 Hey, everybody, Dr. O here. We're going to have some real talk about loose skin. Losing weight and reclaiming your health is one of the most amazing feelings in the world, but not all the glitters is gold. Some people who lose a significant amount of weight end up having to deal with a lot of loose skin, and loose skin is a common frustration for people who have lost a lot of weight. It is also a major fear for people who are considering weight loss. I've actually been surprised by the fact that I get more questions about loose skin than any other topic. I receive a lot of questions about a lot of things, but honestly, the number one question I get is about loose skin. So I'm going to cover the science behind loose skin in this video, as well as science-backed strategies to minimize loose skin or avoid it all together in the rest of this series. But let me speak from the heart first. There's a reason that it's taken me a while to get to this. Many people are so afraid of loose skin that they don't start a weight loss program at all. If that is how you feel, then you are the reason I finally made this video, after dozens of people have asked me to. I want you to feel confident that you can control the amount of loose skin that you end up with along your weight loss journey, but I also want to put loose skin into the correct context. I have some loose skin. I lost 180 pounds of fat in 365 days. Some loose skin was inevitable, but I don't have near as much as I expected, and I have less and less of it as time goes on. People that meet me now are actually shocked that I used to weigh 414 pounds because I don't show many signs of it. These here are the pictures of you go to the college that I teach at. These are the pictures that were on the wall, and I had to get a new picture because nobody recognized me anymore. I will share everything that I did and continue to do to minimize loose skin on this video series. But I'm not trying to promise you a miracle. The loose skin that I do have doesn't impact my life in any way. There's no skin irritation, no impact on physical activity at all. Let's start by talking about the best way to never get loose skin. I need to be real with you here for a minute. I will share loads of ways to reduce loose skin in this series, but there is only one guaranteed way to not get loose skin, and that's to stay fat. This guy here didn't have to worry about loose skin at all, but he did have to worry about dying before the age of 55, leaving his wife without a husband, leaving his kids without a dad. That had to be my priority. I wear the loose skin that I do have as a badge of honor. I would much rather have some loose skin than 200 pounds of extra fat on my body. Listen, I am not trying to downplay your concerns one bit. Your concerns and your fears are valid, but loose skin won't kill you, being obese will. Please take that to heart and know that it truly does come from a place of love. Here's how I think about it personally. I take my walks and I think about things and I made this story up in my head or this example. Not losing weight because you're worried about loose skin is kind of like not wanting to win the lottery because you're worried about having to pay taxes on it. It may not be ideal, but you're still in a much better place. Just like with weight loss and loose skin. It may not be ideal, but you're still way better off with some loose skin and I'm going to try to show you how to minimize it than dealing with obesity and metabolic disease. If you really don't want to win the lottery, you can feel free to pass those winnings on to me if you ever happen into it. I want you to celebrate every step of your weight loss journey. It breaks my heart that people are sad about loose skin rather than proud that all of their hard work has finally paid off. If that is you, I am proud of you. I know how hard you've worked. I know the work you've put in because I've put it in myself. I've been right alongside you the whole time. Now let's see what we can do about loose skin together. Why do we even get loose skin? We have to start there because that impacts the solutions that we're going to go after. In this video, we're going to look at what causes loose skin and we're going to look at risk factors for loose skin, which include genetics, age, the amount of weight you lose, the rate of weight loss, and then your poor lifestyle choices. I'm definitely going to share a lot of my opinions about the rate of weight loss because that's one of the most common questions I've got when people found out that I lost 165 pounds in one year. That brings up that part of the conversation. I'm going to share several important tips to decrease loose skin in this video, but parts two and three are going to be where the real magic lies. I'll cover the role that exercise and autophagy from fasting play in reducing loose skin in part two, and then I'll cover collagen and other important skin nutrients in part three. Please reach out though. I say that all the time, but I really want you to tell me any questions you have about loose skin or are there any specific treatments that you want me to address? Things like red light therapy, skin brushing, et cetera. I want to know what questions you have because then I'll add