This is fascinating! I appreciate how you address both the internal and external with these protocols. I’ve been following some of these supplementation suggestions for concerns you’ve addressed in other articles, but I found a few gaps I can fill to help my skin. Thank you
Good. That's exactly how the articles are designed to work. You take what's relevant to your situation, identify the gaps in what you're already doing, and fill them. No need to overhaul everything at once. The fact that you're already supplementing from previous articles and now just tightening the protocol tells me you're building systematically rather than reactively. That's the approach that holds.
Good catch, and this is exactly the right question to ask.
Chasteberry (Vitex agnus-castus) works primarily by acting on the pituitary gland to modulate prolactin and shift the balance between LH and FSH, which downstream influences progesterone production. In a woman who is not on HRT, that's the desired effect. In a woman who IS on HRT, you're already receiving exogenous hormones at a dose your prescriber calibrated. Adding an herb that independently modulates the same hormonal axes can create interference, not necessarily dangerous, but potentially unpredictable. You could end up with effects that neither you nor your prescriber can trace back to a clear cause.
The general rule: any supplement that directly modulates reproductive hormones (chasteberry, DIM, black cohosh, dong quai, maca) should be discussed with the provider managing your HRT before you add it. Some of them are perfectly compatible. Some need monitoring. Some should be avoided depending on the type and route of your HRT. Your prescriber needs to know what's in play so they can interpret your labs and symptoms accurately.
This is amazing and will take a while to unpack it all thank you! 🤩
I have a question about magnesium glycinate please. The label says “serving size is 2 capsules. Amount of magnesium bisglycinate per serving is 1040mg providing elemental magnesium 208mg.”
As you recommend 300-400mg is 2 capsules enough or would I need more or less? Thanks 🙏
This is one of the most common points of confusion in supplementation, and the labeling doesn't help.
Your label is telling you that two capsules contain 1,040mg of magnesium bisglycinate (the compound), which provides 208mg of elemental magnesium (the actual magnesium your body uses). The rest of the weight in that 1,040mg is the glycine molecule that the magnesium is bonded to.
When I say 300 to 400mg, I mean elemental magnesium. So at 208mg per two capsules, you'd need three to four capsules to reach 300 to 400mg of elemental magnesium.
That said, you don't have to jump straight to four capsules. Start with two (208mg elemental) for a week or so and see how you respond. If sleep improves, muscle tension decreases, and you're tolerating it well, you can move to three capsules (312mg elemental). If you want to go to four, increase gradually. The GI system is your feedback mechanism: if you get loose stools, you've found your personal ceiling and you back off by one capsule 🙏
About 30 yers ago ( I’m 66) I made a very conscious decision to never look at my face closely in the mirror. I’ve really appreciated that decision and never gone back on it. Occasionally I look at my face from a distance or in a mirror in a dim space. After being very focused on nutrition for the last ten years or so I think my skin feels better but I actually don’t want to start looking at it. I dont want to obsess. I certainly don’t want to know that my skin is lined and wrinkly, scarred and discoloured!!! I spend a large amount of time outdoors but dont want to wear horrible sun cream. Just a wide brimmed visor and shade. I do use some lovely face cremes but never use a mirror!
I respect this enormously. And I want to say something that might sound counterintuitive coming from someone who just wrote an entire article about facial skin: your decision is healthy. The obsessive mirror-checking that drives most skincare culture is not. You made a conscious choice 30 years ago to opt out of a feedback loop that generates anxiety and self-criticism disguised as self-care, and you've held that boundary since.
The fact that your skin feels better after a decade of nutritional focus is the right signal to track. How your skin feels (elasticity, hydration, comfort, healing speed) tells you more about its health than how it looks in a mirror under bathroom lighting. You're supporting it from the inside with nutrition, protecting it from the outside with shade and a brimmed visor, and moisturizing because it feels good. That's a complete skin protocol executed without a single anxiety-producing mirror check.
Don't change anything. You figured out something most people never will.
