The Promise of Successful Aging — An Interview with Superstar Dermatologist/Nutritionist Dr. Nicolas Perricone

Dr. Nicholas Perricone, MD is a board certified clinical and research dermatologist and is regarded as the Father of the Inflammation Theory of Aging.  Amazingly, he is the author of 3 New York Times #1 Best Sellers: The Perricone Promise, The Perricone Prescription, and the Wrinkle Cure. Here is our 2004 original interview which is still apropos to those wishing to feel and look younger.

FitCommerce: Good afternoon, Dr. Perricone. You are noted for your leading work in anti-aging and advanced skin care, what events in your career prompted you to zero in on this particular field? 

Dr. Nicholas Perricone:  I had just been discharged from the army, I felt kind of fatigued, so I went to see a physician and he said, “You’re in perfectly good health”, and I thought, “Gee, I don’t feel that great”.

So I started reading some nutrition books, such as [those] by Adele Davis, and I started following some of her programs and I felt terrific. So, I continued reading more about nutrition. By the time I went to medical school, I actually had a good solid nutrition background.

Whenever I would observe a disease process, I would ask, “How would altering the nutritional status work in this case in addition to traditional medications?”

Then I discovered the inflammation-aging-disease theory, which means that inflammation is at the basis of aging and a lot of diseases. I knew that I could actually decrease inflammation through nutrition.


So, utilizing all of that in my practice for close to 12 years, I had a lot of information about overall health and wellness and how it affects the skin. The skin is a perfect reflection of what’s going on inside of us: it’s a barometer.

Since my patients were doing so well, I thought I should start telling others about it. The first book I wrote, The Wrinkle Cure, discusses how beauty is really from the inside out.

FC:  In your books you’ve gone into detailed explanation about the harmful effects of “free radicals” as forming chain reactions in cell damage. Where do free radicals come from and how can we combat them? 

NP: First of all, free radicals are generated by many things; one of the ways is by metabolizing our food for energy. Free radicals are also generated by smoking, alcohol consumption, stress, sunlight and a number of other things.

Free radicals are very reactive, and they tend to react with other chemicals, they can also react with our cells in our bodies and cause damage. Free radicals only exist for only a short period of time, for a nanosecond, but they trigger a cascade of inflammation that goes on for hours or days.

So, I like to interfere with the process of inflammation. Because trying to hit a bullet with another bullet is difficult for a fraction of a second. But the results of free radicals can actually be treated. So, we look at inflammation here. One of the best ways to decrease inflammation in the body is through what we eat.

We can eat foods that are pro-inflammatory like sugar or things that are converted to sugar, or we can eat foods that are anti-inflammatory, which is a diet consisting of a lot of fresh fish, fruits and vegetables, and so on.

“Our skin is a reflection of what’s going on inside of us.”

If we cut out the pro-inflammatory foods and add the anti-inflammatory foods, there will be a tremendous impact on our health and well-being. It will decrease the risk of all of the age related diseases like cancer, heart disease, diabetes and all the rest. At the same time, it also improves our appearance, remember, our skin is a reflection of what’s going on inside of us.

I can show people that within 3 days of eating an anti-inflammatory diet, they can look entirely different. They can walk into a room and people will be astounded by how well they look.

FC: You just mentioned how you would like to prescribe good nutrition with classic medicine. Also, you were one of the first to associate disease being caused by inflammation instead of necessarily vice versa. Do you recall when you had that epiphany about the connection between inflammation and disease?  

NP: When I was in medical school. I took a course where I looked at everything under a microscope. Students had to study all disease processes by how they looked to the naked eye, then you had to look at the disease process under the microscope.

It’s called histopathology; you’d have a full course just looking at microscopic slides of heart disease, of cancers. I was looking that these cancer cells and they were surrounded by inflammation. I thought that was rather intriguing. I was taught that cancers existed because they avoided immune systems.

So, I went to my professor and asked, “Is it possible that this cancer is somehow mediated by inflammation rather than just being a side effect of the cancer.” My professor said, “No, it’s just the immune system being activated”.

But then I went on to look at sections of arteries of people with heart disease and there was inflammation there. I was looking at sections of the pancreas of people with diabetes and there was inflammation there. It just went on and on.

