The Skin Microbes: What They Eat

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When we talk about the microbiome of the digestive system, it’s well-known what they eat: sugar. That’s also mostly true for the skin’s microbiome, although those microbes eat other substances as well. In today’s Memo, we’ll cover the types of bacteria and where they’re located. Then we’ll look at their diet.

The Microbes of the Skin

It may come as no surprise that the type of bacteria and other microbe depends on the location. That makes sense: what may grow well in moist areas may not grow well in dry areas.

The sebaceous sites on the head and torso are dominated by species of bacteria that like fatty environments. Remember that sebum is primarily a type of fat, so the type of bacteria that will grow in that area has to be able to thrive in that environment. The Propionibacterium species dominates in the oil glands.

The moist and humid sites contain bacteria such as Staphylococcus and Corynebacterium species. They thrive in the bends of the elbow and the feet, as well as other locations.

Bacteria are not the only important microbes in our microbiome; there are plenty of fungi as well, and I know how gross that may seem to some readers, but try to think about how much you like mushrooms. They’re there to do a job: protect us. The genus Malassezia are found at core body and arm sites. The feet are more diverse in fungi species: Malassezia, Aspergillus, Cryptococcus, Rhodotorula, Epicoccum species as well as others. Here’s something that may comfort some of you: bacteria were the most abundant and fungi were the least abundant.

What about viruses? They seem to be specific to the individual without any single virus dominating. Based on the longitudinal studies of the skin microbiome, they remain largely stable for as long as two years, the length of the longest studies. Pretty amazing considering how the seasons change in places like here in Michigan.

What the Skin Microbes Eat

The skin provides a cool and acidic environment for its residents. The primary nutrients are protein and fats. The microbes have adapted to what’s available in the sebaceous glands, the sweat, and the dead skin cells of the stratum corneum.

For example, the anaerobe P. acnes can survive and thrive by using protein enzymes to break down the amino acids found in the dead skin cells of the corneum stratum. Not only that, they have lipases to breakdown the triglycerides in sebum to use fat as a fuel as well as provide the means for the bacteria to adhere to the skin.

The lipids that can be liberated from the oily sebum and the stratum corneum are also used by the fungi for lipids as they cannot manufacture their own lipids. The Staphylococcus spp. have developed several strategies to survive the dry areas of the body. They’re tolerant of the high salt content of the skin and can use the nitrogen group from urea as a nitrogen source. They also produce chemicals that can break down the stratum corneum to extract nutrients from there as well.

As the researchers who wrote the review paper said, “the skin harbors a heterogeneous community of microorganisms that each have distinct adaptations to survive on the skin.”

The Bottom Line

As you can tell from this week’s memos, the skin microbiome is not just a few bacteria that decided to take up residence and are along for the ride; they have adapted to their environment to survive. How are they impacted by the water we bathe in, the soap we use, and the chemicals we use to look and smell better? That’s what I’ll write about next week.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Reviews doi:10.1038/nrmicro.2017.157

The Skin Microbiome: Anatomy

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The skin microbiome is amazingly complex. Not only do we have all the beneficial bacteria and other microbes, we also have microbes that can be beneficial or damaging depending on how we treat the skin. Let’s begin with location: where are all these microbes located? For that, we need to understand a little bit about the structure of the skin.

The skin is the largest organ of the body and is constructed of two different layers: the outermost or the epidermis and an inner layer called the dermis. The outermost layer called the stratum corneum is composed of dead cells that are chemically crosslinked with each other and with cells below to provide a true barrier. As they’re sloughed off, they’re replaced.

To say “skin is skin” does this organ a disservice. It varies in different locations in the body and provides amazing microenvironments based on UV light exposure, pH, temperature, moisture, and sebum content. What is sebum? That’s the product of sebaceous or oil-producing glands, primarily located on the face, the chest, and the back. The sebum provides a coating that repels water and provides an antibacterial shield to hair and skin.

There are also areas of the body that are moist such as under the arms, between the toes, and in other more private areas. Those areas contain sweat glands which modify the pH of the skin and make it more acidic. That created an unfavorable environment for the growth of some bacteria and other organisms.

That’s the anatomy of the skin. The next question is what type of bacteria and other microbes are found on the skin and exactly what do they eat? We’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Reviews doi:10.1038/nrmicro.2017.157

No More Showers!

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If you saw a book called Clean, you probably wouldn’t think the author decided not to take any more showers. But you would be wrong, because that’s exactly what Dr. James Hamblin announced he would do about five years ago in a magazine article. Over time and a whole lot of research, the article became the basis for his book. In an interview I read with the author, he’s constantly irritated because the most frequent question he gets when people find out he hasn’t taken a shower in five years is “Do you stink?” My thought is if that you’re close enough to ask the question, you probably should know the answer, even with social distancing.