that to the videos coming up. I won't finish this video series until I've answered all of your questions and dealt with all your concerns. Why do we get loose skin? Here's a picture from the OpenStacks Anatomy and Physiology textbook that I teach from, but don't worry, there won't be a test. This is skin. The skin you see on the outside is called the epidermis. The dermis is what connects the skin that you see to the rest of your body. It's a mesh of fibers, as you can see from that picture, made of collagen and elastin. Collagen, which makes up about 80% of your skin structure, that's what provides firmness and strength. Elastin, like the name implies, provides elasticity and helps keep your skin tight. What's elasticity? Elasticity is when something stretches out and then recoils and returns to its normal shape. We're hoping that our skin is elastic. Loose skin is plastic. Loose skin is when you change the shape of something and it deforms. We want to make sure our skin is as elastic as possible. Our skin stretches when we gain weight, just like filling up a balloon with extra air. This stretching weakens and damages these collagen and elastin fibers. The skin then has a hard time bouncing back easily after a significant weight loss. The elastic tissue has lost some of its elasticity. Think about an old pair of underwear. My wife probably doesn't want me sharing this, but think about an old pair of underwear that's lost its elasticity. Either if you've worn a pair of underwear for a long period of time or you've lost weight, your underwear just won't snap back like they used to. My wife hates when this happens. That's why my favorite underwear have always disappeared, especially during my weight loss journey. Once they get a little stretchy, I think I've just broken them in and I really like them, but that's when they disappear because they've lost some of their elasticity. Your favorite underwear can't snap back when you get smaller, which is why you have to buy new underwear or buy a smaller size. This is the same reason why you might get loose skin with weight loss if it doesn't snap back like you want it to. Let's look at some of the science here. What does the science have to say? Image analyzer study of the skin and patients with morbid obesity and massive weight loss. In this one, they took skin biopsies from 30 patients. Here's a quote. Collagen was significantly thinner in the massive weight loss group in both the papillary and reticular dermis. Those are just the two layers of the dermis. Don't worry about it. And significantly less dense in reticular dermis with damage to the elastic fiber network. So what's that saying in English? Thinner collagen, damaged collagen, damaged elastin. The two compounds we need to keep our skin tight and elastic. This thinning of the collagen and damage to this elastin network can leave your skin looking like crumpled up tissue paper. That's how people describe loose skin. Now let's move on. Let's look at some of the risk factors that should make you more concerned about avoiding loose skin as you lose weight. So what are your chances of having loose skin at the end of your weight loss journey? Number one, loose skin risk factor is genetics. Not everyone who loses weight will experience loose skin, just like not everyone who gains weight will have stretch marks. That's because there is a genetic component we can't control. Some people are blessed with really nice elastic skin and others are not. But we can't pick our parents. But if the people in your family who have lost weight ended up with a lot of loose skin, you are at a higher risk yourself. But I don't focus on what I can't control. Let's try to focus on what we can. Pardon me. This is also why I can't tell you that what worked for me will work for you. Some people do everything right and end up with loose skin. Some people do everything wrong and don't have any loose skin at all. So genetics do play a big role. So all that I can do is point you down the most science backed path that I can find. Number two, loose skin risk factor is age. Simply put, young skin bounces back better than old skin. Your body produces less collagen as you get older. We produce about 1% less collagen in our skin every year after the age of 20. This means that we've lost about 25% of our skin's collagen by the age of 50. This makes loose skin more likely. We'll also talk about how stimulating autophagy is even more important as we age since our older cells have more damage and debris. Our cleanup crew has more cleaning to do. But the good news is autophagy works just fine in older skin as long as you know how to actually trigger it. Another study, what does science say here? Full of age associated alterations of the dermal extracellular matrix microenvironment in human skin aging. A mini review. This is a review. So a quote, during aging, dermal collagen fibrils undergo progressive loss and fragmentation leading to thin and structurally weakened skin. So this is why our skin gets worse with age. But age is another factor that we can't control. We can't choose our parents and we don't have a time machine. But we work with what we have. The best time to start losing weight for me and maybe for you was 20 years ago, 30 years ago. But the