The VHA has chosen to target glycemic overtreatment as one focus, with an emphasis upon hypoglycemic safety.
The VHA Choosing Wisely Task Force proposes a voluntary program to improve patient-centered care and support Patient-Aligned Care Teams (PACTs) across the country. Porsha Williams suffered a mid-air medical emergency while on a flight from Atlanta to Miami when she suddenly fainted in her seat. Paramedics met the plane upon arrival in Miami, and checked out Williams and determined that she was fine.
She was met by paramedics upon arrival, who checked her condition and said she was fine, and were happy to see her on her way.Her sister Lauren told the site that Porsha 'has a low blood sugar issue and has had fainting spells in the past'. Next week, I’ll finish this two-part series post Part 2 of this three-part series (yes, it’s grown) with an article that explores topical interventions containing scientifically advanced ingredients that help support youthful skin structure and function, and targeted nutritional supplements that fortify your skin form the inside out. It’s our largest organ by surface area – between 16 and 22 square feet – and serves to regulate excretion of metabolic waste products, regulate temperature, and our skin includes receptors for pain, tactile sensation, and pressure. I’ll be referring to each of these three throughout this article, so it would be helpful to remember their attributes. The Epidermis is the outermost layer of our skin, and thus provides protection against the   environment. Skin contains the sebaceous glands and sweat glands (eccrine and apocrine), which help to prevent dryness, protect skin against bacteria, and maintain core body temperature (thermoregulation). These factors play out through certain intrinsic” and extrinsic” microbiological and genetic processes. Intrinsic, or internal, skin aging is determined primarily by genetic factors, hormonal status, and metabolic reactions, such as cellular oxidative stress. These are the basic factors by which all our other organs age, but with skin, we see what’s happening – our skin visibly discloses many aspects of what’s occurring on the inside, so let’s peek at these four “intrinsic” factors that age skin.
A hallmark of replicative senescence is the shortening of telomeres, the “caps” at the ends of DNA strands that help ensure chromosomal stability during repeated cell division.
Skin cells are some of the most rapidly dividing cells in the body, which makes them vulnerable, because DNA damage accumulates with age and the rapid skin cell division causes them to be intrinsically vulnerable to replicative senescence, especially if measures to protect skin cells from damage aren’t established. With aging, there is a decline in the level of sex hormones (estrogen, testosterone, DHEA), and growth hormone. These particular hormones greatly influence skin health, and they need to be balanced and optimized to decelerate skin deterioration. For women, the change in hormone levels during menopause (especially estrogen) is accompanied by significant changes within the skin. As estrogen levels decline, skin cellular renewal becomes sluggish, resulting in thinning of the epidermal and dermal layers, the first two skin layers.
Oxidative stress plays a central role in initiating and driving events that cause skin aging at the cellular level. Oxidative stress breaks down protein (collagen), alters cellular renewal cycles, damages DNA, and promotes the release of cytokines (pro-inflammatory mediators), which trigger the generation of inflammatory skin diseases. As the outermost barrier separating internal tissue from the environment, our skin is regularly exposed to UV radiation and air pollution. Chronic free radical assault leads to the appearance of uneven, blotchy pigmentation, and weakens the structural framework of the skin (the dermis), giving rise to wrinkles and sagging skin. Free radicals also arise from internal, metabolic reactions like glycation from elevated blood sugar, so simply avoiding exposure to UV light is not adequate for optimal protection. In aging skin there’s a reduced number of immune Langerhans cells, thereby affecting skin’s ability to resist or eliminate stressors or infection that may impact its health. That the number of Langerhans cells diminishes with age is unfortunate because with advancing age, skin immunity declines, increasing the incidence of infection, malignancies and structural deterioration – all of which could be ameliorated by Langerhans cells. However basic and essential it is, glucose does present a problem to people in the industrialized world.  Simply put – we eat too many simple carbohydrates, which overwhelm the insulin that the pancreas makes to shuttle the glucose into our blood.
Similarly, once sugars enter the circulation in the body, they attach themselves to the amino groups of tissue proteins such as collagen to slowly rearrange their youthful structure into damaging advanced glycation end products (AGEs). AGE molecules are particularly destructive since they can undergo extensive cross-linking with other proteins to form strong chemical bridges.
