In this episode, Sarah and Stacy breakdown Botox - what is it, what are the side effects, what are the adverse reactions, and what does the science tell us about the impact of this procedure. Our hosts bring this thorough scientific discussion full circle and share their personal feelings towards this procedure and how they personally handle skin health.

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If you enjoy the show, please review it in iTunes! The Paleo View (TPV), Episode 349: Must-Know Botox Info

• • (0:41) Intro
    • It feels like an eternity to Sarah since she last had the chance to talk to Stacy, which it basically has been since they prerecorded the latest episodes while Stacy was traveling
    • Stacy will share about her travels on next week's episode, but she is still processing it all
    • The trip was wonderful, and she has shared some updates via social media, but it was a family trip with many experiences and she is determining what all she wants to share and all the feels
    • One of the things that happened while Stacy was traveling; she got a massage and it put her back in a flair
    • Stacy did really well up until that point, which was 10 days into the trip. And she is excited to share that the first thing she did when she got home was put her Joovv to use and has been doing red light therapy on her back since returning and feeling the benefits of her Joovv (this week's episode sponsor!)
    • While we will cover Joovv in greater detail later in the show, if you are ready to get all the details on them now, head over to joovv.com/thepaleoview, and learn all about our favorite biohack
    • Sarah is gearing up for Paleo Fx, she leaves tomorrow - so by the show airs she will be on a stage sticking it to the man, which is what she typically does there
    • She often finds herself in the myth-busting role at these events, but doesn't actually like confrontation and wishes she could simply have everyone read the same scientific studies she is referring to
    • It is way easier to be on a soapbox on Skype with Stacy than it is to be in front of a few hundred or a thousand people
    • During Sarah's workshop in February talking about different types of scientific studies became really thematic, and how do you evaluate science and what do you look for and how do you detect pseudo-science - are topics that people would love to know more about
    • Sarah is trying to figure out how to condense these topics for the average person, as she recognizes the need for those in the health field to have access to this information
    • Stacy notes the importance of learning not just how to read these scientific studies, but how to use and apply the information in life without bias
    • To be able to look at the science and let that drive justification or not as to why something is improving your health or not, which is where the topic for this week's episode came from
    • What has been interesting for Stacy as a member of this non-toxic living community is the questions she receives around the use of Botox, among many other things, and where these injections fall in the healthy living spectrum
    • Stacy strives to help people find healthy solutions and Botox is off her list - through even just her preliminary research she has found that it is not for her
    • So on this week's episode, she wants to answer this question from a scientific perspective
    • Whether or not Botox is right for someone is ultimately a personal decision, but Stacy and Sarah's aim for this episode is to talk about the science and why both Stacy and Sarah would or would not make such a decision
    • This is not a judgment show; we want to make everyone feel comfortable when they listen to the show
    • Today's discussion is information driven and we are letting the science speak for itself
      • that is how Stacy and Sarah are driving their decisions
    • If Botox was safe Stacy would go out and have it done in a heartbeat
    • Sarah wants to note that there is a lot of pressure for social influencers to look a certain way, to appear young, healthy and vibrant is a part of the credentials
    • Botox is a fast solution and Sarah understands the allure of it and why many are driven to use it
      • it seems like an effective way to get the results we are looking for
    • What Stacy has personally done, in addition to more natural solutions (infrared - Joovv), is changed who is influencing her life so that she is no longer seeing only seeing a barrage of perfection, but is instead seeing people who inspire her to be herself and be real and be natural
    • If a listener is feeling the pressure of something, Stacy suggests looking into where that pressure is coming from and how you can reduce that pressure
    • You may not even realize where all the pressure is coming from - but ask what can you do to control it and empower yourself to value who you are and how you look
    • Find someone who tells you that your flaws are beautiful
  • (20:59) And Now the Science
    • Botulinum toxin is what Botox is
    • Botox was a carefully considered shortening of the name of a neurotoxic protein
    • The way that it causes botulism is by preventing the release of a neurotransmitter
    • It causes what is called flaccid paralysis, which is paralysis by muscle relaxation
    • It is the most lethal toxin known to man
    • A lethal dose of botulinum toxin is as low as one or two nanograms per kilogram body weight when injected into your muscle or into your bloodstream, which is an incredibly small amount of the toxin
    • It was studied originally in research because of this interest in the ability for it to block nerves that control muscles to cause muscle relaxation
    • There are of course medical uses where botox does have therapeutic benefit, but that is a different evaluation all together
    • However, it is worth noting as we talk about the undesirable side effects that the therapeutic doses tend to be even higher than the cosmetic doses and so the risk of an adverse effect is much higher in the therapeutic applications
    • So if you are dealing with one of these situations where botox may have therapeutic benefits Sarah highly recommend having a very thorough conversation with your medical provider and really understanding what all your options are and what to look for with adverse effects
    • There are very few scientific studies that look at the effects of Botox beyond two years and very few look at the effects of multiple injections
    • What Stacy finds interesting is all of the rebrandings of Botox, and these products aren't different they are just marketed differently
    • So be aware of the Botox, look at the warning labels, and do the research
  • (27:59) Side Effects and Adverse Reactions
    • A side effect is a minor complaint that happens on the side that basically resolves on its own
    • Whereas an adverser effect is a major problem, potentially life-threatening that requires medical intervention
    • Both are known to happen with Botox use
    • These are a list of the side effects:
      • drooping eyelids
      • uneven eyebrows
      • a crooked smile, which can lead to drooling
      • asymmetry
      • swelling
      • bruising, discomfort and inflammation in the injection area
      • systemic effects include:
        • fatigue
        • headache
        • neck pain
        • double vision
        • dry eyes or excessive tearing
        • fever and chills
        • allergic reactions (hives, rashes, asthma, etc.)
