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Alpha Lipoic Acid Please Read!

Erase Your Ugly Scars (Best Treatments!)

One of the most difficult challenges that we dermatologists must contend with is finding effective treatments for scars. Acne, for example, can cause both scarring and pitting that can last a lifetime.

This is why it is so important to halt the beginnings of acne lesions before they turn into full-blown papules or pustules. This means fighting the inflammation that results in the acne lesion on a cellular level -- even better, preventing the inflammation right from the start.

You may be thinking to yourself, �Why is this so important?� After all, what�s the big deal about a few pimples, really, other than the insult to our vanity?

The fact is that if acne is allowed to continue unchecked, being treated only when it becomes visible, the invisible inflammation at the cellular level results in white blood cells surrounding the follicle to destroy tissue. Once this tissue is broken down and repaired by the body, we end up with either atrophic scars (deep, indented scars resulting from collagen loss) or hypertrophic scars (bumpy scars made up of an excess of collagen).

Even worse, very large lesions may result in huge scars known as keloids, which are extremely difficult to treat. The good news is that, armed with a little knowledge, we can prevent acne lesions from ever reaching this stage. As my readers know, acne is an inflammatory disease. Therefore, to successfully prevent and treat acne, we must adopt strategies proven to reduce inflammation in the body. This means following the anti-inflammatory diet and taking nutritional supplements, such as anti-oxidants, which have powerful anti-inflammatory properties. Of equal importance is the twice-daily application of topical anti-inflammatories after a thorough but gentle cleansing.

One of my most exciting discoveries came about almost by accident. Several years ago, I met with Rebecca, a new patient interested in starting an anti-aging regimen. At 34 years of age, Rebecca was already a top editor at a highly regarded beauty and fashion magazine. In fact, we had met when she interviewed me for a feature story on my first book, The Wrinkle Cure.

Although Rebecca did not have loss of skin tone or deep wrinkles, fine lines were beginning to appear in the eye area. She was also losing that radiance and bloom of youth that characterizes the skin of women in their teens and twenties. I started Rebecca on a regimen of topical antioxidants with an emphasis on two of my favorites: alpha lipoic acid and DMAE. I recommended that Rebecca apply Alpha Lipoic Acid Face Firming Activator to her face and neck morning and evening. At our follow-up appointment six weeks later, Rebecca was bubbling with happiness. "You will not believe this Dr. Perricone," she enthused. "Everyone is raving about my skin -- and that�s not all. The linear scar that was under my eyebrow has all but disappeared!"

Inspired by Rebecca�s success, I speculated that this combination of alpha lipoic acid and DMAE may help in the treatment of the scars and pitting of the skin that can occur from acne. I conducted several studies in my office with very satisfying results. Since that time, alpha lipoic acid�s ability to greatly diminish the appearance of scars has been tested many times.

Studies have been completed showing that alpha lipoic acid indeed can prevent and reverse scar formation. A double-blind, placebo-controlled study by plastic surgeon D. G. Genecov, M.D. and his group applied a lotion containing both alpha lipoic acid and DMAE twice daily to the scars generated by cleft lip palate surgery on the upper lip of children. The children's parents applied the cream twice daily, not knowing whether it was an inactive base or the cream containing alpha lipoic acid. After one year, the results revealed that those receiving the alpha lipoic acid -- DMAE lotion had much diminished scar formation. Their lips appeared almost normal, as opposed to those receiving the placebo.

This study is important, because it illustrates that we can prevent serious scarring and the accompanying deformity without resorting to invasive procedures that may provide only marginal results. Thanks to studies such as these, I believe this powerful alpha lipoic acid/DMAE combination will be used on a regular basis in the future to help prevent and treat scar tissue.

It is not surprising that alpha lipoic acid would work on scars as well as wrinkles -- and here's why:

Alpha lipoic acid stops the activation of NF kappa B, thereby suppressing the inflammatory response within the cell. In addition, alpha lipoic acid also controls a transcription factor called AP-1. AP-1 is activated when a cell is under oxidative stress -- that is, when there is an excess of free radicals and not enough protection from antioxidants. Once activated, AP-1 heads straight for the nucleus of the cell, where it activates the genes that control the production of enzymes that can digest collagen. This digestion of collagen is actually one of the causative factors in the birth of a wrinkle.

It is also important to note that alpha lipoic acid exerts an even greater action on AP-1, and it is this: You see, while AP-1 can be activated by destructive free radicals, it can also be activated by alpha lipoic acid! On the face of it, this does not sound like good news. However there is a significant difference in its effects, depending on what activates AP-1. When AP-1 is activated by alpha lipoic acid, the enzymes activated by AP-1 digest only damaged collagen. Because scars are made up of damaged collagen, alpha lipoic acid can actually reverse existing scar tissue.

A discussion on scars is an ideal place to dispel a very common myth in dermatology. And, that is that patients with a darker complexion have less sensitive skin than the lighter skinned northern Europeans. Actually, the reverse is true! One of the biggest problems plaguing African American skin is a hyper-inflammatory response in the skin to the slightest injury. Thus a single acne lesion will often result in the formation of an atrophic (indented) scar or a hyper-trophic or keloid scar larger than the actual lesion itself.

This occurs because the cellular response to injury in African Americas results in the greater production of pro-inflammatory chemicals and collagen damaging enzymes. I strongly advise my African American patients to fully embrace the anti-inflammatory lifestyle. I also recommend they use a topical alpha lipoic acid/DMAE combination to prevent the appearance of scarring, a gray or ashy appearance and uneven pigmentation.

