Beauty Tips

 Because so many well-formulated beauty lines exist out there today that work well for the vast majority of people, I’m a lot less likely to see skin problems caused by products than skin problems triggered by stress. When I see a full-scale acne breakout on a patient who has rarely had a single pimple in the past, I first explain that acne is the symptom, not the problem (making for a long appointment with me). Over-the-brink stress can also show up as sudden hair loss in women, or I’ll hear a patient lament, "I did not have this wrinkle last week" or "I look ten years older than I did three months ago:’ With a little sage (doable!) advice and direction from me, they make the connection and realize that the stress, sleeplessness, and anxiety are ruining their looks, accelerating their aging like gasoline on a fire, and maybe setting them up for depression, too.

 It’s amazing to think that what goes on up in the brain can have such an impac our appearance, but guess what: What goes on in our skin can also have a huge impact. Your brain and skin are like twins in so many ways, and the things science is currently uncovering about their special relationship are astounding. Let’s take a tour

Your skin: behind the scenes: You think you’ve got a lot to juggle! Skin is the ultimate multitasker, by design. Its major function? Playing gatekeeper to the outside world, shutting out invading viruses, bacteria, and toxins. But it also keeps tabs on the scene inside your body, fighting off infections, warming you up, cooling you down, and keeping you moist (90 percent of you and 70 percent of your skin is water). Skin also sometimes acts like a sponge, absorbing the sun’s UVB rays, which help the body manufacture vitamin D for jobs like bone building and maintaining the nervous system.

Skill Fact: Our skin is our largest organ, taking up about 16 percent of our total body weight. It contains hair, oil and sweat glands, nerves, and blood vessels,

Your skin is also: A communications specialist, silently telegraphing health or illness, pleasure or pain, embarrassment or enthusiasma total-body outfit the means by which you touch and feel everything (and are touched, as in, mmm, massage) a shock absorber, insulator, and wound healer one of the few organs that regenerates itself: Skin sheds dead cells and grows new ones continually, totally renewing itself every four to five weeks.

 Like a beautiful cross-section of a multitiered layered cake, the skin is an amazing concoction of layers that is both fragile and strong. Some layers are moist and delicate, others are rich and sturdy; each supports the ones above it. However, if one layer is off, it can undermine the whole effect, making the surface sag or the texture dry or the colors all wrong. Disruptions can come from the outside world, too: Allergy-provoking toxins and acne-flaring hormones are the skin’s equivalent of too much heat, overbeating, or bad ingredients.

INTERNAL VERSUS EXTERNAL SKIN AGING: The skin, like all other organs, undergoes chronological aging and environmental aging. Stress aging can have an impact on both: It can accelerate internal aging as well as exacerbate external aging. Chronological aging, otherwise called intrinsic or endogenous aging. depends on the passage of time and is influenced by your genetics, hormonal changes, and metabolic processes. Habits like smoking cigarettes, drinking too much alcohol. and of course, having too much stress, can also factor into your chronological aging. This kind of aging can be seen on body areas not exposed to UV sunlight, and can reflect the aging process taking place in internal organs. Aged skin in nonexposed areas shows typical characteristics including fine wrinkles, dryness, sallowness, and loss of elasticity.

 Environmental skin aging, on the other hand, is exactly that, aging accelerated by the elements you encounter from the outside world. This can entail UV radiation from the sun, but also air pollution, invasions of pathogens like bacteria and viruses, chemicals, and mechanical stress (e.g., constant tugging and pulling. as in the small crease you’ve got to the right of your mouth because you favor that side when you smile). Of all these external sources of age accelerators, UV radiation is the most influential one. Also called photoaging, it can damage the skin to such an extent that the skin prematurely ages. For this reason, you’ll find that many of my strategies and skin recipes on the program (and that I hope you will adopt forever) help to treat UV damage and prevent further damage.

Thin Skin Fact:
 During Internal aging, the skin gradually loses its structural and functional characteristics. Anatomically, the epidermis undergoes thinning by 10 to 50 percent between the age of thirty and eighty years, although the number of the cell layers remains the same

Skinography: a quick tour: While it helps to think of skin as a cake with multiple layers from a structural standpoint. from a mechanical perspective, the skin acts more like a large. multilevel manufacturing plant. It requires a certain supply of materials, including fuel, to keep the assembly lines operating and the overall system working efficiently. Most people don’t realize all that can be found in skin. Skin isn’t just skin, as in a collection of one type of cell. Much to the contrary, skin holds an array of compounds so it can do its job. These include proteins, amino acids, water, vitamins, trace minerals, antioxidants, fats, and sugar. In addition to protecting you against foreign invaders from the outside world, it also must protect itself by keeping its structures intact, hydrated, and healthy. It’s a hungry and thirsty machine that needs more and more input and maintenance as you age because, like any machine, it becomes more inefficient and less reliable with time and constant use

THE FIRST LAYER: Let’s start at the very bottom with the foundation: a layer of subcutaneous fat, which provides energy storage and protective padding, cushioning flesh and bones when you slip on ice, for instance. It also insulates your body from heat and cold, and it’s the starting point for these other vital skin components.

 Sweat glands they filter out toxins, water, and excess salt and are an essential part of your air-conditioning system. As sweat evaporates, it cools your jets. These glands start here but like any good AC system, they spiral upward.

