Monday, June 14, 2021

Diabetes Part 1 - Oh So Sweet!

            Among the 3 diseases in our 3 "high" series, I would argue that type 2 diabetes is the most complicated disease but probably the most preventable one. If we eat healthily, exercise regularly, and keep our BMI (body mass index) normal, we can delay the onset and slow down progression of type 2 diabetes! In this blog, my cousin, Charmain, and I will discuss what we can do to prevent type 2 diabetes. 

What is high blood glucose? 

Glucose, which is the end product of sugar, is a source of energy for the cells in our body.  Foods, particularly carbohydrates, are digested and broken down into glucose for absorption in the small intestines.   

As you all probably know, blood glucose levels are different before and after a meal, which is why most people fast for at least 8 hours before getting a blood test. The body has a very intricate system to prevent blood glucose from being too high or too low, and the pancreas is the main organ responsible for producing the hormones that control it. Insulin is secreted when glucose levels are too high, and glucagon when they are too low. Insulin signals a lot of organs, mainly the liver, muscle and fat cells, to increase glucose uptake, thereby reducing the level of blood glucose. In the liver, glucose is stored as glycogen, in fat cells as triglycerides. In the muscle, glucose is metabolized and used up. Glucagon, on the other hand, tells the liver to break down glycogen and produce glucose. In diabetes, the blood glucose level is high, a term called hyperglycemia. Persistent hyperglycemia is the cause of most diabetic complications. 




What is Hemoglobin A1C (HbA1C)?

    HbA1C, also known as glycosylated hemoglobin, is a blood test that physicians order for the screening of diabetes. It is the percentage of glucose attached to walls of the red blood cells. Glucose in the blood sticks to the red blood cells, which generally circulate in the blood for about 90 days. The more glucose in the blood, the more glucose is “stuck”. Therefore, the amount of glucose on the red cells indirectly measures the level of blood glucose circulating in the blood stream for the last 2-3 months. Normally, less than 5.6% of the red blood cell wall is glycosylated. When the percentage is persistently over 6.5, the diagnosis of diabetes is made. Unlike fasting glucose that can be “cheated” by eating healthily for the few days prior to the blood test, the HbA1C cannot be “cheated”. The blood glucose level has to be persistently less than 140mg/ml (7.8mmol/l) to have a normal result of <5.6%.


What is type 2 diabetes?

    Diabetes Mellitus has type 1 and type 2. Type 1 diabetes is not preventable, and is usually diagnosed in childhood or young adulthood. Patients with type 1 diabetes need to be on insulin and are closely monitored by their doctors, so we will concentrate on type 2 on our blogs. 

    Type 2 diabetes results from insulin resistance. As we grow older and gain weight, the body stops responding to the insulin produced. The liver, muscles and fat cells are not as responsive and need more “push” to do their work. The pancreas, trying to keep the blood glucose normal, then secretes more insulin to “push” the liver, muscles and fat cells to work harder. Leading to a state of insulin resistance. At this stage, the blood glucose is high and the insulin level is also high! The problem is the body not knowing how to respond to the insulin anymore. Without intervention, the pancreas will become “exhausted”, unable to produce enough insulin to reduce the amount of blood glucose. As blood glucose continues to rise, insulin resistance will lead to pre-diabetes and eventually diabetes. However, with diet, exercise, and weight loss, all of this can be prevented! Insulin resistance can be reversed!



How do we reverse insulin resistance?

Insulin resistance is mainly a result of aging and weight gain. The aging process cannot be reversed yet as of 2021, but we can definitely work on weight gain. As we age, the fat distribution when we gain weight also changes. It is the intra-abdominal visceral fat which is metabolically active, and that is the culprit for insulin resistance. Here, genetic predisposition comes to play a role. Asians tend to gain weight centrally. There is actually a term, TOFI - Thin Outside Fat Inside, to describe the propensity for asians to store fat intra-abdominally! In general, a BMI of >25 is considered overweight, triggering the screening for diabetes. For Asians, a BMI of >23 is already considered overweight and at risk for diabetes! So, at the early stage when glucose is only slightly elevated, diet and exercise has the most impact. Even with just a 5 lbs weight loss, the course can be reversed and diabetes can be prevented!

        To reverse insulin resistance, it is also important to:

  • exercise
  • stop smoking
  • drink less alcohol
  • sleep more
        Sounds familiar? Very similar to what you can do for high cholesterol and high blood pressure too!