His primary concern over taking showers is our addiction to cleanliness, which is something I’ve thought about as well. (Never fear, I’m not going to quit taking showers.) His concern is with the microbiome of the skin. We all hear research on the microbiome within the digestive system just about every day, but the microbiome of our skin is actually the first line of defense in our immune system. Whatever we do to our skin affects the microbiome of our skin. With all the various soaps, detergents, and shampoos, as well as the chlorine that’s in most water treatment systems, that has to have some impact. Is the impact good or bad?

That’s what we’re going to take a look at in this week’s memos. Could how we treat our skin microbiome impact our immune system? We’ll look at the state of research to date.

What are you prepared to do today?

        Dr. Chet

Reference: Clean The New Science of Skin. James Hamblin. Penguin Random House. 2020.

Research Update on Fish Oil Supplements

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Researchers performed a meta-analysis of studies that examined EPA and DHA as dietary supplements to see if there was a reduction in CVD events and mortality. In this study, researchers included 40 studies with 135,267 participants. While they examined many different variables, including whether EPA was better than DHA and whether they could find the best combination or ratio, almost every analysis they ran demonstrated benefits for those who use fish oil supplements: a 13% decrease in the risk of a heart attack, a 10% decrease in any coronary heart disease event, and a 35% reduction in the risk of a fatal heart attack.

For me, the most significant finding was that there was a dose-response effect of taking fish oil supplements. In other words, CVD events decreased with higher intake of fish oil supplements.

The Problems with the Prescription Study

There were three issues with the EVAPORATE study I talked about in Thursday’s Memo. First, there was a significant loss of subjects. Most of the loss was in the experimental group, which reduced the number of subjects from 40 to 31.

Second, they did not compare the prescription fish oil with an equivalent amount of fish oil dietary supplement, whether it contained DHA or not, which seems to be a glaring omission to me.

Finally, the study was funded by the manufacturer; several of the researchers had a relationship with the pharmaceutical manufacturer as well. That doesn’t mean anything shady was going on, but it does put in question the conclusions that can be drawn about the significance of the entire clinical trial.

The Problem with the Fish Oil Supplement Study

The primary problem with the fish oil supplement study is that it was a meta-analysis. Even though that method is becoming popular, and even though by all accounts the researchers tried their best in selecting the correct studies for inclusion, there’s always the specter that they may have left out some studies. To their credit, they re-ran the analysis without several of the clinical trials and did get slightly different findings. However, it did not change the outcomes related to heart attacks or coronary heart disease events.

The study was funded by Global Organization for EPA and DHA Omega-3s. Just as with the pharmaceutical study, there’s an inherent bias implied. In both cases though, if the funding organizations didn’t sponsor the research, who would? There are only so many research dollars available, and many dollars are being siphoned off to fund urgent COVID-19 studies.

The Bottom Line

I think that these studies establish that fish oil is beneficial to reduce CVD events and reduce disease progression. Because there appears to be a dose-response relationship to fish oil and the reduction of CVD risk, the higher amount of fish oil a person takes, up to four grams, the better the potential outcomes.

Which one is better: prescription versus supplements? Until there’s a study that directly compares prescription fish oil to fish oil supplements, I don’t believe it matters; both studies we reviewed demonstrate benefits. The key is that if you have been diagnosed with CVD, you should take fish oil. Talk it over with your physician first and then get going. Your heart will love you for it. And don’t forget to eat better and move more as well.

What are you prepared to do today?

        Dr. Chet

References:
1. European Heart Journal (2020) 00, 1–8 doi:10.1093/eurheartj/ehaa652
2. https://doi.org/10.1016/j.mayocp.2020.08.034

Research Update on Prescription Fish Oil

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Let’s begin by taking a look at the prescription fish oil supplement medication. To review, this is a 100%-EPA fish oil that received FDA approval in December of 2019. The amount prescribed for people with high triglycerides is four grams of highly processed fish oil per day. Data from the REDUCE-IT trial suggested that there was a 25% decrease in mortality in the experimental group compared with the control group.

The current trial was called the EVAPORATE trial: Effect of Vascepa on Improving Coronary Atherosclerosis in People with High Triglycerides Taking Statin Therapy. The study began with 80 men and women, ages 30-85, with greater than 20% blockage in at least one of their coronary arteries, elevated triglycerides, and taking statin therapy; 68 subjects completed the 18-month study. The primary endpoint was to see if there was any reduction in plaque buildup in the coronary arteries.

