Skin

Collagen Supplements for Skin, Hair, and Nails: What to Know

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When Mary Claire Haver, MD, became interested in the potential of collagen supplementation about a decade ago, she struggled to find many gold-standard studies that showed major improvements in the aspects that mattered most to her patients, such as cellulite, wrinkles, and bone health.

Now the data seems to be more plentiful, though still murky. Collagen supplements appear to be safe to take and somewhat effective, depending on what problem you’re trying to solve, what type of supplement you take, and which ingredients are included.

“I always say to look for the evidence,” Haver said. “I saw randomized controlled trials with a particular type of collagen supplement — called VERISOL — that showed improvement. Since it helped and certainly wouldn’t hurt, I began taking it, and it became part of my routine.”This video is from the WebMD Archive.

Can Collagen-Boosting Foods Erase Wrinkles?

Can Collagen-Boosting Foods Erase Wrinkles?

Can foods rich in collagen-boosting proteins reverse signs of aging? Find out what you should include in your diet to promote healthy collagen production for a radiant complexion.

Haver, an OB/GYN in Texas who has drawn a major following on social media under the brand The ’Pause Life, speaks about the challenges of menopause and the changes in nutrition, exercise, and supplementation that may help. Haver sells collagen supplements with VERISOL under her brand, but she still cautions her patients and followers to be careful about what they choose to use since supplements aren’t regulated by the FDA. 

“Companies can slap a label on anything and market it, and part of why I created my brand is because it’s so hard to find reputable products,” she said. “On top of that, you also see ‘meno-washing,’ where companies market products as menopause-related and mark up the prices.”

In general, Haver recommends looking for supplement companies that use third-party testing, checking the manufacturing location and date for freshness, and being aware of unrealistic claims. If anything seems too good to be true, it probably is.

“I receive DMs from followers with screenshots from Instagram or TikTok ads, asking if a product is good or if the claims are real,” she  said. “Buyer beware: Nothing cures menopause, but there are things we can do to support our bodies, including the proper supplements.”

What Is Collagen?

Collagen serves as a major structural protein in connective tissues and provides support to skin, hair, nails, bones, tendons, and cartilage. Collagen is also a building block for proteins such as keratin, which forms skin, hair, and nails. Other substances, including hyaluronic acid and elastin, work with collagen to maintain skin elasticity and moisture.

More than two dozen types of collagen exist, with type I making up 90% of the collagen found in the human body. Although the body naturally produces collagen through amino acids found in protein-rich foods, production decreases over time due to aging, alcohol consumption, smoking, and sun damage, which can lead to common issues such as wrinkles, joint pain, and dry skin.

Collagen supplements typically use types I, II, and III, with types I and III being good for skin, hair, and nails and type II being good for joints and cartilage. The most bioavailable forms — or most readily available for digestion — are sold as hydrolyzed collagen, or collagen peptides that are broken into smaller molecules that the body can absorb. 

But collagen isn’t considered a “complete protein” because it doesn’t contain all of the essential amino acids needed to help the body function, so supplementation can’t replace protein powders or other supplements with all nine essential amino acids.

What Do Studies Show About Collagen Supplements?

New studies about collagen supplementation have emerged in the past decade, with a notable increase in recent years. For instance, a 2021 systematic review of 19 studies that tested hydrolyzed collagen supplements among 1,125 people showed favorable results for skin hydration, elasticity, and wrinkles. In 2023, another review of 14 studies with 967 people found encouraging results for skin moisture levels and elasticity. Yet another 2023 review of 26 studies with 1,721 people also showed improved skin hydration and elasticity. Additional studies have noted potential benefits for joint stiffness and pain, bone density, and brittle nails. 

“The good news with collagen is that, unless the product is adulterated or doesn’t follow good manufacturing practices, it typically won’t harm you to take,” said Mahtab Jafari, PharmD, a professor of pharmaceutical sciences at the University of California, Irvine. Jafari and her research team test botanical extracts and dietary supplements for their anti-aging properties and long-term health effects.

With collagen products, Jafari suggests paying close attention to ingredients. She recently received a call from someone who started taking collagen and developed a rash. After looking at the product, Jafari saw that it used marine-based collagen, and the person was allergic to fish. Collagen supplements may use fish, chicken, cow, pig, eggshells, or other sources of protein, she noted, yet companies sometimes make it difficult to learn about the sources or ingredients of the product.

In addition, Jafari said, companies may use studies or data to back up their claims, but that may not tell the whole story. Most collagen-related studies use self-reported measures from study participants, who may look in the mirror and write down what they see. This can skew the results since some of the measurements are subjective, including the appearance of wrinkles, fine lines, skin hydration, or elasticity.

“Consider all of the other variables that aren’t measured: Did all of the study participants use sunscreen? What are their stress levels?” Jafari said. “If you don’t use sunscreen to prevent sun damage, for instance, then oral collagen isn’t necessarily going to help.”

Supplement-related studies also tend to have major limitations. Most of the studies are observational, which means they don’t directly test the product as part of an experiment, and they often include a small number of people. In collagen-related studies, nearly all have included only women, most focused on skin (rather than hair, nails or joints), and many are funded by supplement companies.

“There are a few studies that suggest collagen supplements may be helpful, but more rigorous research is needed to confirm that this is true,” said Temitayo Ogunleye, MD, an associate professor clinical dermatology at the University of Pennsylvania’s Perelman School of Medicine.

Although studies are improving, few shed light on the correct dosing or the other ingredients, such as vitamin C or hyaluronic acid, that may boost the positive effects of collagen, she says, as well as potentially less helpful ingredients such as added sugars or artificial flavors. 

“Many of the studies utilize supplements with other ingredients, making it difficult to tease out which ingredient may be contributing to perceived changes,” she said. “There is also a lack of standardization for measuring improvement or increase in collagen synthesis to objectively assess response to therapy.”

What Else Should I Consider With Collagen Supplements? 

Collagen supplements are generally safe to use, but other methods may be just as effective, such as eating a balanced diet with enough protein, Ogunleye said. 