When it comes to scars on the body, whether they be from acne (the upper back and shoulder area is particularly susceptible) or from an injury or trauma, I have had excellent results with a substance known as Polyenylphosphatidyl Choline. Phosphatidyl-E with Tocotrienols HAND AND BODY. This highly emollient and soothing substance is derived from lecithin (a natural food substance) and possesses anti-oxidant and anti-inflammatory properties. When combined with DMAE and applied to scars topically in a penetrating base, the results are very satisfactory -- and continued applications result in a significant diminishment in the appearance of the scar.

If your goal is to keep your skin as young and supple as possible and diminish the appearance of unsightly scars along the way, topical alpha lipoic acid/DMAE combination could be what you are looking for. Best of all, because alpha lipoic acid is known as the �universal antioxidant,� it is the ideal treatment for complexions of all colors, tones and types.

As always I welcome your comments, letters, emails and photos.

Warm regards,

Nicholas V. Perricone

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Your Guide to Quackery, Health Fraud, and Intelligent Decisions

A Skeptical View of the Perricone Prescription

Harriet Hall, M.D.

Stephen Barrett, M.D.

Nicholas Perricone, M.D., has written three similar books: The Wrinkle Cure [1], The Perricone Prescription [2]; and The Acne Prescription [3]. All contain many claims that are questionable, controversial, fanciful, unsupported by published evidence, or just plain wrong. Although he mentions standard skin-care treatments, sometimes favorably, his books provide little guidance about when they might be appropriate or sufficient. Although he provides long lists of references, practically none of them directly support what he promises. Despite this, his books have made best seller lists and the Public Broadcasting System (PBS) has featured him during fundraising campaigns.

Perricone claims that following his advice can quickly improve appearance, improve general health, increase mental sharpness, and make people more energetic. In The Perricone Prescription, for example, he promises to "stop skin from wrinkling, sagging and dulling" and says that, "being wrinkle free for life is achievable" if you follow his 28-day program. He offers "increased vitality, sharpened cognitive and problem-solving skills, and improved memory" and claims that "looking and feeling old is now an option." He also describes his program as "proven . . . to reverse the many signs of premature aging and stop its progress." [2:1-5]

Background History

Dr. Perricone makes much of his connection with Yale University. He is a former assistant clinical professor of dermatology at Yale University School of Medicineâ€â€an unpaid position in which he supervised students from time to time. However, his affiliation ended in 2002 when his contract was not renewed. In an interview reported in the Washington Post, Perricone said that the school authorities had been very critical of his books, public appearances, and anti-inflammation theories [4]. The report also noted that he subsequently became an adjunct (visiting) professor at Michigan State University's College of Human Medicine and pledged $5 million to establish the Perricone Division of Dermatology there.

Perricone's books are sprinkled with statements that his ideas are based on his own research. However, the extent and quality of this research is unclear. A PubMed search for his name brought up only six citations, of which only two appear to be original research, both on topical glycolic acid [5,6]. His books describe situations in which he tested various ideas in a few patients, usually over a short period of time, but he provides few details and apparently published none of those findings in medical journals.

Most of Perricone's recommended strategies are nutrition-related. In The Wrinkle Cure, he describes how his interest in this subject developed:

My own fascination with nutrition was sparked during my undergraduate days, before I entered medical school. I had always suffered from sallow, acne-plagued skin, allergies, and fatigue, so I started reading everything I could find on the subject -- which, at the time, meant pretty much everything written by Linus Pauling, Ph.D. . . . and Adelle Davis. I began experimenting with vitamins on my own, and the results were gratifying. My skin and allergies improved, and I had much more energy. . . .

When I entered medical school, however, my interest in nutrition made me an eccentric. My classmates thought I was nuts because I popped vitamins after meals and bundled up to go running in the dark, cold mornings of Michigan winters. [1:3,6].

The references to Pauling and Davis may help explain why Perricone spouts so many strange ideas. Although Pauling was a great chemist, his late-in-life beliefs in vitamin megadoses have been thoroughly discredited [7]. Adelle Davis achieved great popularity during the 1970s, but close examination of her writings indicates that she consistently misinterpreted research reports or simply made things up [8]. The irrational nutrition-related beliefs Perricone absorbed before going to medical school were apparently untouched by his science-based education.

Perricone's "Prescription"

The Perricone Prescription provides detailed instructions that include exactly what foods to eat, when and in what order to eat them (proteins first), what exercises to do, what supplements to take with each meal, and what to apply to your skin at what times of day. He even includes a section of recommended recipes. His program includes:

Diet: Three meals and two snacks daily, high quality protein (above all, wild salmon), "good" fats, and carbohydrates with a low glycemic index. No sugar. A long list of prohibited foods including carrots, bananas, duck, potatoes, flour, raisins, corn, soda (even diet soda) and many others.

Nutrient supplements: 25 different ones, some taken more than once a day: alpha lipoic acid, vitamins A, B1, B2, B3, B5, B6, B12, folate, biotin, vitamin C, vitamin C ester, vitamin E, calcium, chromium, magnesium, selenium, l-carnitine, acetyl l-carnitine, coenzyme Q10, l-glutamine, omega-3 fatty acids, grape seed extract, gamma linoleic acid, and turmeric.

Skin treatments: sunscreens, cleansers, moisturizers, eye-care products and enriched night cream; various creams with ingredients such as vitamin C, vitamin C ester, alpha lipoic acid, DMAE, PPC, tocotrienol, and olive oil.

