James Hamblin on showering, soap and public health
Read the full transcript of our Science Focus Podcast interview with James Hamblin about skincare and washing – listen to the full episode at the bottom of the page.
Amy Barrett: So tell me, why did you stop showering?
James Hamblin: That's a reasonable question with a complex answer. A few years ago, I started following the science of the skin microbiome that was just starting to come in to literature at the time and kind of just telling us that we have trillions of microbes all over us, all the time.
And at the same time, there was this emerging industry of skin probiotic products that kind of ostensibly help that microbiome flourish. So I went into experimenting with, well, you know, maybe there's something to not trying to aggressively eliminate all these microbes.
Even though I was finding the products that were out there weren't really necessarily good or helpful, it at least got me questioning the basic premise of showering. And there's more to the story which I go into in the book. But that's that's the basics of what stirred my interest.
AB: And did you stop all at once, or did you do it gradually?
JH: Gradually, gradually is definitely the key. I recommend anybody who is considering cutting back or even stopping certain practises altogether. You know, I liken it to training for a marathon, your body just sort of gets used to the process and changes over time.
So, yeah, we've all gone, you know, a few days without showering or without using deodorant. And if you're used to doing those things regularly, yeah, you smell pretty terrible and feel bad. And so it's not a surprise to think that many people think, well, the situation would continue to just get worse if I left it that way.
But in fact, most people can wean off of wean themselves off of products, probably not entirely, but can do radically less than many of us thought was necessary.
AB: So why should we lessen the products that we're using. What is it about these products? Are they doing any damage at all?
JH: You know, I am definitely not telling anyone what to do.
I think a lot of the personal care rituals that we do bring a lot of value to us, just as ritual, as social bonding, as social currency, signifiers of the way we want to be perceived in the world. And that has a lot of value outside of, you know, the traditional health and medical space. And so I take that very seriously. And if you enjoy these things and have the time and money, you know, more power to you.
I just think there is room to question a lot of what people believe is necessary for health purposes, just for the fact that most of products – shampoo, conditioner, body wash, moisturiser, deodorants – are all sold to us in pharmacies alongside medicines and things to treat, you know, symptoms of disease.
And so that makes it feel very necessary. And we're sort of imbued with this morality and righteousness of what it means to be clean. So for people who do want to cut back, either because they're having skin issues or they just want to simplify things and save time and money and water and plastic bottles and whatever else. You know, in that case, I think there is sometimes benefit to be added in all those areas, especially if you're someone who's spending a lot of money and worrying a lot about all the products you're using.
There is not one right way to do all this. These are very personal decisions about how we groom ourselves and how we maintain our skin and how we create our appearances. And I have no interest in telling anyone what's right or wrong. The book is really just an exploration of why we believe what we believe, and the effects of our practices on our own ecosystems and on the environment around us.
AB: But it seems kind of counterintuitive to say that if you're someone who gets skin issues, you should actually try not using skincare products.
JH: Yeah, and that's probably too vast of a statement. But there are a lot of dermatologists who are seeing conditions like dry skin and eczema and acne that are made worse, it seems, when people get into these cycles of over washing, that you are just kind of aggravating things. You are stirring up the microbiome so that it's constantly just in flux.
That your skin's oils – that are needed for the healthy functioning of skin – are being totally taken away to the point that your skin can't really operate effectively and the microbes that feed on those oils can't form a stable equilibrium.
And, you know, the instinct in much of the modern world is, when there's an issue, to add yet more products or to do something more aggressively. And so it is sort of counterintuitive, as you say, to think, well, maybe I'm just making it worse, or maybe this is, at the very least, not helping. And so just like anything in health and medicine, a good thing can be overdone.
AB: Yeah, and you talk about the microbes that we have. Can you just tell me more about our microbiome and how that relates to skincare?
JH: Sure. You know, it's an emerging science that we are just beginning to understand. But there is an ecosystem of microbes on our skin at all times all over our body. Of bacteria, viruses, archaea, fungi, and even mites, microscopic mites.
They're not they're causing disease, not in the sense of something like coronavirus, which we definitely want to get rid of. Absolutely. Wash your hands. None of that that's not being contested.
But in subtler ways, these non-disease-causing microbes are much more common and they're all over us. And they do affect, it seems, the functioning of the skin, in that different proportions of these microbes are present during things like acne outbreaks and eczema flares. And so there's a hope that as we better understand this microbiome, similar to the gut microbiome, that we'll be able to help use products or not use products or change behaviours, change lifestyles in ways that will help keep that microbiome diverse and thriving and healthy and minimise any of these unwanted symptoms.