 Lymphatics and blood vessels-they permeate the foundation layer, sending and receiving messages (you know: "ahhh, that feels nice;” ‘wow, that’s cold;” “ouch!”), delivering nourishment, and providing transport and cleanup crews for cuts and infections. As with the sweat glands, they extend upward into the next layer, like zillions of tiny staircases.

 What happens naturally as you age. Your skin’s fat layer shrinks. Without that extra insulation, you feel the heat and cold more keenly, and your cheeks look more hollowed. (So why doesn’t fat disappear from other parts of your anatomy too, like, say, your belly and hips! Sorry, but that’s a different kind of fat.)

THE MIDLAYERS: This is the dermis, the largest layer of skin (accounting for about 90 percent of skin). It provides the struts and beams that add structure, strength, and elasticity, thanks to sturdy, protein-based connective tissue made of thin, white collagen fibers and wavy, rubbery, branching elastin fibers. Elastin holds the collagen together. This mesh of fibers forms the skin’s infrastructure and gives it strength and resilience. Nearby, fibroblasts constantly churn out these two fibers. Unluckily, production slows down over time, and quality control gets sloppy, too. It’s been theorized that these fibroblasts, as well as other cells, have a finite number of times they can divide. And when division comes to a halt, guess what: You age.

 There are other things in these rich layers, including sebaceous or oil glands. These produce sebum, an oily, moisture-loving substance that helps keep skin soft. Hair follicles are located here as well; each one grows a single hair, varying in thickness from coarse eyebrows to the downy fuzz that senses you’re about to be touched even before you actually are.

 Right above these are water-loving ingredients called glycosaminoglycans, (GAGs for short) that help moisturize skin and bolster collagen. Hyaluronic acid is a dominating GAG that surrounds the collagen-elastin network, binding it together and helping to keep the skin moist and plump. As you age, levels of hyaluronic acid decline, making the skin less pliable, drier, and gaunt. Additional blood and lymph vessels and nerve endings inhabit these two layers as well.

 The dermis takes center stage in keeping your skin hydrated. The fact it’s comprised of about 60 percent water and a gel … like mix of various molecules designed to nourish and hold moisture says a lot. Most of the signs of aging we all see in people are happening in this layer.

 What happens naturally as you age. As Bette Davis said, growing old ain’t for sissies. Fibroblasts decrease in number, and fewer fibroblasts mean less collagen and elastin, and that means the internal scaffolding begins to get shaky and skin loses its bounce back ability. Add in the millions of times you’ve smiled, frowned, winked, and yawned- no one keeps a totally straight face and you’ve etched in a grid of furrows and wrinkles. Fat shrinkage beneath the surface contributes to deeper folds. Skin tends to become drier over time. too, especially after menopause. partly because oil and sweat production slow and partly due to hormonal changes-an effect stress can mimic, by the way, but we’ll get to that later.

 In addition, the skin’s water-holding GAGs decrease with age so there is a lot less moisture to go around. It’s a double whammy: The tough, fibrous collagen-elastic matrix weakens and the nearby hydrating molecules decrease in volume. Thus, there’s less water around to keep the collagen and elastic flex ible and moist, The drought further affects new cells developing. as well as the dead cells on the skin’s surface.

 Finally, skin becomes paler, because its supply of blood vessels diminishes. Blood vessels are necessary for transporting nutrients and moisture, and removing cellular waste. When an area of the skin loses its access to critical ingredients it needs to stay renewed, hydrated, and nourished; it begins to show the signs of aging. Smoking and sun damage will worsen this scenario. Smoking will suffocate your skin, limiting its access to oxygen. UV rays from the sun will cause blood vessel walls to thicken, and as the blood vessels dilate, they become visible as tiny red threads just below the surface. They may also twist and break.

THE UPPER LAYERS:
 Now we’ve reached the skin areas that are closest to the light above-the layers of the epidermis. The epidermis has a love-hate relationship with the outside world: It pulls in water, heat, and light, and pushes away bacteria, dirt, germs, and toxins .

 Keratinocytes are the primaty players here. These plump cells form at the base of the epidermis and flatten out as they rise to the surface, die, and eventually £lake off. Ironically, these dead cells, collectively known as the stratum corneum, make up what we call our skin-the birthday suit we touch, wash, dry, pamper, and protect (even if we sometimes pierce or tattoo it).

 Keratinocytes produce keratin, which is the same tough protein that’s in hair and fingernails; on the skin’s surface, it helps form a roadblock against would-be intruders.

 Tough-guy immune system forces called Langcrhans’ cells are located here, too; they detect foreign substances. More than that, recently these cells have gained greater recognition as extraordinary players in immunity. In late 2005, researchers at Yale School of Medicine demonstrated that Langerhans’ cells in the skin, which had been thought to alert the immune system to invaders, instead dampen the skin’s reaction to infection and inflammation. We now view these cells not just as sentinels or stimulators of immune reactions as previously thought, but more as environmental peacekeepers. The skin is constantly challenged by the environment, but most challenges are not dangerous and do not warrant an immune response. Your Langcrhans try to keep the peace before warranting a full-fledged response.

 Melanocytes churn out melanin, which determines the color of your skin, that is, whether you’re dark or pale. It’s the pigment that protects skin from too much ultraviolet light by darkening it after repeared UV exposure, at least in some people. Some types of melanin (Irish Americans know this all too well) are simply too light to provide any UV protection.