Exercise: For strength, endurance, and flexibility; 40 minutes a day, 6 days a week.

Miscellaneous advice: 8-10 glasses of spring water a day; no tobacco, coffee, or alcohol (but tea is allowed); melatonin for sleep if needed.

Perricone markets his own line of high-priced nutritional supplements and skin care products worldwide. Typical prices from his Web site include:

$120 for 4 oz alpha lipoic acid and other ingredients for spider veins

$570 for 2 oz neuropeptide facial conformer

$195 for a 30-day supply of supplements for weight loss

$438-458 monthly for the entire skin and nutrient program based on skin type [9].

In November 2003, The Wall Street Journal reported that Perricone's company (N.V. Perricone) grossed $11.9 million in 2001, $42.4 million in 2002, and was expected to top $52 million in 2003 [10]. The article also noted that Perricone's PBS fundraising specials had generated over $4 million for PBS in both 2001 and 2002.

Questionable, Unverifiable, and Erroneous Statements

Perricone says that he gradually came to believe inflammation is the underlying cause of aging and of many diseases and that his own research shows that treating inflammation would reverse the aging process. In fact, he characterizes inflammation as "the key to the whole process of disease of every type." [2:20] Inflammation is indeed associated with many diseases, but it is not always clear whether the inflammation is a cause or a result. Nor is it clear that nutrients that help fight inflammation (such as vitamins C and E) do anything to reverse most of those diseases. Inflammation is characterized by the presence of white blood cells in a skin biopsy specimen. However, their presence can be due to hundreds of different causes, including systemic diseases, infections, foreign substances, insect bites, autoimmune processes, viruses, genetic abnormalities, and malignancies. Inflammation can be nonspecific and even be due to scratching. And the presence of white cells doesn't necessarily mean there are any associated clinical or molecular abnormalities [11]. Inflammation doesn't always increase with age; the inflammatory response to skin injuries actually decreases as you get older [12].

Dietary deficiencies can cause inflammation in the skin (pellagra is a classic example), but there's no evidence that supplementing an already adequate diet would prevent inflammation. Nor is there evidence that inflammation causes wrinkles. (The leading controllable factors are sun damage and cigarette smoking.) If Perricone truly wanted to test his theories, it would not be difficult. They could be tested on an animal model with biopsies before and after various treatments. Also, one could look for epidemiologic data on patients taking prednisone or nonsterioidal antiinflammatory drugs (NSAIDS) to see whether they have fewer wrinkles [13].

In acne, hair follicles become plugged with comedos composed of dead skin cells and sebum (a mixture of fats and waxes). If bacteria invade, the surrounding skin can become inflamed, and pimples or pustules may form. Most people with acne have a mild (noninflammatory) form and get occasional whiteheads or blackheads. There is little evidence that acne is related to diet. If self-experimentation suggests that a specific food aggravates acne, avoiding the food may be reasonable, but Perricone’s sweeping claims have no scientific support.

Page 33 of The Perricone Prescription illustrates an extraordinary degree of illogical thinking about nutrition. After describing a breakfast consisting of orange juice, cold cereal with banana, skim milk, a low-fat bran muffin, margarine and coffee, the book states:

As [Megan] drinks the juice, she is causing a burst of inflammation in her body as the juice floods her bloodstream with sugar. This causes a sharp spike in her insulin levels, resulting in a rapid acceleration of the aging process, increasing the risk of heart disease, every form of cancer, memory loss, and mental deterioration. To add to the problems, the sugar flood is causing the collagen to cross-link, laying the foundation for the birth of wrinkles, sagging, and loss of tone.

Page 45 contains an equally ridiculous passage which concludes that eating bagels, cookies, or caffeinated, sugary sodasâ€â€which Perricone inappropriately regards as addictingâ€â€places people at risk for "exhausting our pancreas, burning out our adrenals, and placing us at risk for insulin resistance and diabetes."

Here are more of Perricone's claims followed by our comments in brackets:

Substances like olive oil "penetrate, strengthen, and refresh your skin cells." [What do "strengthening" and "refreshing "your skin cells mean?]

You look puffy the morning after eating Chinese food because of an inflammatory response to what you ate. [Any puffiness would probably be because the salt and MSG caused the body to temporarily retain water.]

When you are mildly dehydrated your metabolism drops and you gain weight. [Actually, dehydration usually decreases appetite and results in weight loss.]

His program works by a synergy between diet, supplements, skin care, and exercise. [synergy means the combination works better than the sum of the individual components. There are no published data comparing the combination with each factor alone or with other combinations.]

Slow, steady release of insulin into our bloodstream keeps us younger. [He doesn't indicate how he thinks this could be measured. It can't.]

Sugar makes the insulin receptors on the cells burn out. [untrue]

The contemporary American diet rarely contains enough protein. [untrue. Americans tend to consume more protein than they need.]

DMAE is your magic bullet for great skin tone. [A PubMed search shows only one small study that showed an effect of topical DMAE on skin [14]]

There are probably unidentified components of salmon that promote health and slow aging. [This possible, but he has no basis for saying it is probable.]

Salmon improves manic-depressive patients who don't respond to medication. [He mentions a study but doesn't give a citation for it, and it is not listed in PubMed.]

Socrates prescribed olive oil for various diseases. [so what?]

Olive trees live for centuries and re-grow after being cut to the ground. [implied benefits from olive oil for human longevity by magical analogy.]

Adults should limit milk intake because they may have lactose intolerance or allergies. [it would make far more sense to base an individual decision on whether the individual actually is intolerant.]

