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Dr. Oz was once a highly respected cardiothoracic surgeon and Columbia professor. His show still capitalizes on this reputation and the excellent bedside manner that he projects through the television.
However, Dr. Oz is now a primarily a talk show host and a celebrity. His programming is heavily driven by producers, not by medical research. The quality of guests that are invited onto the show varys wildly, and so does the quality of advice that the show’s research assistants script for him to present. When this is combined with the public’s insatiable desire for new and easy solutions for complicated or difficult problems, sometimes a fad is born that can’t possibly live up to the hype. This has resulted in a lot of scepticism from the medical community about the quality of advice on the Dr. Oz Show.
In one show in particular, Dr. Oz promised the ability to “fake and facelift” and “drop a decade” through a combination of supplements, creams, and serums. How good was his advice?
Advice: Topical Vitamin C
The use of a topical vitamin C serum is excellent advice with a great deal of evidence backing it up. First, Dr. Oz specifically recommends specifically looking for the form ascorbic acid (also written L-ascorbic acid). This is fantastic! Vitamin C in the form of ascorbic acid, which Dr. Oz recommends, is a very potent antioxidant–so powerful that it is now the gold standard to which other potential antioxidants are compared. Beyond that, though, ascorbic acid has been shown to reduce sun damage when it is applied before sun exposure, and it reduces post-inflammatory erythema (redness from inflammation and acne) and skin discoloration, which includes post-acne dark marks on the skin that many people call scars. There is also some research that suggests that ascorbic acid may enhance collagen production and fibroblast growth factor expression–and there is even some direct research on its ability to reduce wrinkles if delivered into the skin.
Dr. Oz suggested that you would see changes in 2 to 4 weeks using vitamin C. While this is certainly possible, and I have seen changes in my skin that fast with the really well-formulated serum that I created for myself, it is more realistic to expect noticeable changes in 8 to 12 weeks.
There are a number of forms of vitamin C that are found in skincare products. Aside from acorbic acid, other forms include retinyl palmitate, L-ascorbyl palmitate, magnesium ascorbyl phosphate, sodium ascorbyl phosphate, and tetrahexyldecyl ascorbate. The gold standard is ascorbic acid because it has the most research behind it, though there is research on some of the other forms that does not exist for ascorbic acid–such as a trial showing that sodium ascorbyl phosphate 5% is very effective in the treatment of acne. (It should be said that I have personally noticed a similar effectiveness with ascorbic acid.) Tetrahexydecyl ascorbate might even be better than ascorbic acid at least in some ways, but it does not yet have much research behind it. For now, ascorbic acid has the most evidence behind its effectiveness at both preventing and reversing the signs of aging.
The problem with ascorbic acid lies in the fact that it oxidizes very quickly when it’s dissolved and comes into contact with air, and therefore, it needs to be in a solution that is either anhydrous (meaning without water) or stabilized in other ways, and if it is not anhydrous, it should be in oxygen-free packaging, such as a tube or vacuum pump. The anhydrous solutions have another problem because unless the ascorbic acid is dissolved in water on the skin, it will not penetrate. And the various ways in which ascorbic acid can be stabilized will have different durations of effectiveness. When ascorbic acid is combined with other vitamins, especially vitamin E and alpha-lipoic acid, it has been shown to be far more effective. Finally, penetration enhancers can greatly increase the ability of ascorbic acid to effect the deeper layers of the skin. The pH also matters–ascorbic acid needs to be quite acidic for it to penetrate the skin well.
All of this means that the level of effectiveness of an ascorbic acid serum depends only somewhat on how much ascorbic acid there is in the serum. Look for a formula that lists it near the front of the list of ingredients, but don’t pick a 30% serum over a 10% serum based on the ascorbic acid content alone! If the serum is well-formulated with good penetration enhancers, even 25% would be far too strong for almost anyone’s skin. Dr. Oz suggested 3 to 10%. I would counter that 10% to 15%, perhaps as high as 20%, of a well-formulated ascorbic acid serum would be preferable to anything below 10%. Above 20%, again, is perfectly comfortable if the formula just isn’t very good. However, it would create a very strong burning sensation if it was that high if the formula is excellent.
