That's the technical name, retinyl palmitate. It's an ester, like ascorbyl palmitate, we talked about before. 

 

0:11:25.6 TD: Yeah. 

 

0:11:25.8 BF: This is retinyl palmitate, same idea. Then there's the prescription strength vitamin A, that's the kick-butt form, and that's the form that most people know about or at least knew about up until recently, that's the only form people know knew about, and that was called retinoic acid. It comes in a brand name product called Retin-A, although now there's a lot of generic forms, and now there's a lot of pharmaceutical versions, different in tartars and a few other ones, but the main form for many years was called retinoic acid was found in Retin-A, and come in different strengths, 0.1%, 0.01%. 0.05%, those are the main strengths. Retinoic acid had... By the way, Tretinoin is what Johnson & Johnson call retinoic acid, those are the kind of nomenclature that people would get confused up. Retinoic acid, Tretinoin, Retin-A. 

 

0:12:13.4 BF: Now, you need a prescription for Retin-A, obviously, and you have to go back to the doctor every six months every year. It's a really not pleasant formulation. It's a standard drug formulation, drug companies are not elegant cosmetic formulators, and basically they took this mineral oil and petrolatum and just goop and stuck some retinoic acid in it, because they're not really formulators, they're Johnson & Johnson's drug company. So retinoic acid's awesome, let's be very clear. It is awesome, it is an incredibly valuable anti-aging tool, but has a downside, and that is you need to go to the doctor every six months to a year, you gotta get refills, gotta go to the pharmacy, blah, blah, blah. It's kind of... A bit difficult to work with. Thus, the importance of the middle. 

 

0:12:53.4 BF: Form of vitamin A, which is much weaker than retinoic acid, about 100 times weaker than retinoic acid, but much stronger than retinyl palmitate. It has... It's weaker than retinoic acid, but it has the advantage of you don't need to go to the doctor to get it. You can get it over the counter and you get it on the internet. However, if you really wanna have a good retinol product, it has to have enough retinol in it. And there are... Unfortunately, in the skin care business, there's games that are played and there are people who will tell you about the retinol, but there's not a lot of retinol in there. And on top of that, as Maggie alluded to, not... People can't really use a lot of retinol. Alot of people can't anyway, and so it's a tricky ingredient to work with. 

 

0:13:32.3 BF: What I'd figured out was if retinol... What I wanted to do when I formulate, if retinoic acid is 0.01%, 0.1%, 0.05%, and the conversion factor of retinol to... Or retinoic acid to retinol is 100 times, if you wanna equipotent, that is the same potency of a retinol product, the same retinoid potency as a prescription product, you've gotta work with that 100 times factor and turn your 0.01% into a 1%, or your 0.05% into a 5% if you wanna have it to be the same potency. 

 

0:14:11.0 BF: So when you're using a retinol product, if you really want good retinol benefits and really wanna leverage the power of vitamin A, you gotta have enough of it. So I always suggest a 1% to start and then work your way up to a 5%. Not everybody can use a 5%, but a lot of people can, and you get dramatic benefits. But as Maggie said, sometimes it can be a little bit strong, a little bit irritating. So in addition to using supplements, protecting the fats and working on fat absorption at the level of the intestine, what you wanna do is you wanna break yourself in slowly, and you wanna make sure you're taking advantage of the rest period. We're so obsessed with do, do, do, move, move, move, you know? Action, action, action. 

 

0:14:50.9 TD: Yeah. 

 

0:14:50.9 BF: We're in this action culture that we don't realize that the rest period is when the things happen. They don't happen... Your muscles don't grow when you're in the gym. They grow the next day when you're not doing anything. So understanding how to leverage the rest period, it's a great strategy for understanding the skin, but it's a great strategy for life. If you really wanna maximize your effectiveness and your quality of life and be successful, you have to honor the rest period, take advantage of the rest period. And we all love the rest period. 

 

0:15:19.7 TD: I love the rest period. That's all I was thinking. 

 

0:15:21.8 BF: Well... No, I know. 

 

0:15:22.4 TD: Yeah. 

 

0:15:22.5 BF: But check this out, you don't really love the rest period. 

 

0:15:24.5 TD: I don't? Okay. 

 

0:15:25.2 BF: No, no. Have you ever been stuck in bed all day?  

 

0:15:27.4 TD: Yeah, that's... 

 

0:15:28.0 BF: That's not very much fun. 

 

0:15:29.1 TD: No, it's terrible. 

 

0:15:29.5 BF: The kind of rest we love is the kind of happens after stress. That's the kind of rest you love after the... 

 

0:15:35.9 TD: That's a great point. 

 

0:15:37.2 BF: Right?  

 

0:15:37.3 TD: Yes. 

 

0:15:37.6 BF: Right? It's not the rest period we love, it's the rest after the stress that we love. And it's the same thing about the skin. The rest period after you use your retinol, that's what you wanna take advantage of. So when people start a retinol program, they tend to overdo it because that's just the way we live in our culture. We do, do, do, right? But the rest period is really where you wanna leverage and take advantage. And that requires a little bit of savvy, understanding where that sweet spot is, 'cause you don't wanna underdose, but you don't wanna overdose. So I always recommend people start with a low strength. I like 1% retinol, low strength. And by the way, vitamin C and retinol work together. I hope we have time to talk about that 'cause it's a very important point and a very... And it's a misunderstood point. I like a low dose of retinol with vitamin C, and then work yourself into a higher dose slowly over time, because your skin does get used to retinol over the course of time. It gets stronger and stronger, just like your skin gets used to lifting weights. You get stronger and stronger. 

 

0:16:33.7 TD: Are there Fitzpatricks that need to be concerned about the... 

 

0:16:36.9 BF: It's more of a question of sensitivities. 