For most people, it is easy to gain weight but very hard to lose it. Weight gain is something that we cannot allow ourselves to do once we reach adulthood! A lot of diseases, besides the 3 ”high” that we have been discussing, can also be avoided by not gaining weight. Diseases that range from arthritis to cancer, like breast cancer! One of the methods that I find helpful is not allowing myself to purchase larger size clothes. When the pants are feeling tight around the waist, that means I need to eat less and exercise more and get rid of that belly fat! Staying on a strict diet and exercise regimen is difficult, but we all have to strive and work hard on it. Starting with portion control and eating less, the stomach (the organ) will eventually shrink! Feeling 75% full is more than sufficient. Whatever diet you decide on, it has to be a forever diet. For more on what to eat, please visit Charmain dietitian. 


This blog is already long enough, but we have only touched on the surface of diabetes. I hope you understand the role of insulin and the significance of insulin resistance. We will discuss more on the complications and treatment of diabetes in our next blog.



Until our next blog! Resist the temptation! 


Sunday, June 6, 2021

Cholesterol - the good and the bad

    The next of the 3 "highs" that my cousin Charmain and I will be discussing is high cholesterol. High cholesterol is probably the most common among the 3 "highs".  The recommendation for treatment and diet is still evolving and changing as we learn more about it. The information that we are writing now in 2021, may be different from 2011 and probably will change again by 2031! 

    One of the most common blood tests patients request is for cholesterol. Physicians will usually order the lipid panel which includes the total cholesterol, triglycerides, high density lipoproteins (HDL), very low density lipoproteins (VLDL), and a calculated low density lipoprotein (LDL). I will go over what all these mean in this post and explain some of the misconceptions about cholesterol. 

What is Cholesterol?

    Cholesterol is the type of fat circulating in our blood. Every cell needs cholesterol, and it is the building block of hormone synthesis. One of the most important organs in our bodies, the brain, is largely made up of cholesterol. However, we all know that too much cholesterol can be harmful to our health. Most people probably imagine these fat to stick onto the inside wall of the blood vessel like a mound. In fact, these waxy fats start to accumulate within the blood vessel wall in a crystalized form, gradually narrowing the lumen where blood flows. This accumulation is called plaque or atherosclerotic plaque. There is a layer of the inside wall of the blood vessel, called epithelium, over the plaque. As the plaque grows larger, the epithelium is stretched and thinned. When it tears, exposing the cholesterol crystals underneath (called ruptured plaque), the body will attempt to immediately wall it off with platelets and fibrin like a wound, thereby blocking the entire lumen of the blood vessel. This sudden blockage of blood flow in a coronary artery will cause a heart attack; in one of the arteries supplying blood to the brain, it will lead to a stroke. 

    Triglycerides is another type of cholesterol and is the most common type of fat in our body. They are the fats from the food we eat—the storage form that any excess calories are converted to, and released when we need the energy. High levels of triglycerides contribute to fatty deposits on the blood vessel walls, increasing risk of heart attack and stroke. Very high level of triglycerides in the blood can "clog" arteries, causing pancreatitis. Imagine pouring oil down the drain! 

 LDL and HDL, low and high, which do you want high or low?

   Cholesterol is carried in the blood by a protein called lipoprotein. 

    LDL - low density lipoprotein, the "bad" cholesterol that deposits within the wall of the arteries causing atherosclerosis. 

    HDL- high density lipoprotein, the "good" cholesterol that picks up the excess cholesterol and transports it to the liver.  

    VLDL- very low density lipoprotein, transports triglycerides. So, its level goes up and down with triglycerides. 

    Too much LDL or too little HDL increases the risk for cardiovascular diseases (CVD) such as heart attack or stroke. There are subtypes of LDL, some larger and less dense, some smaller and denser and thought to be more atherogenic. There are a few laboratories that perform tests to further classify them, but in general the more LDL, the higher the risks for CVD. So, to summarize this, you want the bad LDL to be low and the good HDL to be high to reduce your risk for CVD.


What is high cholesterol? Hypercholesterolemia or Hyperlipidemia? or others?

    Hypercholesterolemia or hyperlipidemia is the term usually used for high cholesterol level in the blood. Since cholesterol is further broken down into LDL and triglycerides, there are other more specific terms. There are also classification based on lipoprotein dysfunction and genetics. Here, we will just use hypercholesterolemia. 

When do we start treatment for high cholesterol?