Dr. Oz also wisely suggests to use a vitamin C serum in the morning (when it can do the most to counteract sun damage) after cleansing and exfoliation and before moisturizer and sunblock. This is exactly when and where I would recommend it, as well. A morning routine should consist of cleansing, then any toners and/or essences, then a vitamin C serum. After the vitamin C serum has time to dry, spot-treat any trouble spots, like around the eyes or an active pimple, and then add moisturizer, and finally put sunblock on the top.
Some people confuse the phototoxicity that comes from a component of many citrus fruits with something to do with vitamin C. Phototoxicity in citrus comes from furocoumarin derivatives. These are naturally occurring chemicals that have nothing to do with vitamin C. Vitamin C is not phototoxic, and it doesn’t cause photosensitivity.
Products to Consider
Review: The Ordinary has a line of products that are extraordinarily cheap and have very few but selectively powerful active ingredients. The price is the main benefit. The drawback, though, is that many of their products not only have few actives but also that many of the formulations are poor. This means that their high concentration active might not do as much as a better formulation with far, far less of the active included.
Such is the case with their vitamin C suspension. The Ordinary gets around the issues with the oxidation of the L-ascorbic acid by presenting it in an anhydrous liquid–that is, a liquid without water. In this form, though, the ascorbic acid cannot dissolve. The formula is gritty, which makes it very difficult to apply under makeup, and it will have poor skin penetration. A better alternative is to buy pure L-ascorbic powder and add it to your daily moisturizer right before applying it every morning. This would be even cheaper, smoother, far more effective, and you wouldn’t have an extra liquid product in your application process.
Review: This is a close approximation or even an exact dupe of the more expensive SkinCeuticals original formula. It has a good, simple formula, with hyaluronic acid as a humectant-type moisturizer, ferulic acid as a stabilizer, and vitamin E to increase the effectiveness of the ascorbic acid. It also has ethoxydiglycol, a mild penetration enhancer. It’s a solid formula for a phenomenal price. The main problem with the formula is the dropper application. Because this is not in an airless bottle, the vitamin C will still slowly oxidize, despite stabilization. If you’re on a very tight budget, choose this and keep it in the refrigerator!
Product: philosophy Turbo Booster C Powder
Review: Many cosmetics companies are now selling ascorbic acid separately to mix into your daily powder. There is no reason to get branded ascorbic acid unless it comes in a bundle, in which case you’re mostly paying for the formulation of the base, which, if well formulated, should dramatically increase the effectiveness of the ascorbic acid. If the vitamin C powder is meant to be used with any serum or moisturizer, get the serum or moisturizer you want with plenty of actives and add in ascorbic acid from a wholesale company. This powder by philosophy is spectacularly extortionate for what it is.
Review: Clinque gets around the problem of oxidation by having the vitamin C added right before use. The percentage is on the low side, so supplementing this with a extra powder is advisable. The airless packaging is excellent. The recommendation to add the serum to your moisturizer potentially raises the pH and dramatically reduces the serum’s effectiveness. I would recommend adding it in a single layer first, allowing it to dry, and then adding more. It is especially troubling that this recommendation would be made at all. I have not been able to yet locate the other ingredients. When I do, I will update this review.
Rating: ★★★★ as a serum, but ★★ as a vitamin C serum
Review: Dr Dennis Gross deals with the issue of stabilization by using mostly 3-O-Ethyl Ascorbic Acid, which is more stable than L-ascorbic acid. It may work as well, or it may not. There is no research on this type of ascorbic acid. The formula does not contain vitamin E, which is a strange choice given the weight of research about how much better vitamin C works with vitamin E, but it does contain CoQ10, which is excellent, and niacinamide, lactic acid, carnitine, hydrolyzed soy protein, turmeric extract, phytic acid, and several additional beneficial botanicals. Everything but the lactic acid is likely present in good amounts, too. It also contains superoxide dismutase, which may be especially helpful for acne-prone people. Overall, this is an excellent serum, but it may not be an excellent vitamin C serum.
Review: You have to get thirteen ingredients deep to find the first ingredient that isn’t a cheap, non-active moisturizing or thickening ingredient, and the first vitamin C derivative is much farther down the list, with ascorbic acid toward the bottom if the long and complicated and mostly unimpressive list. To put things in perspective, there is likely 1.5% or less of the thickener xanthan gum, which is about a sixth of the way down the list of ingredients; less than 1% of the preservative disodium EDTA, which is only a third of the way down the list; and less than .5% of the preservative BHT, which is about halfway down the list. While a few actives do need to be added in extremely small concentrations, this is not true of the ingredients in this product. Sadly, philosophy is engaging in heavy fairy-dusting–including minuscule amounts of actives and selling bottles of mostly fluffy moisturizer as if they were extremely powerful.
