The Wrinkle Cure: Nicholas Perricone, MD

Last Editorial Review: 10/23/2003

By Nicholas Perricone
WebMD Live Events Transcript

The opinions expressed herein are the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Think the only way to look younger is to go under the knife or Botox needle? Think again, says Nicholas Perricone, MD, author of The Wrinkle Cure. We talked with Perricone about his skin care and diet regimen.

Moderator: Hello, Dr. Perricone. Welcome to WebMD Live. How are you today?

Perricone: Fine, thank you for inviting me today.

Moderator: What are the five worst things we do to our skin?


  1. Sun exposure
  2. A pro-inflammatory diet (That consists of sugar and starches)
  3. Cigarette smoking
  4. Lack of sleep
  5. Excess alcohol consumption

Moderator: How does eating simple carbs affect your skin?

Perricone: Scientists have established that anything that causes a rise in our blood sugar results in inflammation on a cellular level, and I believe that inflammation is at the basis of virtually every disease process such as cancer, Alzheimer's disease, heart disease, and wrinkled skin. In addition, when our blood sugar goes up rapidly and continually, the sugar can actually attach to the collagen in our skin, making it stiff and inflexible. There is a scientific term for that: glycation. When your collagen is cross-linked by sugar, you end up with stiff and sagging skin. I believe that 50% of aging of the skin is the result of this glycation reaction. Beginning with lack of sleep, when we do not get enough sleep it results in elevation of a hormone called cortisol. Now cortisol, even though it is an essential hormone in the body, in excess quantities is called the "death hormone." It has a lot of negative side effects. It actually breaks down tissue. For example, it can break down muscle tissue, thin our skin, decalcify our bones, and elevate our blood sugar. Of course, when blood sugar is elevated we are in an inflammatory state. On the days we do not get enough sleep, we tend to crave carbohydrates, and that's because cortisol raises blood sugar and insulin levels, setting up this craving.

Moderator: What do the other things you mentioned (sleep deprivation, sun exposure, alcohol consumption and smoking) do to our skin?

Perricone: If you truly want to maintain a youthful appearance, it is essential to get enough sleep. We should also mention that when we are getting adequate sleep, we release another hormone that is actually a youth hormone called human growth hormone. Human growth hormone does exactly the opposite of what cortisol does -- that is, it builds us up rather than breaking us down. It results in increased muscle mass, thicker skin, stronger bones, and an overall more youthful body.

Looking at cigarette smoking, we know that by inhaling just one puff of one cigarette, we create three trillion free radicals in the lungs. Free radicals are a bad form of oxygen that attack our cells and produce a tremendous inflammatory response. In addition, cigarette smoke causes blood vessels to constrict, especially in the skin, resulting in lack of oxygen and nutrients, which accelerates skin aging. We are all aware of the fact that cigarette smoke increases chances of lung cancer, but it also greatly predisposes us to heart disease.

Alcohol in excess results in a rapid and sustained increase in blood sugar, which we now know is pro-inflammatory and causes the glycation reaction. In addition, alcohol is metabolized by the liver to toxic chemicals called aldehydes and ketones, which are toxic to cells and are pro-inflammatory. Alcohol also dehydrates us, and when we are dehydrated, our skin looks terrible and we are also in a pro-inflammatory state that accelerates the aging process.

When we walk out into the noonday sun during the summer, within five minutes the sunlight creates free radicals in the skin. This results in an inflammatory cascade that accelerates the aging process, causing wrinkles, precancers, and cancer as well as discoloration. We must not expose ourselves to sun for long periods of time. In addition, we should use a sunscreen on a regular basis.

Finally, eating a diet that is rich in antioxidants such as vitamin C, vitamin E, and others can help protect us from free radical damage. I believe it would also be wise to place a lotion on the skin in addition to sunscreen that has antioxidants as part of the formula, such as a vitamin C, E or alpha-lipoic acid cream.

Moderator: It sounds as though diet is at the heart of caring for your skin. Can you please explain your "Three-Day Diet for Better Skin" -- do special "face-changing" foods really visibly change the way you look in just 72 hours?

Perricone: The three-day diet is a perfect example of food groups that act as natural, powerful anti-inflammatories. The diet consists of eating the following meal twice a day for three days in a row, with the remaining meal of the day following the concepts of staying away from pro-inflammatory foods.

The first important item in this anti-inflammatory meal is salmon. Salmon is important because it is high in protein and we need protein to repair our cells. It has been my experience in my practice that women tend not to have protein-adequate diets, and this results in accelerated aging. In addition, salmon contains high amounts of an essential fatty acid classified as an omega-3 oil. Omega-3 oils are powerful, natural anti-inflammatories that nourish the brain and therefore can alleviate mental depression, nourish the immune system, and therefore help prevent infection and cancer. And essential fatty acids nourish the skin, giving it a radiant and beautiful appearance.