Collagen and Your Body: What to Know

photo of collagen strands micrograph
1/11What Is Collagen?Collagen is a protein your body makes naturally. It makes up about a third of all of the protein in your body. It’s essential for healthy joints. It also keeps skin elastic to lessen wrinkles. For that reason, collagen supplements are popular. They claim to make skin look younger, but does science support the hype? And do you need more?   
illustration of human anatomy
2/11What Collagen Does for Your BodyThe word comes from the Greek word “kólla,” which means glue. Collagen’s strong fibers work like glue to hold things together in your body: muscles, bones, tendons, ligaments, organs, and skin. 
types of collagen triptych
3/11Types of CollagenThere are 16 different types of this important protein in your body. But most of it is type I, II, or III. Each one has a different job. Type I builds skin, bones, tendons, and ligaments. Type II helps to make cartilage, the flexible tissue between bones and in your ears and nose. Type III helps create muscles and blood vessels. 
photo of mature couple flying kite
4/11Collagen as You Get OlderAs you get older, your body makes less collagen. You can’t measure exactly how much you have, but when it drops you may have symptoms such as joint pain or stiff tendons or ligaments. Your muscles may weaken. You could also have papery skin. Taking collagen supplements may help ease these symptoms. Talk to your doctor about the best approach for you. 
photo of sunshine, smoking, sweets triptych
5/11What Hurts Your Collagen Levels?Besides time, three main things will lower your collagen levels: sunlight, smoking, and sugar. Too much exposure to ultraviolet light makes its fibers unravel. This can lead to sun damage, such as wrinkles. Many of the chemicals in cigarette smoke can damage it, which can make skin sag and wrinkle. Sugar causes the fibers to cross-link and tangle. This makes your skin less elastic over time.
photo of eczema on chest
6/11What Collagen Can’t DoThere’s no proof that collagen treats skin conditions such as eczema or atopic dermatitis. While collagen shots can help to treat acne scars, there’s no evidence that collagen supplements can stop or treat acne. And no studies show that it helps with weight loss.
photo of collagen cream
7/11Do Collagen Creams Work?Skin creams with synthetic collagen may not be an effective way to boost this protein in your body. They add a protective barrier on your skin and stop water loss, but they don’t raise the amount of it in your skin. It’s better to protect your skin from the sun, especially early in life when skin may be more sensitive. 
foods that boost collagen levels
8/11Foods to Boost Your Collagen LevelsYou can help your body make more collagen by eating healthy foods. To make it, your body puts together amino acids called glycine and proline. You find these acids in high-protein foods such as chicken, fish, beef, eggs, dairy, and beans. Other nutrients, like vitamin C, zinc, and copper, also play a part. You can get vitamin C in citrus fruits, tomatoes, and leafy greens. For zinc and copper, try shellfish, nuts, whole grains, and beans.
photo of bone broth
9/11Bone Broth and CollagenSome good sources for the proteins that help build collagen are foods like red meat, chicken, and bone broth. To make bone broth, you simmer animal bones in water for 1-2 days. This draws some collagen proteins out into the broth. Your body doesn’t absorb it right into your skin or joints, though. It breaks it down into amino acids that help build tissue. You can buy bone broth in grocery stores or make your own.
photo of collagen powder
10/11Do You Need Collagen Supplements?If you eat a balanced diet, your body likely makes enough collagen for your needs.  Most of the studies into collagen supplements have been small. We need more large studies to understand their effects on health. But if you do want to try one, they’re generally safe and don’t have side effects. They usually come as a powder that you can mix into drinks or sauces.
photo of collagen supplement label
11/11Are Collagen Supplements Regulated?The FDA doesn’t regulate collagen supplements, so companies that make them don’t have to prove that they work or are safe. If you buy them, look for these keywords in the ingredients: collagen hydrolysate, hydrolyzed collagen, or collagen peptides.

Next

Medically Reviewed by Zilpah Sheikh, MD on March 12, 2024

“Since it’s broken down as other proteins, I don’t see why ingesting collagen would be more beneficial than eating other forms of protein,” she said. “Creams aren’t worth the effort.”

For anti-aging properties in particular, Ogunleye recommends sun protection and retinoids over supplements, as well as lifestyle modifications such as getting enough sleep and reducing stress.

“My takeaway is that all the data is very weak,” said Robert Anolik, MD, clinical assistant professor of dermatology at the NYU School of Medicine. “As it stands now, I don’t recommend that my patients consume collagen supplementation because I believe it ultimately needs more data for a medical recommendation simply because there is no strong proof of efficacy.”

Anolik points to the simple physical nature of consuming food or a supplement: You can’t dictate where the collagen goes in the body after being digested, so if you decide to take a supplement, it should be p

art of an overall approach rather than a specific solution.

“Just because we consume collagen doesn’t mean that it’s going to migrate right into the skin layers where we want it,” he said.  “Additionally, just because we consume something doesn’t mean it will act in that specific function in our body. I’d love to have a stronger hairline, but if I swallowed some hair, it unfortunately won’t go right to my scalp.”

The 7 Best Vitamins for Healthy and Glowing Skin

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If you want healthy skin — and who doesn’t — you want to ensure you get the right combination of vitamins, minerals, and nutrients. With so many out there, how do you know what specific vitamins promote skin health?

Whether you have adult acne, wrinkles, dry skin, slow-healing wounds, or other skin concerns, nature makes it easy for you. Hundreds of plants contain vitamins that boost skin health, keeping your skin moisturized, elastic, and having a smooth complexion.

Vitamins are vital for healthy skin and its function. With the right ones, we can stave off nearly every aspect of unhealthy skin getting in our way.

What Causes Unhealthy Skin?

Even if you’ve got a comprehensive skincare routine — exfoliate, wash, moisturize, repeat — if you’re not getting the right nutrients or you’re stripping away the ones you do have, you may end up with unhealthy skin.

If your skin is blotchy, has an uneven texture, has dark spots or acne, is dry and flaky, looks wrinkled, is tight or feels uncomfortable, you likely have unhealthy skin. Chapped lips are a telltale sign that your skin is dry.

Many things can wreak havoc on your skin:

  • Smoking
  • Stress
  • Excessive alcohol
  • Dehydration
  • Picking at your skin
  • Exposure to toxic chemicals
  • Consuming too much sugar

The best path to get healthy skin is preventing unhealthy skin! Eat healthy, exercise, and stay away from things that keep your skin from looking its best. If you’re eating junk food — including sugar and processed foods — you’re probably going to have skin issues.

Stress also depletes vitamin levels — and that affects your skin. When you’re stressed or your vitamin levels are low, it can lead to acne breakouts. Your body heals as you sleep, including your skin. So give your skin enough zzz’s to do its magic.