second best time was the day that I actually started two and a half years ago. So we can't control it, but we're going to live with it and we're going to deal with it. The next loose skin risk factor is the amount of weight loss. This also makes sense. The more weight you have to lose, the greater the amount of loose skin you can potentially expect. Your skin has to stretch and adapt when you gain weight. The more stretching has occurred, the harder it will be for your skin to snap back. Another study, skin changes after bariatric surgery. So this would involve rapid weight loss as well as a large amount of weight loss. Recent studies demonstrated that major weight loss is associated with damage in some components of the cutaneous, meaning skin, extracellular matrix, particularly elastin fibers and collagen, which lead to higher rates of complications and poorer aesthetic results, which is what they're talking about there with loose skin. So we keep hearing collagen, elastin, collagen, elastin. Well, that's why we're talking about it, because in the solution videos, we're going to talk about how can we improve collagen and elastin formation and function. Another loose skin risk factor is the rate of weight loss. So finally, we have one that we can control. Rapid weight loss puts you at increased risk of loose skin. One problem with losing weight quickly is it doesn't give your skin enough time to contract back to its original shape. It takes time for your collagen and elastin fibers to snap back and return to the normal shape if they're going to it all. So slow your weight loss if you want to minimize your loose skin. Let's say you're older, maybe you have poor skin genetics, maybe you have a lot of weight to lose. Well, you may want to slow your weight loss down than to minimize how much loose skin you end up with. Give your skin some time to adjust to the smaller you as you go. And this is a big but. I don't really know what to think of this. This is kind of the hardest part of this video for me to talk about. Why? Well, the good news is that slowing your weight loss leads to the potential for less loose skin, but we really don't know how much it'll help. I haven't seen randomized controlled trials that have people lose the same amount of weight over a faster or slower timeline and then actually seeing the end results. So it might help, but it might not. The bad news is slowing your weight loss might decrease the chances that you actually reach your goal. And it might not even matter in the end. That's what I mean by this. People who lose weight quickly typically have a lot of weight to lose. So it's hard to tell if it was the speed of weight loss or the amount of weight loss that increased the risk of loose skin. Really slowing your weight loss down to protect your skin will have to be a personal decision. As for me, I'm glad that I lost weight quickly. I transformed my health over a short period of time and the quick rate of weight loss is what motivated me to stick to the plan. I fear that slowing your progress down too much might cause some people to give up. So I personally wouldn't trade a little bit of loose skin for doubling the amount of time that it took me to lose the weight, but you will have to make that decision for yourself. I'm definitely not saying it's a bad idea. There's lots of reasons to want to lose weight slowly. I just can't promise you that if you purposely slow your weight loss that you won't have loose skin at the end of the journey. So what's the science say here? Skin protein profile after major weight loss and its role in body contouring surgery. This study showed that there was a persistent increase in inflammatory markers in skin after rapid weight loss. So your skin is inflamed when you lose weight really quickly. So we'll talk about how an anti-inflammatory compounds might help. It also showed a decrease in a type of collagen called collagen 14, as well as an increase in what's known as immature type 3 collagen. Don't worry about that, but again, rapid weight loss seemed to change the type and amount of collagen that was in the skin. So we will come back to this point later in the series when we are talking about collagen. All right, so we were talking about rate of weight loss here. All this being said, you know by now that I'm a huge fan of losing fat as fast as you can without losing any lean mass like muscle. So I want you to be very smart about how quickly you lose weight. I just have different priorities, right? When I tell you to slow your rate of weight loss, I'm telling you to do it so you don't lose muscle. But if you do, if you slow your rate of weight loss, you may also protect your skin as well. So I talked more about the importance of rate of weight loss here for preserving your muscle mass and your metabolism in this video if you want to watch it. All right, the last risk factor or group of risk factors for this video, poor lifestyle choices. I can't cover these in detail here, but anything that is bad for your skin will make you more likely to have lose skin after weight loss. I can certainly expand on these in future videos if you have questions, just ask. So we see excess sun exposure, smoking, dehydration, stress, poor sleep, a nutrient deficient diet, and sugar