About Our Guest- Dr. Keira Barr – Women’s Skin Health— What you need to know
As a global speaker, internationally best-selling author and wellness expert, Dr. Keira Barr is a dual board-certified dermatologist. With all of the discoveries she’s made and her own experience with skin cancer, Dr. Barr has developed a process and path that fortifies your body, your life and your skin. By working with other professional and entrepreneurial women revitalize their lives and re-energize their bodies, she has helped them achieve and exceed their physical and personal goals of happiness, confidence and success and has redefined the delivery of skincare.
Full Podcast Transcription
Dr. Keira Barr 00:00
So out of my own experience, like I said, I was a mess in many ways and had to figure it out. And I thought oh my gosh, if I’m a physician, and I was really struggling, how in the world is the average woman supposed to figure this out and connect the dots like I have to be part of the solution. And so that really is how it’s shaped my practice just because I needed it for myself and I figured other women needed it as well.
Diva Nagula 02:02
Hello everyone and welcome to another episode of From Doctor to Patient. Today I’m pleased to have Dr. Keira Barr with us as a global speaker, internationally best selling author, and wellness expert. Dr. Barr is a dual board certified dermatologist. With all the discoveries she’s made and her own experience with skin cancer, Dr. Barr has developed a process and path that fortifies your body, your life, and your skin by working with other professional and entrepreneurial women to revitalize their lives and re energize their bodies. She’s helped them achieve and exceed their physical and personal goals of happiness, confidence, and success and has redefined the delivery of skincare. Dr. Barr, thank you so much for joining us today. How are you doing?
Dr. Keira Barr 03:04
I am doing great. How are you doing?
Diva Nagula 03:07
I’m doing fantastic. You know, it’s interesting. Everyone that comes out to join me on this show has a really interesting story of how they got to where they are today. And I’d love to hear your story on how you wound up doing what you’re doing now.
Dr. Keira Barr 03:25
Yeah, we always like to say like, our mess becomes our message, right? And for me, it was about eight years ago. And I thought I was killing it in my career. I was in academics, I was running marathons, you know, had the kids, the husband, all the things and it was just the beginning of a downward spiral. Because I started to experience a lot of trouble sleeping, feeling more anxious. As a dermatologist, I had a lot of pigmented lesions that were growing and changing over the course of a decade having a biopsied every couple of months. But back then I thought that was just normal. Just a lot of gut issues. I mean, you name it, I had it. And ultimately, what the wake up call for me was that as a dermatologist, I had to diagnose myself with melanoma. And it really was one of those. It’s your worst nightmare. Because, you know, thankfully, I knew what to look for. I caught it early. But my skin, it was my understanding, it was my first indoctrination into what mindfulness and medicine really is. Because my skin had been sending me clues and messages. My body had been shouting at me with all the pain and all the hormone shifts and, and I was deaf to it. And it really wasn’t until that diagnosis that I realized that everything I thought I was doing right Was not so right.
Diva Nagula 05:04
That’s fascinating. You know, we all think about issues with our system, and how it relates to improper lifestyles such as poor food practices, poor stress management, poor sleep. But no one ever ties this to skincare and skin regimen. And it’s interesting. And then that’s where you come along and have this unique niche.
Dr. Keira Barr 05:28
Yea, and it’s funny, never would have connected the dots going forward, it’s only going backward. Can we do that? Right, thanks to Steve Jobs for that famous quote. But for me, that’s so true that it wasn’t some, it wasn’t just about what was showing on the skin, I realized it had so much to do with how I was showing up in it, you know, well, how did I wind up with the skin cancers? Because as a kid, I was made fun of for what was on my skin and all the shame and humiliation embarrassment that I felt, tried to mask that with a suntan, you know, that low self esteem and low self confidence that I had for a lot of my life, you know, going into medicine, being the pleaser, the perfectionist, it really just one thing layers on the other. And then it also determines other choices that we make. You mentioned food choices, how to nourish ourselves. And you know, and it’s not just about the food, it’s who we spend time with and, and how we manage our stress. And I learned quickly that, you know, what shows up on the skin is a reflection of how the body’s functioning, both physically mentally and emotionally.
