Transcription
Hi and welcome to The Honest Channel. I'm Clare Johnston, a journalist with an interest in all things anti-aging. Today, I've brought back two familiar guests on this channel to debate the science behind red light therapy.
Dr. Qian Xu is an experienced aesthetic specialist with a background in emergency medicine and surgery. She's also the co-founder of Redjuvenate Medical Clinic, which offers red light therapy for a range of uses, so she has an interest in this subject and particularly good knowledge. If you want a very helpful overview of the different forms of red light and their uses, you'll find it in this interview with Dr. Qian right here.
Ivan Galanin is the founder of Adipeau Skincare. Previously, he trained in inflammation research with Sanofi before going on to work with the Mount Sinai School of Medicine. Now, he spends a lot of time researching the skin's regenerative abilities and the best ingredients and methods to support them for his skincare company, which is why he has a good command of the various studies out there. His background, combined with the fact he digs and questions some of the conventional thinking around the most popular skin treatments, is what gives us a genuine debate.
I'll also be featuring dermatologists and other scientists and specialists in the discussions I have on this channel, so let me know if that's you and you'd like to take part, or if you have any suggestions. To be clear, I choose the participants; no one influences that and no one pays me to appear on this channel. What I aim to do through the mix of content and contributors is present a range of evidence and views that may just help us think through what we apply to our skin day in and day out, and potentially for years.
To follow up on the tretinoin discussion, which you can find here, I'll be speaking to a leading dermatologist on the channel soon about both tretinoin, often referred to by the brand name Retin-A, and hyaluronic acid. So watch out for that interview. Remember that in skincare, in the absence of long-term studies and large-scale trials that follow participants for 5, 10, or 15 years, there are very few definitives. What we're really looking to do in these discussions is widen our thinking about how we approach skincare.
So today, we pose a question about red light therapy: could too much of it be a bad thing?
Well, thank you to both of you for returning to the channel for our second debate, hot on the heels of the tretinoin one. This time we’re looking at red light and whether too much of it can be a bad thing. I also have a few questions to pose from viewers as part of this discussion as well.
I'd like to start, if we can, with Dr. Qian, because this is an area of expertise for you. Can I ask you just to run through the different forms of red light and their uses and benefits, and let us know which is best for anti-aging?
So, essentially, red light is a particular wavelength of light that appears red. In terms of the different forms of red light, you can get localized machines and whole-body machines. I'm sure a lot of viewers are already familiar with those red LED masks that, in the beauty sector, have been used quite often. In more recent years, more of the whole-body red light therapy has become more and more popular.
Red light is a particular wavelength of light that can penetrate quite deep into the skin. It does many things, but the main thing is it can help to improve mitochondrial function, and those are the bits of the cell that produce energy. One of the things is that it can help the cells produce more energy, help the body produce more energy, and therefore function better. It also helps to balance out the inflammatory response as well; it helps to reduce chronic inflammation and dampen down severe inflammatory response chances, so it's good for things like arthritis and just general chronic inflammation in the body.
In terms of anti-aging effects, because it helps the cells to release more energy from food or do that more effectively, the extra energy that the cells have can then be used to regenerate, heal, and recover quicker. So the general anti-aging effects are not only on the skin but actually work on the whole body. The effect is dependent on the amount of light that's exposed to the body and the length of time.
What about the different forms of red light, which people get confused about between sort of infrared and those? Those are basically different wavelengths. The visible red light is between 600 and 800 nanometers; those are kind of in the visible range. 800 is kind of approaching the invisible part of the spectrum. The near-infrared is a longer wavelength of light that is not visible to the naked eye. Infrared light is an even longer wavelength of light that produces heat and can penetrate much deeper into the body, but you can't see it, so it's invisible.
Red light is the visible part of the wavelength of the spectrum. In sunlight, a white light has a whole range of different wavelengths of light, from ultraviolet, which again is invisible but has a very short wavelength on one end of the spectrum, then you start to get into the visible part of the spectrum, starting with violet and going through the whole colors of the rainbow into the red end of the spectrum.