consumption. So let's talk about a few of these. Excess sun exposure does reduce collagen and elastin production of the two key ingredients to healthy skin. Getting too much sun or getting enough sun to damage your skin will decrease the two main ingredients we need. So that's a bad idea. Smoking, not only does smoking damage the collagen you do have in your skin, it actually reduces the production of new collagen. So getting too much sun and smoking, both really bad ideas. Let's look at sugar a little bit as well. I have a couple of things I want to show you here. So what's the science say about sugar and skin health? So dietary sugars and endogenous formation of advanced glycation and products, emerging mechanisms of disease. So advanced glycation and products are just basically proteins that are damaged by glucose in your body. So too much sugar accelerates skin aging by forming cross-linking collagen fibers. So the collagen you do have is just not as healthy as it should be. Cross-linking prevents your skin from properly regenerating, which is what we're trying to do. We're trying to regenerate more elastic, tighter skin as we lose weight. So here's a quote, emerging evidence indicates that high dietary simple sugar consumption can represent a substantial source of endogenous ages or advanced glycation and products. And then also there's research that shows that fructose, and all the research shows this, fructose is more reactive than glucose in generating these glycation precursors. So a diet high in sugar, like table sugar, which is glucose and fructose, or a diet high in high fructose corn syrup could actually accelerate this problem, this accelerated skin aging. Another one, advanced glycation and products in the skin, molecular mechanisms, methods of measurement, and inhibitory pathways. So let me read a quote, and then I'm gonna tell you my favorite story to kind of explain this glycation damage. So advanced glycation and products easily accumulate in the extracellular matrix of the dermis, changing the balance between the synthesis and degradation of the extracellular matrix and ultimately leading to impaired skin homeostasis. And we want to break down old skin, synthesize new skin, advanced glycation and products get in the way. All right, throw it still a little dry from the guinea pig, I think. So let me, so what's the most famous example? So if you're wondering, what is this? Well, have you ever gone to the doctor and had your hemoglobin A1C tested? That's actually a test of glycation, right? So the most famous example of glycation damage is the damage that your red blood cells are undergoing because of the glucose or sugar in your blood, right? So the higher your hemoglobin A1C, the more glycation damage these cells have actually taken. So they can look at your red blood cells and look at how damaged they are because of glucose and they can estimate what your average blood sugar has been over the last couple of months. So my grandfather, this is the story I tell my students in the classroom, my grandfather was a bomber pilot during World War II and he flew some pretty scary missions in Romania at the Ploesti oil fields. But so he would go out and fly and they would take damage, then they would come back. Basically, you could estimate how bad of a fight it was by looking at how much damage my grandfather's bomber had taken. So it's the same thing at looking at your red blood cells and looking at how much damage they're taking and knowing what the average blood sugar has been. So glycation is bad and having too many of these advanced glycation end products also bad. So if you clean up your diet, you'll improve your skin health. We'll talk a lot more about nutrition in part three. Okay, so now we know why we get loose skin and we know who's most likely to have extra loose skin but what do we actually do about it? So I wanna talk about what I did to minimize loose skin while I lost 165 pounds in a year in the rest of this series. So I'm super excited about it but in the next video, this will be the main one. The most common questions I get and the most common answers that I give are about autophagy when it comes to loose skin. So in the next video, we're gonna focus on how autophagy allows our body's cleaning crews to remove damaged proteins that interfere with our skin's ability to regenerate and tighten up and snap back. I'll also cover the importance of adding muscle to fill in the skin that fat has left behind. Then in part three, we'll cover the importance of feeding your skin the nutrients that it needs to tighten up and heal. We'll talk about quite a few of them but collagen will be the really big one. And in part four, we'll cover other miscellaneous things that I've tried as well as things I'm doing now to continue to improve my skin moving forward. So please ask questions. I wanna leave no stone unturned because I know this is an important topic to many of you based on how many conversations I've had with you about it. So I wanna know all your questions and concerns so I can help answer them. All right, I hope this video helped. I hope that this whole series helps you. Feel better about your weight loss journey because that's what I really care about. So you have a wonderful day. Be blessed.