Diva Nagula 06:44
That’s that’s exactly what I wanted to chat more specifically with you. We all know about this gut brain connection, and how they’re influential with one another and our overall well being. But you say that there’s this brain skin connection, and there’s a fully functional HPA axis system within the skin. I’d love to hear more about this, this is really exciting, because this is something that’s not taught to us in medical school.
Dr. Keira Barr 07:15
Yeah, it’s fascinating. I didn’t learn it in residency either. And yet, the brain and the skin are derived from the same embryologic tissue. So from that perspective, they’re absolutely connected. But when we think about stress, in particular, we always think about it, you know, our brain sends signals to the hypothalamus, the pituitary releases a whole bunch of stress, hormones and other chemicals that circulate throughout the body, the skin can receive all those signals, but what they discovered in the recent past is that the skin itself has the same machinery that it can not only be a receiver of stress signals, but it can create the same hormones, the cortisol, the adrenaline, as well as our sex hormone. So the skin, I mean, I’m a little biased, I think it’s an amazing organ. But as your largest organ, it is incredibly complex. And is it’s the reason why, you know, when someone tells you your zipper is down you might blush, or when you’re stressed out that your acne gets worse, or your eczema gets worse, it’s a two way street, both the signals from the brain to the skin and from the skin to the brain.
Diva Nagula 08:26
So how do we improve this, like this mind skin connection, the skin mind connection, I mean, if this is something that we can modulate, like, if we can modulate our skin using specific tips that you might have, we could actually kind of calm our brain down, and how can we utilize this connection? For our advantage?
Dr. Keira Barr 08:48
I think, there’s absolutely ways to leverage it. And really, it just begins with breathing. And I know that sounds really simplistic, but most of us, myself included, when I’m stressed out or agitated, I’m breathing because I have to breathe to live. But most of us aren’t paying attention to how our breathing, you know, whether we’re breathing, more rapid, more shallow in our chest. And so even just beginning with taking notice of how you’re breathing and allowing yourself to take some nice deep breaths, as that’s an instant reset it, you know, activates the biggest nerve which activates that rest and relaxation response. And I think many people think that meditation or mindfulness has to be this overwhelming thing that they have to add to their to do list, but it really can begin just with with breathing.
Diva Nagula 09:48
Yeah, I couldn’t agree more. And that’s I talk about this a lot in my podcasts. And in my book, you know, meditation can be daunting for people who’ve never really explored the mindfulness field, and the thought of actually spending an additional 15 minutes to a busy day, you know, trying to be quiet. And then also stressing about whether you’re doing it correctly or not, is in and of itself a hindrance to the whole purpose of meditating. So I always advocate, you know, breathing, because we do this on a regular basis. And we don’t have to do this, in a sequential order of 15 to 20 minutes, it can be done, you know, two to three minutes, five, six times a day.
In fact, I like to tell people, like, if you’re going to work or, you know, we’re going to work, you know, you often get in an elevator, or you would get in on an escalator or something where, you know, it’s repeated, where you’re doing this several times a day, and if it’s a one to two minutes, where you could just sit there and just focus on your breathing and just kind of like, you know, Zen out for a minute or two, and really focus on how you are taking in the air, you’re following the air down into your body, make sure that you’re doing diaphragmatic breathing, instead of doing your shallow chest breathing. You know that can make a tremendous difference in your overall well being just by doing a two minute breath three or four times a day. And it’s amazing, you know, most people are very much like “I’ve got a meditative!”. And that’s great. And I think you can always work your way up there, you know, but I think the first thing is, for people who are quite often in the fight or flight stress response, the first thing you need to do is try to counteract that and kind of get into a state of parasympathetic or rest or digest before going into a true meditation practice.
Dr. Keira Barr 11:36
I couldn’t agree more. And I think those of us that are you know, the perfectionists, am I doing it wrong here, my mind is wandering and all these things. And I so agree breathing is the simplest thing that you can do in multiple times throughout the day. You know, I think the biggest thing too, with the work that I do now, yes, my background is in dermatology. But as a woman in mid life, I realized that so many of the changes that I was seeing on my skin dryness, the wrinkles, the, you know, thankfully, I didn’t struggle with acne, but I have a lot of women who do. And stress totally shifts your hormones. And you know, your body’s going to prioritize that fight flight or freeze response, and elevating that cortisol while every thing else takes a backseat, including production of your stress hormones, your sex hormones. And those of us in midlife, that’s a double whammy, because the hormones are already cascading downwards as we transition to menopause. So, yes, hormone replenishment has a roll, but stress management plays such a much bigger role in our overall health and well being. So that’s where I agree, I think you start where you are, and you do what you can multiple times throughout the day, ideally.