Best Vitamins for Skin

The combination of stress and lower vitamin levels increases oxidative stress, leading to skin damage. Many vitamins and minerals have antioxidant properties that protect the skin from free radical damage (which leads to premature aging). Ensuring you get adequate levels of these vitamins can make a big difference.

We’ve compiled a list of the best vitamins for your skin. Whether they improve collagen elasticity, reduce the appearance of acne, or give you glowing skin, these are the best of the best.

Vitamin E

Vitamin E is actually a group of eight fat-soluble compounds — four tocopherols and four tocotrienols. Most dietary supplements only contain alpha-tocopherol. Vitamin E is a potent antioxidant, which means it counteracts damage caused by free radicals inside the body and on your skin.[1, 2]

If you stay out in the sun too long, this vitamin can help counteract its effects, like dried-out skin and blemishes.[1] Vitamin E also has anti-inflammatory properties.[2] Interestingly, people who have acne tend to be low in it.[3]

You can take vitamin E internally or you can use it directly on your skin. Many people like to get capsules of the oil, poke it with a pin, and squeeze it onto their face as a moisturizer. Choose an organic, plant-based vitamin E supplement. If spreading oil on your face doesn’t appeal to you, take it internally.

The recommended daily allowance of vitamin E is 15 mg for men and women — and most people do not get enough.[2] Almonds, sunflower seeds, hazelnuts, and avocados are excellent sources of the vitamin.

Vitamin C

Sun exposure generates free radicals on the skin, which contribute to premature aging. If you want to slow down the signs of aging, vitamin C helps with its powerful antioxidant and anti-inflammatory properties.[4] It works best when taken with vitamin E.

Vitamin C boosts collagen production in the skin, the protein that helps your skin stay tight, which keeps it looking young.[4]

Putting vitamin C serum directly onto your face is great for collagen production.[4] The topical version comes in a dropper bottle for easy application, but you can also take vitamin C internally as a dietary supplement.

The recommended daily allowance of vitamin C is 75 mg for women and 90 mg for men.[5] People are unable to produce vitamin C on their own, so you have to get it from foods or supplements. You’ll get the highest amount of vitamin C from citrus fruit, bell peppers, and broccoli.

Omega-3 Fatty Acids

If you’ve spent too much time in the sun, omega-3s can help. While not a vitamin per se, omega-3s are important nutrients that protect against photo-aging and sunburn effects on the skin.[6] That means less dry or damaged skin. Omega-3s can also help eye health, boosting tear production and keeping eyes moisturized.[7]

There are three types of omega-3 fatty acids: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Of the three omega-3 fatty acids, only ALA has an established recommended daily allowance: 1.6 g for men and 1.1 g for women.[7] While you can find ALA in flaxseed oil and olive oil, you can only find both EPA and DHA in algae oil.

Try eating olives, flaxseeds, and chia seeds. You can also get omega 3s from hemp oil, sea buckthorn oil, and algae oil. We recommend avoiding fish oil due to the high incidence of mercury and other oceanic contaminants.

Vitamin D

Also called “the sunshine vitamin” because your skin produces it when exposed to the sun, vitamin D supports healthy, glowing skin. Interestingly, similar to vitamin C and E, when you’re low in vitamin D, you may be more likely to get pimples.[8] Some people use vitamin D serum on their skin for this reason.

Vitamin D supports wound healing, and also protects against the sun’s damage.[9] Healthy levels of vitamin D delays aging, promoting normal hair growth and excellent skin health.[9]

The recommended daily allowance of vitamin D is 15 mcg for men and women.[10] It can be challenging to get vitamin D from food. It most commonly comes from being out in the sun. Global Healing’s certified organic Suntrex® D3 not only encourages glowing skin but also supports immunity and the nervous system.

Vitamin K

Vitamin K is a skin-healing powerhouse. The delicate area under your eyes is prone to dehydration, which can bring dark circles, wrinkles, and fine lines. Applying vitamin K on the skin may help with these issues.[11]

Interestingly, when people with bruising on their faces applied vitamin K topically, it improved the appearance of their skin within a couple of days.[12] This versatile vitamin may even speed up the wound-healing process.[13]

Make sure you get 90 mcg of vitamin K per day if you are a woman and 120 mcg if you are a man.[14] Leafy greens, broccoli, parsley, and cruciferous vegetables contain the highest concentration of vitamin K.

Vitamin B3 (Niacin)

Vitamin B3 or niacin (which converts into niacinamide) can even out your skin tone and help you avoid excessive wrinkles and fine lines that come with age.[15]

Applied on the skin, B3 makes your skin more elastic and even out skin tone, including red blotchiness, skin sallowness (yellowing), and hyperpigmentation.[15]

The recommended daily allowance of vitamin B3 is 14 mg for women and 16 mg for men.[16] Plant-based sources of vitamin B3 include nutritional yeast, brown and wild rice, corn, and acorn squash.

Vitamin B7 (Biotin)

If you lack enough vitamin B7 (biotin), you can end up with rashes and irritated skin, brittle nails, and hair loss.[17, 18]

If you want to make sure you’re getting enough, Global Healing’s Biotin is plant-based and extracted from organic Sesbania herb. This ensures that all the cofactors and co-nutrients found in nature are present in your supplement.

The recommended daily allowance of biotin is 30 mcg for men and women.[18] Biotin is mainly found in animal sources, so I recommend a supplement.

Tips and Tricks for Healthier Skin

There’s plenty you can do to improve the appearance of your skin. Check out these tried and true practices.

Eat a Plant-Based Diet

Boost your intake of whole, natural foods, particularly fresh raw fruits and vegetables as well as nuts and seeds. You’ll get some of those essential vitamins for your skin and also start feeling more energy. Eliminate or cut down on sugar, meat, dairy, and processed foods, and say goodbye to tobacco and alcohol. The havoc they wreak on your skin just isn’t worth it.

Get Your Sweat On

Sweat naturally detoxifies your skin. So hop in the sauna, get in a tough workout at the gym, or go to a hot yoga class. Once all the toxins hit the road, you’ll be left with younger-looking skin that people will envy. Make sure to wash your skin right after your workout!

Go All Natural

Choose natural skincare products, because standard beauty creams and washes contain toxic chemicals that can actually contribute to aging. Use a dry brush before your shower, and don’t use too much soap and shampoo (and use natural, organic products). Select an all-organic moisturizing cream like Luminous, a 100% natural and organic luxury face cream with aloe leaf juice, coconut oil, vitamin E, hemp seed oil, and exotic essential oils like blue chamomile, lavender, and Tunisian neroli.

Try a Cleanse

If you want to improve the look and feel of your skin, a cleanse is one of the best things you can do. A cleanse involves following a clean, healthy diet while taking supplements that support your body’s natural detoxification abilities. This allows your body — including your skin — time to rest and renew. If you don’t know where to start, consider Global Healing’s Chemical and Heavy Metal Cleanse Kit™.

Points to Remember

Your skin requires specific vitamins to look its best, whether you’re concerned about skin tone, moisture, wound healing, blemishes, or other issues.

Vitamin C and E are both potent antioxidants, counteracting the oxidative damage caused by free radicals. Interestingly, vitamin D and E are low in people with acne. Make sure you are getting your recommended daily allowance. Vitamin D may help promote normal aging of the skin and hair.

Vitamin K can reduce the appearance of bruises and speed wound healing. Omega-3 fatty acids can give you extra power to fight off sun damage.

If you eat the right foods and minimize exposure to toxic chemicals (try a cleanse!), you’ll give your skin a boost that will make it appear more youthful and healthy. But it never hurts to lend a helping hand to our body’s natural process by ensuring you get enough of these vitamins for healthy skin.

How Collagen Supports Collagen

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collagen

The most abundant protein in the body, collagen is a key component of skin, tendons, and ligaments. As the body ages, it makes less (and lower quality) collagen. This contributes to reduced elasticity and less fresh-looking skin.

Where do you get collagen?

Eating meat twice a week provides all the collagen most people need, says Mark Tager, MD, author of Feed Your Skin Right: Your Personalized Nutrition Plan for Radiant Beauty. Other foods can help stimulate collagen production too. “To make collagen, we require other cofactors, such as vitamin C, copper, zinc, vitamin A, and silica — all of which can be supplied by a healthy diet.”

Meanwhile, sales of collagen supplements are booming. Collagen peptides, also known as hydrolyzed collagen, are made from the bones, skin, and connective tissue of cows, pigs, and chickens, as well as from fish scales and skin. These proteins break down into amino acids in the digestive tract, which are absorbed into the bloodstream and distributed to the skin.

Unlike vitamin C, which dissipates quickly, collagen peptides remain in the skin for up to 14 days. Collagen supports moisture retention by increasing production of hyaluronic acid, which makes skin more pliable. It even fires up the body’s ability to make new skin cells — a capacity that declines with age.

“I admit I was skeptical of the hype around collagen,” says Julie Garden-Robinson, PhD, RD, a food-and-nutrition specialist at North Dakota State University. But she was swayed by a raft of studies showing its benefits. Most notably, in 2021, the International Journal of Dermatology and Venereology published a meta-analysis of 19 double-blind, randomly controlled trials on the effects of collagen supplementation on skin aging, where the majority of subjects showed improved elasticity and fewer wrinkles.

Worth noting: Collagen products that claim to be animal-free are engaging in a sleight of hand. “Collagen comes from animals,” explains ­Julie Greenberg, ND, AHG, a naturopathic doctor who specializes in integrative dermatology. “Vegan collagen products contain high-dose nutrients, such as vitamin C, amino ­acids, and silica. These are believed to help the body make more of its own collagen.” Some truly vegan collagen products made from yeasts and bacteria are in development, but they’re not available yet.

If you eat a vegetarian or vegan diet, Garden-Robinson suggests getting two servings of protein a day from a variety of sources, including nuts and beans. This gives you “ample protein to nourish your body’s needs and help maintain collagen,” she says.

And if you eat animal products and you want an extra dose of collagen, she suggests drinking a cup of bone broth.

Oral roflumilast effective, inexpensive treatment option for patients with psoriasis

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Key takeaways:

  • 34.8% of patients with psoriasis treated with roflumilast achieved PASI 75 by week 12 compared with 0% of the placebo group.
  • Oral roflumilast is an option for patients who are candidates for systemic therapy.

NEW ORLEANS — Oral roflumilast may offer an inexpensive and effective treatment option for patients with psoriasis who are candidates for systemic therapy, according to a presentation at the American Academy of Dermatology Annual Meeting.

“Generic versions [of oral roflumilast] are available now and are cheaper than a Starbucks coffee,” Alexander Egeberg, MD, PhD, DMSc, of the department of dermatology at Bispebjerg and Frederiksberg Hospital and the department of clinical medicine at the University of Copenhagen, Denmark, said during the late-breaker presentation. “We now have the FDA approval for the topical version, but so far there have been no studies on oral roflumilast in psoriasis.”

Psoriasis elbow
Oral roflumilast may offer an inexpensive and effective treatment option for patients with psoriasis who are candidates for systemic therapy.

Egeberg presented results from the multicenter, double-blind, randomized, placebo-controlled phase 2 trial evaluating the efficacy and safety of oral roflumilast monotherapy without titration in adults with moderate to severe plaque psoriasis.

A total of 46 patients were randomly assigned to receive 500 µg of oral roflumilast (n = 23) or placebo (n = 23) once daily for 12 weeks followed by an open-label period for an additional 12 weeks during which all patients received 500 µg of oral roflumilast.

Results showed that the study met the primary endpoint, with eight roflumilast-treated patients achieving a PASI 75 response by week 12. Three patients also achieved PASI 90.

In contrast, none of the placebo-treated patients reached PASI 75; however, nine patients achieved it when switched to roflumilast during the open-label study portion.

By week 24, 10 roflumilast-treated patients reached PASI 75, five reached PASI 90 and two reached PASI 100.

The study reported no new safety signals, and oral roflumilast was deemed well tolerated by patients with adverse events being mild and transient, according to the researchers.

“Because this is a generic, you can start using it tomorrow,” Egeberg concluded.

7 Ways to Improve Your Skin through Your Gut

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skin care

You know the old saying, the eyes are the windows to the soul. Maybe that’s true. But what researchers know for sure is that the skin is the window to what’s going on inside the body. 

And when people deal with skin problems like acne, psoriasis, eczema by immediately resorting to over-the-counter creams and lotions, or the pharmaceuticals potions dermatologists routinely prescribe, sufferers often wind up just masking the problem, treating symptoms whose causes are more than skin-deep. And sometimes, even making matters worse. So, what to do instead? How about a more enlightened approach that connects the dots? Here’s where to start:

Skin health – or the opposite — starts on the inside.