I have never read an article that specifically divided the areas of a woman’s face, and discussed the particular issues and treatments this concise. It was fascinating and very informative. Thank you. 🙏 😊
Thank you. The face is one of the most visible maps of internal health, and most skincare content treats it as a cosmetic surface rather than a diagnostic one. Each zone reflects different vascular, hormonal, and metabolic inputs, and when you understand what's driving the change from underneath, the interventions become targeted rather than generic. Glad it connected 🙏
Absolutely. The reason flaxseed appears repeatedly is because it delivers three things at once: ALA omega-3s, lignans (which have mild estrogen-modulating activity through the enterolactone pathway), and soluble fiber. Finding a single substitute that does all three is difficult, but covering each component separately is straightforward.
For the omega-3s: chia seeds are the closest alternative (similar ALA content, different fiber profile, generally better tolerated digestively). Hemp seeds work too, with a lower ALA concentration but a better omega-6 to omega-3 ratio than most seeds. If you tolerate fish, wild-caught salmon or sardines deliver EPA and DHA directly, which are more bioactive than ALA anyway.
For the lignans: sesame seeds are the next highest food source of lignans after flaxseed. Significantly lower concentration, but meaningful if consumed consistently.
For the fiber: chia seeds again, or psyllium husk if you need bulk specifically.
If the digestive issue with flax is bloating or gas, it may be a fiber volume issue rather than a flax-specific intolerance. Starting with half a teaspoon and building up slowly over two weeks can sometimes resolve it. But if you've already tried that and it still doesn't work, the alternatives above have you covered.
Ah thank you so much! I’ll try starting with a smaller amount of flax and work up over time - hopefully that fixes it. Otherwise, thanks for all the suggestions, I tolerate those well.
Wow! I saw a few of these changes in perimemopause. The dryness especially on the forehead. I changed my moisturizer but it didn't do much, now I know why. I also has the decolletage is an even red. That area did get sunburnt a few times when I was much younger. Now, I lather my mineral based sunscreen on it often but I didn't realize that hormones played a role too but that makes sense that the redness showed up so much later. Thank you. You're information is invaluable!!!❤️❤️❤️
The forehead dryness is one of the earliest and most overlooked perimenopause skin changes. Estrogen maintains ceramide production in the stratum corneum (the outer skin barrier), and as estrogen declines, ceramide output drops and the skin's ability to retain moisture decreases. No moisturizer can fully compensate for a structural change in the barrier itself. The moisturizer sits on top. The ceramide loss is underneath.
The décolletage redness is a combination of what you identified (cumulative UV damage from years ago) and what perimenopause adds: thinning skin (estrogen maintains dermal collagen density), increased vascular visibility as the skin becomes more translucent, and vasomotor instability (the same mechanism behind hot flashes can cause localized flushing in areas with high vascular density like the chest). The sunburns from earlier created the initial damage. The hormonal shift made it visible because the skin that was masking it got thinner.
Mineral sunscreen is the right call. But supporting from the inside (omega-3s for the inflammatory component, vitamin C and zinc for collagen synthesis, adequate protein for the raw material of skin repair) is the other half of the equation ❤️
ooohhh, & those chin hair!!! (prob the only one ‘dent’ to my face right now). i’m literarily now forced to shave? almost every other day…i’m so less than impressed.
The chin hair is androgenic, and it's one of the most common and least-discussed perimenopause and menopause changes. Here's what's happening: as estrogen declines, the relative ratio of androgens (testosterone, DHEA) to estrogen shifts. You don't necessarily have more androgens than before. You just have less estrogen to counterbalance them. The hair follicles on the chin and jawline have androgen receptors, and when that ratio tips, those follicles convert from producing fine vellus hair to coarser terminal hair. Same mechanism as male-pattern facial hair, just driven by a ratio change rather than absolute androgen levels.
The every-other-day shaving is annoying but it's not dangerous. If it's driving you crazy, the longer-term options are electrolysis (permanent, targets individual follicles) or laser (semi-permanent, works best on dark hair against lighter skin). On the nutritional side, supporting estrogen metabolism and managing insulin resistance can help because insulin increases ovarian and adrenal androgen production, which worsens the ratio further. Spearmint tea has modest evidence for mild anti-androgen effects (two cups daily in the studies).
You're not the only one. You're just one of the few willing to say it out loud
i’ll be looking into electrolysis then, down this road for sure. in the meantime, i’ll continue to work the nutritional angle i already started for now. approx 1 month in now…😊
I have a question about Fosamax (alendronate) that isn’t about me but about a friend.