Product: Drunk Elephant C-Firma Day Serum
Review: I have mad respect for this fairly new company. All of their formulas seem intelligent and honest. This formula not only contains an ideal 15% L-ascorbic acid, but it also contains ferulic acid for stability and vitamin E to increase its effectiveness. There are all kinds of other goodies inside, including a peptide, tea extract, lactobacillus extract, licorice extract, hydrolyzed proteins, and a laundry list of very respectable botanicals–all in an airless bottle! I highly recommend this formula.
Product: SkinCeuticals C E Ferulic Serum
Review: The granddaddy of all vitamin C serums, the SkinCueticals C E Ferulic Acid serum is the first of its kind. Ferulic acid to stabilize, vitamin E to increase effectiveness, and a mild penetration enhancer plus hyaluronic acid for humectant-type moisturization. The dropper applicator will allow for oxidation, though, even with the stabilizing effect of the ferulic acid, so preferably store this in the refrigerator. The only issue with it is that there are now better and/or cheaper products. Drunk Elephant is is both, while Timeless is pretty much the same thing but cheaper.
Advice: Oral Phytoceramides
Phytoceramides are a particular type of lipid that come from plants (which is where the phyto- comes from). Ceramides in the skin are part of the lipid component of the outer layer of skin crucial for preventing water loss and maintaining a healthy epidermal barrier, along with cholesterol and saturated fatty acids. This is a source of a lot of confusion, because there is no evidence that phytoceramides that you eat can somehow get into your skin–despite Dr. Oz’s claims. Instead, the ceramides in your skin are manufactured locally, and mammalian ceramides are chemically different from phytoceramides from yeast and plants, despite the claims of many supplement companies.
That said, there is some very limited evidence provided by exactly one study that oral phytoceramides might reduce skin wrinkling. The main difficulty with this study is that phytoceramides were just one component of a complicated protocol. Another study showed some statistically significant but generally unimpressive improved hydration of the skin from phytoceramides.
If phytoceramides do work to improve skin, it would probably be through their action as PPAR ligands, which would increase insulin sensitivity and therefore make it easier to retain and build fat in facial skin. (They also might increase bone density, which is good because some PPAR agonists may impair bone building.) Other PPAR-gamma agonists have been examined for their potential to reverse the wasting that occurs in the faces and limbs of people who are on standard HIV treatment, so the possibility that phytoceramides can support a youthful skin appearance is suggested by this.
However, there has been a fair amount of research that suggests that oral phytoceramides can cause cell death, too. The research has centered on synthetic phytoceramides because they can be manufactured to be water soluble, but there is still strong reason to worry that natural phytoceramides might cause similar issues. Because they are much less bioavailable, they would be much less dangerous. Any amount you might normally get from your diet, for example, would be perfectly safe. But this might be because dietary phytoceramides are generally inert, not very available for your body’s use. Because natural phytoceramides are found in low levels in foods that we eat, phytoceramides are FDA approved for consumption, but they have not been proven safe in the concentrations that are normally used in supplements, and they also aren’t approved by the FDA to improve skin or to treat any other condition. Astonishingly, one of the doctors on the Dr. Oz Show appeared to be familiar with the research about how phytoceramides can kill cells because he talked about how they might “fight cancer.” While it is true that there is interest in phytoceramides for killing cancer cells, he failed to note that the studies found that they were able to kill all kinds of cells, which might include cancer cells, too.
There is not sufficient evidence to conclude that phytoceramides would actually improve the skin in any meaningful way and plenty of reason to worry that they might harm your health, if they were. Therefore, at best they are over-hyped, and at worst, they are flat dangerous. This is a swing and a miss for Dr. Oz.
Products to Consider
I don’t consider it ethical to recommend phytoceramides!
Advice: Sonic Brush
Dr. Oz recommended facial brushes, preferably sonic facial brushes, for daily mechanical exfoliation. He specifically recommended the Clarisonic brand but suggested rotating rather than sonic brushes for those a budget. Rotating facial brushes spin, while sonic brushes like Clarisonic vibrate back and forth.