Instead of high-tailing it to the drug store for relief, with my patients I often recommend looking into the skin-gut connection first, instead of pharma options. What’s going on inside the gut, especially with the trillions of the bacteria that live there, often directly affects the skin. When the gut microbiome is out of synch with the  rest of the body – a case of too few microbial strains or an overabundance of unfriendly strains – it often makes itself know in the form of common skin rashes, irritations and/or eruptions. 

Your gut and skin are allies.

That the skin and the gut share this connection (and interconnection) shouldn’t come as much of a surprise. Both defend the body against foreign invaders, the skin from harmful bacteria and other toxins in the air and the soil, and the gut from any microbial bad news that enters the GI system along with the food we eat, preventing it from getting into the bloodstream. Both the skin and the gut depend on the friendly bacteria, working in tandem with our human cells, to keep these defenses in good working order. 

Your gut and skin talk to each other – a lot.

Even if we don’t always know the exact conversation between gut and skin, we do know they’re talking to each other. Studies which have looked at people with psoriasis have found that they also have a disordered or altered gut microbiome. It’s a similar story with acne. Studies show an overpopulation of unfriendly bacteria on the skin of acne-sufferers, similar to what we see in the guts of people with common problems like IBS. There is the strong suggestion that gut “dysbiosis” contributes to skin “dysbiosis,” which is also a strong indicator that getting your gut in order should be put high on the healing to-do list.

Messed up microbiomes make skin struggle.

For some skin struggles, topical (and possibly toxic) creams may temporarily tame some symptoms, but they don’t deal with root causes, and one of the biggies is an unbalanced gut microbiome. Though there are a number of ways the delicate bacterial balance in your gut can shift to an unwell state, two big ones – which I can all but guarantee your dermatologist won’t check for (but should!) – are SIBO, or small intestinal bacterial overgrowth and SIFO, or small intestinal fungal overgrowth. To help you and your practitioner determine if SIBO or its fungal cousin SIFO may be wreaking havoc, check out my pointers on how to know if either are undermining your gut health and messing with your skin’s health. 

Inflammation is one of their common enemies.

Inflammation is likely the most common link between skin and gut. As generations of teenagers have discovered, a fatty, greasy high-carb diet is a sure way to pump up the over-production of skin oil, or sebum, which can lead to acne. Research suggests that part of the problem is that a low-fiber, high-carb diet starves the good gut bacteria which contributes to toxins escaping into the bloodstream (“leaky gut”), triggering inflammation throughout the body, including the skin. 

Stress is also a major gut and skin health wrecker.

Stress, another source of systemic inflammation, is another place where gut and skin meet. Again, teenagers, and for that matter, the rest of us, have learned that periods of higher-than-usual anxiety, especially when combined with low or poor sleep, often leads to skin break-outs. At the level of the gut, researchers have found that this kind of mega-stress can actually throw off the production of neurochemicals inside the gut which help calm the body, likely further stressing the skin.  

In addition to run-of-the-mill (but serious) stress, doctors in the mental health field have known for years that patients experiencing serious emotional issues often also have gut and skin problems. On the happier side of the coin, I and my integrative health colleagues appreciate that when we work with our patients on diet and stress to address their gut problems, over time, that healing process tends to result in upgraded skin health, as in skin that’s plumper, smoother, and with a healthier glow. Granted, it’s not a snap-your-fingers instant complexion fix – but over a period of weeks and months, the improvements are hard to miss. 

Get your skin and gut in order – so they can shine.

If you’re ready to start turning the ship around, here are a few steps to start taking now, for big benefits in due time. Try them at your own pace, adding one step at a time, or several at once if that’s easier for you to manage: 

1) Eat Smart: Cut back on sugar and high-carb foods and you’ll likely see the difference in a healthier complexion, for some people in just a matter of days. Add lots of fiber rich veggies, and keep the starchy ones to a minimum. Also steer clear of of lousy-for-the-gut, cheap, industrial oils in processed foods. If you do consume them, don’t be surprised by a dermis rife with skin irritations and/or extra-oily skin prone that’s to break-outs. 

2) Two-week elimination diet: What you eat can have a huge impact on how your skin looks. What’s making it misbehave? One of the most common is food sensitivities, with the most common food irritants being dairy and gluten. If you’ve spent a life loading up on either or both, try going cold turkey for two weeks and see if you one of these common food-skin triggers may be causing a lot of the trouble. 

3) Anti-inflammatory allies: Foods high in omega 3 fatty acids have an system-wide anti-inflammatory effects. Hard to beat small, fatty fish like sardines and anchovies for an anti-inflammatory boost. Think calm, healthy gut, equals calm, healthy skin. If you’re way into sugar, start taking steps to kick it – it’s a major inflamer.

4) Prebiotics and probiotics: High-fiber foods like onions, asparagus and radishes are prebiotic, that is, they feed the friendly bacteria that tamp down inflammation. A cruciferous veggie like broccoli does that and more, helping to detoxify environmental toxins in the liver that can negatively affect skin health. Probiotic foods like sauerkraut, kimchi and kombucha help maintain a healthy gut microbiome balance. 

5) Drink up: Yep, good old-fashioned water. One study found, the more you drink, the healthier your skin was likely to be, so get your  6 – 8, 8 oz glasses every day.

6) De-Stress: Yoga and meditation, any form you like, are excellent ways to take the edge of those over-active stress hormones that can stress out your skin. Deep, high-quality sleep, at least seven hours night, is a must. And moving your body, be it a brisk walk or something more vigorous, packs a beneficial one-two punch. Not only does the physical activity have a calming effect on the nervous system but the sweating that goes along with it stimulates the excretions of toxins from the skin. 

7) Do some SIBO sleuthing: Most of the time, conventional medical professionals are happy to ignore the gut. You, however, should not. If your gut is out of balance, or ‘leaky’, focus on healing and sealing your gut to guide it out of dysbiosis and back into balance. If you and practitioner determine that it’s actually SIBO (or SIFO) causing the trouble, then anti-microbials first is the way to go, as prebiotics and probiotics can worsen symptoms at first – making proper diagnosis especially important. 

Winter Skin Hazards

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Dry Skin Woes

Dry Skin Woes

1/18

Is your skin feeling dry and tight — even itchy or flaky? Any number of things can strip your skin of its protective oils. The result: Everything from chapped lips and itchy skin to cracked heels. Relief is in your grasp. Use this guide to see top cold-weather threats to your skin and what you can do about them.