Diva Nagula 13:00
I mean, obviously, you know, when we’re in our teens and approaching the adolescence, you know, there are a huge amount of hormonal skin changes. And that’s a lot of things that people are focused in on and relate to when we talk about skincare and acne during this time period, but again, you were just referencing, how some of this, these changes can also appear for females when they go through menopause. And so what can they do to prep themselves for these hormonal changes in relation to their skin?
Dr. Keira Barr 13:31
Yeah, yeah, I love it. I always joke like, what you didn’t expect when you were expecting menopause, right? Exactly. changes happen, you’re like, I’m breaking out and getting none of the useful benefits. I hear you. And, you know, that’s where, again, we just talked about mindfulness. And mindfulness plays such a role in how we can prepare because being mindful of what we’re eating, how nourishing ourselves the food on our plate. We know for acne in particular, there are many people who are very sensitive to the effects of dairy. Because dairy can increase the insulin growth factor one receptor, which still stimulates us oil glands to produce more oil and oil production, sebum production is one of the major contributing factors to acne. It also, by stimulating the IGF1, increases the amount of cells that are sticky in that hair follicle. So those are two of the biggest components of acne, acne is bacteria, inflammation, those sticky skin cells and the oil production and dairy is contributing to two of those. So being mindful of, you know, when you eat dairy, is it a correlation? Are you noticing that your skin is getting more irritated, more inflamed, you know, and just practicing mindfulness there. Same thing with sugar. and I know sugar gets a bad rap. I’ve got a sweet tooth. We just had Halloween… I know, it’s not all or nothing. But we know that sugar plays a huge role in skin health, because it contributes to formation of these glycation, advanced glycation end products. And those advanced glycation end products bind to the collagen and the elastin, which gives your skin that youthful structure and integrity. And when these products bind to the collagen, elastin, making them stiff, and more friable, it leads to those wrinkles and those fine lines that you’re noticing. Just bringing mindfulness into our approach to our stress management, but also into how we are nourishing ourselves. Are dairy and sugar contributing to what is showing up on your skin? And it’s amazing and empowering that anyone, you know, they don’t need to go to the doctor, they don’t need any special thing. They just look in the mirror and be like, Okay, this is what I’m seeing. How do I correlate that to what may be in my grocery cart?
Diva Nagula 16:04
Exactly. And it’s so funny because I talked about how we should pay attention to specific foods that could be allergens. And as you mentioned dairy and processed foods and sugar. But what about gluten? Does that have an impact on our skin health as well?
Dr. Keira Barr 16:22
You know, it’s really interesting, I think, more research is coming up, but one in particular subset is psoriasis. And there’s more and more studies coming out with psoriasis and, and going on gluten free diet, and showing significant improvement. Granted, it’s not across the board. For me, I’ve been gluten and dairy free for many years now. So I’m always have like, of course, you should try it. But I think there’s value in doing an experimentation, especially if you’re dealing with an inflammatory skin condition, eczema, psoriasis, it may or may not make a difference, but there have been enough cases where it’s shown to improve skin health.
Diva Nagula 17:10
It’s interesting. I always talk about it and I don’t put a lot of emphasis on on skin. But I would imagine that skin manifestations in regards to acute inflammation is probably one of the very first signs, right. So if your body’s under a lot of inflammation, you know, whether it’s caused by stressors, it’s either mental or physiological, or whatever it may be, I would imagine that probably one of the first signs of this inflammation is going to manifest through skin issues.