She developed swelling and pain that began near one eye, then progressed to her jaw, and more recently has involved her hands and wrists.
Several physicians have suggested the jaw symptoms may be related to Fosamax, but I’m wondering whether the combination of facial pain, jaw involvement, and later painful swelling of the hands and wrists points to a different biochemical or inflammatory process. Have you come across anything in the literature that might connect these findings?”
I realize you can’t diagnose someone over the internet, but I’m curious whether, from your understanding of nutrition, biochemistry, and medication interactions, you can think of any mechanisms or contributing factors that physicians might not routinely consider. For example, could nutritional deficiencies, mineral balance, hormone status, drug interactions, or other cofactors influence how someone responds to bisphosphonates such as Fosamax?
If you’ve written about this topic or know of research that addresses it, I’d appreciate any direction you can provide.
Sherry, this is a thoughtful question and I appreciate both the level of detail and the fact that you're not asking me to diagnose your friend. I'll share what I know about the biochemistry, and you can take it to the conversation with her physicians.
The jaw involvement is the most well-documented serious side effect of bisphosphonates. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurs because bisphosphonates accumulate preferentially in bone with high turnover rates, and the jaw (particularly the mandible) has one of the highest bone turnover rates in the body due to the constant mechanical stress of chewing. The drug suppresses osteoclast activity so aggressively in these high-turnover zones that normal bone remodeling breaks down, and the tissue can't repair microdamage. This is well-established and multiple physicians flagging it is appropriate.
The progression from periorbital swelling to jaw to hands and wrists is the more interesting question you're asking. Here's where it gets speculative but worth exploring.
Bisphosphonates don't only affect bone. They have documented effects on soft tissue inflammation, particularly in the upper GI tract (which is why alendronate has strict instructions about staying upright after taking it). There's a lesser-known literature on bisphosphonate-associated musculoskeletal pain and inflammatory responses that aren't limited to the skeletal system. The pattern you're describing (periorbital, jaw, hands, wrists) follows a distribution that looks more like a systemic inflammatory or autoimmune process than a localized bisphosphonate toxicity.
Mechanisms worth exploring with her medical team: calcium and parathyroid hormone disruption (bisphosphonates alter calcium homeostasis, and aberrant PTH response can produce diffuse pain and swelling), vitamin D status (bisphosphonate efficacy and side effects are both modified by vitamin D status, and deficiency can amplify inflammatory responses), magnesium depletion (bisphosphonates can affect mineral balance, and magnesium deficiency produces musculoskeletal symptoms including periorbital twitching and hand/wrist pain), and the possibility that the bisphosphonate unmasked or triggered an underlying autoimmune process (drug-induced autoimmune phenomena are documented with many medication classes, and the symmetric hand/wrist involvement is a pattern worth investigating rheumatologically).
What I'd suggest her doctors consider if they haven't already: rheumatologic workup (ANA, RF, anti-CCP, ESR, CRP) to rule out an autoimmune process running alongside or triggered by the bisphosphonate, and a thorough review of her mineral and vitamin D status.
I haven't written specifically about bisphosphonate side effects yet, but the bone health articles cover the broader context. I hope this gives you something useful to bring to the conversation.
I generally don't recommend specific brands because the moment I do, it looks like a sponsorship or an affiliate arrangement, and I don't have either. What I will give you is what to look for on the label so you can evaluate any brand yourself.
For supplements: third-party testing (look for NSF, USP, or ConsumerLab certification on the label or the company's website). These certifications mean an independent lab verified that what's on the label is actually in the bottle, and that it doesn't contain contaminants. For specific forms (magnesium glycinate vs oxide, methylfolate vs folic acid, ubiquinol vs ubiquinone), the form matters more than the brand. I always specify which form in my articles for that reason.
If you're stuck between two products and want to know which one to choose, DM me with the labels and I'll tell you what I'd look for.
This is fascinating! I appreciate how you address both the internal and external with these protocols. I’ve been following some of these supplementation suggestions for concerns you’ve addressed in other articles, but I found a few gaps I can fill to help my skin. Thank you
Good. That's exactly how the articles are designed to work. You take what's relevant to your situation, identify the gaps in what you're already doing, and fill them. No need to overhaul everything at once. The fact that you're already supplementing from previous articles and now just tightening the protocol tells me you're building systematically rather than reactively. That's the approach that holds.