SOS for Chapped Lips

SOS for Chapped Lips

2/18

No one is immune from dry lips in winter! Here’s how to cope: Drink plenty of water to stay hydrated and use a humidifier at home. Liberally apply beeswax or petroleum jelly to your lips. Put on lip balm or lipstick with sunscreen every time you go outside. Avoid being in the sun and wind too much. Don’t lick your lips — it may feel better briefly, but it only makes chapped lips worse.

Heal Cracked Heels

Heal Cracked Heels

3/18

Painful, cracked heels are a common skin condition, especially in winter. They are often caused by dry skin. Having calluses around the rim of the heel can complicate the problem. In some cases, dry cracked feet can lead to infection or make walking painful. Keep feet healthy by marinating cracked heels in petroleum jelly, covering them with plastic wrap, and putting on a pair of socks overnight. You should see improvement in a few days.

Give Dry Hands Extra Care

Give Dry Hands Extra Care

4/18

Your hands may be hard hit by the cold winter air. Washing your hands frequently helps eliminate cold and flu germs, but it also increases dryness. And unless you wear gloves every time you go out, hands may be more exposed to cold than other parts of your body. Give dry hands some extra TLC by using a glycerin-based moisturizer when you wake up, before you go to bed, and any time your hands feel dry throughout the day.

Use Super-Fatted Soap

Use Super-Fatted Soap

5/18

The same products that keep your face looking fresh in the spring and summer may cause skin problems during winter. Choose a gentle, super-fatted, fragrance-free soap — bar or liquid — for cleansing. Super-fatted means the soap is loaded with oils. Use a non-astringent toner, or just skip it altogether. If skin is dry, moisturizers that contain urea, dimethicone, glycerin, lanolin, or mineral oil can be good bets.

Choose a Winter Moisturizer

Choose a Winter Moisturizer

6/18

Should you change your moisturizer? Maybe. If you usually use a light lotion, try a heavier cream, at least on dry skin patches. Ointments — like petroleum jelly — have more oil than creams or lotions. That makes them more greasy, too, so they may be best for feet and body. Minimize the greasy feeling by using a very small amount and gently but thoroughly rubbing it into skin. Apply after a warm shower (more on that later). 

Decode Moisturizer Choices

Decode Moisturizer Choices

7/18

Humectants — like urea, glycerin, hyaluronic acid, propylene glycol — absorb water from the air. They are oil-free. Emollients — like baby or mineral oil, plant oils (like jojoba oil), petroleum jelly, lanolin, stearic acid — help replace oils in the skin. Many moisturizers contain a combination. You may want to skip some anti-aging moisturizers in winter. Those that contain retinoids can further irritate already dry, sensitive skin.

Clear Away Dead Skin First

Clear Away Dead Skin First

8/18

To get the most out of your moisturizer, exfoliate. Clearing away dead skin cells lets a moisturizer better penetrate dry skin. Exfoliate gently with a moisturizer that contains lactic acid or salicylic acid. Some exfoliants can be irritating, especially in winter, so try them on a small patch of skin first. If your skin is really dry or irritated, ask your doctor before starting a new skin care product or regimen.

Winter Showers

Winter Showers

9/18

A shower can add water to your skin — as long as you keep it short and sweet. Long, hot showers can actually draw moisture from your skin. Appealing as a hot shower on a cold morning may be, lukewarm water is a better choice. It won’t strip away skin’s natural oils.

Lock In Moisture After Your Bath

Lock In Moisture After Your Bath

10/18

Right after you step out of the tub, pat skin dry and apply moisturizer to retain the water your skin just absorbed. A glycerin- or hyaluronic acid-based moisturizer can increase the amount of water that’s drawn into your skin. Baby oil (mineral oil) is also a good choice, because it prevents water from evaporating from your skin. Don’t stop there: Liberally re-apply moisturizer throughout the day, especially to troublesome dry skin patches.

Plug In a Humidifier

Plug In a Humidifier

11/18

It’s cold outside! So you’re staying inside, with the heat on. That warm, dry air can mean parched, dry skin. Use a humidifier to restore moisture to the air. You can find inexpensive models at most drug stores. Put one in your bedroom; better yet, invest in two or three and place them strategically around your home to stave off irritated, itchy skin this winter.

Lube Your Locks

Lube Your Locks

12/18

Protect your hair this winter by shampooing every other day instead of daily. Shampoos and excess shampooing can strip hair of moisture. Use warm water and a mild shampoo with sunscreen. Apply extra conditioner to keep your hair hydrated, shiny, and soft. Don’t overstyle with the blow dryer or flat iron. And protect your hair from the elements by wearing a hat.

Winter Sunscreen Required

Winter Sunscreen Required

13/18

Think you can’t get a sunburn in winter? Wrong. Skiers and other winter athletes are at special risk of sunburn because snow reflects sunlight. In fact, it bounces 80% of the sun’s rays back to us, compared to less than 20% for sand and surf. Even if you’re not hitting the slopes, you still need the protection of a sunscreen with an SPF of 30 or more. Apply daily, and reapply at least every two hours if you’re outside.

Bundle Up Against Frostnip

Bundle Up Against Frostnip

14/18

Frostnip, a mild form of frostbite, tends to affect the earlobes, cheeks, nose, fingers, and toes. Signs of frostnip include pale skin, numbness, or tingling in the affected area. Avoid frostnip by dressing warmly, including a hat, earmuffs, and gloves. The best treatment is to re-warm the affected areas. Although frostnip is uncomfortable, it doesn’t cause any damage to skin.

Be Alert for Frostbite

Be Alert for Frostbite

15/18

Frostbite is more serious and can cause lasting damage. Deeper tissues freeze, causing skin to become hard, pale, and cold. It may ache but lack sensitivity to touch. As the area thaws, it becomes red and painful. Hands, feet, nose, and ears are most vulnerable, but any body part can be affected. Treat frostbite by getting to a warm place, wrapping affected areas in sterile dressings (separate fingers and toes) and going to an emergency department immediately. Don’t rewarm affected areas if there’s a chance they could freeze again.