Alcohol is bad, so hard liquor is bad, but wine is OK. [A glass of wine and a shot of whiskey contain approximately the same amount of alcohol.]

Avoid tap water; drink spring water. [bottled water is not tested as thoroughly as public water supplies and many brands fail to meet tap water standards. Several surveys have found more contaminants, bacteria, etc. in some bottled waters than in tap water. Tap water is generally safer.]

Spring water flushes toxins from the body. [What toxins? What difference does it make whether it's spring water or other fluids?]

Everyone needs 8-10 glasses of water a day. [A comparison of two diets, one with and one without plain water, showed no difference in hydration whether water was supplied by plain water or other beverages [15]].

The same substances work on the central nervous system and the skin. [A personal observation, not otherwise supported. He theorizes that the nervous stem and skin are alike because they originated in the same one of three cell layers of the early embryo.]

Vitamin C deficiency causes wrinkles. [sun exposure and tobacco use are the only recognized factors known to cause wrinkles.]

Growth hormone is the true "youth hormone." [Only in the sense that it helps youths grow into adults!]

Coffee causes weight gain, while tea cause weight loss. [Neither is correct.]

Lack of essential fatty acids can cause miscarriage. [A PubMed search for fatty acids and miscarriage showed only one study in the blue fox; it showed just the oppositeâ€â€that supplementing the diet with essential fatty acids in the form of evening primrose oil increased the rate of miscarriage.]

Alpha-lipoic acid is an anti-aging drug. [There are no known anti-aging drugs.]

Lack of Science

Dr. Perricone would be more credible if he could show us a study demonstrating that people who followed his prescription lived longer, had "younger" skin demonstrated by objective measures, or felt better compared to those on a placebo programâ€â€or that they were better in any measurable way. Instead, he provides only testimonials, exaggerated claims, partial truths, and incorrect statements. He cherry-picks possibly supportive studies from the literature and ignores contradictory studies. He cites lots of lab studies (in vitro or in animals), but few that demonstrate any clinical effects in humans. The diet he recommends is low in calories, and weight loss alone may improve the way his patients look and feel. His advice about tobacco and sunscreens is appropriate, but there is little science behind the rest of his program. He seems to have gathered every nutrient and skin cream he had any reason to hypothesize might work and advised using all of them. A more rational approach would have been to first see which ones really worked, and later to see if any combinations of the effective agents worked better than a single agent. No scientist worth his salt does experiments without controls; Perricone treats everyone, so that there is no basis for comparison.

The Perricone Prescription includes full-color before-and-after photographs of women who tried its 28-day program. These photos are far from convincing, with differences in position, lighting, facial expression, makeup, and weight loss that could affect the appearance. The reader is asked to make purely subjective judgments and to notice undefined qualities such as "vibrancy," "radiance," and "improved contours." Dr. Hall's own informal poll indicated that most people prefer some of the "befores" to the "afters."

A Washington Post reporter's experience illustrates how inexact this type of study can be. Page 12 of The Perricone Prescription states that, "Without exception, every patient who has tried the Three-Day Nutritional Face-lift has had good results, and has returned convinced that my Wrinkle-Free Program works. And you will, too." Noting that this statement is preposterous, the reporter decided to test the program on herself. On the fourth day, she had lost three pounds, and it seemed to her that her pores were smaller, her eyelids less heavy and her chin line "less blurry." However, 18 out of 26 of her friends who looked at before-and-after photographs said she looked younger before she started the program [4].

Perricone and his patients may agree that they look better after treatment, but the photographs are the only attempt he makes to present objective evidence. It seems rather silly to depend on subjective impressions and photographs when several objective methods of measuring improvement are available. Reputable published skin studies have used skin surface measurements by semi-automated computer morphometry, laser profilometry, and skin biopsies whose specimens are examined with immunohistochemistry and electron microscopy [16]. Moreover, the creams and lotions he recommends could easily have been evaluated by applying them to one side of the face and using the other side as a control.

Perricone provides little information from sources that disagree with him. Mercury in fish is a possible concern with a high salmon diet, but he doesn't even mention it. He lists all the positive effects of nutrients but omits to mention the toxic effects of high doses, even though some of his supplements may push people into the toxic range. He does not mention that only three nutritional factors have ever been found to correlate with longer life in mammals: calorie restriction, and restriction of methionine and tryptophanâ€â€in rodents [17].

Overview

Dr. Perricone has mixed a pinch of science with a gallon of imagination to create an elaborate, time-consuming, expensive, prescription for a healthy life and younger skin. There is no reason to think his program is more effective than standard measures. Although some of his advice is is standard, most of his recommendations are based on speculation and fanciful interpretation of selected medical literature. He makes lots of money by convincing patients and consumers, but he hasn't succeeded in convincing critical thinkers, doctors, scientists, or anyone who wants to see hard evidence. Perricone's "prescription" isn't science; it's creative salesmanship.

For Additional Information

Paula Begoun's Product Review

References

Perricone N. The Wrinkle Cure: Unlock the Power of Cosmeceuticals for Supple, Youthful Skin. New York: Warner Books, 2000.

Perricone N. The Perricone Prescription: A Physician's 28-Day Program for Total Body and Face Rejuvenation. New York: HarperCollins, 2002.

Perricone N. The Acne Prescription: The Perricone Program for Clear and Healthy Skin at Any Age. New York: HarperCollins, 2003.

Weiss S. Got wrinkles? Go fish. Washington Post, Dec 17, 2002.

Perricone NV, DiNardo JC. Photoprotective and antiinflammatory effects of topical glycolic acid. Dermatologic Surgery 22:435-437, 1996.

Perricone NV. Treatment of pseudofolliculitis barbae with topical glycolic acid: a report of two studies. Cutis 52:232-235, 1993.

Barrett S. The dark side of Linus Pauling's legacy. Quackwatch Web site, May 5, 2001.

Barrett S. Adelle Davis's legacy. Quackwatch, March 27, 1999.

Supplements. N.V. Perricone, M.D., Cosmeceuticals, accessed Feb 27, 2004.

Beatty S. Hot at the mall: Skin-care products from physicians. The Wall Street Journal, Nov 14, 2003, pp A1, A8.

Bosset S and others. Photoageing shows histological features of chronic skin inflammation without clinical and molecular abnormalities. British Journal of Dermatology 149:826-835, 2003.

Swift ME, et al. Age-related alterations in the inflammatory response to dermal injury. Journal of Investigative Dermatology 117:1027-1035, 2001.

Bredt R. Personal communication to Harriet Hall. M.D., Feb 6, 2004.

Uhoda I and others. Split face study on the cutaneous tensile effect of 2-dimethylaminoethanol (deanol) gel. Skin Research and Technology 8:164-167, 2002.

Grandjean AC and others. The effect on hydration of two diets, one with and one without plain water. Journal of the American College of Nutrition 22:165-173, 2003.

Beitner H. Randomized, placebo-controlled, double blind study on the clinical efficacy of a cream containing 5% alpha-lipoic acid related to photoageing of facial skin. British Journal of Dermatology 149:841-849, 2003.

Zimmerman JA and others. Nutritional control of aging. Experimental Gerontolology Jan-Feb;38(1-2):47-52, 2003.

This article was revised on August 12, 2004.

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I have read several cases of people breaking out due to using that ALA product..... As soon as I found out about ALA and DMAE I decided to start using a product with both of them (ReFine Serum).... I've been using it for quite some time now and while I like the product and continue to use it, I can assure you I am still scarred.

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Its more related to preventing future scars not old ones. My opinon if something has the ability to help prevent scarring im gunna use it.

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While I think a good diet and nutrition can make you look better than any skin cream I'm super wary of doctors/the gov/anyone saying one type of diet fits all. And in perricone's plan there's too much friggin' salmon I mean geeez, also iodine, which may be in high amounts in a fish based diet can aggravate/cause acne.

However FOOD CAN BE ADDICTING...A recent study came out showing tastes/smells in food affecting the same parts of the brain as narcotics.

Everone knows by now junk food/sugar/fructose/basically refined food is crap and will make you look like shit and age you faster. Eat wholesome food, a balanced diet, drink plenty of water and make small adjustments to tailer your diet for YOU. Some poeple do better eating more carbs others more protein.

I think Murad vitamins are better, they're cheaper and you won't and up paying more than you would for any other regular multi except his are tailored for specific skin probs. But I can't stand any doc saying you must use their "program" ugh doubt.gif

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I must, in the defense of Dr. Perricone, have been using his diet regimen and multi-vitamin pack for over a year and still continue to use it. It works for me -- his anti-aging protocols has actually made me look younger, in fact, alot younger. And in the last 6 months, I've incorporated scar revision in my program (retin-a, copper peptides, acid peels, micro-dermabrasaion, and currently on smoothbeam) and have gotten at least 60% improvement thus far.

I am glad I took the anti-aging route first instead of jumping into a scar revision program because the anti-aging program prepared my skin for scar revision by

1. losing weight in my face

2. restoring a red hue to my skin

3. stopping and/or elimnating small keratoses growth in my face area.

4. shrinking my pores

This was an iterative process and I enjoyed watcing the results. One thing I did notice was that by "losing wieght in my face", I noticed more scars. This is good because now I know the "truth" of my skin and its easier to correct it.

I owe alot to Dr. Perricone. Really he made a difference in my life.

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Obaji and Perricone have great marketing. IMO their products are way over priced and deceptive.You can do your own research (look at their patents and make your own). It is simple to add alpha lipoic acid to a base cream.cleanser etc. Or you can buy cheaper alternatives (but superior formulation) such as Derma Q Gel.(Alpha Lipoic Acid, Q10 and C).

I have taken large amounts of Alpha Lipoic Acid for an incison and found it did help with healing the incision, but removing any existing acne scars it did nothing. However I like its antioxidant effects along with Q10 so I often use this in a topical as well as oral. (Antiaging)

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Your Guide to Quackery, Health Fraud, and Intelligent Decisions

A Skeptical View of the Perricone Prescription

Harriet Hall, M.D.

Stephen Barrett, M.D.

Nicholas Perricone, M.D., has written three similar books: The Wrinkle Cure [1], The Perricone Prescription [2]; and The Acne Prescription [3]. All contain many claims that are questionable, controversial, fanciful, unsupported by published evidence, or just plain wrong. Although he mentions standard skin-care treatments, sometimes favorably, his books provide little guidance about when they might be appropriate or sufficient. Although he provides long lists of references, practically none of them directly support what he promises. Despite this, his books have made best seller lists and the Public Broadcasting System (PBS) has featured him during fundraising campaigns.