Dr. Keira Barr 17:43
Yeah, the skin is you know, it’s is a reflection of a window to your overall health and well being. And I think there are many things that may show up on the skin first, that create opportunities to dive deeper. I remember during residency, you know, there was a patient, he came in with a large lesion on his forehead, and we biopsied it. And it was, unfortunately it was metastatic cancer. He didn’t know he had cancer. So it was you know, the skin was the first outward manifestation because he had otherwise been feeling well. It’s the same thing, you know, when we’re dealing in midlife with some of these hormonal changes, especially for women. You know, they’re noticing the dryness, and it’s not just on their skin, but it’s in their, you know, their genitalia, as well. And there’s some attributes in the vaginal area. But they’re still having their cycles. So they’re not equating that things are starting to shift but your skin giving you those clues. And so I think that’s really fabulous that you have this very visible ally that can help inform you of things that may be going on. Same thing with metabolic issues, you know, when we think about blood sugar dysregulation, and that plays a big role in menopause, contributing to worsening of hot flashes and such. Some people may notice that they have darkening or thickening on their skin, especially the skin folds. I’m looking at my neck as I think about the back of the neck and a condition called Acanthosis nigricans. And that’s a sure clue that there’s metabolic dysfunction, how that individual is handling certain processes in their body so the skin can be a huge asset.
Diva Nagula 19:33
And those those are if I’m not mistaken for my dermatology course in med school. Those are skin tags.
Dr. Keira Barr 19:39
So skin tags are a little bit different. So it can’t those neiger cans is a thickening. It’s like a darkening and a thickening of the skin is almost velvety. Right? Yes, often times accompanied but you’re absolutely right because it’s oftentimes accompanied by skin tags and skin tags love the same areas, those skinfold So there has been some times, especially if there’s no rupt, onset of skin tags, that that is a clue to underlying medical issues as well. The random skin tag, especially around the IRA, many of us get those and they have no other affiliation. But sometimes when they’re in abundance and the kind of acute onset, those are good clues,
Diva Nagula 20:22
What are your thoughts about movement and exercise when it relates to skincare? Is there any specific movement patterns that correlate with a healthier skin?
Dr. Keira Barr 20:33
Yeah, I love this question. And first of all, as someone who definitely over exercised, I think, being mindful of how you’re moving your body is really important, I thought, you know, no pain, no gain, and I was in pain all the time, and I was gaining nothing. So I think, don’t believe the hype, you know, and really tune into your body and and listen to what works. That being said, there is some really good research out there. Regarding skin health, they were looking at older individuals, and they were biking, and it was a course of 12 weeks, individuals who are exercising versus not exercising. And they looked at certain markers in this interleukin 15. And they found that those markers went down and the appearance of the skin improved. In fact, there was almost a decrease in wrinkling, if you will, for those individuals who were exercising versus those who weren’t. And that was even later in life. So it’s never too late to start. And then there’s another really cool study looking at yoga. So if you’re not into the more aerobic, and you want more the gentle movements, they were looking the asanas and pranayama breathing the movement with the breath. And that they found that yoga had a significant impact on the glycation process that I mentioned earlier with sugar, they found that yoga actually minimized or reduce the amount of glycation end products that were created. So again, improving the appearance of skin, decreasing wrinkles, so yay for exercise!
Diva Nagula 23:25
Yeah, so I mean, really, I guess the exercise, obviously, if it’s balanced, is really more about the reduction of your underlying stress hormones, which is really causing an improvement of the skin issues that maybe going on.
Dr. Keira Barr 23:40
Yeah, you know, I think we under estimate the impact that stress has on our overall well being but especially our skin, I mean, high levels of stress, that cortisol, it’s going to impair collagen repair collagen formation and again, fine lines, wrinkles or wound healing. So yeah, your skin will definitely let you know.
Diva Nagula 24:02
How is your approach change? I mean, since you had your melanoma? I mean, I’m sure that practicing dermatology, they don’t teach you the holistic side of Dermatology you know, you do have to learn it because you espouse the integrative holistic approach, you know, from before or have a personal experience. But, you know, when someone goes to a dermatologists office now, it’s the last thing that you expected to talk about is your, your stress level, your mindfulness practices, you know, so I find it very interesting that that from a dermatologist perspective, it totally makes sense, but that’s not what people expect when they go to dermatologists office for the very first time.