Beat the Itch of Winter Skin

Beat the Itch of Winter Skin

16/18

Dry winter skin can be incredibly itchy. Beat itchy skin by taking a lukewarm bath with oatmeal or baking soda, reapplying your moisturizer frequently, and steering clear of wool and other rough fabrics. If these techniques don’t make a difference, see a dermatologist. You may have an underlying condition such as eczema or psoriasis that requires different treatment.

Show Eczema the Exit

Show Eczema the Exit

17/18

Eczema is an umbrella term for different kinds of skin inflammation. It is marked by dry, reddened skin that itches or burns. When skin becomes dry and irritated in winter, eczema can flare.  Stay one step ahead by moisturizing frequently with an oil-based ointment that contains sunscreen. Sweating and overheating can also trigger the itch/scratch cycle, so dress in easy-to-peel-off layers. Ask your dermatologist about prescription treatments.

Put Psoriasis in Its Place

Put Psoriasis in Its Place

18/18

Psoriasis is more than dry skin. It’s caused when the immune system misfires and speeds up skin cell growth. Dry air, lack of sunlight, and colder weather can make it worse. Follow tips for dry skin: short, lukewarm showers, lots of moisturizer, and humidifiers throughout the house. Ask your dermatologist about phototherapy, which uses ultraviolet light B (UVB) rays to slow the growth of skin cells, and about the best treatments for you.

Nerve cells actively repress alternative cell fates, researchers find

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A neural cell maintains its identity by actively suppressing the expression of genes associated with non-neuronal cell types, including skin, heart, lung, cartilage and liver, according to a study by researchers at the Stanford University School of Medicine.

 It does so with a powerful . “When this protein is missing, neural cells get a little confused,” said Marius Wernig, MD, associate professor of pathology. “They become less efficient at transmitting nerve signals and begin to express genes associated with other cell fates.”

The study marks the first identification of a near-global repressor that works to block many cell fates but one. It also suggests the possibility of a network of as-yet-unidentified master regulators specific to each cell type in the body.

“The concept of an inverse master regulator, one that represses many different developmental programs rather than activating a single program, is a unique way to control neuronal cell identity, and a completely new paradigm as to how cells maintain their throughout an organism’s lifetime,” Wernig said.

Because the protein, Myt1l, has been found to be mutated in people with autism, schizophrenia and major depression, the discovered mode of action may provide new opportunities for therapeutic intervention for these conditions, the researchers said.

Wernig is the senior author of the study, which will be published online April 5 in Nature. Postdoctoral scholars Moritz Mall, PhD, and Michael Kareta, PhD, are the lead authors.

Repressors

Myt1l is not the only protein known to repress certain cell fates. But most other known repressors specifically block only one type of developmental program, rather than many. For example, a well-known repressor called REST is known to block the neuronal pathway, but no others.

“Until now, researchers have focused only on identifying these types of single-lineage repressors,” said Wernig. “The concept of an ‘everything but’ repressor is entirely new.”

In 2010, Wernig showed that it is possible to convert skin into functional neurons over the course of three weeks by exposing them to a combination of just three proteins that are typically expressed in neurons. This “direct reprogramming” bypassed a step called induced pluripotency that many scientists had thought was necessary to transform one cell type into another.

 One of the proteins necessary to accomplish the transformation of skin to neurons was Myt1l. But until this study the researchers were unaware precisely how it functioned.

“Usually we think in terms about what regulatory programs need to be activated to direct a cell to a specific developmental state,” said Wernig. “So we were surprised when we took a closer look and saw that Myt1l was actually suppressing the expression of many genes.”

These genes, the researchers found, encoded proteins important for the development of lung, heart, liver, cartilage and other types of non-neuronal tissue. Furthermore, two of the proteins, Notch and Wnt, are known to actively block neurogenesis in the developing brain.

Blocking Myt1l expression in the brains of embryonic mice reduced the number of mature neurons that developed in the animals. Furthermore, knocking down Myt1l expression in mature neurons caused them to express lower-than-normal levels of neural-specific genes and to fire less readily in response to an electrical pulse.

‘A perfect team’

Wernig and his colleagues contrasted the effect of Myt1l with that of another protein called Ascl1, which is required to directly reprogram skin fibroblasts into neurons. Ascl1 is known to specifically induce the expression of neuronal genes in the fibroblasts.

“Together, these proteins work as a perfect team to funnel a developing cell, or a cell that is being reprogrammed, into the desired cell fate,” said Wernig. “It’s a beautiful scenario that both blocks the fibroblast program and promotes the neuronal program. My gut feeling would be that there are many more master repressors like Myt1l to be found for specific cell types, each of which would block all but one cell fate.”

Source:medicalxpress.com

Our Skin Has Smell Receptors That Help It to Heal Itself, Scientists Discover

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Smell is one of the most ancient human faculties — it has also been the least understood by science until recently. Biologists first uncovered the inner workings of chemical sensors in our noses, otherwise known as olfactory receptors, in the early 1990s, a finding that lead to a Nobel Prize.

Our Skin Has Smell Receptors That Help It to Heal Itself, Researchers Discover

But the story doesn’t end there. Over the last decade, scientists have discovered that smell receptors are not only found in the nose, but also throughout the body — in the brain, colon, heart, liver, kidneys, spine, prostate and even sperm — and play a crucial role in a range of physiological functions. And now, a team of researchers at Ruhr University Bochum in Germany have confirmed even our skin is covered with these receptors.

“More than 15 of the olfactory receptors that exist in the nose are also found in human skin cells,” said lead researcher, Dr. Hanns Hatt. What’s more, exposing the skin receptors to specific odors triggers a cascade of reactions that prompt healing of injured tissue.

An Unconventional Way of Using Scent to Heal

The researchers in Germany are enthusiastic about our sense of smell — although, not via the nose, but the skin. Writes Bob Roeher in New Scientist:

“They found that Sandalore—a synthetic sandalwood oil used in aromatherapy, perfumes and skin care products—bound to an olfactory receptor in skin called OR2AT4. Rather than sending a message to the brain, as nose receptors do, the receptor triggered cells to divide and migrate, important processes in repairing damaged skin.

Cell proliferation increased by 32 per cent and cell migration by nearly half when keratinocytes [skin cells] in a test tube and in culture were mixed for five days with Sandalore.”

It may seem bizarre to have scent receptors beyond the nose, but Dr. Hatt and other researchers point out that odor receptors are some of the most evolutionarily ancient chemical sensors in the body, able to detect a profusion of compounds, not simply those floating in the air. It’s also not clear whether olfactory receptors in the nose were the first to develop in our evolutionary past.