Is any of this contraindicated for women already on HRT? Just looked up chasteberry and it can interfere with hormones. Thanks.
Good catch, and this is exactly the right question to ask.
Chasteberry (Vitex agnus-castus) works primarily by acting on the pituitary gland to modulate prolactin and shift the balance between LH and FSH, which downstream influences progesterone production. In a woman who is not on HRT, that's the desired effect. In a woman who IS on HRT, you're already receiving exogenous hormones at a dose your prescriber calibrated. Adding an herb that independently modulates the same hormonal axes can create interference, not necessarily dangerous, but potentially unpredictable. You could end up with effects that neither you nor your prescriber can trace back to a clear cause.
The general rule: any supplement that directly modulates reproductive hormones (chasteberry, DIM, black cohosh, dong quai, maca) should be discussed with the provider managing your HRT before you add it. Some of them are perfectly compatible. Some need monitoring. Some should be avoided depending on the type and route of your HRT. Your prescriber needs to know what's in play so they can interpret your labs and symptoms accurately.
This is amazing and will take a while to unpack it all thank you! 🤩
I have a question about magnesium glycinate please. The label says “serving size is 2 capsules. Amount of magnesium bisglycinate per serving is 1040mg providing elemental magnesium 208mg.”
As you recommend 300-400mg is 2 capsules enough or would I need more or less? Thanks 🙏
This is one of the most common points of confusion in supplementation, and the labeling doesn't help.
Your label is telling you that two capsules contain 1,040mg of magnesium bisglycinate (the compound), which provides 208mg of elemental magnesium (the actual magnesium your body uses). The rest of the weight in that 1,040mg is the glycine molecule that the magnesium is bonded to.
When I say 300 to 400mg, I mean elemental magnesium. So at 208mg per two capsules, you'd need three to four capsules to reach 300 to 400mg of elemental magnesium.
That said, you don't have to jump straight to four capsules. Start with two (208mg elemental) for a week or so and see how you respond. If sleep improves, muscle tension decreases, and you're tolerating it well, you can move to three capsules (312mg elemental). If you want to go to four, increase gradually. The GI system is your feedback mechanism: if you get loose stools, you've found your personal ceiling and you back off by one capsule 🙏
Thanks for clarifying that!
That is perfect, thanks so much! I hope this helps someone else too! :)
About 30 yers ago ( I’m 66) I made a very conscious decision to never look at my face closely in the mirror. I’ve really appreciated that decision and never gone back on it. Occasionally I look at my face from a distance or in a mirror in a dim space. After being very focused on nutrition for the last ten years or so I think my skin feels better but I actually don’t want to start looking at it. I dont want to obsess. I certainly don’t want to know that my skin is lined and wrinkly, scarred and discoloured!!! I spend a large amount of time outdoors but dont want to wear horrible sun cream. Just a wide brimmed visor and shade. I do use some lovely face cremes but never use a mirror!
I respect this enormously. And I want to say something that might sound counterintuitive coming from someone who just wrote an entire article about facial skin: your decision is healthy. The obsessive mirror-checking that drives most skincare culture is not. You made a conscious choice 30 years ago to opt out of a feedback loop that generates anxiety and self-criticism disguised as self-care, and you've held that boundary since.
The fact that your skin feels better after a decade of nutritional focus is the right signal to track. How your skin feels (elasticity, hydration, comfort, healing speed) tells you more about its health than how it looks in a mirror under bathroom lighting. You're supporting it from the inside with nutrition, protecting it from the outside with shade and a brimmed visor, and moisturizing because it feels good. That's a complete skin protocol executed without a single anxiety-producing mirror check.
Don't change anything. You figured out something most people never will.
I have never read an article that specifically divided the areas of a woman’s face, and discussed the particular issues and treatments this concise. It was fascinating and very informative. Thank you. 🙏 😊
Thank you. The face is one of the most visible maps of internal health, and most skincare content treats it as a cosmetic surface rather than a diagnostic one. Each zone reflects different vascular, hormonal, and metabolic inputs, and when you understand what's driving the change from underneath, the interventions become targeted rather than generic. Glad it connected 🙏
Victor, is there an alternative to the flaxseed protocol? It appears repeatedly in your recommendations, but I have digestive issues with it. Thanks!