    • Adverse reactions include:
      • difficulty speaking
      • difficulty swallowing
      • severe muscle weakness
      • loss of bladder control
      • vision problems
    • Then there is a gray area of in between where some studies qualify certain reactions as adverse whereas other studies define the same reactions as side effects
      • Like vomiting, heart function, lung function, etc.; based on how severe they are they get put on either end of the spectrum
    • What Sarah finds kind of scary is that very few studies have looked at repeated treatments and long-term effects, especially beyond two years
    • It is estimated that there are 5 million Botox treatments a year globally and that it is a 2 billion dollars a year business right now - and this is just looking at the cosmetic use
    • There was one study published in 2005 that looked at participants over the course of 12 years who were using Botox for both therapeutic and cosmetic reasons
      • The study found that during the study period there were 20 cases of adverse effects in 16 of the participants, about a 1/3 of the participants
        • This included: difficulty swallowing, droopy eyelids, neck weakness, nausea, vomiting, blurred vision, general or marked weakness, difficulty chewing, hoarseness, swelling, difficulty speaking and heart palpitations
    • A 2015 review of the research found that there have been very few long-term studies and the risk of adverse effects seems to really increase after the 10th or 11th injection
      • For most people this is three to four years out of doing this regularly
      • This hasn't been studied rigorously, despite the wide use of Botox
    • Around 2015/2016 there was a spike in studies showing problematic effects and it started to hit the news that Botox might be as safe as we think it is
    • There have only been a handful of studies in the past few years that build on that
    • In the grand scheme of things though, it takes three to four years to build on these ideas and complete the research, so we are essentially waiting on these research labs to come out with their follow up papers
  • (30:30) The Latest Findings
    • In this timeframe, 2015/2016, there were a couple of papers that showed Botox actually travels through neurons
    • So up until 2015, it was believed that Botox could defuse a short way through the cells
    • Now it is known that it migrates, which explains how you could get full body weakness from a Botox injections
    • This is the explanation for these systemic adverse effects
    • These studies haven't hit the general body of knowledge around Botox
    • The studies Sarah referenced:
      • Long-term botulinum toxin efficacy, safety, and immunogenicity
      • The 2015 findings
      • Serious and long-term adverse events associated with the therapeutic and cosmetic use of botulinum toxin
      • Botulinum neurotoxin type A induces TLR2-mediated inflammatory responses in macrophages
      • A 2009 study titled, “The link between facial feedback and neural activity within central circuitries of emotion--new insights from botulinum toxin-induced denervation of frown muscles”
      • A 2010 study titled, “Cosmetic use of botulinum toxin-A affects processing of emotional language"
      • A 2011 study titled, “Embodied Emotion Perception”
      • 2014 study titled, “Botulinum toxin-induced facial muscle paralysis affects amygdala responses to the perception of emotional expressions: preliminary findings from an A-B-A design"
      • A 2014 study titled, “Altered cortical activation from the hand after facial botulinum toxin treatment”
      • 2016 study titled, “Deeper than skin deep – The effect of botulinum toxin-A on emotion processing”
    • In addition to the impact that Botox has on the nervous system, there is also direct immune effects, which also has some concerning implications
    • There are only a couple of studies that look at this, but Botox is basically causing an incredibly intense inflammatory response
    • As Sarah was researching this and feeling frustrated at the lack of long-term studies, she thought that this would have been a component that would have been needed for FDA approval
    • Sarah hit on this entire other field of research that looks at the impact of Botox of mental and emotional health
    • An important piece to note from the latest research is that Botox is only 80% effective, so 20% of people who get Botox (whether used for therapeutic or cosmetic use) and don't actually get the benefits of Botox
    • There is a collection of studies showing that Botox blunts emotional responses and emotional experiences
    • Stacy's mind has been completely blown by these findings
    • The idea of not being able to pick up on emotional queues would devastate Stacy
    • There are 8 to 10 studies that have looked at these emotional and mental effects, so it has been fairly thoroughly looked at and it is showing the impact that Botox has on the brain stem