Perricone claims that following his advice can quickly improve appearance, improve general health, increase mental sharpness, and make people more energetic. In The Perricone Prescription, for example, he promises to "stop skin from wrinkling, sagging and dulling" and says that, "being wrinkle free for life is achievable" if you follow his 28-day program. He offers "increased vitality, sharpened cognitive and problem-solving skills, and improved memory" and claims that "looking and feeling old is now an option." He also describes his program as "proven . . . to reverse the many signs of premature aging and stop its progress." [2:1-5]

Background History

Dr. Perricone makes much of his connection with Yale University. He is a former assistant clinical professor of dermatology at Yale University School of Medicineâ€â€an unpaid position in which he supervised students from time to time. However, his affiliation ended in 2002 when his contract was not renewed. In an interview reported in the Washington Post, Perricone said that the school authorities had been very critical of his books, public appearances, and anti-inflammation theories [4]. The report also noted that he subsequently became an adjunct (visiting) professor at Michigan State University's College of Human Medicine and pledged $5 million to establish the Perricone Division of Dermatology there.

Perricone's books are sprinkled with statements that his ideas are based on his own research. However, the extent and quality of this research is unclear. A PubMed search for his name brought up only six citations, of which only two appear to be original research, both on topical glycolic acid [5,6]. His books describe situations in which he tested various ideas in a few patients, usually over a short period of time, but he provides few details and apparently published none of those findings in medical journals.

Most of Perricone's recommended strategies are nutrition-related. In The Wrinkle Cure, he describes how his interest in this subject developed:

My own fascination with nutrition was sparked during my undergraduate days, before I entered medical school. I had always suffered from sallow, acne-plagued skin, allergies, and fatigue, so I started reading everything I could find on the subject -- which, at the time, meant pretty much everything written by Linus Pauling, Ph.D. . . . and Adelle Davis. I began experimenting with vitamins on my own, and the results were gratifying. My skin and allergies improved, and I had much more energy. . . .

When I entered medical school, however, my interest in nutrition made me an eccentric. My classmates thought I was nuts because I popped vitamins after meals and bundled up to go running in the dark, cold mornings of Michigan winters. [1:3,6].

The references to Pauling and Davis may help explain why Perricone spouts so many strange ideas. Although Pauling was a great chemist, his late-in-life beliefs in vitamin megadoses have been thoroughly discredited [7]. Adelle Davis achieved great popularity during the 1970s, but close examination of her writings indicates that she consistently misinterpreted research reports or simply made things up [8]. The irrational nutrition-related beliefs Perricone absorbed before going to medical school were apparently untouched by his science-based education.

Perricone's "Prescription"

The Perricone Prescription provides detailed instructions that include exactly what foods to eat, when and in what order to eat them (proteins first), what exercises to do, what supplements to take with each meal, and what to apply to your skin at what times of day. He even includes a section of recommended recipes. His program includes:

Diet: Three meals and two snacks daily, high quality protein (above all, wild salmon), "good" fats, and carbohydrates with a low glycemic index. No sugar. A long list of prohibited foods including carrots, bananas, duck, potatoes, flour, raisins, corn, soda (even diet soda) and many others.

Nutrient supplements: 25 different ones, some taken more than once a day: alpha lipoic acid, vitamins A, B1, B2, B3, B5, B6, B12, folate, biotin, vitamin C, vitamin C ester, vitamin E, calcium, chromium, magnesium, selenium, l-carnitine, acetyl l-carnitine, coenzyme Q10, l-glutamine, omega-3 fatty acids, grape seed extract, gamma linoleic acid, and turmeric.

Skin treatments: sunscreens, cleansers, moisturizers, eye-care products and enriched night cream; various creams with ingredients such as vitamin C, vitamin C ester, alpha lipoic acid, DMAE, PPC, tocotrienol, and olive oil.

Exercise: For strength, endurance, and flexibility; 40 minutes a day, 6 days a week.

Miscellaneous advice: 8-10 glasses of spring water a day; no tobacco, coffee, or alcohol (but tea is allowed); melatonin for sleep if needed.

Perricone markets his own line of high-priced nutritional supplements and skin care products worldwide. Typical prices from his Web site include:

$120 for 4 oz alpha lipoic acid and other ingredients for spider veins

$570 for 2 oz neuropeptide facial conformer

$195 for a 30-day supply of supplements for weight loss

$438-458 monthly for the entire skin and nutrient program based on skin type [9].

In November 2003, The Wall Street Journal reported that Perricone's company (N.V. Perricone) grossed $11.9 million in 2001, $42.4 million in 2002, and was expected to top $52 million in 2003 [10]. The article also noted that Perricone's PBS fundraising specials had generated over $4 million for PBS in both 2001 and 2002.

Questionable, Unverifiable, and Erroneous Statements

Perricone says that he gradually came to believe inflammation is the underlying cause of aging and of many diseases and that his own research shows that treating inflammation would reverse the aging process. In fact, he characterizes inflammation as "the key to the whole process of disease of every type." [2:20] Inflammation is indeed associated with many diseases, but it is not always clear whether the inflammation is a cause or a result. Nor is it clear that nutrients that help fight inflammation (such as vitamins C and E) do anything to reverse most of those diseases. Inflammation is characterized by the presence of white blood cells in a skin biopsy specimen. However, their presence can be due to hundreds of different causes, including systemic diseases, infections, foreign substances, insect bites, autoimmune processes, viruses, genetic abnormalities, and malignancies. Inflammation can be nonspecific and even be due to scratching. And the presence of white cells doesn't necessarily mean there are any associated clinical or molecular abnormalities [11]. Inflammation doesn't always increase with age; the inflammatory response to skin injuries actually decreases as you get older [12].