Absolutely. The reason flaxseed appears repeatedly is because it delivers three things at once: ALA omega-3s, lignans (which have mild estrogen-modulating activity through the enterolactone pathway), and soluble fiber. Finding a single substitute that does all three is difficult, but covering each component separately is straightforward.
For the omega-3s: chia seeds are the closest alternative (similar ALA content, different fiber profile, generally better tolerated digestively). Hemp seeds work too, with a lower ALA concentration but a better omega-6 to omega-3 ratio than most seeds. If you tolerate fish, wild-caught salmon or sardines deliver EPA and DHA directly, which are more bioactive than ALA anyway.
For the lignans: sesame seeds are the next highest food source of lignans after flaxseed. Significantly lower concentration, but meaningful if consumed consistently.
For the fiber: chia seeds again, or psyllium husk if you need bulk specifically.
If the digestive issue with flax is bloating or gas, it may be a fiber volume issue rather than a flax-specific intolerance. Starting with half a teaspoon and building up slowly over two weeks can sometimes resolve it. But if you've already tried that and it still doesn't work, the alternatives above have you covered.
Ah thank you so much! I’ll try starting with a smaller amount of flax and work up over time - hopefully that fixes it. Otherwise, thanks for all the suggestions, I tolerate those well.
Wow! I saw a few of these changes in perimemopause. The dryness especially on the forehead. I changed my moisturizer but it didn't do much, now I know why. I also has the decolletage is an even red. That area did get sunburnt a few times when I was much younger. Now, I lather my mineral based sunscreen on it often but I didn't realize that hormones played a role too but that makes sense that the redness showed up so much later. Thank you. You're information is invaluable!!!❤️❤️❤️
The forehead dryness is one of the earliest and most overlooked perimenopause skin changes. Estrogen maintains ceramide production in the stratum corneum (the outer skin barrier), and as estrogen declines, ceramide output drops and the skin's ability to retain moisture decreases. No moisturizer can fully compensate for a structural change in the barrier itself. The moisturizer sits on top. The ceramide loss is underneath.
The décolletage redness is a combination of what you identified (cumulative UV damage from years ago) and what perimenopause adds: thinning skin (estrogen maintains dermal collagen density), increased vascular visibility as the skin becomes more translucent, and vasomotor instability (the same mechanism behind hot flashes can cause localized flushing in areas with high vascular density like the chest). The sunburns from earlier created the initial damage. The hormonal shift made it visible because the skin that was masking it got thinner.
Mineral sunscreen is the right call. But supporting from the inside (omega-3s for the inflammatory component, vitamin C and zinc for collagen synthesis, adequate protein for the raw material of skin repair) is the other half of the equation ❤️
ooohhh, & those chin hair!!! (prob the only one ‘dent’ to my face right now). i’m literarily now forced to shave? almost every other day…i’m so less than impressed.
😢
at least, now i know why. thanks.
The chin hair is androgenic, and it's one of the most common and least-discussed perimenopause and menopause changes. Here's what's happening: as estrogen declines, the relative ratio of androgens (testosterone, DHEA) to estrogen shifts. You don't necessarily have more androgens than before. You just have less estrogen to counterbalance them. The hair follicles on the chin and jawline have androgen receptors, and when that ratio tips, those follicles convert from producing fine vellus hair to coarser terminal hair. Same mechanism as male-pattern facial hair, just driven by a ratio change rather than absolute androgen levels.
The every-other-day shaving is annoying but it's not dangerous. If it's driving you crazy, the longer-term options are electrolysis (permanent, targets individual follicles) or laser (semi-permanent, works best on dark hair against lighter skin). On the nutritional side, supporting estrogen metabolism and managing insulin resistance can help because insulin increases ovarian and adrenal androgen production, which worsens the ratio further. Spearmint tea has modest evidence for mild anti-androgen effects (two cups daily in the studies).
You're not the only one. You're just one of the few willing to say it out loud
OMG
THANK YOU.
i’ll be looking into electrolysis then, down this road for sure. in the meantime, i’ll continue to work the nutritional angle i already started for now. approx 1 month in now…😊
haaaaaa.
Not sure what I read that made me subscribe, but this ain't it. Have fun obsessing, everybody!