UV radiation, wavelength and environmental toxins are three environmental (external, or “extrinsic”) factors that age skin. Among the most significant of extrinsic factors in skin ageing is solar ultraviolet radiation (“UVR”). When skin is exposed to excess UV radiation, a series of harmful biochemical reactions occur within the skin referred to as “photoaging”.
The destruction of collagen is a major contributor to the loss of skin suppleness and structure that occurs with as we age.

UV-A radiation (long wave) induces oxidative stress that stimulates post-UV inflammation and hyperpigmentation (melanin production). A suntan is evidence of skin damage, and represents the skin’s attempt to protect itself from further damage. UV-B radiation also stimulates the synthesis of vitamin D within the skin, but obtaining optimal vitamin D levels only through sun exposure may result in excess sun exposure damage that would override the beneficial effects of vitamin D. That means we should consider vitamin-D supplementation, particularly if you’re a person of color over 40 years of age living above latitude of 34 degrees, the latitude of Atlanta, Georgia. Supplementation with about 5000– 8000 IU of vitamin D daily is a good way to ensure optimal vitamin D status for most individuals.
Tobacco use is a major factor that contributes to many chronic diseases and reduced life expectancy. Increased lines and wrinkles, uneven tone, dehydration, and dull and frail skin aptly describe “Smoker’s skin”. The good news for smokers is that if they quit, dramatic improvements in their skin often occur within nine months.
In addition to the well-documented role of a wholesome, plant-based diet in maintaining the youthful suppleness of skin, modern nutritional science is demonstrating the relationship between specific nutrients and optimal skin health, which we’ll get to shortly. Unsurprisingly, the typical North American diet falls considerably short of providing the nutritional composition needed to keep skin healthy and vibrant. The North American diet contains excessive amounts of simple carbohydrates and saturated fats, and this dietary pattern correlates with an increased appearance of skin wrinkles. The glycemic index measures how rapidly and significantly foods cause blood sugar elevations following consumption. When sugar comes in contact with collagen (a protein), a reaction, called glycation, occurs resulting in the formation of tissue-destroying advanced glycation end products (AGES).
Glycation occurs in all tissues of the body, but is accelerated by a high sugar diet, and – as concerns the skin — excessive sun exposure.
Protein glycation and AGE formation are accompanied by increased free radical activity in skin collagen, which accelerates skin aging.
Choose whole foods that are densely packed with micronutrients and antioxidants, instead of commercially manufactured, overly processed foods, which are devoid of nutrition, yet rich in unhealthy fats and high glycemic carbohydrate calories.
Clinical studies have shown that catechins from green tea, anthocyanins from dark berries and red cabbage, bioflavonoids from citrus, carotenoids such as lycopene and lutein from tomatoes, resveratrol from red wine and genistein from soy (fermented is far superior) offer potent secondary antioxidant protection in the skin. Having the right amount (and type) of fats through diet or supplementation is critical to maintain healthy skin as we age.
In the past, a traditional diet provided a healthy ratio of 4 to 1, omega-6 to omega-3 fatty acids. We’re consuming much too much arachidonic acid (a polyunsaturated omega-6 fatty acid) from foods such as egg yolks, poultry skin and organ meats from animals fed corn-based diets, instead of grass.  This has a pro-inflammatory effect in the body and skin.
What’s typically needed in our diet is to increase the consumption of foods containing omega-3 fatty acids, such as fish oil, salmon, walnuts, flax seeds and chia seeds.
The North American diet relies heavily on over-processed, salty foods.  High sodium intake may increase the risk of developing hypertension.
People with borderline and established hypertension have significantly lower skin capillary densities than non-hypertensive subjects, but by reducing sodium intake in hypertensive people, microcirculation and capillary densities in the skin can be improved.
Studies indicate that calorie restriction (”CR”) promotes longevity through improving body composition and optimizing metabolic function.  This is evident with long-term studies of various primate species, and the health benefits of CR are indicated in humans as well. CR may promote healthier skin aging due to improved skin cell renewal and repair mechanisms. Some studies indicate that the Mediterranean Diet is linked with improved health and longevity. The Mediterranean diet focuses on fruits, vegetables, whole grains, legumes, monounsaturated fats (MUFA, such as those found in olive oil), and a healthy ratio of omega-3 to omega-6 polyunsaturated fatty acids (PUFAs). An impressive amount of epidemiological data link the Mediterranean diet with improved cardiovascular, cognitive, and metabolic health, not to mention the skin. The Mediterranean diet may exert an anti-inflammatory effect due in part to its emphasis on extra virgin olive oil, which is high in compounds that modulate oxidative stress and quell inflammatory reactions. The anti-inflammatory compound in olive oil is “Oleocanthal”, which may have anti-inflammatory actions similar to ibuprofen.
In one hospital-based study in Italy (Fortes 2008), researchers compared medical and lifestyle history, sun exposure habits and dietary patterns of more than 300 controls (subjects without melanoma) to over 300 cases of cutaneous melanoma patients. In this article, we examined what skin is, how and why it degrades over time, and what are the food-based nutritional interventions that can slow down – or in some cases, reverse – the rate that skin ages.
Dramatically reduce your consumption of foods and drinks that spike blood sugar, which are high glycemic carbohydrates.

Pregnant women in particular should seek the advice of a physician before using any protocol listed on this website. The information and protocols on this website raise many issues that are subject to change as new data emerge.
You're gonna get (1) the Newsletter, (2) the four-part guide, Transform Your Body and Mind, and (3) the 12 Ageproof Biohacks. Three physicians on the flight reportedly responded when a flight attendant asked if there was a doctor on board. Her sister, Lauren Williams, told TMZ that doctors helped Porsha come to with the help of a sugar pill. Our face, neck, hands and feet reveal that without certain nutritional and topical interventions, time will wrinkle us, as our skin loses its fibrous tissue, and slows it’s rate of cellular renewal. It’s comprised of keratin, which strengthens the skin, and melanin, found in the basal layer of the epidermis, responsible for depth of skin color. It contains fat cells that insulate the body and help to preserve heat, as well as other connective tissues. Known as “replicative senescence,” this can be the result of DNA damage induced by factors such as UV radiation, toxins, or age-related deterioration. Moreover, capillary blood circulation velocity decreases significantly, and the ability for the skin to maintain hydration, strength and elasticity suffers as a result. These exposures induce the production of highly volatile molecules called free radicals, which damage the cellular environment of the skin.
When the proteins in meat (and many other foods) are exposed to heat they cause the meat to turn dark brown in a chemical process called the Maillard reaction. As a result, once healthy collagen fibers lose their elasticity, they become rigid, more brittle, and prone to breakage.
Epidemiological and clinical studies have identified excessive sun exposure as a primary causal factor in various skin diseases including, premature aging, inflammatory conditions, melanoma and non-melanoma skin cancers. Chronic sun exposure damages the dermal connective tissue and alters normal skin metabolism. Ironically, it is oxidative stress that creates the “tanned” skin so often mistakenly associated with health and vitality. Sun on your body is a healthy thing, but limit exposure to 15 minutes at a time for body parts without sunscreen.
Epidemiology data suggest that a high glycemic diet may contribute to inflammatory skin conditions such as acne, rosacea, psoriasis, and eczema. You don’t want to exacerbate what may already be an out of proportion ratio of your omega-6 and omega-3 fatty acids. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a physician or other qualified health care professional. The information and protocols described on this website are for adults only, unless otherwise specified. I'm a big believer in sustainability, and am a bit nutty about optimizing my diet, supplements, hormones and exercise.
The ultimate goal of these voluntary efforts is to foster evidence-based, patient-centered, critical clinical thinking and shared informed decisions between VHA healthcare teams, clinicians and Veterans.
Turns out, the reality star has an issue with low blood sugar and has fainting spells from time to time. Depending on various factors such as genetics and lifestyle, normal physiologic skin functions may decline 50% by middle age. Unlike the epidermis, the dermis contains nerves, blood vessels, and fibroblasts that provide sensory receptors, deliver nutrients, and maintain the structural foundation of the skin. Also, there are other very good anti-inflammatory foods you can consume instead of olive oil, which I write about in, Why Dr.
Product labels may contain important safety information and the most recent product information provided by the product manufacturers should be carefully reviewed prior to use to verify the dose, administration, and contraindications. Joe Garma has not performed independent verification of the data contained herein, and expressly disclaim responsibility for any error in literature.
National, state, and local laws may vary regarding the use and application of many of the treatments discussed.

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