    Primary treatment for hypercholesterolemia is to prevent heart attack or stroke, so the level of cholesterol to start treatment is different for everyone. It depends on family history, other diseases and cardiovascular risk factors the person may have. The guidelines for treatment also changes frequently. As of 2021, normal person without any other risk factor, will consider medication for LDL higher than 160. Statins are the medications widely used for the treatment of high LDL. They are relatively safe and usually very effective in bringing down the LDL levels. There are also magnitudes of data showing that statins can significantly lower the risks of heart attack and stroke. 

What about fish oil or omega 3?

    Omega 3 has been used for the treatment of hypertriglyceridemia, high triglycerides in the blood. The 2 most studied omega 3 fatty acids are EPA and DHA. EPA has been shown recently to be beneficial in reducing the risks of CVD. While DHA is important in fetal development and thought to reduce the risk of Alzheimer's disease, recent studies have shown DHA to increase total cholesterol. So now the treatment of choice for hypertriglyceridemia is pure EPA omega 3 fatty acids. 


What can we do?

    Now that I have confused everyone with all the alphabet soup, let me confuse you more with what we can eat! We used to say eating fatty foods is bad, to avoid oil, red meat, eggs, shellfish and so on. Although we haven't really completely turned a 180, it is now OK to eat eggs, shellfish and butter! This part is where my cousin, Charmain dietitian can help and clarify. 

    Other things you can do:

  • Eat less sugar and carbohydrates
  • Exercise regularly
  • Lose some weight
  • Stop smoking
  • Drink less alcohol
    I hope this article helps you understand more about cholesterol. Feel free to ask us questions and we would love to hear comments and suggestions. Until the next blog on high sugar then!



Saturday, May 8, 2021

Hypertension - the silent killer!

    


    On the last blog that my cousin Charmain and I collaborated on, we talked about the 3 "highs"- high blood pressure, high cholesterol and high blood sugar. On this blog, we will specifically discuss high blood pressure. 

What is High Blood Pressure?

    Blood pressure is a measurement that is taken at every doctor's visit. There are 2 numbers to the blood pressure reading, one over the other, normal is around 110/70. The upper number, also known as systolic pressure, is the pressure in the artery when the heart contracts or pumps blood. The lower number, diastolic pressure, is the pressure when the heart is relaxed. The measurement is usually taken with a cuff around the left arm while you are in a sitting position. Nowadays, most medical facilities use machine to measures blood pressure although some doctors may still listen for it with a stethoscope. Many external factors affect the reading such as how you sit, the size of the cuff, just being in the exam room and so on. As such, a single reading of high blood pressure in one setting may not be clinically significant.



What does it mean to have high blood pressure?

    Abnormal blood pressure is an indicator that something is wrong with the the blood vessels in our body. When the numbers are consistently higher than normal, that suggests that the wall of the blood vessels are starting to change and stiffen. It may also be a sign that there is something wrong with the kidneys, and occasionally the adrenal glands. The doctor will order blood tests, urine tests, occasionally some heart tests depending on each individual’s case and conditions, and the diagnosis of hypertension will be given accordingly. Once you are diagnosed with hypertension, the blood vessels have started to stiffen and become narrow, eventually damaging the vital organs: brain, heart and kidneys. 

What is hypertension?

    When the blood pressure is higher than 130/80, that is stage I hypertension. Therapeutic lifestyle changes (TLC) is the the treatment. At this stage, eating healthy, exercising and losing weight will be the most important and can actually prevent disease progression!  Stage II hypertension is when the blood pressure is over 140/90. At this point, medications will usually be prescribed to control the blood pressure and to protect the internal organs such as heart, brain and kidneys. Progressing onto stage II hypertension does not mean that you have failed to sufficiently alter your diet and exercise, as it is part of the aging and disease process. Diet and exercise is still very important, but medications will be needed as well to prevent the complications of hypertension.


What are the complications of hypertension? 
  
    Throughout this time with high blood pressure, stage I and stage II hypertension, there are usually no symptoms. Unlike what you might have seen in Korean dramas, there is usually no headache, no chest pain or discomfort of any kind. A lot of people feel normal walking around with hypertension! However, it is quietly damaging your body. We call hypertension the silent killer because hypertension itself is generally asymptomatic; unfortunately, once you have symptoms, it is already too late. It is the complications of hypertension that led to symptoms: chest pain from a heart attack, inability to move one side of the body from stroke, swelling and inability to breathe because of heart or kidney failure. 