The subjects in the prescription fish oil group saw a 17% decrease in overall arterial plaque; there was a plaque increase in the placebo group. The researchers did not track cardiovascular events or mortality in this study. We’ll take a look at the OTC fish oil supplement study on Saturday as well as determine the clinical significance of each trial.

What are you prepared to do today?

        Dr. Chet

References:
1. European Heart Journal (2020) 00, 1–8 doi:10.1093/eurheartj/ehaa652
2. https://doi.org/10.1016/j.mayocp.2020.08.034

Research Update: Fish Oil and Heart Disease

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The prescription fish oil Vascepa has been approved since December of last year. The fish oil medication was originally intended for those who had a family history of high triglycerides of 500 mg/dl or greater. In the approval process, the recommendation was lowered to those whose triglycerides were at least 150 mg/dl and who were taking a statin medication. But the research hasn’t stopped.

Research on Vascepa as well as over-the-counter (OTC) fish oil supplements continues. From the pharmaceutical perspective, more research on the use of the medication could result in an increase in the potential applications of this pharmaceutical. From the dietary supplement perspective, research may help establish the efficacy of using fish oil dietary supplements instead of the prescription medication

Last week within one day of each other, studies on prescription fish oil and fish oil supplements were published that both demonstrated significant benefits. We’ll review those studies the rest of the week and see if we can find out whether fish oil dietary supplements match up with pharmaceutical fish oil. If you want a preview of the studies, check the references below; they’re both open access.

What are you prepared to do today?

        Dr. Chet

References:
1. European Heart Journal (2020) 00, 1–8 doi:10.1093/eurheartj/ehaa652
2. https://doi.org/10.1016/j.mayocp.2020.08.034

Mental Health 2020: Take Control

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In the last Memo I said that there are no simple rules to be made whether we talk about the pandemic or politics. These are complicated issues no matter how much we wish they were not. There are no absolute answers, and that results in a loss of control. We appear to have lost control of our lives, and that uncertainty creates anxiety and subsequently depressive symptoms.

Posttraumatic Stress Disorder?

Could this unrelenting stress result in something such as posttraumatic stress disorder (PTSD)? Generally, PTSD is associated with a single traumatic event. After the last presidential election, that term was floated because for over half the electorate, the results were unexpected. Psychologists and psychiatrists were quick to suggest that term didn’t apply.

There have been no studies published on the general population related to PTSD and COVID-19 in the U.S., but research from Italy and China indicates that even though the pandemic is an ongoing stressor, it can potentially lead to a PTSD scenario in some people. Whether it’s called PTSD or given some other name, the loss of control is very stressful to most Americans.

Is It Time for Digital Detox?

Is there anything we can do to ease the current level of stress? One psychologist suggests that we take a social media and digital detox. I have to agree.

You want proof? “Russian interference.” That phrase alone can start a social-media firestorm. I don’t even have to go into the particulars, and people on both sides of the issue have their digital knives drawn. Didn’t you just for that split second get ready to attack, depending on your political persuasion, even though I didn’t say another word? Do you think that’s healthy? I don’t think so.

I think that if you use social media or the Internet, take a break or limit it the time spent on it every day. I certainly have. I believe in a controlled fast to help your body detoxify itself, and the same applies to our mental health. Just as you eat better foods while you detox your body, get back to reading more positive books and magazines to detox your mind. End your online session with cat videos or baby pictures or scripture—whatever makes you smile and feel good.

It comes back to control. You’re in charge of you, and you can control what you do and see. You can’t control what other people say or do. Do you really think you’ll be able to change someone’s mind about politics or the pandemic with what you have to say? When they respond in a vicious way, is that going to help your mental state? Get control of your digital world and detox your brain.

The Bottom Line

We live in challenging times and we certainly live in a constant state of stress. That can definitely impact our mental health whether we realize it or not. As I said, much of what is impacting us today is not under our control.

What we can do is control how we respond to it. Eat better. Eat less. Move more. And clear your mind with a digital detox. It all comes down to one question:

What are you prepared to do today?

        Dr. Chet

References:
1. https://wbur.fm/33q5hHX
2. https://bit.ly/2FsESRN
3. https://bit.ly/3kecphl

Mental Health 2020: The Stats

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At this point, there have been no substantive studies of mental health resulting from either the pandemic or the political climate in the U.S. There are metrics that have been tracked via online survey since April; the surveys added modified questions that ask about factors related to the pandemic.

The results for symptoms of anxiety show that 30.8% of respondents indicated more symptoms in late April compared to 31.4% in late August although the percentage fluctuated as high as 36.0%. The results for symptoms of depression ranged from 23.5% in late April to 24.5% in late August with a percentage fluctuation as high as 28.8%.

What do the numbers mean in comparison with pre-pandemic times?
From January to June 2019, 8.2% of adults aged 18 and over had symptoms of anxiety disorder while 6.6% had symptoms of depressive disorder. The current surveys are not perfect and there’s no statistical analysis, but by all appearances we are more anxious and tend to exhibit more depressive symptoms.

I think what contributes to the anxiety is that there’s no simple solution. Humans like binary choices: this is right, that’s wrong. And that just doesn’t apply in this case. Could we be creating a population at risk for a form of posttraumatic stress disorder? Is there anything we can do about it? We’ll take a look at that on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm
2. https://www.cdc.gov/nchs/fastats/depression.htm

Mental Health Update: Fall 2020

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As I write this, I just got back from working out. I went to my gym for the first time since it opened last Wednesday after closing in March. Everyone wore masks. Everyone cleaned up their equipment, but that’s the standard anyway so that wasn’t surprising. Nobody fainted from lack of oxygen. Everybody just worked out, cleaned up after themselves, and went on their way. No big deal.

But it’s a big deal to many people who have been anxious over the closures in their states, including their gym. That can lead to depressive symptoms. If you follow social media, that can hurt considerably: comments suggesting the virus is one big scam or people are too concerned. In fact neither is true; spending less time on social media might be the single best thing you could do for your mental health. I go back to what I wrote several months ago: don’t let yourself be immobilized by fear of this virus, but show it the proper respect.

On top of that, the political climate is a mess. There are no longer any discussions, just arguments that can be vicious. The anger is palpable. When you lose contact with family and friends you care about because of political differences, that also leads to anxiety and depression. Throw in unemployment, concern about finances, keeping a roof over your head, and more, and it seems our mental health is taking a beating.

But is it? I’ll take a look at the research this week.

Reminder for all Insiders: our monthly Conference Call is tomorrow night at 9 p.m. ET. One topic I’ll be discussing is a remarkable study done on COVID-19 and genetics by a supercomputer. You don’t want to miss it. If you’re not yet an Insider, you have until 8 p.m. to join and still participate live.

What are you prepared to do today?

        Dr. Chet

By Any Means Necessary

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Riley has finished his first week of in-classroom school. He seems to have adapted quite well, which is no surprise—he is the most social child I’ve ever known and makes friends with everyone.

Much like me, he’s not much of a morning eater. Occasionally I’ll eat breakfast but for the most part, it’s not going to happen until I’ve been awake for several hours. A cup of Joe isn’t going to work for Riley, so milk and water suffice. I gave him a fruit and vegetable pouch yesterday, but he wanted to take it for a snack at school. I talked him out of it; he ate about half and saved the rest for after school.

Riley is a choosy eater: he chooses to refuse many foods that most kids eat such as apples, oranges, and bananas. Until recently, he had a strong gag reflex that was triggered by many solid foods, so we’ve continued to use pouches as a nutritional stop-gap; we watch for sales and usually pay about a dollar per pouch.

The reason I hesitated to have him take it for snack was that I wasn’t sure kids who are five still use them, and I didn’t want him to get embarrassed among his new friends. Then my health brain kicked in. He’s gotten used to eating blueberries, raspberries, and grapes in small quantities, but that’s about it. Vegetables? Other than potatoes, carrots, and Grampa’s spaghetti sauce with hidden vegetables, it’s a tough sell. But in those pouches, he eats just about everything. What’s more important: eating the fruits and vegetables in whatever form or worrying about what people think? So if he wants to take pouches to school, he will because getting those fruits and veggies into him is more important by far.

Just as serious: how are you doing with your consumption of vegetables and fruit? If you don’t get your five to ten servings, check out the pouches. They contain one or two servings of pureed vegetables and fruits, organic with no additives, and include very interesting blends; some of Riley’s faves are in the illustration. I’ve tried them and if I didn’t like vegetables and fruits, I’d use them. Cold, they’re refreshing. They’re shelf stable, so you can keep them in your desk or locker or car for convenient, healthy snacks. It sure beats making or buying a smoothie every day, and they’re a better alternative than the doughnuts in the break room or whatever you find in the vending machine.

If you’re concerned about the ecological impact, the New York Times reports, “While the pouches are not recyclable through municipal services, they can be mailed to TerraCycle at a cost of at least $93 per shipment, except for a few brands that have set up free mail-in programs with the recycling company. Pouch caps are collected in some locations by Preserve, which manufactures goods like toothbrushes and razors from recycled plastic.”

If you know you’re never going to eat kale or spinach, try a pouch. As I said, get your fruits and vegetables by any means necessary.

What are you prepared to do today?

        Dr. Chet