Both types of brush are mechanical exfoliators, which means that they clear away flakes from the outer surface of the skin. While chemical exfoliation usually involves alpha-hydroxy or beta-hydroxy acids, mechanical exfoliation can include anything that physically removes skin through friction or abrasion. Types include not just rotating brushes but any kind of loofah, face scrub, washcloth, or microdermabrasion.
That said, ultrasonic brushes are my favorite type of facial mechanical exfoliators, too. To use them correctly, you let the brush do the work and apply no pressure to the brush head beyond what you need to make contact with the skin. You should never scrub your face with a rotating or sonic brush! When used properly, without any additional force, these brushes are incredibly gentle on the skin while effectively cleaning away all traces of makeup, moisturizer, loose skin, and dirt, and they get farther into pores than other types of mechanical cleansing without creating damage to the skin. Their gentleness and effectiveness in cleansing sets brushes apart from other types of mechanical exfoliation–they really prep skin for skincare and makeup better than anything else that can be used on a daily basis. They are especially useful if you use intensive treatments that can create peels or flakiness.
I recommend using them with a regular cleanser. Many exfoliating face washes can cause scratches, while those with softer plastic microspheres are more gentle but hardly more effective than a regular cleanser and are problematical for the environment–and certainly not recommended for septic systems. One study found that a plain old washcloth is more effective than facial scrubs for cleaning skin. They really don’t add much to an already very effective rotating or ultrasonic brush.
These brushes anecdotally improve acne in most people. However, in some, they make acne worse. These people should either use a simple, pure soap like Ivory to clean the brush head after every use and then make sure that the brush head dried thoroughly between uses. This may require rotating between two different brushes. One brush manufacturer makes a rotating brush with a UV sterilizing base for this problem, which is another alternative.
Sonic brushes promise better cleaning power than regular rotating brushes. Does the hype hold up to the evidence? Most studies of sonic or ultrasonic brushes versus oscillating/rotating brushes involve dental care rather than facial care. In a number of different studies, various sonic toothbrushes do not do better at cleaning than an oscillating/rotating brush that is not sonic. But of course, gentleness would be much more important when it comes to skin than when toothbrushing, and this is a comparison of one company’s flagship product with various other products. They certainly wouldn’t publish any negative results.
Proctor and Gamble did the only decent studies on ultrasonic and regular rotating brushes. They produce the inexpensive Olay Pro-X brush, which is rotating. They compared makeup removal and stratum corneum (outer skin) exfoliation and found no difference between brush types, while the brushes were better than hands, an exfoliating scrub, or a washcloth. They also compared their rotating brush to hand cleansing when comparing barrier function and stratum corneum hydration (which both relate to gentleness) and facial bacteria population and found more benefits to using a brush. Interestingly, they didn’t compare a sonic brush in these studies. The cynic in me has a strong suspicion that this is because they felt the sonic brush would perform better in a statistically significant manner than their rotating brush when it came to these parameters. However, I have no proof of this.
There is not any published evidence that Clarisonic is the best cleansing brush. But there are a few clear advantages that do not relate directly to measurable data. First, the Clarisonic comes with far more options and heads than any other system. You can choose the heads with the right amount of stiffness for your face or body and even a pedicure system for your feet and a foundation applicator. The oscillating motion of the Clarisonic also splashes less during use than rotating brushes according to many people, though I haven’t really had a problem with this with any brush, perhaps because dampen my brushes while they are spinning and don’t find the need for a large amount of cleanser on my face.
I give Dr. Oz’s recommendation a B+ because sonic and rotating brushes both definitely give you an excellent and gentle clean that prepares the skin for product and gives you a young, healthy glow. However, there really isn’t evidence that sonic brushes do this better than rotating brushes, and these brushes have not been shown in any study ever to reduce fine lines, wrinkles, discoloration, or sagging, which are the the major contributors to the appearance of aging skin beyond dullness.
In general, this show was a bit of a mixed bag. There was one great piece of anti-aging advice, one poor piece of advice, and one piece of advice that is great for skincare but not necessarily helpful specifically for anti-aging!
What did you think about the show or Dr. Oz’s recommendations?
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