    Some of the common complications of hypertension are:
        
  • Heart -     Heart attack, enlarged heart (cardiomegaly), weakened and enlarged blood vessel (aneurysm), heart failure
  • Brain -     Stroke, memory loss and even dementia
  • Kidneys - Kidney damage and eventually kidney failure
  • Eyes -      Retinopathy from bleeding into the back of the eye causing blurred vision and sometimes loss of vision

       Most of these complications of hypertension may not be fatal, but they lead to long term disability.

What can we do?


    This is where your hard work can pay off. Taking care of your body helps not just yourself, but your family members too! Nobody wants to be a burden on their family! Besides TLC, which my cousin Charmain will elaborate on, it is very important to take medications as prescribed and to follow up regularly with your doctor. Medications do not just bring down the blood pressure numbers, the newer classes of anti-hypertensives can specifically protect the kidneys and heart! Sometimes, we use these medications on patients who do not have hypertension, just for the sole purpose of protecting the heart and kidneys. Work with your doctor to find the best medication for you. 


    Immediate things you can do:
        
  • Eat less sodium or salt. Definitely, do not use table salt. 
  • Eat more fresh food, especially celery, cucumber, green apple, bitter melon. 
  • Eat less processed food.  
  • Walk at least 30 minutes daily, better if you can exercise more
  • Drink less caffeine! This one is the hard one for me! 
  • Stop smoking. 
  • Drink less alcohol. 
  • Reduce your stress, which is easier said than done. Try meditation and remember to love yourself! 
  • Buy a blood pressure monitor, about US $30 at Costco, and monitor yourself. 
    Controlling your blood pressure can slow down the disease process. To emphasize one more time, taking your medications regularly, together with dieting and exercising, will reduce your risks for heart attack, stroke and kidney failure!
    
    Hopefully, this gives you a general idea of what hypertension is. We will be happy to answer any questions. If you find this helpful, please follow us and read our next blogs on high cholesterol and high blood sugar!

    

Friday, April 30, 2021

3 "highs”- 三高- is not a death sentence

    A chance encounter with my cousin Charmain online, we came to realize that we both started blogging! So, we thought it would be a great idea to collaborate and write about nutrition and health as well. She is a Registered Dietitian Nutritionist while I am a retired physician, so hopefully we can help our readers achieve a healthier life. We thought we will start with something common, the "3 highs" - 三高. Through this series of blogs, we hope to explain the "3 highs" in ways everyone can understand and to work through some lifestyle modifications.

    Now that we are in the latter half of our life's journey, we pay more attention to our health, or at least we should. We eat healthily and exercise so that we can get a good report card during our annual well visit. I actually first heard the name "3 highs" from patients! They believed that once you have the "3 highs", you are on your way to your grave! Well, while there is some truth to it, the “3 highs” markedly increase one’s cardiovascular risk, but it is not a death sentence. The risk of cardiovascular death can be reduced with medications and therapeutic lifestyle changes (TLC).

    The 3 "high"s are:

        high blood pressure

        high cholesterol

        high blood sugar. 

    The diseases they can lead to are:

        hypertension

        hyperlipidemia

        diabetes

    It may be too simplistic to think of them as just numbers that are elevated. In fact, they are indications that certain organs in the body are not functioning normally anymore, the blood vessels are starting to change and are signs of diseases at the early stages. It will be a super long blog to write about all 3 and nobody wants read lengthy articles. It is long enough as it is! So, we will discuss the 3 separately.

   Why do people fear the "3 highs"? With every one "high" and the subsequent disease, the cardiovascular risk is increased. So, for example with just high blood pressure, the risk for a heart attack and stroke is significantly increased compared to someone without. Adding high cholesterol, the risk is further increased. Having all 3, the risk for cardiovascular disease is even higher. Again, things are actually not that simple with risks not exactly additive and other factors do play their roles, but hopefully, you get the sense of it. 

    When the numbers are elevated but not to the level of the definition of disease, lifestyle modification is the most important treatment. Let's use high blood pressure as an example. Normal blood pressure for a normal weight adult is around 110/70. When the reading is over 130/80, then they have hypertension. Before it gets to hypertension, it is elevated blood pressure. At this stage, eating healthily, exercising and losing some weight are key in preventing or slowing down the disease progression.  