AB: You've written that the primary immune organ is the skin. How does the skin actually protect us from getting ill?
JH: In so many ways. There's the obvious barrier function, which I think is the way that most people think of the skin, as a sort of inanimate coating that just sort of keeps our organs from falling out all over the floor.
But, you know, we know that as soon as you have a break in the skin, you know, that can become infected and a person can die really quickly and they did before the advent of antibiotics.
So, it's not just important in that way. These microbes on our skin are the interface between the natural world and us and the immune cells in our blood are percolating up through the skin and are in touch with the signals we're getting from our environment and are helping to learn and to sense environments and to helping to titrate that immune system such that it doesn't overreact to things that are harmless and that it reacts very efficiently to things that that are.
And I think that's where you get into an area of wanting biodiversity on your skin. We get into in the book this idea of a biodiversity hypothesis, but that if you have a diverse array of exposures, you're more likely to have a robust immune system that's well trained to effectively do its job when it's needed and not to flare up when it's not.
AB: There are some people that say that now as a society we’re perhaps to clean and that's why. Because, you know, we're not all out playing in the mud and we're not as active in the “dirty” world, that that's why we get more infections and we have more diseases. Is that actually the case?
JH: That was kind of the central question I set out to understand in the book. And it seems there is this idea that you're describing, which used to be known and sometimes still is known as the hygiene hypothesis. Partly that we don't have these diverse exposures that train our immune system so that it's not well calibrated and so everything's just less accurate at pinpointing and acting up only when the immune system is needed to act up.
It seems there's probably less to do with hygiene practices in shaping that immune system than with the ways we've changed our environments and our food systems and our built environment, especially, that we are not in contact, as you describe, with soil and with the natural world so much.
We could be contributing to it with things like over-washing and trying to sterilise and sanitise everything. But it becomes difficult when you have conditions like the pandemic, like air pollution that causes us to need to filter our air and to stay inside.
And people don't have access to pristine natural environments where they could go, if they wanted to go, to be exposed to the microbes that we speak about.
So it's really a double-edged sword. And it's not clearly the case that hygiene is good or bad, but that we want to be targeted with what we're doing. And if there are practises where we're simply trying to sterilise and sanitise and kill microbes for no specific purpose, it would be good to understand how we can cut back.
AB: I guess the amount of water you use and the amount of plastic waste that you have must be considerably less now than what it was.
JH: Yeah, it is. You know, really transportation and energy sectors are the major contributors of greenhouse gases. But every little thing counts, I think. And when you look cumulatively at how much, you know, liquid soap and detergent and shampoo and body wash are shipped around the world and how those products are sourced, you know, either from petroleum, from animals or from plants like palm oil, that have to be farmed. The impact, as you add it up, is significant, such that if we all did even slightly less, the global impact would be meaningful.
AB: In terms of skin, we think sometimes that it is just this outer layer, that I think I forget myself is even there most of the time. But it's actually quite complex. Can you just tell me a little bit about the different layers of the skin and what they do?
JH: Well, you know, most of us learn about the dermis and epidermis as these just barriers that are that are blocking things from falling out or coming in. But in fact, they're full of tiny nerve particles that are reacting to our environment. They're full of tiny blood vessels that are leaking out immune cells that are kind of our body’s first line of defence in sensing any threats in the environment and learning to differentiate self and other.
And then on top of that, there is this film of oils and microbes that are sort of forming this interface or a continuum with the outside world. The microbes are technically organisms that are distinct from us, but we carry them around, they live with us always. Not the exact same ones, but in the same species.
So, it's hard to say, you know, where the self ends and other begins. And that's the layer that I think a lot of people don't think about when they're thinking about skin as this sort of static, boring barrier thing.
But to me, that's been a really revelatory way to think about how connected we are to our environments. And likewise to think about what exactly I'm doing when I'm trying to disrupt that biome and whether it's good.
AB: So, in terms of someone who showers daily is using – Actually, knowing that I had this interview, I counted how many products I use, and once I got to 10, I thought, oh, my goodness, I can't keep going. Because I’m just going to be horrendously embarrassed when I talk to you.
But am I doing damage that is irreparable or is it that actually, if I gradually ween myself off, I can cultivate my own microbiome back to how it should be?
JH: That's a great question. