Mark J. Tager on Secrets to a Glowing Complexion

Mark J. Tager, M.D., instructs medical practitioners and consumers in new approaches to wellness, emphasizing the complementary treatment of chronic conditions and the use of personalized nutrition as a cornerstone of optimal health. His synergistic approach to skin health and beauty has been shaped by years working in the integrative, aesthetic and regenerative fields.

Tager received his undergraduate and medical training at Duke University and currently teaches at the school’s Integrative Medicine Center. He has served as founding vice president of marketing for Reliant Technologies, where he helped launch the Fraxel laser for skin rejuvenation, and also served in executive positions with Syneron and Lutronic, two leaders in advanced aesthetic technologies.

The author and co-author of 10 books and hundreds of educational videos recently created the 40-hour continuing education course “Personalized Nutrition for Practitioners” on behalf of the American Nutrition Association. His most recent book is Feed Your Skin Right: Your Personalized Nutrition Plan for Radiant Beauty, which serves as the basic content for the 10-hour online professional training program “Inside Skin Beauty”.

What are the characteristics of healthy skin?

Healthy skin begins with good barrier function. The epidermis—the outermost layer of skin—keeps water and key nutrients in and helps repel harmful agents such as bacteria and chemicals. Healthy skin has a glow that comes from good blood flow, rapid skin turnover, ample collagen and clarity—by this I mean skin that has been protected from harmful UVA/UVB rays to minimize aging spots and premature skin damage. Radiant skin reflects light, so when someone is taking care of their skin, there is literally a glow about them.

How does skin health relate to overall health?

Our skin is the largest organ in the body and a reflection of overall health. From 5 to 8 percent of the blood flow goes through the skin with each heartbeat. The skin communicates with the gut and brain via hormonal and electrical messages.

What foods do you recommend for healthy skin?

Make plants a central part of your diet. A wide array of colorful plants provides the body with key antioxidants that help ward off the effects of oxidation. Interestingly, many plant ingredients have a mild, skin-protective effect when eaten because their key function in the plant is to protect it from harmful UV rays. While the effect is nowhere near that provided by sunblock, you do gain a “natural SPF” [sun protection factor] of 3 or 4 from some of the yellow-orange carotenoid phytonutrients, as well as the red-purple anthocyanins.

The second benefit of plant-based foods is providing fiber to the body. In addition to promoting healthy bowel movements, fiber is the preferred food of the helpful gut bacteria. They convert fiber into, among other things, short-chain fatty acids which, in the gut, protect the lining, and, when they enter the bloodstream, help to maintain a healthy skin microbiome.

 I’m also a big fan of whole grains and fermented foods such as kimchi, sauerkraut and yogurts, as these are supportive of a healthy gut.

What are some supplements to take?

The key supplements for the body in general and the skin in particular include a good multi-vitamin/mineral that isn’t loaded with artificial flavorings, colorings, bulking agents or other chemicals. I recommend a separate omega-3 fatty acid supplement, which serves as the glue holding together the skin cells and fortifying the skin barrier; 1,000 to 1,200 milligrams of fish oil a day will meet most people’s needs.

Beyond that, some people will benefit from additional mitochondrial support in the form of COQ10, alpha-lipoic acid and Acetyl-L-carnitine. As we age, our mitochondria, the power plants of our cells, age as well. We see this reflected in the skin. Magnesium is critical for mitochondrial health, too, and many people are deficient in this. I like the threonate form of magnesium, as it crosses the blood-brain barrier and can help with cognition.

I’m also struck by how many older people are affected by enzyme deficiencies—amylases for starch, proteinases for proteins, lipases for fat. Our body requires enzymes to digest, absorb and metabolize food and macronutrients. As we age, we lose the ability to produce these key enzymes in large enough quantities. So, even if you eat a healthy diet, if the right enzymes aren’t present, you will not reap the benefits of the nutrients in the food.

Research is beginning to support the skin benefits of both oral and topical collagen peptides, which are clumps of amino acids that form as a result of heating up animal tissue such as cow, chicken or fish. At present, there is no vegetarian collagen.

What topicals do you recommend?

Topical skin care is a $180 billion global market, so the choices are astronomical. I’m a believer in a simple approach: a daytime and nighttime regimen that’s easy to do, doesn’t take a lot of time and provides effective protection, moisture retention and rejuvenation.

The night routine involves the application of a retinoid and a heavier moisturizer. Not everyone can tolerate retinoids, but for those who can, they aid in skin turnover, so this helps the skin become more translucent. The category of skin-rejuvenating products has exploded in recent years. I am a fan of vitamin C preparations, peptides, exosomes and growth factors.

The daytime routine involves sunblock. There are many good physical blockers with zinc, titanium and an SPF of 30 or more. A number of companies make great tinted moisturizers that can be used in lieu of foundation makeup. The key is to find one that you will use.

What aesthetic procedures should we consider?

I’m a big fan of fractional rejuvenation, which essentially produces small thermal wounds that heal quickly, leading to skin turnover and bringing heat into the dermis for collagen remodeling. Microneedling creates a similar effect, although it does not have the added benefit of the heat going into the dermis. There are multiple products that combine microneedling with radio-frequency heat, and this provides a dual action.

How do we personalize a plan to optimize skin health?

It starts with a hard look at your diet. There is no way that anyone can out-supplement a crappy diet. If you are working with a professional, they will take a careful, functional-medicine history looking for the medications that deplete key nutrients; get basic bloodwork that can shed light on imbalances; and closely examine the hair, skin and nails for nutrient insufficiency.

There are new tests that can shed light on personalization. One of these is a nutritional genomic test for skin health. This identifies the genetic variants that affect a host of skin-related processes, including the assimilation of vitamins and minerals; the rate at which collagen is broken down in the body; and glycation, the binding of sugar to collagen, making it more brittle and contributing to wrinkles. Then there are more advanced blood, urine, saliva and stool tests that can provide a snapshot of hormones, the microbiome and the metabolites that are produced in the body. Increasingly, these tests are going direct to the consumer, but I highly advocate having a well-trained professional help with the interpretation.

How does gut and skin microbiome testing relate to skin health?

The three to four pounds of bacteria in our gut produce more than 30 neurotransmitters, key vitamins and short-chain fatty acids. The gut communicates with the skin via these chemical messengers, but also through the nervous system, most notably through the vagus nerve, which sends signals to the brain. Ideally, we want to live in harmony with the good bacteria in the gut and support healthy communication.

There are less helpful bacteria in our gut, as well. These bacteria can proliferate and crowd out the good bugs. This is known as dysbiosis. Increasingly we are seeing specific changes in gut microbiome composition associated with conditions such as atopic dermatitis, psoriasis, acne and rosacea. Changes in diet, including the removal of offending agents, as well as the addition of nutrients that repair the skin barrier and probiotics, can help restore this balance. I think we are in an infant stage with our understanding of the skin microbiome. This will change.

What is a healthcare synergist?

Synergy is the ability to construct a large whole from disparate parts. Today, traditional health care is a series of silos. You go to the orthopedist for knee pain, the gastroenterologist for gut issues, the cardiologist for problems of the heart and blood vessels; rarely do people see a clinician who has a whole-person approach and looks across the different silos. Optimal health is a process of synergy. It’s not just one thing: one supplement, one type of exercise, one perfect food. It is the process of making small changes that synergistically create large benefits, benefits that often don’t accrue with a reductionist framework. This is how I’ve always viewed health care. Today there is a growing movement of integrative and functional medicine that is reshaping this paradigm.

Sandra Yeyati is national editor of Natural Awakenings. 

This article appears in July 2024 issue of Natural Awakenings.