    As we grow older, our internal organs and blood vessels begin to age. Living a healthy lifestyle helps but eventually, a lot of us still need medications. Many people hesitate do take medication and always bargain with physicians for more time for TLC (not tender loving care, but therapeutic lifestyle changes). The need to start medication does not mean that you failed. It is actually an adjunct to the overall treatment and to reduce your overall cardiovascular risk. So when your doctor prescribes medications for you, they are not just treating the numbers, they want to protect your internal organs, like your brain, heart, kidneys, etc, as well as your overall health. The numbers are just a barometer that represents the state of your body.



    The next part of the blog is from Charmain Dietitian on how to change your diet, which includes:

        1. Eat a variety of whole and fresh foods everyday. Frozen, canned or dried nutritious foods are equally good to use. Read label on the package and choose the most natural ones with less ingredients, and keep a check on fat, salt and sugar content. 

        2. Enjoy a rainbow color of fruits and vegetables to achieve a wide spectrum of vitamins and minerals. 5 A Day ( 5 servings of fruits and vegetables a day) is a good start.

        3. Choose a variety of options from each food group

                - high fiber starchy food

                - low fat dairy or dairy alternatives such as soy drinks

                - eat some beans, pulses, fish, eggs, meat and other lean protein. Among protein foods, consume plant-based protein more often, such as legumes, nuts, seeds, tofu, fortified soy beverage

                - choose unsaturated oils and spreads, and eat them in small amounts

                - fluids 6-8 cups per day. Water should be the beverage of choice

        4. Pay attention to portion size

        5. Limit foods and beverages high in add sugar, saturated fat and sodium; i.e. eat less processed foods

        6. Stop smoking

        7. If you drink, limit alcohol to 2 drinks or less in a day for men and 1 drink or less a day for women, according to CDC and NHS. Spread your drinking over 3 or more days if you regularly drink as much as 14 units a week. If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink-free days each week.

        8. People at high risk of or people with cardiovascular disease who are overweight or obese, seek advice and support to work towards achieving and maintaining a healthy weight.  

        9. Resources American Dietary Guidelines, Canada's Food Guide, UK Eat Well Guide.

    For more details for specific dietary changes, refer to Charmain's blog.  If you find the above dietary information useful and wants to start making some lifestyle changes, Charmain would like to help. Feel free to contact her for 1:1 consultation or group sessions. 


    So, I hope that you will be interested in learning more about the 3 “highs” and have the incentive to further improve your lifestyle by subscribing to our blogs! Do not hesitate to ask questions!

Sunday, March 28, 2021

Will learning a new language really prevent aging of the brain?

    Brain aging is probably the most worrisome aspect of aging that most people would be interested in preventing. It is known that memory declines sharply after menopause. I am personally going through this now and can attest to the truth of this statement. Besides having difficulties recalling names of movie stars and even friends and relatives! I used to have really good memory, and could reproduce 75% of a lecture; now I would be happy if I could remember just a couple of points!

    There are mountains of research and books on the topic of memory loss. In regards to the menopause-related decline, researchers have tried hormone replacement therapy to see if that would help. There is now a disclaimer on the hormone treatment, indicating that it will not help in the prevention of Alzheimer's. So, our quest to search for the miracle drug for eternal brain youth continues. 

   Medications aside, there are also lots of research and books on what we can do to keep our brain young and healthy. Some of the well known factors that can reduce the risks of dementia are:

1. Healthy and balanced diet 

2. Physical activity

3. Sufficient sleep

4. Social interaction

5. Community service

    In addition to doing all of the above, some researchers suggested that learning a new language or musical instruments will open up areas of our brain that have not been utilized, and in doing so help reduce the chance of dementia. The theory is that we only use about 10% of our brain capacity, so learning something completely new will form new pathways and connections in our brain, “opening” up new areas that have not been used, and hopefully reducing the risks for dementia. Since there is no harm in learning new things, I decided to learn Japanese. It was fun learning a new language and going back to school made me feel young, especially when I was interacting and learning with people half my age! Unfortunately, the pandemic changed the learning process for the whole world. The classes all became online and we no longer interacted like we used to. We attended class via Zoom, listened to the teacher explaining the grammar structure and went into little discussion “rooms” to practice with fellow students. Gone were the little conversations with fellow students. We hardly saw each other’s faces! Nobody showed their face online! I feel that I am not learning as well online as I was in person. I am still studying as hard as I was before the switch, and I am doing all the assigned homework. I understood the teacher perfectly during the lecture but once the video is off, I find that I can’t remember as well and kept having to refer to the textbook. So, what was it that was helping the brain? Was it really just learning a new language? Or was it the action of going to school, learning with a group of people and interacting with them and the teacher? 