“If skin was aging, it had inflammation in it. If it wasn’t aging, it had no inflammation.”

I really felt that inflammation was at the basis of a number of disease processes. Then when I started my dermatology residency, we did the same thing, we looked at every skin disease, including aging skin, under the microscope. If skin was aging, it had inflammation in it. If it wasn’t aging, it had no inflammation.

So, I put together this inflammation-aging-disease theory. I was convinced from medical school and from my residency that inflammation is the bad guy, that we should be treating it. So, I started looking at ways to decrease inflammation and found that nutrition was huge; the right foods can actually decrease inflammation.

We can take nutritional supplements in the form of capsules that also have anti-inflammation activity. And as a dermatologist, I was doing extensive research in applying things to the skin to try and stop the aging process and try to improve aging skin and found that anti-inflammatories had a tremendous benefit to the appearance of skin.

“All anti-oxidants have anti-inflammatory activity.”

So, this is really a 3-tiered program. There’s the anti-inflammatory diet, as the first and most important portion. The second tier is taking nutritional supplements, usually anti-oxidants, that have anti-inflammatory activity. (All anti-oxidants have anti-inflammatory activity).  The third tier was putting anti-inflammatories directly on the skin, once again, natural substances found in foods and things like that.

“All fat cells produce inflammation chemicals.”


Fat cells produce inflammation chemicals which can also prematurely age us.

This is my 3-tiered program. It’s what I write about. My approach to beauty and wellness is definitely a holistic approach. We also know that a bad lifestyle creates inflammation, [things] like not drinking enough water, not getting enough sleep, and emotional stress causes tremendous inflammation in the body. Also being overweight, because all fat cells produce inflammation chemicals.

FC: Our readers understand that there’s a connection between regular exercise and general health, but is there also a connection between fitness and better health, successful aging and healthy skin? 

NP: First of all, my approach to everything is moderation. The diet is moderate, the lifestyle is moderate, and I think exercise should be moderate. I certainly see the health benefit to regular exercise.

I recommend 3 kinds of exercise. I recommend an aerobic cardiovascular type of workout, some weight resistance, we need to have extra muscle mass, it helps to decalcify bones. I believe in some flexibility exercises. These are all important because exercise reduces stress, decreases body fat, improves circulation, all those things are anti-inflammatory. However, I do have a problem when people exercise too much because that becomes a pro-inflammatory process.

“I believe you can improve your [sports] performance with extended exercise, but not necessarily improve your health.”

When we exercise for over an hour, our endogenous anti-oxidants get used up, and the metabolites produce inflammation in the body. So, once again, look to moderation.

So, if you’re doing some cardiovascular activity, I’m recommending 20-30 minutes 3-4 times a week. I’d recommend some weight resistance training, 20-30 minutes maybe 2-3 times per week, and some flexibility training, maybe 4-5 times per week. And that’s it.

Certainly there are marathoners out there. I believe you can improve your performance with extended exercise, but not necessarily improve your health.

FC: You’ve also spoken in the past how exercise stimulates the formation of HGH (“human growth hormone”) and that HGH is beneficial to other parts of the body, can you please expand on this? Another topic of interest to the boomer generation is this whole notion that HGH helps to foster youthfulness and weight control, etc. Obviously taking HGH injections could carry some risk, however, there are some theories that some forms of exercise can elevate the natural HGH. If that were possible, would that have a positive effect on successful aging? 

NP: Yes, I think certainly we want to maintain youthful levels of hormones, but we also know that hormone supplementation hasn’t worked out for us in many cases. We know for a fact that exercise on a regular basis gives you elevated levels of growth hormone. That’s good, because growth hormone will increase your muscle mass, will increase bone density, increase skin thickness, boost your immune system, maintain the normal size of your organs, your heart, your kidneys, liver, all that.

So, we want to maintain youthful levels of growth hormones as best we can, and certainly exercise is one of the strategies. Another strategy is getting enough sleep. Reducing stress, and even eating the right foods can actually enhance growth hormone production.  When cortisol is high, growth hormone production goes down, so we want to lower cortisol by lowering our stress.

FC: Just a follow up question to exercise, clearly exercise helps to build muscle which is good, but there are also facial muscles, just kind of a wild question here, if one could build the muscles in their face, would that be a good thing for better appearance? 