 

0:16:38.6 TD: Okay. 

 

0:16:39.1 BF: Now the lower Fitzpatricks are going to have more sun issues, so you gotta be a little bit more careful there. But it's not as much a Fitzpatrick issue as it is a sensitivity issue. And by the way, nobody should have sensitive skin. That is a pathology. If you have sensitive skin, there's something wrong. So you wanna work on why your skin is sensitive. 

 

0:17:00.9 TD: I have never heard that before. 

 

0:17:02.2 BF: Human skin is designed to be a barrier. It's designed to not be sensitive. It's... The purpose of the skin is to be able to handle things. So when we have sensitive skin, it's either a result of a hyped-up immune system, which usually comes in through foods, or nutritional deficiencies, particularly in the fats as we just talked about, or a combination of both. So if you have sensitive skin, you wanna work on that. That's an issue... 

 

0:17:26.9 TD: It's an indicator. 

 

0:17:27.8 BF: Exactly. 

 

0:17:28.6 TD: Yes. 

 

0:17:28.9 BF: That's how you wanna treat it, as a diagnostic tool, because without being hyperbolic or dramatic here, if you have sensitive skin, you're on the road towards autoimmune diseases, and you're on the road towards accelerated aging, and you're on the road towards all kinds of other degenerative issues. So the skin needs to be treated... Skin issues need to be treated as diagnostic of things that are happening inside the body and as an opportunity to correct things that are going wrong in the body to give you a longer life. And so sensitive skin is one of those things. If you have sensitive skin, I'd be loading up on the fats, as we just talked about, and looking for digestive issues. 

 

0:18:03.2 BF: But I really wanna bring this point up, 'cause I hear this question a lot, and that is about the relationship between vitamin C and retinol. And people say, "Oh, you shouldn't use vitamin C and retinol together," and I hear that a lot. Bad information. Okay? Not true. They are perfect together. But, but, and this is a big but, water-soluble vitamin C will break down more quickly in the presence of retinol, and because vitamin C can be a little drying and irritating, it can exacerbate the drying and irritating effects of retinol. And also for that matter, retinol can speed up the oxidation of vitamin C and vice versa, both ways. 

 

0:18:40.4 TD: So it's basically misunderstood because they're using the wrong vitamin C. 

 

0:18:43.5 BF: The wrong form of vitamin C. 

 

0:18:44.6 TD: Right, right. 

 

0:18:44.9 BF: But if you use stabilized vitamin C, they enhance each other. Fat-soluble stabilized vitamin C and retinol act synergistically. The vitamin C will mitigate some of the problems associated with the retinol because fat-soluble vitamin C has a calming effect. And the vitamin C... Or the retinol will improve the penetration of the vitamin C, so they are perfect together as long as the vitamin C is fat-soluble and stabilized. 

 

0:19:15.0 TD: Well, I mean, amazing. So what you're saying is not all vitamin A's are created equally. 

 

0:19:22.2 BF: Exactly. 

 

0:19:22.7 TD: Okay. 

 

0:19:22.9 BF: Vitamin A is a family and it has many children, and one of the children is retinyl palmitate. That's a very weak child. 

 

0:19:30.2 TD: Poor child. 

 

0:19:31.6 BF: Then there's the strong, kick-butt child that you need a prescription for, that's retinoic acid. And then there's the middle child, which is very functional and very useful if you know how to formulate with it correctly, and that's... 

 

0:19:42.2 TD: The perfect child. 

 

0:19:42.5 BF: The perfect child, okay, if you will, and that's retinol. But here's the thing: There's also in nature molecules that are found that are part of the vitamin A family. For example, vegetarians know that there's a form of vitamin A... Are you a vegan?  

 

0:19:54.5 TD: Oh, no. 

 

0:19:54.9 BF: Okay. So there are... Vegetarians and vegans, they can't use vitamin A because vitamin A is only found in animals. Only animals make vitamin A. Plants don't make vitamin A. So what is a vegan to do or a vegetarian to do? Well, vitamin A is a family, so there are plant versions of vitamin A that can be converted into the active vitamin A. The most common and well-known is called beta-carotene. Now beta-carotene is not a great form of vitamin A 'cause there's some biochemical processing that has to take place and not everybody is able to do or able to do effectively, so beta-carotene's okay, but it's not a great way to get your vitamin A. And topically now, there are forms of vitamin A found in nature, one is called bakuchiol, which you may have heard of, and that's marketed as an alternative to retinol because it's a plant retinoid, a plant member of vitamin A, the vitamin A family, but it's not really all that effective. 

 

0:20:48.2 BF: And then there's pharmaceutical versions of this beautiful vitamin A molecule, as I said earlier, adapalene and tazarotene, and these also take advantage of the wonderful benefits of vitamin A. But the reason that they're dispensed usually is because of drug company patents and marketing and advertising. There's really no benefit to using these drug versions over using the real stuff, and there's really no real benefit to using the plant versions over the real stuff. Go with real stuff. Retinyl palmitate is okay, but retinol and retinoic acid, for my money as a pharmacist and as a chemist, they are must-haves for anti-aging. 

 

0:21:24.8 TD: Well, Ben, that was amazing. Again, you continue to just wow me with your knowledge. And I always think, "Ah, I've got it. I know what to do with that retinol," and then you just blow it out. So hopefully everyone really enjoyed this episode. That does wrap our show today. And as always, guys, if you are not an ASCP member, join at ascpskincare.com/join. And if you like this episode, subscribe so you don't miss a single one, okay? Details from what we discussed today will be in the show notes. And if you just can't get enough of Ben Fuchs, The Rogue Pharmacist, you can listen to his syndicated radio program that's called The Bright Side, and you could visit his website, pharmacistben.com. Thanks, everyone and make it a rejuvenating day.Page Break