Dietary deficiencies can cause inflammation in the skin (pellagra is a classic example), but there's no evidence that supplementing an already adequate diet would prevent inflammation. Nor is there evidence that inflammation causes wrinkles. (The leading controllable factors are sun damage and cigarette smoking.) If Perricone truly wanted to test his theories, it would not be difficult. They could be tested on an animal model with biopsies before and after various treatments. Also, one could look for epidemiologic data on patients taking prednisone or nonsterioidal antiinflammatory drugs (NSAIDS) to see whether they have fewer wrinkles [13].

In acne, hair follicles become plugged with comedos composed of dead skin cells and sebum (a mixture of fats and waxes). If bacteria invade, the surrounding skin can become inflamed, and pimples or pustules may form. Most people with acne have a mild (noninflammatory) form and get occasional whiteheads or blackheads. There is little evidence that acne is related to diet. If self-experimentation suggests that a specific food aggravates acne, avoiding the food may be reasonable, but Perricone’s sweeping claims have no scientific support.

Page 33 of The Perricone Prescription illustrates an extraordinary degree of illogical thinking about nutrition. After describing a breakfast consisting of orange juice, cold cereal with banana, skim milk, a low-fat bran muffin, margarine and coffee, the book states:

As [Megan] drinks the juice, she is causing a burst of inflammation in her body as the juice floods her bloodstream with sugar. This causes a sharp spike in her insulin levels, resulting in a rapid acceleration of the aging process, increasing the risk of heart disease, every form of cancer, memory loss, and mental deterioration. To add to the problems, the sugar flood is causing the collagen to cross-link, laying the foundation for the birth of wrinkles, sagging, and loss of tone.

Page 45 contains an equally ridiculous passage which concludes that eating bagels, cookies, or caffeinated, sugary sodasâ€â€which Perricone inappropriately regards as addictingâ€â€places people at risk for "exhausting our pancreas, burning out our adrenals, and placing us at risk for insulin resistance and diabetes."

Here are more of Perricone's claims followed by our comments in brackets:

Substances like olive oil "penetrate, strengthen, and refresh your skin cells." [What do "strengthening" and "refreshing "your skin cells mean?]

You look puffy the morning after eating Chinese food because of an inflammatory response to what you ate. [Any puffiness would probably be because the salt and MSG caused the body to temporarily retain water.]

When you are mildly dehydrated your metabolism drops and you gain weight. [Actually, dehydration usually decreases appetite and results in weight loss.]

His program works by a synergy between diet, supplements, skin care, and exercise. [synergy means the combination works better than the sum of the individual components. There are no published data comparing the combination with each factor alone or with other combinations.]

Slow, steady release of insulin into our bloodstream keeps us younger. [He doesn't indicate how he thinks this could be measured. It can't.]

Sugar makes the insulin receptors on the cells burn out. [untrue]

The contemporary American diet rarely contains enough protein. [untrue. Americans tend to consume more protein than they need.]

DMAE is your magic bullet for great skin tone. [A PubMed search shows only one small study that showed an effect of topical DMAE on skin [14]]

There are probably unidentified components of salmon that promote health and slow aging. [This possible, but he has no basis for saying it is probable.]

Salmon improves manic-depressive patients who don't respond to medication. [He mentions a study but doesn't give a citation for it, and it is not listed in PubMed.]

Socrates prescribed olive oil for various diseases. [so what?]

Olive trees live for centuries and re-grow after being cut to the ground. [implied benefits from olive oil for human longevity by magical analogy.]

Adults should limit milk intake because they may have lactose intolerance or allergies. [it would make far more sense to base an individual decision on whether the individual actually is intolerant.]

Alcohol is bad, so hard liquor is bad, but wine is OK. [A glass of wine and a shot of whiskey contain approximately the same amount of alcohol.]

Avoid tap water; drink spring water. [bottled water is not tested as thoroughly as public water supplies and many brands fail to meet tap water standards. Several surveys have found more contaminants, bacteria, etc. in some bottled waters than in tap water. Tap water is generally safer.]

Spring water flushes toxins from the body. [What toxins? What difference does it make whether it's spring water or other fluids?]

Everyone needs 8-10 glasses of water a day. [A comparison of two diets, one with and one without plain water, showed no difference in hydration whether water was supplied by plain water or other beverages [15]].

The same substances work on the central nervous system and the skin. [A personal observation, not otherwise supported. He theorizes that the nervous stem and skin are alike because they originated in the same one of three cell layers of the early embryo.]

Vitamin C deficiency causes wrinkles. [sun exposure and tobacco use are the only recognized factors known to cause wrinkles.]

Growth hormone is the true "youth hormone." [Only in the sense that it helps youths grow into adults!]

Coffee causes weight gain, while tea cause weight loss. [Neither is correct.]

Lack of essential fatty acids can cause miscarriage. [A PubMed search for fatty acids and miscarriage showed only one study in the blue fox; it showed just the oppositeâ€â€that supplementing the diet with essential fatty acids in the form of evening primrose oil increased the rate of miscarriage.]

Alpha-lipoic acid is an anti-aging drug. [There are no known anti-aging drugs.]

Lack of Science

Dr. Perricone would be more credible if he could show us a study demonstrating that people who followed his prescription lived longer, had "younger" skin demonstrated by objective measures, or felt better compared to those on a placebo programâ€â€or that they were better in any measurable way. Instead, he provides only testimonials, exaggerated claims, partial truths, and incorrect statements. He cherry-picks possibly supportive studies from the literature and ignores contradictory studies. He cites lots of lab studies (in vitro or in animals), but few that demonstrate any clinical effects in humans. The diet he recommends is low in calories, and weight loss alone may improve the way his patients look and feel. His advice about tobacco and sunscreens is appropriate, but there is little science behind the rest of his program. He seems to have gathered every nutrient and skin cream he had any reason to hypothesize might work and advised using all of them. A more rational approach would have been to first see which ones really worked, and later to see if any combinations of the effective agents worked better than a single agent. No scientist worth his salt does experiments without controls; Perricone treats everyone, so that there is no basis for comparison.