 What happens naturally as you age. Your body makes less of all this good stuff, which translates into more challenges. Less melanin (melanocytes drop off by 10 to 20 percent every decade) means more susceptibility to UV rays, more brown spots (white spots too, in some people), more wrinkling, a paler overall appearance, and a higher risk of skin cancer. Hence every skin doc’s mantra for her patients: sunscreen, shade, hats, and more sunscreen. Also. the top layer thins, becoming a less effective barrier to bad guys from the outside and moisture loss from the inside. And the number of immune defenders, those Langerhans cells, drops off, which makes skin extra vulnerable to infection and cancer.

 That ends the monitor of your skin and what happens to it naturally with age, what’s known as intrinsic aging. Extrinsic aging is what doesn’t happen to it naturally. Surely you know that certain habits can influence the speed of your natural aging. Most of these factors, fortunately, are things you can try to control- smoking, tanning, deciding whether to choose Mick Jagger or Denise Austin as a role model. Making healthy choices could win you the Hasn’t Changed a Bit! award at your twenty-fifth reunion, But as you’ve figured out by now, it’s not all physical. In fact, age and beauty is very much a mental match between two brains-the one in your head and the one in your skin.

The Skin Stress Test: One place where stress takes an invisible toll is on the skin’s role as a barrier between you and the world. Researchers have a clever way of testing this. They injure skin slightly by repeatedly applying and pulling off a piece of cellophane tape from a small area. (Sounds painful, but isn’t really.) They then watch how quickly it recovers by measuring the amount of moisture that seeps Out of the irritated area. When a team of scientists did this test on healthy women, they found that two stresses-sleep deprivation and a mock job interview-significantly held up the skin’s recovery. However, exercising on a treadmill didn’t slow it a whir. If that’s what happens in the lab, think of what happens in real life, when sleepless nights are often the norm and a job interview is the least of your pressures.

Skin has a mind of its own: One of the most provocative and exciting discoveries in the last decade is that skin also has its own stress-response system. Just as our central body as a whole (in medical terms, we refer to this as systemic) has a brilliant system set up to handle stressful situations, our skin has its own local, fully functional equivalent. In other words, the skin has established its own independent, yet parallel version of the hypothalarnic-pituitary-adrenal axis. It can produce forms of the same molecules famously manufactured and used by the central body during a stressful event, including ACTH and CRH, cortisol, beta-endorphin, as well as serotonin and melatonin-two hormones key to mood. It’s amazing to think that skin is not only an unexpectedly prominent target organ for multiple signals, which have a profound impact on its health and risk for disease, but also an astonishing factory for the same signals. Our skin and nervous system share a language we are just beginning to understand. And, in fact, the field of medicine devoted to translating this complex language is one of the fastest moving, most exciting, branches of skin research.

 Hardly any other organ is continuously exposed to such a wide range of stressors as the skin. Twenty-four hours a day, over our entire lifetime, the skin remains our interface with the world, so it’s easy to see how it must be exquisitely well designed, innervated, and self-sufficient to a degree. It not only reacts to your real brain’s red alerts but it actually orchestrates its own network of messages. When the skin is under attack-by the sun’s UV rays, for instance-certain skin cells release CRH, the messenger that the brain puts in charge when stress shows up. Likewise, cortisol, which rushes out from the adrenal glands in a crisis, can also be produced in the skin by pigment cells and hair follicles.

Skin’s Twin:
 Your skin and entire nervous system, including your brain, share the same embryological origin in the ectoderm, a germ layer when you were just a bundle of initial cells. No wonder the two share similar hormones and neurotransmitters. They are practically twins.

 How could the skin he so smart For starters, skin has always shared a unique bond with the brain and central nervous system. Let’s cast back to a time when you were nothing but a small bundle of cells (no, not a bundle of joy yet; I’m talking about when you were just an embryo of only a few weeks old). Back then, you consisted of two distinct layers: an outer ectoderm and an inner endoderm. The ectodermal cells gave rise to your entire nervous system (which includes your brain, spinal cord, and peripheral nerves), portions of special sensory organs, outer skin and its glands, hair, nails, and linings of the mouth and anal canal. The endodermal cells, on the other hand, became the outer linings of your digestive tract, respiratory tract, urinary bladder, and urethra. (Another layer, called the mesoderm, which grows soon after these two first layers, is what forms all types of interior tissues like muscle, bone, blood, lymph, and the lining of the body cavities.)

 I’ve been deeply fascinated by this since high school biology. It’s not very intuitive to think that your skin, which is thought of as being on the outside, shares its beginnings with the brain and nervous system, which are thought of as being on the inside. It’s hard to picture your brain and nervous system as being on your outside, but remember that we’re talking about the very early stage of life when you were an embryo and far from looking the way you do today. So, while the brain essentially started as an outer layer on you when you were just a ball of cells, it eventually folded inward, leaving your developing skin layer (in good hands on its own!) to fend for itself on the outside. That’s quite a close relationship to have from the beginning. No wonder the skin and brain share such close personal ties, and can act like each other in a lot of ways.