Fair enough. Not everything is for everyone. I hope whatever you were looking for, you find it somewhere. Best of luck.
Hi Victor,
I have a question about Fosamax (alendronate) that isn’t about me but about a friend.
She developed swelling and pain that began near one eye, then progressed to her jaw, and more recently has involved her hands and wrists.
Several physicians have suggested the jaw symptoms may be related to Fosamax, but I’m wondering whether the combination of facial pain, jaw involvement, and later painful swelling of the hands and wrists points to a different biochemical or inflammatory process. Have you come across anything in the literature that might connect these findings?”
I realize you can’t diagnose someone over the internet, but I’m curious whether, from your understanding of nutrition, biochemistry, and medication interactions, you can think of any mechanisms or contributing factors that physicians might not routinely consider. For example, could nutritional deficiencies, mineral balance, hormone status, drug interactions, or other cofactors influence how someone responds to bisphosphonates such as Fosamax?
If you’ve written about this topic or know of research that addresses it, I’d appreciate any direction you can provide.
Thank you.
Sherry Hawbecker
Sherry, this is a thoughtful question and I appreciate both the level of detail and the fact that you're not asking me to diagnose your friend. I'll share what I know about the biochemistry, and you can take it to the conversation with her physicians.
The jaw involvement is the most well-documented serious side effect of bisphosphonates. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurs because bisphosphonates accumulate preferentially in bone with high turnover rates, and the jaw (particularly the mandible) has one of the highest bone turnover rates in the body due to the constant mechanical stress of chewing. The drug suppresses osteoclast activity so aggressively in these high-turnover zones that normal bone remodeling breaks down, and the tissue can't repair microdamage. This is well-established and multiple physicians flagging it is appropriate.
The progression from periorbital swelling to jaw to hands and wrists is the more interesting question you're asking. Here's where it gets speculative but worth exploring.
Bisphosphonates don't only affect bone. They have documented effects on soft tissue inflammation, particularly in the upper GI tract (which is why alendronate has strict instructions about staying upright after taking it). There's a lesser-known literature on bisphosphonate-associated musculoskeletal pain and inflammatory responses that aren't limited to the skeletal system. The pattern you're describing (periorbital, jaw, hands, wrists) follows a distribution that looks more like a systemic inflammatory or autoimmune process than a localized bisphosphonate toxicity.
Mechanisms worth exploring with her medical team: calcium and parathyroid hormone disruption (bisphosphonates alter calcium homeostasis, and aberrant PTH response can produce diffuse pain and swelling), vitamin D status (bisphosphonate efficacy and side effects are both modified by vitamin D status, and deficiency can amplify inflammatory responses), magnesium depletion (bisphosphonates can affect mineral balance, and magnesium deficiency produces musculoskeletal symptoms including periorbital twitching and hand/wrist pain), and the possibility that the bisphosphonate unmasked or triggered an underlying autoimmune process (drug-induced autoimmune phenomena are documented with many medication classes, and the symmetric hand/wrist involvement is a pattern worth investigating rheumatologically).
What I'd suggest her doctors consider if they haven't already: rheumatologic workup (ANA, RF, anti-CCP, ESR, CRP) to rule out an autoimmune process running alongside or triggered by the bisphosphonate, and a thorough review of her mineral and vitamin D status.
I haven't written specifically about bisphosphonate side effects yet, but the bone health articles cover the broader context. I hope this gives you something useful to bring to the conversation.
Victor, do you recommend any brands at all?
I generally don't recommend specific brands because the moment I do, it looks like a sponsorship or an affiliate arrangement, and I don't have either. What I will give you is what to look for on the label so you can evaluate any brand yourself.
For supplements: third-party testing (look for NSF, USP, or ConsumerLab certification on the label or the company's website). These certifications mean an independent lab verified that what's on the label is actually in the bottle, and that it doesn't contain contaminants. For specific forms (magnesium glycinate vs oxide, methylfolate vs folic acid, ubiquinol vs ubiquinone), the form matters more than the brand. I always specify which form in my articles for that reason.
If you're stuck between two products and want to know which one to choose, DM me with the labels and I'll tell you what I'd look for.
Thanks, I think I mean more so in the face products.
Leave me alone, Victor.