NP: That’s a great question because I’ve spent years on this particular problem, and I actually have a device in front of the FDA specifically to exercise facial muscles. Now my experience has been the following: when I started seeing superstars, super-models, actors, and actresses, as patients, they’re genetically gifted because they’re extremely beautiful. I thought that beauty was coming from perfect bone symmetry.

And looking at them, they didn’t necessarily have perfect bone symmetry; they did have a lot of soft tissue symmetry, and a lot more soft tissue in the face – that is more musculature.


So, if you look at a young Michael Douglas, or Michelle Pfeiffer, you’ll see the extra musculature in the cheekbones, in the jaw line, in the chin with the cleft, it’s all musculature with a good amount of subcutaneous fat there.

Anything that accelerates muscle loss is a disaster and that’s why I think Botox is dangerous. “

So, let’s take a picture of Michelle Pfeiffer 20 years ago, and put her picture up now. What you’re going to see, is that she’s going to go from a lot more musculature, from round to a little flatter. So, that loss of convexity is interpreted as aging. So, the best strategy for the face would be to increase muscle mass and increase subcutaneous fat.

So, the worst thing we could do for a face would be anything that would decrease muscle mass, like Botox injections which atrophy muscles because they’re paralyzed.

When you look at a person, you’re processing the convexities, not the wrinkles. I have 25-year-old patients, blond hair, blue eyed, with a lot of wrinkles, but they still look 25 because they have convexities. Those people that atrophy their facial muscles look older and you’re interpreting them as older. I don’t care if they don’t have a line or a wrinkle; you’re going to say “old”.

FC:  What about good nutrition for good health, beauty and successful aging?

“That’s the key, once we control blood sugar and insulin, then we control inflammation, and if we control inflammation, we control the onset of disease and the onset of aging.”

NP: I know that the key to maintaining low levels of inflammation in the body by carefully controlling blood sugar and insulin. If you’re eating a lot of starches, your blood sugar and insulin are going to be elevated, that’s a fact.

Now I certainly don’t believe in no carbs. That’s disastrous because what you do is produce ketosis, and ketosis produces inflammation. People should have balance. A red flag should go up when people say ‘no carbohydrates’, or ‘low fats’, anything that isn’t balanced should be a red flag to the consumer.


Proper nutrition can reduce inflammation and keep you youthful looking, but everything in moderation.

But your carbohydrates should come from fresh fruits and vegetables, legumes – and it should be balanced. That’s the key, once we control blood sugar and insulin, then we control inflammation, and if we control inflammation, we control the onset of disease and the onset of aging. It’s a simple formula and the formula is always based on moderation.

FC: Can you expand a little bit on why there are “good fats” and “bad fats”.  

NP: Sure, first of all, the bad fats are fats that are not natural. [In] trans fatty acids, the hydrogen bonds are kind of reversed, so our body can’t deal very well with them and they can actually cause a rapid increase in body weight, [and] inflammation within the arterial walls. [They] also make the cell membranes stiff so that the receptors don’t work as well. So, we get increased insulin insensitivity by having a lot of bad fats in our diet.

Good fats are the essential fats, certainly the omega 3’s and the omega 6’s, we’re aware of the omega 9’s, those are ‘essential.’ I even believe you should have some saturated fats in your diet, because it helps to strengthen the cell membrane.

Fats serve many functions. You need fat to burn fat, you need fat to maintain a supple cell membrane, you need fats for storage of energy, and you need fats for a health immune system and for beautiful skin.

Low fat/no fat diets are disastrous. The brain is extremely sensitive to not having good fat, when you have trans fatty acids, cell membranes become stiff, you’re not going to think as clearly, you’re going to age more rapidly. The brain is 70% fat by weight; if you starve those brain cells of fat, it’s a set up for mental depression.

“…The point is that low fat, no fat is disastrous, it’s bad for our immune system, bad for our skin, bad for our brain”

I don’t think it’s any coincidence that in the late eighties and early nineties, when the no fat, low fat diet took off, that we had the onset of a lot of mental depression and therefore the development of products like Prozac and all the others.

In fact, there’s an interesting study that was done in Massachusetts. A group of patients who had clinical mental depression were evaluated by a group of psychiatrists and they were given a numerical score based on depression. The group was broken in half, half was given the traditional SSRI (Serotonin Specific Reuptake Inhibitor) like Prozac and Paxil, the other half was given salmon every day or fish oil supplements or both.