    I am going to continue learning Japanese and possibly another language as well. It is fun learning for the sake of knowledge and self improvement! Speaking and understanding another language open up a whole new world and the ability to interact with people in their native language is something that I would love to do when we get to travel again. Furthermore, if learning a new language can help me reduce the risk for dementia, it would be a bonus! So, let’s explore the world and pick up a new language!



Tuesday, March 23, 2021

The evolution of toner

    Remember the toners that we used to use to help reduce acne? Remember how it stung? We were told toners reduced the oil on the face and helped prevent acne, the sting was supposed to be the feeling of the acne shriveling and disappearing! We might as well be wiping alcohol directly on the face! Since then, I have skipped the toner in my skincare routine and honestly have not given it much thought and continued to feel that it is only for the acne prone youngsters. 

    It was not until recently when I received a sample of the Mamonde Rose Water Toner that I realized that the toner has evolved! It is no longer just an astringent and alcohol to remove the oil and shrink the pores! The evolved toners also moisturize and desquamate besides cleanse and balance the pH of the skin.  The Mamonde Rose Water Toner did not sting at all, it felt so good on the face! It was smooth and fragrant and left the skin feeling supple, clean and refreshed. 



    Rose water is a natural toner. Damask rose is the most commonly used rose for this purpose. It has been used for centuries but has become popular recently. Rose water has antibacterial and antioxidant properties and contains lots of nutrients including vitamin A an C. It can clear the skin from acne and blemishes and even has some anti-aging effect. Needless to say, the fragrance of the rose alone is therapeutic and relaxing as well. I have used quite a number of different rose water, some with other chemicals and some are purely 100% rose water. Although refreshing, I feel that they do not leave my face as hydrated as the Mamonde Rose Water Toner, which is 90.97% Damask rose water.  

    So, now this Rose Water Toner has become my second step after a thoroughly cleansed face and SKII-essence. 

   

Sunday, February 14, 2021

Multi-step skincare routines - why it takes women longer to get ready 😬

     I have been getting some questions regarding the steps of skincare routine. With all the toners, oils, serums, lotions and creams, it definitely can be quite confusing. Everyone’s routine would be different. What we put on our skin also depends on our skin type and age. Here, I will outline the general steps and include some of the products that I am currently using. 

    First and most important step to all good skin care is thorough cleansing. I do not have a particular cleansing cream or foam. However, I do use a brush and I have tried both the Clarisonic and Foreo. Now that Clarisonic has been discontinued, I will continue with the Foreo which is actually more portable, easier to use and clean. 

    On a fresh clean face, the first thing I use is the SK-II Facial Treatment Essence. It soften the skin and prime it for better absorption of the serums and oils. Please read my previous blog if you want to know why this Essence is irreplaceable for me. 


    Next step for me is the toner. My experience with toners in the past was that they sting because they usually contain some astringent, so I was not in the habit of using one. That is until I received a sample of the Mamonde Rose Water Toner. It did not sting! Instead, the Rose Water smells really nice and feels good on the skin. It is a mild toner. The whole Mamonde line is flower based, using the properties of different flowers to achieve the desired effects. I have become a fan of their toner. 

    As I have dry skin, I will use a hydrating water and lotion after the toner. My favorite pair now is the Sulwhasoo TimeTreasure Invigorating Water and Emulsion. 



    Then the skin is ready for the serum. During the day, I am currently using the Mamonde Red Energy Serum. At night, the Estée Lauder Advanced Night Repair. I also like SKII RNA Power Youth Serum. I like the feel of richness and smoothness of serum on my dry skin. 

    After the serum, occasionally I will put on some oil. Oil may not be right for everyone. My skin is dry and I need the oil especially during the winter months. My all time favorite is the SKII Pitera Oil which is now discontinued. Neutragena has a retinol oil that I am going to try next. I will let you know how well it works next time!

After the oil is patted into the skin and well absorbed, I apply a generous amount of the cream - Olay Regenerist. You can read all about the reason why this is my favorite cream in my previous blog

    Last but definitely not least, especially during the day, I always put on sunscreen. It will be applied again before leaving the house. The sun, after all, is the greatest enemy of the skin!

So, to summarize all the steps:

1. Wash face well

2. SKII Facial Treatment Essence, there is no substitute for this one.

3. Toner

4. Water or Essence of other brands

5. Emulsion or Lotion

6. Serum

7. Oil, which is optional and depends on weather and condition of the face

8. Cream

9. Sunscreen!