 Think about what it means from an evolutionary perspective, though, to have your skin and brain so intimately connected. If you were in danger, and your skin got wind of this first (let’s say, when a sneaky’ saber-toothed tiger tried to take a bite out of your hand while you were looking the other way), wouldn’t it be ideal for your skin to have the ability to respond on its own quickly rather than wait for your brain to send the signal? In other words, when you retract your hand and leap as far back as you can from the beast, you can thank your skin first, and your brain second.

 Now, that may be oversimplifying what happens at the cellular level, but the point is our skin’s ability to act in many ways like our brains isn’t a fluke. It’s rooted in our survival mechanisms, which have been encoded in us since the dawn of humans. The skin is our first line of defense against the potentially dangerous outer world where we are vulnerable to injury, illness, and disease. It makes total sense that skin can signal to, and inspire, the brain to take action. I’ve always wondered, for example, why it can seemingly take a few moments to feel pain when you stub your toe. ‘The skin reacts fast, as you feel the pressure and watch the area swell with blood and bruising. But perhaps the physical sensation of pain is delayed because the brain needs that extra blip of time to get the message that your toe is injured. Something to think about-literally.

 We are just beginning to decode this complex intersystem communication that intimately meshes the body’s largest and most external organ with the endocrine, nervous, and immune systems. The fact that skin can produce some of the same substances once thought to be exclusive to the brain and nervous system, and the fact that skin, as a pivotal immune agent, can initiate immune responses on its very own (as opposed to waiting for the brain to take action) is nothing short of extraordinary. The skin has its own flight-or-flight response system independent of the brain.

 What this also means, however, is that skin can instigate responses that result in unwanted outcomes, such as acne, rashes, and troubling skin conditions. In addition, the messages that come firing out from the skin locally or through the central nervous system can have a direct effect on the production of beauty-promoting collagen and elastin. Certain stress responses will halt or slow down their growth. We’ll be taking a look at how this happens shortly. This gives whole new meaning to the notion that you look how you feel. Contrary to popular belie£ skin is not passive and it’s not just about the barrier function.

Calling All Skin Cells! The back-and-forth signaling system between your central body and skin, as well as within your skin alone, is like your body’s own wireless network. The communications happen thanks to small chains of amino acids called peptides, which facilitate the talking that goes on between cells. Neuropeptides originate in the nervous system and brain (hence, the llcuro parr), including the peripheral nerve endings in skin. One neuropepride that gets a lot of attention in research circles is called Substance P. It’s a well-known chemical that promotes pain in the body, and can also increase sebum production (not a good thing if you’re prone to acne). Substance P may further be a player in depression and anxiety, which are often affiliated with acne.

 When the body senses stress, nerves, especially nerve endings in the skin, send out Substance P in response. When neuropeptide receptors in skin receive messages, they react by sharing the message our to other cells, which tells them how to function. ‘"This is how the feeling of embarrassment can move from your brain to your skin, causing it to blush. Similarly. when you are happy. your skin glows; you are white as a ghost when frightened. It’s as if we were chameleons and can change pretty quickly; what we are thinking and how we are feeling has an outward appearance.

 And by the same token. how the skin rhinks and feels determines what goes on locally, too. Environmental stress factors such as pollutants, heat, allergens, high or low humidity, and mechanical stretching can usher Substance P as well as other peptides locally to take action. When external trouble starts, it has to throw up defenses and put its repair crews on alert fast. What’s more, the production of collagen and elastin in skin reflects the activity of these peptides. Certain messages will either halt or encourage collagen and elastin growth, thus leading to either youthful-looking skin or a prunish appearance. These messages will also affect other systems that factor into our appearance, such as how much blood flows to the skin, fostering a healthy glow or a pallid look.

Skin Is Big and Nervous:
 The skin boasts a lot of number ones: It’s t he largest organ in terms o f size, and has the biggest nerve supply of any organ in the body. (Trivia: Your fingertips win for being the most nervous region of your ski n. Those little digits receive approximately 300 impulses [ technically, mechanoreceptive nerve fibers] per square centimeter!) No wonder we call ourselves "touchy" and "feely"

Seven sneaky ways stress can mess with your looks: Given what you’ve learned thus far, it’s not hard to draw the connections and understand how chronic stress can affect how you look. Let’s explore seven big conclusions.

STRESS CAN CAUSE WRINKLES: Recall that cortisol degrades collagen. When you consider what exactly a wrinkle is-a weakening and lessening of collagen and elastin fibers in the skin’s dermis-it’s easy to understand how stress, then, can directly cause wrinkles. When you live in a chronic state of stress, routinely bathing your body in cortisol, it becomes harder and harder for the skin to repair itself naturally, continue to form healthy collagen and elastin, and deal with damaged areas. At the same time, your body is responding to the stress through inflammatory pathways, which can exacerbate skin issues.

 But here’s the good news: If you can decrease your levels of cortisol and increase your levels of beta-endorphins, which act as anti-inflammatories in the body as well as in skin, you can reverse this damage. And that’s exactly what you are doing on this program. It’s a win-win when you can control your cortisol levels and maximize your beta-endorphins. How do you increase your betaendorphins? Restful sleep and frequent sex and exercise are three great ways, which is why they are highlighted during the nine days.

 It’s important to remember, too, that aging is simply a process by which your capacity to repair tissues and manufacture fresh new cells declines. What we want to do is tip the scales in favor of slowing down that natural decline, as well as boost the speed of cellular repair. Beta-endorphins retard that decline, and controlling corcisol levels keeps the repair shop dear of this villain that will do more damage.