Dr. Keira Barr 24:39
Yeah, and for the most of the visits, they probably won’t be like that. There’s a growing group of us who are interested in integrative dermatology. And I have to admit, you know, I walked away from traditional practice and the focus of my practice now is really supporting women in menopause with hormone replenishment and focusing on stress Management because those two things go hand in hand for really, really helping to rebalance hormones. So, out of my own experience, like I said, I was a mess, in many ways, and had to figure it out. And I thought, Oh my gosh, if I’m a physician, and I was really struggling, how in the world is the average woman supposed to figure this out and connect the dots, like, I have to do something different, I have to be part of the solution. And so that really is how it’s shaped my practice just because I needed it for myself, and I figured other women needed it as well.
Diva Nagula 25:40
So I know, that your focus is with women’s health, women’s skin health, and specifically those that are going through menopause. Do you have like a stack of supplements that you’d recommend for women? And you know, if I may elaborate a little bit not only for women, but for other people that are also having skin issues or just in terms of preventative care or something that they should be taking just for to enhance their skin help?
Dr. Keira Barr 26:07
Yeah, so I love this question. And you should see my pantry. It’s an apothecary, I definitely have lots of supplements, but I think food first right is on our plates, trying to get the nourishment there. Sleeping, you know, the the basics, going back to the fundamentals, because we can’t supplement our way out of the bad diet or bad habits, or mindset. And so I’d like to focus there first. But in terms of supplements, you know, especially for skin health, and immunity and mood, vitamin D levels are really important. We talked about inflammation. So our omega three fatty acids are important. Notes for acne in particular, there’s a few good studies that are looking at pomegranate, to be very helpful, some of the B vitamins. But I think the most important thing, you know, when we talk about skin health, what, yes, our hormones are shifting, but some of the most visible signs of aging are from UV exposure. So creating greater resilience of the skin from the harmful rays of the sun. So antioxidants are really important. And there’s a few like polypodium leucotomos. This is one that we can’t get from food. So that is one supplement that I would recommend. It’s derived from a South American foreign plant. So polypodium leucotomos and nicotinamide or niacinamide, which is the analog of vitamin d3. Both of those have been shown to be in really quite effective for helping minimize the the effects of the UV rays.
Diva Nagula 27:52
What are your thoughts on vitamin C and collagen supplements? Is that have any role on overall skin health?
Dr. Keira Barr 28:01
Yeah, so vitamin C and vitamin E, they work synergistically. There’s a lot of research on that. That’s why you’ll see a lot of the skincare products have vitamin C and vitamin E, they’re really potent antioxidants do a wonderful job in helping to rejuvenate and repair the skin, taking them orally. You know, vitamin C has so many benefits, not just for the skin. So yeah, I think there’s value in taking that. In terms of collagen, I think my answer is, I don’t know, I don’t know how much it will help an individual because a lot of it has to do is what is the health of your gut? How much are you actually absorbing how much is that is then going to get to the periphery? There are some studies that have shown an improvement in skin tone texture with collagen, so I think that it can’t hurt. Do I know how much it will help and how much of return on your investment you’re going to get? I’m not sure.
Diva Nagula 29:05
That’s good. That’s a good point. And out of curiosity, since you’ve gone through skin cancer and you’re a dermatologist, what is your personal skincare like?
Dr. Keira Barr 29:16
Yeah, so very simple. I’m like the least compliant patient. So it has been really simple. So you know a good cleanser in the morning and I do use an antioxidant topical serum that has the vitamin C, Vitamin E. A few others I use pomegranate seed oil on the skin because it’s high in vitamin C as well. And then a moisturizer that has an SPF of 30 or above so I use zinc based products and to really protect my skin from the sun during the day. The evening routine looks similar washing my face, antioxidant serum, and then because as we mature our skin cell turnover slows sound a little bit may give your complexion a little bit of more of a dull appearance, so using a topical retinoid, at least a few times a week is something I recommend. And for those who can’t tolerate the retinoids, because they create some dryness and irritation for some people, there are now alternatives like bakuchiol, which has proven to have similar benefits without the dryness and irritation. So really simple three steps in the morning, three steps in the evening. And obviously, if there are some specific concerns, you can add a few more products. And but I say the less the better, because the fewer the chemicals you’re putting on your skin, the fewer that you get absorbed.