One of the questions that a viewer sent in was: because it's present in sunlight in daylight, why do we need to supplement or why should we supplement? That's a very good question. People who have been exposed to plenty of sunlight will get the whole spectrum of light in the sun, and it has the beneficial effects that the red light can offer the body. But it also has harmful effects from the UV rays that can damage skin. Most things are pros and cons.
The UV rays are also needed for the production of vitamin D, so red light actually doesn't stimulate vitamin D production; UV light does. But then UV rays can also damage your skin and age the skin. So there is this balance of, you know, it's good to get a bit of sunlight, but if you’re out in the sun for too much, it can age your skin quicker. Personally, I would get a bit of sunlight just normally walking around; I put my sunscreen on, but I also take vitamin D supplements.
I would prefer to get red light treatment because that's concentrating the good parts of the sunlight and using the benefits of that, as it were, without the harmful effects of the UV rays.
I want to go now to Ivan, who has been looking at some of the scientific studies relating to red light. Can we start, Ivan, with the good stuff that you've found out about red light?
Yeah, it very clearly works. Compared to Retin-A, I would say there is a suggestion that it actually works on more parameters. The body of clinical work supporting red light is not near the same as the body of clinical works supporting Retin-A, but it does seem to have a broader anti-aging efficacy than Retin-A, I would say. Some of the studies have been very good. The study that everyone focuses on, which was done in 2007 in Korea in mostly Korean women with Fitzpatrick type 3 and 4 skin, is types three and four.
In more commonly Caucasian skincare studies, the skin types that are evaluated are one, two, and three. The study that was done was really quite good, so red light does work. Here’s the really interesting thing: it works in a natural way. One month of red light treatment had a positive effect that increased for three months after the people were treated.
Specifics about those positives were they saying an increased increase in collagen production or what were they seeing? I think fine lines, coarse lines, even some melanin reduction. I mean, it was the typical anti-photoaging endpoints. With respect to collagen, they did look at biopsies to see, okay, what did they see? They really saw structural collagen improvements. What I mean by structural is not sort of abnormal deposition of collagen in scar tissue; they seemed to see beneficial. The collagen fibers were bundled better, but those results were, I'd say, anecdotal. They provide no statistics about the collagen induction results, so we have to put it in the category of interesting but not definitive science.
Dr. Qian, do you have anything to add to that?
It's interesting. I mean, red light, even from clinical practice, from the results that I've seen, it definitely does work. In my clinic, we tend to offer the whole body red light therapy more for medical therapeutic uses rather than for skin rejuvenation. I can't really comment too much on the effects of red light on skin, but I do, when I do microneedling treatments, add in the red light at the end of it to help with the healing process and reduce downtime.
Generally, my interest in red light is more the health benefits. Yes, it does have benefits to the skin, but I think to use red light enough to give you that benefit on the skin, it’s probably if someone has a mask at home that they use on a regular basis, then yes, possibly they'll see that benefit. But from in-clinic treatment, it's just not practical.
Of course, when we're using those masks at home, often we're using them very frequently over quite a long period of time, and this is what we'll come on to now with some of the other research that Ivan's been looking at.
I think before we get to that, one of the things that I was startled by looking at the study was the pro-inflammatory effects of red light therapy. Immediate pro-inflammatory effects: when you look at the biopsy of the skin taken 20 minutes after treatment, there's a significant, very significant induction in inflammatory cytokines, a six-fold to seven-fold increase in inflammatory cytokines.
What's startling is that in the 15 years since that study was done, no one has really tried to explain what this inflammatory response is that you see with red light therapy and how quickly it resolves, how does it resolve. An inflammatory response doesn't necessarily have to be bad. For example, with exercise, everyone knows that post-exercise, acutely, you have an inflammatory response that lasts for four hours.