 I had a woman come to me in her fifties who proclaimed how much better and younger she felt now than ten years previously, when her life was out of balance. She had gone from being a diehard trial lawyer-working crazy hours, forgoing sleep, and avoiding exercise-to becoming a new mother. Having the baby instantly changed her life (not to mention priorities), because with the baby came the need to take better care of herself first, if she was to be a good mom and still handle the rigors of her daily life. She explained that no sooner did she begin to make a few lifestyle changes than she began to see a noticeable difference in her looks and energy level. When she showed me a photo of her old self from ten years earlier, it was stunning to see the transformation. She had come to me for a full body check and to make sure she had a plan for staying as young as possible, especially since she was taking on motherhood at a time when her friends were becoming grandparents. I told her she was well on her way to preserving her good looks and vitality just by having a more balanced life now.

STRESS CAN BRING ON NASTY ADULT ACNE: Acne isn’t just for hormonally crazed teenagers anymore. Many adults can’t seem to outgrow it because of Stress hormones. Yet most people don’t make the connection. They come into my office asking whether it’s their chocolate habit (no), or if their skin has somehow gotten oilier (not likely), or whether their soap, makeup, or moisturizer could be to blame (possibly, but not probably).

 If there’s simply too much going on in their lives, odds are it’s stress acne and CRH is the culprit. Acne is an inflammatory condition and CRH has already been linked to other inflammatory disorders. Also, the skin’s own production of CRH may fuel inflammation that leads to acne. What can make things worse is that tense people often can’t leave pimples alone. Squeezing, poking, and picking at them becomes an almost obsessive way to release tension, but it also makes breakouts worse, exacerbating the inflammatory response, and you’re left feeling a tad more stressed. It’s one of those vicious cycles. When you add a wrinkle or two to that, you’ve got a cocktail of frustration. I see more patients who complain of both pimples and wrinkles than people who complain of one of those two things alone. And luckily there is something you can do about it. You’re not stuck living with skin not knowing whether you’re six teen or forty-six. I’ve devoted an entire section to acne in chapter 8 so hang tight.

STRESS CAN MAKE YOUR SKIN IRRITATED AND ALLERGIC: Your skin has mast cells, which release histamines in response to biochemicals like stress hormones. Histamines are key players in allergies and inflammation; they can trigger ailments like hay fever and asthma, and in the skin they can wreak havoc on skin disorders and disease. These mast cells are located right near blood vessels and nerve endings, and they can be activated by a plethora of biochemicals, chiefly those classic stress hormones ACTH and CRH. Scientists now believe that mast cells are among the richest source of CRH outside the brain.

 What’s more, mast cells have the capacity to generate CRH on their own, so imagine the damage they can do when they run amok. Once triggered through the biochemical pathways-by anger, depression, pain, pollutants, UV light, free radicals, heat, cold, or any mind/body stressors-mast cells can stir up a soup of chemical pests. These, in turn, can set off a range of skin conditions or simply aggravate existing ones, from dermatitis and hives to psoriasis and even hair loss. And because your skin talks to your brain and vice versa, something like a nasty itch can ratchet up your entire body’s stress levels and keep you in a cycle of inflammation and irritation.

 There’s some early evidence that when skin gets inflamed by stress, including simple sun exposure, it forms more nerve fibers, which makes it even more sensitive and may contribute to photo aging. Put simply, the more the skin is exposed to certain stress hormones, the more receptors your skin will have to perpetuate a reaction. Stress, even if it’s just psychological, can trigger a physical change in neuronal connections.

STRESS CAN MAKE YOUR HAIR FALL OUT AND YOUR NAILS BRITTLE: When I was in college, a friend of mine experienced sudden hair loss about three months into her freshman year. Her hair was on her clothes, bedding, and personal items. It wasn’t coming out in clumps, and she wasn’t balding in any specific area, but her head was definitely shedding the hair at an alarming rate. She had arrived with a thick head of hair, but it became noticeably thinner by the time we all went home for Thanksgiving weekend. That’s when she scheduled a visit with her doctor, hoping to find out she had a thyroid problem or some disorder that would have a quick fix.

 Her physician found nothing wrong with her and recommended she see a dermatologist, which she did right away. That’s when she got the bad news: Most of the hairs on her head were in the resting, or telogen, phase of the hair cycle. At any given time, a random number of hairs will be in various stages of growth and shedding. Her doctor had plucked a few strands to examine the ends that came from the follicle. He noted that they had prematurely stopped growing and had entered into an inactive phase called the telogen phase. The culprit! While genetics could share some of the blame, especially given the fact she was eighteen years old- a time when the genes for hair loss could be turning on-the doctor pointed to stress as being the most likely cause. This was not good news for my friend, who was stressing out over her hair loss. Hearing that hair loss was a normal response to stress wasn’t what she was hoping for. How does one stop stressing over a side effect of stress? This is when you need some serious mind-over-matter techniques .

 Stress can cause sudden hair loss by literally flipping the switch on the hair follicle’s growth stage from an active to a resting phase. Once the follicle enters this resting phase prematurely, it stays there for about three months, after which time a large amount of hair will be shed. Usually by then the person has recovered from the stressful event so she will regain a new head of hair. Women who go through pregnancy and experience sudden hair loss about three months after childbirth can blame their hormones for that loss. Between 20 and 45 percent of mothers lose hair after giving birth as their estrogen and progesterone levels drop, and hair follicles are thrust into the inactive phase. Luckily, most mothers will regain their head of hair nine to twelve months after the child’s birth (assuming they get a good handle on their stress levels caused by a baby),

 More recently, when a patient came to me complaining of sudden hair loss, I immediately asked her what happened in her life over the previous six months. Turns out she had a medical scare when doctors found a spot on her lung and thought it was cancer. She had prepared for the worst and went through all the emotions of possibly having to deal with lung cancer, It wasn’t cancer in the end, so she thought she had gotten over it quickly. When I explained that this experience likely spun her hair follicles into a resting phase prematurely, and that her hair would come back with time, she was relieved. It helped her tremendously to understand that the lag time between the crisis in life and the hair loss can be confusing. When you experience an overall shedding of hair (your hairbrush fills up and the drain gets clogged in the shower every day), you must cast back a few months to find the trigger. And rest assured that you can recover your hair when it grows back. Just knowing that can take the stress out!

 Now if gray hair is a problem, that’s another issue largely determined by genetics. Whether or not extreme stress, especially the psycho emotional kind, can turn hair prematurely gray is a contested area of study. Stress has been shown to affect melanocytes in hair follicles, which are responsible for giving your hair color. No one goes gray overnight, though, contrary to old wives’ tales. Researchers are now finding that stress may have detrimental effects on melanocyte stem cells, suggesting this could result in permanent damage that contributes to stress-induced graying. Researchers are also finding that hair follicle stem cells that are vital for maintenance and the cyclic renewal of hair growth may also fall prey to irreversible damage and bring on more serious types of hair loss such as alopecia areata. People who have this condition experience hair loss in clumps and have round hairless patches on the scalp.

The immune system is also involved, as stress activates T cells, which are part of your immune system and supposed to attack pathogens like viruses and bacteria. When activated, T cells surround the follicles, they do so like a swarm of bees-effectively killing them. So it’s as if stress becomes a pathogen, and your immune system goes on the attack, even though it’s attacking you. We call this an autoimmune disease, and volumes of articles could be written about the link between stress (even stress as simple as an emotional letdown) and autoimmune disorders. I think viewing stress as a pathogen in itself is a realistic way to look at it.

Q: Does excess and embarrassing hair on my face mean something is wrong with me?

A: Very unlikely. If you feel like you’re growing a light beard and face new hairs every morning, especially on your chin, see your doctor. This could potentially be a problem involving your adrenal glands: or it could be polycystic ovarian syndrome, a disorder whereby high levels of male hormones get pumped out. But, more than likely, you can thank your genes . for excessive hair and there is absolutely nothing wrong with you! What I think is wrong, however, is the means by which too many women try to remove the hair-shaving. Never shave your face; it’s demoralizing for a woman and will dampen your feminine spirit. If you ‘ve had it with waxing and plucking, then consider laser hair removal. Prescription creams that retard hair growth are also available, but laser hair removal will nip your hairs in the bud forever. You may have to schedule a monthly electrolysis session for up to a year, but then you’ll never have to fight those unsightly follicles again.

Hair Razing Fact: Sudden stress-related hair loss characterized by a general thinning throughout the entire scalp is called telogen effiuvium. Stress can literally shock hair follicles into an inactive state, after which they will likely fall out. this is seen more in women because pregnancy is one such event that can trigger this kind of hair loss. It’s not so much chat pregnancy itself is be stressful on the body (although the physical stress on the stretched-out skin is what causes those lovely stretch marks!), bur the hormonal changes can affect a head of hair. Pregnant women may notice thicker and healthier hair during their pregnancy, attributed to the increased levels of hormones estrogen and progesterone. But after the baby is born, those hormone levels drop rapidly, triggering a shift from active to resting phases in the follicles. Then out comes the hair about three months later. Coupled with the drop in hormone levels at the birth of a child is, of course, the general stress chat a new mother experiences, all of which bodes poorly on those precious hair follicles.

 Nails are not resistant to stress of the physical kind. Brittle, peeling nails also are a common side effect of traumatic stress, chiefly the kind caused by repeated wetting and drying, and chronic exposure to detergents, water, toluene and formaldehyde in polish, and harsh solvents (like those found in nail polish remover). Other factors could also be at play, including genes, poor diet, and underlying medical conditions. Let’s not forget the fact that many try to cope with psychological stress by self-inflicting hair and nail problems (skin, too) that go beyond what I would normally expect from stress alone. For example, how many of us find ourselves rigorously biting or picking at our nails when we are nervous, anxious, or stressed out maximally? How many of us pick at our skin or consistently touch and play with acne and plareups? Do you pull on your hair to the point you feel a few strands fall out? It’s important to note these habits and take steps to avoid engaging in these beauty-busting behaviors. Like the eyes, nails can say a lot about your health and how well you take care of yourself.

Filing Down a Nail Myth: Contrary to popular belief. our nails do not contain much calcium, so supplementation, while good for our bones, may not help Out nails. In fact, vitamin and mineral deficiencies are rare causes of nail problems. More often than nor, brittle nails are caused by excessive exposure to harsh soaps, irritants, polish remover, and the wetting and drying of nails (all typical of a busy, kitchen-maven mom). Brittle nails can also be seen with medical conditions like psoriasis, fungal infections, and thyroid problems. Age also factors in, and the older you are the more likely your nails will become brittle. That said, one little nutrient that may help give your nails a boost is biotin. Found abundantly in foods like cauliflower, peanuts, and lentils, biotin is absorbed into the core of the nail, where it may encourage a better, thicker nail to grow and help prevent splitting and cracking. In one study, people who consumed 25 milligrams of biotin daily had marked increases in nail thickness after six months. To get this much biotin, ask your doctor about taking it in supplement form.

Hangnail Hangup:
 What causes a hangnail? The culprit is a cuticle that gets too dry and splits off. When a hangnail sprouts, carefully trim it so you’re not tempted to peel it. You can also help it out by applying a topical antibiotic like Neosporin; this will kill the bacteria and hydrate the skin. Preventing hangnails is all about keeping your cuticles moisturized You can use any cream to do this, and push back your cuticles once a week.

STRESS CAN AFFECT YOUR HORMONES, WHICH IN TURN AFFECT YOUR MOOD, AND VICE VERSA:

 The biochemistry of mood and how it affects our physiology is a fascinating topic, and one we’ve already covered with talk about cortisol, in particular. There is a lot of interaction between hormone physiology and mood that works both ways. Our mood can impact our physiology, and our physiology can influence the balance of our hormones. Additionally, our body can interpret our mood- anger, sadness, exhaustion, and so on- as, you guessed it, stress.

 Take, for example, tiredness. It’s late at night and you haven’t been getting much sleep lately. You’re irritable and feel like you’ve just tied the end of Your rope and are now hanging on. Not only has your level of stress caused a surge in cortisol, which can trip your appetite, but chances are your body’s balance of appetite hormones-namely leptin and ghrelin-will also be out of whack, so you’ll crave sugary, high-calorie foods. This is when you rummage through your refrigerator for last night’s chocolate cake, topping it off with mac-and-cheese leftovers from your kids’ dinner. Then the guilt sets in, and you hate yourself for gorging so late at night on fattening food. When you notice that you’re up a tick or two on the scale the next day. that stresses you out some more. The cycle continues the next night when you stare at the ceiling stressing about all sorts of things, from your weight gain to your unfinished chores and bad mood that resulted in a fight with your husband after dinner.

 Don’t blame yourself. Food and mood go hand in hand, and sometimes we have our own biochemistry to thank for how we behave. Two other hormones I want to mention before moving on, especially as they relate to mood, are serotonin and melatonin. Technically, these are nor stress hormones, bur they do get involved in the stress cycle by virtue of the fact they affect how we feel. Serotonin is our pleasure hormone, and its strong connection to mood and emotion is why drugs to treat depression help elevate the levels of serotonin in the brain. Levels can be affected by many factors, including stress hormones, chemicals in the foods we eat, sleep deprivation, and the amount of sunlight we get in a day. Low serotonin and melatonin levels in the brain are thought to be contributing factors to depression. Melatonin is also a brain chemical related to mood but this one has closer ties to sleep; it serves as the body’s main regulator of sleep-wake cycles. It may also be linked to several other aspects of physiology and consciousness.

 The point of all this is to show you just how intertwined our moods and physiology can be. Every second of the day, your body’s endocrine system choreographs a complex dance between glands and target organs to effect certain changes. As these changes occur, your physiology shifts, which can affect how you actually feel. Volumes of articles could be written on hormonal physiology alone, even as it relates to stress. My goal here is to simply show you a few examples of how hormones shape what we do and how we feel. If stress can sit at the top of a cascade of events that lead to undesirable hormonal changes in the body (like those that trigger insomnia, insatiable hunger and weight gain, and collagen breakdown), then what we wane to do is find ways to gain the upper hand on our stress level and ensure we foster an environment in our body that keeps all those hormones in check-in balance. And again, that is what the program helps you to achieve.

Lost in Translation:
 You may be extremely uptight and worried about making a presentation at work or confronting your spouse about a sensitive issue, and while you may call yourself anxious, your body will say stressed. You cannot divorce mood and emotions from hormones and stress, so let’s get a handle on them’

The Bigger Picture: The hyporhalamus is often referred to as the seat of the emotions. It takes center stage in emotional processing; [he moment we even think about something stressful or encounter a stressful experience, the hypothalamus secretes CRH, which eventually leads to cortisol rushing out of the adrenal glands. Here’s one way to see the big picture on how influential hormones can be once stress triggers the release of this master of ceremonies: cortisol leads to collagen and muscle breakdown, fat retention, hunger leads to overeating. sleep loss leads to exhaustion, moodiness, lack of control at the dinner table leads to more sleep loss, more stress, more weight gain, more collagen breakdown leads to wrinkles, baggy eyes, breakouts, poor diet choices leads to more frustration when we realize that now were overtired, overweight, moody, and looking haggard

STRESS CAN MAKE YOUR EYES LOOK OLD: When someone says you look tired, you might feel the urge to slap him or her across the face. Seriously, the person is probably referring to your eyes, and not getting enough sleep is mostly to blame. Stress ages eyes by robbing us of deep, slow-wave sleep, the superrestorative kind that’s essential to the youth and health of our whole body. Recall that it’s during deep sleep that growth hormone gets released in the body to go to work on repairing and replenishing your cells. Blame CRH, too, which (among other things) acts like a stimulant, keeping you up at night. In short, getting too little shuteye sets off a series of skin problems-inflammation, leaky capillaries, and poor waste removal. Fluids that should be carted away while you sleep never get picked up, sort of like what happens when the trash collectors don’t show up and the garbage gets overloaded. In your face, the excess liquid has to go somewhere, so it pools in the delicate tissue under the eyes. The result? Dark, puffy, under-eye circles.

STRESS MAY DRIVE YOUR SKIN INTO A MINI-MENOPAUSE: The jury is still out on exactly how or if this is possible, but it’s worth mentioning even if you’re years away from the real thing happening. It appears that the constant flow of cortisol that goes along with chronic stress causes a dip in estrogen, one that mimics, on a smaller scale, the dip that occurs during menopause. And if you’re already in menopause, the dip in estrogen can actually increase cortisol! That’s something to think about considering that we now spend a third of our lives in menopause.

 With less estrogen around, the three main ingredients that keep skin moist-basically, sweat glands, oil producers, and the superlubricator hyaluronic acid-slow their flow. Less estrogen means less collagen and less moisture. So, while estrogen levels may not drop enough to shut down your period, stress may make them dip enough to make your skin look dull and dry.

 Although it’s not exactly clear why estrogen holds such sway over our skin, we know that women who take hormone replacement therapy can reverse these changes, helping skin regain its youthful strength: It becomes less than paper thin, blood flow to the skin improves, and collagen production rebounds. In one study collagen production was almost 50 percent higher in women taking hormones. The influence of estrogen on several body sys terns is well documented, but we’re just beginning to understand this hormone’s influence on skin and will likely see more studies done in the future.

 While no one is recommending that most women take estrogen these days (or not yet, though this case isn’t totally closed), that’s not the point here. The point is anything that puts a significant damper on the flow of estrogen in your body will ultimately age your skin. Stress does that, which is a critical reason to learn how to tame it.

Less Stress, Safer Sex:
 Low estrogen can put a damper on your sex life. And this isn’t just about stressed out women in menopause. Stressed-out women on birth control p ills can also experience low estrogen levels. which can cause a thinning of the vulva-that area that includes the inner and outer lips, the clitoris, and the opening of t he vagina, and Its g lands. If it gets too thin you could experience tearing during sex. Ouch! Yet one more reason to wipe out as much stress as you can,

What can you do about all this? First, don’t feel overwhelmed. I’ve given you a lot of information in this chapter and some of it may have left you feeling like you can’t get control of your body because so much of what goes on happens naturally. True, the human body seemingly has a mind of its own and, when you’re faced with stress, it’s impractical (and unrealistic) to think you can just say "Stop the cortisol" and your adrenal glands will listen. However, I want you to see the bigger picture here. I’ve outlined a few sequences of events that happen when we respond poorly to stress and let it get to us. Suddenly, our battle with stress ends up being a battle for a restful night’s sleep, a battle to lose and maintain weight, a battle to feel energetic, a battle to exercise, a battle to look vibrant, a battle to take proper care of ourselves, a battle to maintain our health. And a battle to be happy. Some of you may already be in this vicious cycle and it’s time to break it.

 My hope is that once you begin to establish better coping skills for handling stress, and begin to employ the techniques I’ve outlined to nourish and treat your body optimally both inside and out, you will discover a path to wellness and beauty. You will achieve sound sleep. A fresh, glowing appearance. Energy. Motivation to stay active. And peace of mind. The benefits that await you are infinite.

 I’m here to tell you that you can shift the balance of power into your hands and support a healthy balance in your body simply by changing the way you strategize through life. This entails establishing a few new habits and kicking out some old ones, which is exactly what the program outlined in chapter 4 helps you to do. I know you can do this. You must, because the time has come to put mind over matter, literally. It will affect everything about you, from your neurology to your immunology. Scientists currently are studying everything from the physiology of meditating monks to the DNA of caretaking moms. You know that those bags under your eyes disappear when you’ve hopped off the hamster wheel and slept well for a week.

Why Women Live Longer: Things aren’t all bad! As stressed as we are, women still have the advantage over men when it comes to coping. New evidence? In most parts of the world women now live about ten years longer than men. New cause? Differences in how we respond to a brain chemical called oxytocin, suggests the latest stress research. Sometimes referred to as the bonding hormone or Love hormone, oxytocin makes people (animals, too) care for each other. Sex (and masturbation) will trigger its release, but it also has ties to stressful situations. When the going gets rough, it helps people feel more connected and less frightened.

 Here is where the sexes are not created equal. While both men and women release oxytocin in some stressful siruations, in men, testosterone appears to block oxytocin, so they stay in edgy fight-or-flight mode. In women, however, estrogen enhances nurturing oxytocin, so under stress we may shift from fight or flight to a calmer state called tend and bifriend. Oxytocin also tempers surges in blood pressure, heart rare, and cortisol levels.

 The tend-and-befriend theory makes evolutionary sense. Eons ago, while men sprang into action to fight off a saber-toothed something, the women dosed in to nurture and protect the babies, assuring survival. So, maybe it’s no surprise that today when we are stressed to the max, rather than fighting or fleeing, we often turn to each other, seeking comfort and consolation. Survival just might depend on it.
 

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