The Perricone Prescription includes full-color before-and-after photographs of women who tried its 28-day program. These photos are far from convincing, with differences in position, lighting, facial expression, makeup, and weight loss that could affect the appearance. The reader is asked to make purely subjective judgments and to notice undefined qualities such as "vibrancy," "radiance," and "improved contours." Dr. Hall's own informal poll indicated that most people prefer some of the "befores" to the "afters."

A Washington Post reporter's experience illustrates how inexact this type of study can be. Page 12 of The Perricone Prescription states that, "Without exception, every patient who has tried the Three-Day Nutritional Face-lift has had good results, and has returned convinced that my Wrinkle-Free Program works. And you will, too." Noting that this statement is preposterous, the reporter decided to test the program on herself. On the fourth day, she had lost three pounds, and it seemed to her that her pores were smaller, her eyelids less heavy and her chin line "less blurry." However, 18 out of 26 of her friends who looked at before-and-after photographs said she looked younger before she started the program [4].

Perricone and his patients may agree that they look better after treatment, but the photographs are the only attempt he makes to present objective evidence. It seems rather silly to depend on subjective impressions and photographs when several objective methods of measuring improvement are available. Reputable published skin studies have used skin surface measurements by semi-automated computer morphometry, laser profilometry, and skin biopsies whose specimens are examined with immunohistochemistry and electron microscopy [16]. Moreover, the creams and lotions he recommends could easily have been evaluated by applying them to one side of the face and using the other side as a control.

Perricone provides little information from sources that disagree with him. Mercury in fish is a possible concern with a high salmon diet, but he doesn't even mention it. He lists all the positive effects of nutrients but omits to mention the toxic effects of high doses, even though some of his supplements may push people into the toxic range. He does not mention that only three nutritional factors have ever been found to correlate with longer life in mammals: calorie restriction, and restriction of methionine and tryptophanâ€â€in rodents [17].

Overview

Dr. Perricone has mixed a pinch of science with a gallon of imagination to create an elaborate, time-consuming, expensive, prescription for a healthy life and younger skin. There is no reason to think his program is more effective than standard measures. Although some of his advice is is standard, most of his recommendations are based on speculation and fanciful interpretation of selected medical literature. He makes lots of money by convincing patients and consumers, but he hasn't succeeded in convincing critical thinkers, doctors, scientists, or anyone who wants to see hard evidence. Perricone's "prescription" isn't science; it's creative salesmanship.

For Additional Information

Paula Begoun's Product Review

References

Perricone N. The Wrinkle Cure: Unlock the Power of Cosmeceuticals for Supple, Youthful Skin. New York: Warner Books, 2000.

Perricone N. The Perricone Prescription: A Physician's 28-Day Program for Total Body and Face Rejuvenation. New York: HarperCollins, 2002.

Perricone N. The Acne Prescription: The Perricone Program for Clear and Healthy Skin at Any Age. New York: HarperCollins, 2003.

Weiss S. Got wrinkles? Go fish. Washington Post, Dec 17, 2002.

Perricone NV, DiNardo JC. Photoprotective and antiinflammatory effects of topical glycolic acid. Dermatologic Surgery 22:435-437, 1996.

Perricone NV. Treatment of pseudofolliculitis barbae with topical glycolic acid: a report of two studies. Cutis 52:232-235, 1993.

Barrett S. The dark side of Linus Pauling's legacy. Quackwatch Web site, May 5, 2001.

Barrett S. Adelle Davis's legacy. Quackwatch, March 27, 1999.

Supplements. N.V. Perricone, M.D., Cosmeceuticals, accessed Feb 27, 2004.

Beatty S. Hot at the mall: Skin-care products from physicians. The Wall Street Journal, Nov 14, 2003, pp A1, A8.

Bosset S and others. Photoageing shows histological features of chronic skin inflammation without clinical and molecular abnormalities. British Journal of Dermatology 149:826-835, 2003.

Swift ME, et al. Age-related alterations in the inflammatory response to dermal injury. Journal of Investigative Dermatology 117:1027-1035, 2001.

Bredt R. Personal communication to Harriet Hall. M.D., Feb 6, 2004.

Uhoda I and others. Split face study on the cutaneous tensile effect of 2-dimethylaminoethanol (deanol) gel. Skin Research and Technology 8:164-167, 2002.

Grandjean AC and others. The effect on hydration of two diets, one with and one without plain water. Journal of the American College of Nutrition 22:165-173, 2003.

Beitner H. Randomized, placebo-controlled, double blind study on the clinical efficacy of a cream containing 5% alpha-lipoic acid related to photoageing of facial skin. British Journal of Dermatology 149:841-849, 2003.

Zimmerman JA and others. Nutritional control of aging. Experimental Gerontolology Jan-Feb;38(1-2):47-52, 2003.

This article was revised on August 12, 2004.

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Hey Old Guy, you skeptic you! LOL  What a response you gave. I always read QuackWatch. But I don't think they are as objective or as well researched as they want us to believe.  But I do think the devils advocate is very much needed. (Or are they Angels in disquise? lol).

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