The thing with red light is that no one has actually studied this any further than waving their hands and saying that it’s maybe a trauma-free wound response—there's no data for that. That was interesting for me to see.
I wanted to add something there, really, to say that inflammation is not all bad because there are different types of inflammation: acute versus chronic inflammation. It really depends on why the inflammation is there. Studies that look at this inflammatory response immediately after red light treatment or any treatment only give a snapshot of the inflammatory markers at that time, but it's a bit meaningless when you take it out of context on its own.
When you just look at snapshots, the immediate inflammatory response may actually be beneficial. What's more important is the long-term result of it. Sometimes acute inflammation can be good, but when you have consistent acute inflammation and too much of it over a long period of time, that can then become bad. So it's always a balance.
I couldn't agree with you more, and that's where you look at the other aspect of this: have people been followed long term? The answer to that is no. I think the longest-term study followed some tiny group of patients for 18 months. One of the endorsers of red light therapy, who did a review of the clinical studies, said it's safe, people have been followed for as long as 18 months, and there was only one study with a small group of people.
Over what frequency of use in that 18-month period can you remember? I can't remember, but the point is that the number of subjects in that study was not enough to say that; it was like 20 subjects. Any group with 20 subjects is just not enough, and for the authors to suggest to make that inference I think is irresponsible.
I completely agree with Dr. Qian: you can't judge that snapshot of inflammation and say it's bad or it's good, but it’s something that merits follow-up, especially when you have a six-fold increase in IL-1 beta, a classic pro-inflammatory cytokine.
Remember that clinical picture was four weeks of treatment and then three months follow-up. I'm not sure that this is the guidance that most people are getting when they get their home masks. They're not told, you know, use it for four weeks and then don't use it for three months. I'm sure that the manufacturer doesn't emphasize that point because it's not a great selling plan.
That is a good point because the face masks—people are using them very regularly over very long periods of time, and you're right, I don't think that has been looked at: the effects of that long term.
Dr. Qian, like in your practice, in medical practice where you're using red light, what are the frequencies and durations? Do you give patients a break of a few months if they've done a course of them? How would you normally approach it?
Again, this is a very individualized treatment plan, so it depends on what it is they're treating. We've had quite a few people who have come through with long COVID or chronic fatigue syndrome, and they have really found it beneficial to use the whole body red light treatment for two or three times a week for a few weeks. Then they start to notice really good improvements and often they will naturally give it a break. I think it’s different when you’re paying for a treatment versus having a device at home.
If you are paying for a treatment, then people tend to pay for the treatment for as long as it's needed for them to see the result, and then they tend to stop for a while because then they feel like they don’t need to pay for any more for a bit.
We've had a couple of long COVID patients who have had a course of 10 treatments over a few weeks, and then they will have a break for a few months. They do find the results tend to last for a while, and when they feel like they need a boost, they will come back and have another course of treatment.
Recently, I had a client with rheumatoid arthritis. She's quite young and she had rheumatoid arthritis. She was on medication and went to this health summit and heard about red light therapy. She found us, so she wanted to try red light therapy. She signed up for our monthly subscription unlimited so she could come as much as possible.
She practically came about four times a week, and when she started red light therapy, she just came off all her medications. I didn't tell her to do that; she just decided to stop taking all her medications for rheumatoid arthritis. She did it for a month, and she didn’t need to go on her medication at all; it was controlling her symptoms. She then went on for another month, and again didn’t take any of the medications.
You know, it’s been really effective and quite life-changing for her to not be needing those medications. I know this is only one case study, but you know, she talked; she heard there’s been talk about this health summit, so obviously there are other similar cases.
It was really encouraging, and it just makes me, as a doctor, think: If this sort of much safer natural way of treating arthritis works, why aren't we using more of it? Absolutely.
Do you think, as far as, you know, I mean I think we all agreed that your protocol with tretinoin just sounded so sensible. Rather than using something without question every single day for the rest of your life, you know, why not use it in that prime beneficial stage of about three to six months when we know you get all the major benefits with tretinoin, Retin-A, and then come off for a while and, you know, go to something lower strength and see how your skin responds? You can always go back.