Diva Nagula 30:38
Right? And, you know, let’s go back to basic skincare with sunscreen, like what is the optimal SPF? And what about the ingredients that are used in specific brands? For sunscreen, you know that we see a bunch of fillers, we see a bunch of stuff that actually that are high in chemicals and could actually damage our skin? Can you just give us an idea of what we should be using and what the appropriate SPF is for us?
Dr. Keira Barr 31:06
Yeah, I think that’s a loaded question in many ways at a minimum SPF 30 or above. The problem is they’ve done studies that show that the vast majority of people only put on 25 to 50% of the recommended amount of sunscreen. So even if you have an SPF 50 or 100 or, or 30 you know, how much of that SPF are you actually getting? We don’t really know so make sure you’re putting on you know the recommended ammount. You don’t have to slather yourself so that you’re completely coated but you need to put on the recommended amount of sunscreen to get the benefit. That being said, which sunscreens to use, I’ve always only recommended the mineral based sunscreens particularly zinc oxide. Number one, it’s an ingredient that can be used from when you’re got littles to the elderly, so one bottle, everyone can use it, well tolerated. It’s the chemical sunscreens that are really come under scrutiny. The oxybenzones, avabenzones is one that is known to cause allergic contact dermatitis irritant contact dermatitis, so I’ve always steered away from that. And some of the fillers or preservatives that you had alluded to, you know, BHT and others, you know, they’ve been linked to potential endocrine disruption. And so as someone who’s really keen on helping women rebalance their hormones and wants to help them feel good as are in midlife and beyond, I don’t want anything coming into their body that can potentially mess with that. So SPF 30 and above and ideally stick to your mineral based sunscreens.
Diva Nagula 32:58
And I believe The Environmental Working Group has a great classification on really great sunscreens in a ranking order. And yeah, they have great recommendations for manufacturers and brands. And I usually go to that list to determine which one I want to use.
Dr. Keira Barr 33:15
I agree, it’s the Environmental Working Group, ewg.org/skindeep. And so not just sunscreens, but any personal care product is a great resource.
Diva Nagula 33:27
Right. And that’s another important thing to mention is that we can really damage our skin and our system, by these products that we’re applying on a regular basis, I mean, our personal care products from cosmetics to haircare to soap, all these things carry a lot of chemicals in it. And, you know, we don’t really think about it, but you know, we can put up to 100 Plus, of these chemicals on a day before we leave the door to go to work in the morning. And it’s it’s after over many, many years and, and time spent doing the same routine, you know, these chemicals can get built up into our system and cause like an inflammatory response. And people don’t think about that. And it’s not always about the foods you eat. And it’s not always about, you know, the pesticides and herbicides that we are exposed to, but it’s also the personal care products that we use on our skin and hair and scalp and on a daily basis.
Dr. Keira Barr 34:21
I couldn’t have said it better. I agree. And I think you know, and good habits start young too, you know, with our kids, they were looking at statistics for teenage girls who are using 12 to 17 products on average, which is more than you know, the adult so the younger generation are being exposed to a lot of chemicals too. And so I think it’s again, this is where mindfulness comes into practice. Being mindful of what you put on your body is really important. And that’s something that again, when I was in training, never was told or taught or thought to do on my own is read the labels. It’s so simple that we can just read the labels and be empowered, like, oh, and then you could look it up on a website like EWG and look up those ingredients and to see if there are some of them have very long, complicated scientific names, but in fact, they’re perfectly safe and they’re perfectly fine. So I think just being able to read your food labels, being able to read your personal care labels, your laundry detergent, your soaps, all the things that come in contact with your body. Just read those labels.
Diva Nagula 35:35
Exactly. Well, thank you Dr. Barr I really appreciate the time that you’ve spent with me today and for anyone who wants to find more information about you what’s the best way they can look you up?
Dr. Keira Barr 35:45
Yeah, so my website is a great place, drkeirabarr.com and then on Instagram, I’m starting to get a little bit more social, @drkeirabarr, they can find me there.
Diva Nagula 35:56
Awesome. Thanks so much for joining us again and hope to meet you in person!