One of the biggest mistakes that a person can make is to follow a low-fat or no-fat diet. You must have adequate amounts of essential fatty acids to be healthy and it should be understood that good fat helps burn body fat. That is, we can actually lose fat by eating the right kinds of fat. The trend of the no-fat diet in this country is responsible for ill health, mental depression, increased cardiovascular risks, and obesity, and is because of misinformation that people have received. Salmon is an incredibly excellent source for the omega-3 essential fatty acids.

Salmon also contains another important nutrient called DMAE. DMAE is the substance that's probably responsible for grandma telling us to eat fish because it is brain food. DMAE is known as a cognitive enhancer -- that is, that it can improve memory and problem-solving ability. It does so because it improves nerve function. Now, we all know that nerves are not just in our brain but also carry messages to our body -- for example, our muscles -- and therefore, we need healthy nerves to maintain good muscle tone. Aging is characterized by wrinkling and sagging. We really did not have a way of treating the sagging component of the aging process except for invasive cosmetic surgical procedures. DMAE, when eaten in larger amounts, can increase muscle tone and therefore decrease the appearance of sagging. As a side note, DMAE can be placed into a lotion form and applied to the skin to decrease sagging and increase muscle tone.

The second portion of this anti-inflammatory meal is a dark-green salad such as romaine lettuce with olive oil and lemon juice as a dressing. The reason for this is that the dark-green lettuce contains antioxidants that act as natural anti-inflammatories, and in addition, these dark-green vegetables such as romaine lettuce also contain small amounts of essential fatty acids such as omega-6. The olive oil is recommended because it contains a small amount of essential fatty acid but a larger amount of a fat called oleic acid. Oleic acid helps the cells absorb essential fatty acid more efficiently. Olive oil also contains a high level of a class of antioxidants and natural anti-inflammatories designated polyphenols. The polyphenols are responsible for the health benefits of the consumption of olive oil, which indicates that it may decrease our risk of heart disease. Lemon juice instead of vinegar has greater amounts of natural antioxidants like vitamin C and bioflavonoids.

The dessert portion consists of a serving of mixed berries such as raspberries, blueberries, and strawberries, and a slice of cantaloupe melon. These fruits are loaded with antioxidants, which act as natural anti-inflammatories, and it should be emphasized that bright, colorful foods contain high levels of antioxidants. In addition, these berries will not cause a rapid rise in blood sugar that may be characteristic of other fruits such as bananas. The cantaloupe melon contains vitamin A, which is a natural anti-inflammatory, and it helps nourish the skin, and cantaloupe also contains a large amount of water, which helps hydrate us.

Finally, we must drink eight to 10 glasses of pure water a day (no, diet sodas and coffee don't count!). When this meal is eaten twice a day three days in a row and the other meal consists of a good source of protein, essential fatty acids, and healthy fruits and vegetables that will not cause a rapid rise in blood sugar, there will be a tremendous difference in your appearance and the way you feel. There will be such a difference you'll be so radiant that when you walk into a room, you will get comments about how great you look and questions about what you have done. You will also notice mental clarity, an elevation in mood, and energy that will complement the way you look. The difference in your appearance is so obvious that if you do before and after photographs, you will be impressed at the difference in your appearance.

When we decrease inflammation in the body, the brain works better, your mood is elevated, your skin becomes more radiant, dark circles and puffiness under the eyes resolve, skin becomes more toned and even fine lines can diminish. We must remember that the skin is a reflection of our internal health. Therefore, if our skin improves, all other vital organs also improve. This decreases our risk of every disease that we suffer from.

Member: What about tea?

Perricone: If we just substitute green or black tea for coffee in our diets, I predict that in 6 weeks without changing anything else, you will loose 7 to 8 pounds of body fat. In addition, green tea contains substances that help relax us and elevate our mood and counteract the negative effects of the small amount of caffeine that is present. In addition, coffee elevates cortisol levels, which can accelerate the aging process. Therefore, I'm allowing tea as part of the 8 to 10 glasses of water required a day.

Member: I take herbal supplements in my water intake during the day -- does that not count as "pure water?"

Perricone: There are so many possibilities in terms of ingredients in herbal supplements that it is difficult to determine if this would be suitable. I recommend getting your water in a pure form with no additives.

Member: Can salmon be replaced by anything? I really hate fish of any kind.

Perricone: This is a common question and you can take fish oil capsules to obtain the omega-3 oils. The problem is there are many essential fatty acids that I believe have not yet been identified by scientists, and therefore, you would be missing out on the unknown therapeutic affect of eating a wonderful fish like salmon. What I do with my patients is ask them to cut the salmon into small squares and then put them in their mouth and swallow them like a pill with water. They can actually get four ounces of salmon down like that, and when they start feeling the effects, they realize, "you know what, I really don't hate fish all that much." They inevitably find that it tastes pretty good and they stop the pill-like method and switch to normal chewing.

Member: What if I don't eat meat?

Perricone: You can get adequate amounts of protein by eating fish and soy products. I do not think that vegetarians age well because without sources of protein like fish and meat, they must obtain their protein from sources that have a high carbohydrate content. This results in elevated blood sugar, inadequate high quality protein, and accelerated aging.

Member: What sunscreens do you recommend, and how do you feel about self-tanners?

Perricone: Self-tanners are actually a harmless and easy way to increase pigment in your skin without causing damage. There are many sunscreens to choose from, and you must find one that is compatible with your skin. Many people are allergic to specific sunscreen components yet they are perfectly fine with another sunscreen. My favorite sunscreens are called physical sunscreens as opposed to chemical sunscreens. Physical sunscreens are nothing more than tiny little particles made out of zinc or titanium that act as tiny mirrors that reflect the sun's rays. Chemical sunscreens, by contrast, work by interacting with the skin cells and absorbing the sun's energy and protecting cells in that manner. I feel physical sunscreens, because they do not interact with the cells, are more desirable.

Member: Is there any hope for me after lying out in the sun for 30 years now? My skin looks like I was burned with hot water!

Perricone: The skin and the body have an incredible ability to repair themselves. I have seen studies looking at sun-damaged skin after two years of sun avoidance and the results were quite impressive. In addition, I would recommend eating the anti-inflammatory diet as outlined in my book. I would also strongly suggest taking nutritional supplements in the form of capsules that are powerful antioxidants and anti-inflammatories such as vitamins C, E, alpha-lipoic acid, and coenzyme Q-10, as this will also help to repair your skin. Finally, I would also recommend applying lotions with powerful antioxidants in them such as alpha-lipoic acid, vitamin E, vitamin C ester, or DMAE.

Moderator: Your book is The Wrinkle Cure: Unlock the Power of Cosmeceuticals for Supple, Youthful Skin. What are "cosmeceuticals"?

Perricone: The term cosmeceuticals was created to describe a topical cream that is a cosmetic because it is using natural substances such as vitamin C ester or alpha-lipoic acid. Yet, because of its efficacy, it works more like a pharmaceutical.

Member: I have read your book, seen your PBS show, and tried a lot of your products in your little black bag from Sephora. If I can only afford 1 or 2 products, what do you suggest? I'm a female in NYC, 41 years old.

Perricone: I would suggest alpha-lipoic acid, face-firming activator applied in the morning, and vitamin C ester concentrated restorative cream applied in the evening. These two products are extremely effective and they both contain DMAE, which will treat the sagging component of aging skin.

Member: How do I reduce the wrinkles under my eyes?

Perricone: I believe you must follow the three-tiered program in the wrinkle cure. That is, you must follow the anti-inflammatory diet. You should take nutritional supplements that contain antioxidants, and finally, apply topical lotions that contain alpha-lipoic acid, vitamin C ester, and DMAE. These substances come in a form specifically designed for the delicate tissue surrounding the eyes.

Member: I have moderate ichthyosis and am 44 years old. I have been following your diet and supplement plan for four weeks now. I have also just purchased your Vitamin C Ester Amine Complex Face Lift with DMAE and your Face Finishing Moisturizer with DMAE. Do you have any special recommendations as to the ichthyosis?

Perricone: Ichthyosis is a skin problem characterized by a collection of scales. The most effective treatment for the common form of ichthyosis is the use of topical glycolic acid, which is an alpha-hydroxy acid readily available in products at pharmacies as well as upscale department stores and health food stores. The alpha-lipoic acid face and body lotions contain a small amount of glycolic acid and may be of benefit. There are many lotions available that contain just glycolic acid at higher levels if needed.

Moderator: Dr. Perricone, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Perricone: The Wrinkle Cure is a book that discusses much more than just wrinkles. What I am trying to do is get my readers to understand that beauty and health come from the inside out. The Wrinkle Cure uses vanity as leverage to get us to do the right thing. This will result in not only beautiful, radiant skin but will decrease our risk for all the major diseases that destroy the quality of our lives and shorten them considerably. You can control the rate at which you age by following this program, and I am not saying that you will live to be 100; however, my goal is to have you live a life that is independent and allows you to pursue your goals up until the last few days or hours that we have.

Therefore, we can live to age 75 or 80 and never be a burden to ourselves, our families, or our society because we can prevent those events that make us dependent. I wish you all a healthy and happy future.

Moderator: We are out of time. I'm sorry we couldn't get to all of your great questions. Thank you, Dr. Perricone, and thank you, members, for joining us today. For more information, please read The Wrinkle Cure: Unlock the Power of Cosmeceuticals for Supple, Youthful Skin, by Nicholas Perricone, MD. You can also visit his web site at or

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