And the end of 8 weeks with the evaluation, those people in the group eating salmon or taking fish oil capsules had greater elevation of depression than those taking the SSRIs.

So the point is that low fat, no fat is disastrous, it’s bad for our immune system, bad for our skin, bad for our brain, and therefore we have to be very careful, we have to have enough fats.

Now, you can get some saturated fats as long as they’re not trans fats, because saturated fats strengthen the cell wall. If you have too much essential fat, like omega 3s and omega 6s, you end up with the cell wall being too supple and not being strong enough. Again, it’s just moderation.

 FC: In addition to our good nutrition taken by foods that we eat, etc., a lot of older people are big on supplementation. From a general health and good skin standpoint, is supplementation important even if we’re eating a healthy diet? 

NP: Yes, I’m a great believer in supplements because, remember the battle is against inflammation, and many supplements provide an extra layer of protection against inflammation or extra ability to decrease inflammation in the body.

Let’s face it, we don’t have a perfect lifestyle. We don’t get enough sleep, we’re stressed by a number of things, both psychological and chemical, toxins in the environment, we go through the long list. So I think supplements are important to bring down inflammation and detoxify our bodies.

“The most important step here is a good diet”

I also believe that as people get older, they should probably take some supplements like branch chain amino acids, because we’re not as efficient in terms of metabolizing our protein. So, if you look at a range of supplements, I think they all help with the battle, but I want to emphasize to everybody I talk to that the most important step here is a good diet. I still recommend, as a second level of protection, supplements, and the third level would be the topical anti-inflammatories and topical neuropeptides.

But the whole approach here once again is holistic. Beauty is released from the inside out and we have to understand that, and know what the most important steps are. However, I can say that when people do all three steps and add lifestyle changes, they get the most benefit of anybody.

FC: O.K. So if a patient were on a tight budget and had a balanced diet, what would be the 2 or 3 ‘must take’ supplements? 

NP: I would suggest they take fish oil capsules, alpha lipoic acid, and Coenzyme Q10. And then a multiple vitamin, which is very affordable, along with that.

FC: And the fish oil, is that for the omega 3s? 

NP: Yes, the omega 3s, DHEA and EPA have tremendously powerful anti-inflammatory effects. CoQ10 is a tremendously powerful anti-inflammatory, as well as alpha lipoic acid. Because inflammation, once again, is the key here, I want to recommend those 3 along with a multiple [vitamin].

But certainly everybody has a budget. I want to emphasize one thing, I believe that you can have a good diet, a good healthy diet and it’s cheaper than having a junk food diet. I wish it wasn’t as expensive eating fish and fresh fruits and vegetables. And you know what? I’m pretty sure I can challenge anybody to have a really good diet, look at what they spend on a fast food meal, and what they spend on other processed foods in the supermarket, and show them that they will actually save money while at the same time saving their health and their beauty.

FC: And not to mention, perhaps over a lifetime, the medical costs related to that junk food diet.  

NP: Of course, we can’t even begin to calculate the difference in having a healthy life where you’re independent and you’re going to accomplish your mission in life.

FC: As you peer over the horizon, what do you see coming out as products or what have you observed that can affect our successful aging and beauty? 

NP: I think we’re going to get more sophisticated in terms of nutrition and supplements, we’re going to understand that a lot better. I thing we’re also going to perhaps start having administered to us, hormone supplementation in a safe way.

I also believe that we’ve done enough work now with the genetic map that, hopefully, that maybe not in the next half decade, but maybe in a decade, we’ll have some gene therapy to slow the aging process down and regenerate our major organs.

About Nicholas Perricone, M.D.

Dr. Nicholas Perricone

Nicholas Perricone, MD, FACN, is a board-certified clinical and research dermatologist. He completed his internship in Pediatrics at Yale Medical School and his Dermatology Residency at Ford Medical Center. Dr. Perricone is regarded as the Father of the Inflammation Theory of Aging. He is the author of the three New York Times Best Sellers, The Perricone Promise (Warner Books 2004), The Perricone Prescription (HarperCollins 2002), and The Wrinkle Cure (Warner Books 1998).