“They’re called olfactory receptors because we found them in the nose first,” said Yehuda Ben-Shahar, a biologist at Washington University in St. Louis who published a paper in 2014 year on olfactory receptors in the human lung, which he found act as a safety switch against poisonous compounds by causing the airways to constrict when we inhale noxious substances. “It’s an open question,” he said, “as to which evolved first.” [source]

The receptors operate as a lock-and-key system, where an odor molecule acts like a key to the receptors lock. Only specific molecules will plug into specific receptors. When the right molecule “clicks” with the matching receptor, it activates a complex set of biochemical reactions.

“If you think of olfactory receptors as specialized chemical detectors, instead of as receptors in your nose that detect smell, then it makes a lot of sense for them to be in other places,” notes Jennifer Pluznick, an assistant professor of physiology at Johns Hopkins University who discovered in 2009 that smell receptors in the kidneys of mice help regulate metabolic function and control blood pressure.

This isn’t the first time science has discovered smell receptors in a strange place. In 2003, Dr. Hatt and his colleagues found that olfactory receptors within the testes function like a biochemical guidance system, which allows the sperm to locate an unfertilized egg. And in 2009, the team also reported that subjecting olfactory receptors in the human prostate to beta-ionone, a scent compound found in violets and roses, slowed the spread of prostate cancer cells by way of turning off misbehaving genes.

“I’ve been arguing for the importance of these receptors for years,” said Dr. Hatt, who calls himself an ambassador of smell, and whose favorite aromas are basil, thyme and rosemary. “It was a hard fight.” [source]

Grace Pavlath, a biologist at Emory University, is also intrigued by unusually placed olfactory receptors. While studying the receptors in skeletal muscles, she discovered that by soaking them in Lyral — a synthetic fragrance similar to lily of the valley — muscle tissue regeneration was increased. When she blocked the receptors, muscular regeneration was inhibited, leading her to believe that smell receptors are an integral part of the biochemical signaling system, which prompts stem cells to morph into muscle cells and heal injured tissue.

These findings hold promise for the development of pharmaceuticals and cosmetics, such as a smell-based drug that helps to regenerate muscle tissue after an injury, or a topical cream that would accelerate wound healing. The researchers are hopeful that new and innovative ways to utilize olfactory receptors is just around the corner.

Your Car Door Windows Do Not Shield Your Skin, Eyes From UV Rays

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Prolonged exposure to the sun’s ultraviolet A (UV-A) rays has long been associated with increased risk for cataracts and skin cancer.

For many Americans who drive each day, their car’s front windshield protects them from the harmful rays. Findings of a new study, however, revealed that car door windows do not offer the same protection from the sun.

In a new research published in JAMA Ophthalmology on May 12, Brian Boxer Wachler, from the Boxer Wachler Vision Institute, analyzed the UV protection provided by glass in 29 cars that were produced between 1990 and 2014.

The researcher measured the levels of ambient UV-A radiation behind the cars’ front windshield and the side window and found that the windshield windows tend to provide good protection blocking 96 percent of UV-A rays on average. The protection, however, was lower at 71 percent and inconsistent for the cars’ side windows.

The research likewise revealed that only 14 percent of the cars have side windows that provide high level of UV-A protection, which could be to blamed in part for the increased prevalence of skin cancer on the left side of people’s faces and left-eye cataracts.

Based on his findings, Wachler said that automakers may want to consider boosting the amount of UV-A protection in the side windows of vehicles.

“Auto glass with UV-A protection would be expected to reduce the risks of disorders related to sun damage,” Wachler wrote in his study.

Jayne Weiss, from the Louisiana State University Eye Center of Excellence, explained that windshields provide more protection than car door windows because they are made of laminated glass designed to prevent shattering. The car door windows, on the other hand, are only tempered glass.

“Don’t assume because you are in an automobile and the window is closed that you’re protected from UV light,” Weiss said.

Although UV-B rays can be blocked by glass, UV-A is a longer wavelength of light that can go deeper into the skin and this can cause premature aging and even skin cancer.

Experts recommend using sunglasses that block both UV-B and UV-A lights as well as using long sleeve clothing and broad spectrum sunscreen particularly during long drives on sunny days. Drivers with older cars or those whose cars don’t have built-in protection can also buy special window tint products that provide shield against UV rays.

– See more at: http://www.techtimes.com/articles/158182/20160513/your-car-door-windows-do-not-shield-your-skin-eyes-from-uv-rays.htm#sthash.POc8G1k9.dpuf

Scientists grow skin that replicates function of tissue for first time

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Skin grown with follicles, glands and nerves could transform burns treatment and offer alternative to animal testing

Scientists seeking to replicate human skin, pictured, have grown functional elements for the first time.
Scientists seeking to replicate human skin, pictured, have grown functional elements for the first time.

Bioengineered skin complete with functioning hair follicles, glands and nerves has been grown using a new technique that could transform burns treatment and end cosmetics testing on animals.

Working with mice, scientists in Japan created the skin by first producing three-dimensional clumps of cells that resembled embryos in the womb.

They then implanted the so-called “embryoid bodies” into immune-deficient mice, where the cells developed further. Next, the maturing cells were grafted on to the bodies of other mice to complete their transformation into skin.

The end result was functional “integumentary tissue”, the deeply layered tissue that allows the skin to work as the body’s largest organ.

“With this new technique, we have successfully grown skin that replicates the function of normal tissue.

“We are coming ever closer to the dream of being able to recreate actual organs in the lab for transplantation, and also believe that tissue grown through this method could be used as an alternative to animal testing of chemicals.”

At the start of the study, cells taken from the gums of mice were turned into induced pluripotent stem cells by exposing them to a cocktail of chemicals that turned back their developmental clock. These were then coaxed to develop into EBs in the laboratory.

Previous attempts at growing skin from stem cells have only got as far as producing implantable sheets of epithelial cells, which formed the outermost skin layer but lacked functional elements such as oil-secreting sebaceous and sweat glands.

The skin produced by Dr Tsuji’s team made normal connections with surrounding nerve and muscle tissue and sprouted hair.

The research, reported in the journal Science Advances, brings effective regenerative treatments for patients with severe burns and skin diseases a significant step closer.

It could also provide an alternative to testing cosmetics and household products, such as detergents, on animals.

Animal cosmetics testing is illegal in the UK and other EU countries but continues in other parts of the world.