  • (47:59) Closing Thoughts on Botox
    • On a side, Sarah highly recommends the book Brainstorm
    • There is also the potential for side effects on memory and feeling emotions in general
    • The idea of giving up something for the benefit of another thing, in this case, the aesthetics, and does that really make the person happy
    • In Stacy's experience, she has never known anyone who had a cosmetic procedure that said, and now I am complete and fulfilled and everything is great
    • Stacy often hears from people that on the other side of that change you make, that it doesn't actually solve the problem, it just highlights another for you
    • There are so many articles out there about people who become addicted to cosmetic procedures
    • Society has come to a point where we have lost the ability to step back and look at more than just the wrinkle, and this case, all the many other things impacted by one procedure
    • The health consequences are very problematic for Stacy, but the inflammatory response and the mental and emotional issues that come along with it make it all the more horrifying to her
    • Sarah thinks that its this collection of facts that make Joovv such a serendipitous sponsor for this show because when Sarah thinks about the things that would bring someone to Botox her first reaction is - well, what about all the effective, safe things you can do instead
      • Diet and hydration, exercise all have a huge impact on skin health
      • If you are going to invest in something to improve your appearance cosmetically, Joovv red light therapy would be a route that is highly recommended
      • There are a ton of studies showing that the two wavelengths in Joovv help to reduce inflammation and stimulate collagen production in the skin
      • The two wavelengths used in Joovv actually make the skin physically younger, as opposed to just making it appear younger, which is what Botox does
  • (53:34) Infrared Sauna vs. Joovv Therapy
    • An infrared sauna is a higher wavelength that works by increasing your core temperature and forcing you to sweat, which is a detoxification pathway
    • Joovv actually combines two different wavelengths, an infrared wavelength and a red wavelength
    • It can still increase your core temperature if you sit in front of it for long enough, but the addition of the red light to the infrared light is what gives it the magical formula
    • A red light goes deeper into your skin and is the main wavelength that is increasing cellular health
    • Sarah finds Joovv to be the best of both worlds, and has actually found that their product is the only one actually delivering therapeutic doses
    • If you want to shop Joovv, you can go to joovv.com/thepaleoview
    • There are different sizes and different price points, and all offer the health benefits that Stacy and Sarah discussed

• • (59:14) Final Thoughts
    • There are also, of course, topical treatments that people can do to treat wrinkles, but a lot of the antiaging products that are on the market actually intentionally disrupt your hormones
    • For those of us working really hard on lifestyle factors to regulate hormones, what you don't want to be doing is slathering yourself in some sort of cream that is just going to disrupt them
    • Be careful about the products you are using
    • Aging is not the most fun thing in the world
    • There is not one magical thing that fixes everything, it is the little bit of benefit that we get from each choice (diet, lifestyle, the use of biohacks like Joovv) that compounds
    • The goal for Sarah isn't to have her skin look younger, the goal is for her skin to be younger, and that is where the diet, lifestyle, and the smart use of biohacks that have scientific validity all comes together for magic (science) awesome
    • Stacy wants to remind everyone that they are wonderful and beautiful just as you are
    • Accepting yourself where you are and wanting to change is so important, so if there is something you want to change, Stacy suggests finding acceptance with yourself before you go on to find that next great thing because you might find that those laugh lines aren't something you actually want to change
    • If this is something you have done already, this is not meant to be a dig on you
    • Stacy and Sarah's goal is to simply help you be informed and make the best decisions for your health
    • Thank you for tuning in and having patience on this deeply scientific show
    • Thank you Sarah for pulling together all of this research and information
    • Don't forget that you can submit follow up questions through both Stacy and Sarah's websites or on social media
    • We will try to compile any questions received and if Stacy and Sarah need to do a follow-up show, we will as soon as we are able
    • Stacy wished Sarah a wonderful trip to PaleoFx
    • When Sarah returns, Stacy looks forward to discussing both of their wonderful trips

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