Would you say a similar thing with red light? I think so. If you are using it to treat a particular condition, then initially it makes sense in the treatment phase to use it more frequently until you get to that optimum level of functioning or the optimal improvement that you can get. Then reduce the frequency and use it as maintenance.
You know, from personal experience, I’m sure I suffered from long COVID. A couple of years ago, I got it in the very beginning working in AE. When we first got the machine in, I was using it just twice a week—not excessively, just twice a week. After about four weeks, I really noticed the difference. Since then, I've just been using it once a week or whenever I can; on average about once a week.
It’s great! I don’t think that's overdoing it; it's really helped with my sleep. I mean my skin— I do lots of different things for the skin like good skincare and microneedling, but I think the red light has helped as well.
This is where we get into the masks at home that so many people have. Again, Ivan, are you saying that you have a concern about people using those frequently over longer periods of time? What advice would you give?
I don't have any reason to be concerned, but I'm not sure that people are getting the right instructions. Let's go back to the very beginning: what does red light do? As Dr. Qian said, it gives the cells more energy, it increases proliferation of cells, so the skin cells may be proliferating better; maybe there's some repair.
The study that showed pretty meaningful anti-aging benefits had people treated twice a week for four weeks, and that's it. I think that’s really my point: look at the clinical study and don’t think necessarily that if I do like twice as much or three times as much, my benefits are going to be two or three times higher. In fact, you might get worse of an effect.
You can overdo it; that’s really my only point with red light therapy: it seems there’s a disconnect between what the clinical studies showed as being an effective protocol and what people are using in practice.
There’s also the smaller question of there is, you know, seemingly quite a significant acute inflammatory effect that hasn't been followed up, and maybe it's good? Maybe it is good. Long-term exercises are anti-inflammatory; it could be the same thing with red light. We just know no one has actually studied it further.
So why should we be concerned about frequency of use? There was a recent study, an animal study, a mouse study, where the investigators seeded tumors in the mice skin tumors by treating the mice with a chemical that would induce tumors. Then they treated them with red light—not for four weeks, but for 20 weeks.
What happened is that the mice developed larger tumors in the red light group than in the non-red light group. It’s one study, yeah, in mice, and not the protocol that was used in the clinic, but at least it creates a reason for us to ask questions—not to change our behavior, but at least to ask.
Dr. Qian?
It's really interesting; everything in moderation, right? You really can’t have too much of a good thing. If you think about the way red light works, it increases energy; essentially, it increases the amount of energy in the cells. But there is a limit to how much energy a cell can produce and a limit to how fast the mitochondria can work.
There are other factors involved as well, like, are there enough substrates, the basic molecules that the mitochondria need to create energy? If your body is lacking certain nutrients and not having enough of those basic molecules, it doesn’t matter how fast the mitochondria can work; you're still not going to get enough energy.
Red light is one aspect of it, and in terms of this study, there are mouse studies showing that there’s a relationship between red light and cancer growth. I think before we jump to conclusions and start questioning the safety of red light, I think there are lots of things that we need to consider: it's the intensity of the treatment, the red light treatment, and the length of treatment as well.
Also, was the red light to shine on this particular area of cancer, or was it the whole mouse? Lots to consider, like the type of cancer as well. Is that a natural type of cancer that would naturally occur in humans without the chemical?
Red light can help cells proliferate and regenerate faster, grow faster, so if it can do that to normal cells, it can do that to cancerous cells. In the body, as we age, we constantly have cells that mutate and become pre-cancerous or cancerous, but they're normally killed by our immune system most of the time before they become actual cancers and tumors.
If we have a whole body treatment, we're making the whole body work faster. Maybe there's a chance that the cancer cells will proliferate faster. But on balance, if the whole body is working better in general and the immune system is working better, then it's also better at clearing up those cancerous cells.
You can't look at the red light effect on cancer cells in isolation because that's not how it works in the body; that's not what actually happens.
There's been a lot of studies involving mice showing something that has not translated to humans as well, so one study with mice... it’s hard to draw a lot from that.
Do you mind if we move on? I can see we're running low on time and I want to get to another viewer question about red light and fat loss because it is used on the body sometimes as a fat loss aid.
They’re saying, well, if I use it on my face, does that mean I'm going to lose fat volume in my face? The MIT Division of Health Sciences and Technology, a very reputable Mass General Hospital, published a paper a decade ago reviewing the scientific literature around red light therapy and fat loss. They concluded that they thought it worked.
They indicated there were two potential mechanisms: one was that it created transient pores in adipocytes, allowing lipids to leak out. Another is that it activated the complement cascade which would cause adipocytes to die. The truth is we don’t know; no one has been able to figure out the mechanism by which red light therapy causes reduction.
One thing we could deduce is if you’re using a face mask or you’re going for a treatment, it's not going to be a sudden rapid loss of fat in the way we have seen associated with some other more aggressive treatments. I think you could draw on that as a critical point.
So these people that wrote this paper concluded: Lastly, it’s worthwhile to note that low light therapy parameters used for facial skin rejuvenation and acne treatment are close to the ones used in fat reduction. Therefore, it is possible that facial volume loss may occur while using red light treatment; this possibility should be considered.
The safety of red light parameters is a very concentrated discussion, and we could talk for much longer.
What are your closing thoughts?
Yeah, I mean, this is a massive topic and we've just touched the tip of the iceberg. Generally, based on the majority of the evidence for red light and my personal experience, what I've seen in clinical practice, I am a huge believer and fan of red light therapy. I think it is one of the safest and most effective treatments there are for a number of different things, but as with any good thing, you've got to use it in moderation.
You can’t have too much of a good thing because there is only so much benefit you can get from red light, and you get to a point where the more you have doesn’t give you more benefit. It’s important to recognize that, and when you go beyond that point of getting more benefits, there’s a potential for harm. Based on the evidence that we have generally, red light is very beneficial for a number of things.
I would say for those people who are not sure, having some sort of medical guidance is recommended, but it’s just very difficult to get that, particularly in the UK where red light therapy is not so well recognized and not well understood.
Ivan, closing thoughts from you.
That's really the whole point of these debates: to stimulate debate. It’s not to say: Got you, this is black, this is white. It’s to say let's try to understand these tools that we have as well as possible, and let’s not—let’s be open to understanding that we don’t know everything and there are some important questions that we should still focus on in skincare.
I feel like there’s an unnecessary desire to have all the questions resolved ASAP and have it all be neat and tidy and black and white. Whereas we see in fields where there’s a lot of scientific inquiry, like nutrition, it’s constantly evolving, and it’s very hard to say: Okay, this nutrient is good, this nutrient is bad. There’s debate, and that’s really what I’m grateful to you, Clare, for giving us a forum—not to argue for one thing versus the other, but to stimulate discussion and thought.
That’s what I love about this, and I’ve already picked up so much because it’s planted in my mind a seed that has been growing over the last year anyway: Just exactly what am I doing here when I’m applying X, Y, and Z without thought on a daily basis for months, potentially years on end?
It has made me take a step back and simplify my own routines. I’m very much on board with the idea of not pushing our skin too far, too fast, too hard, and to take a step back from our skincare sprints that Dr. Qian mentioned the other week.
I think maybe one thing we could consider is changing the name of these episodes from Dermal Debates to Dermal Discussions because I, you know, I end up always agreeing with so much of Dr. Qian’s points. Not that I had the position that I disagreed to begin with, but I'm exposed to knowledge and experience that I didn’t have that makes a lot of sense to me.
Yeah, it's definitely a better word.
Okay, well our next discussion is going to be on Botox and personally, I can’t wait. So thank you very much to both of you, and I’ll see you then! Thank you very much, Clare. Thank you.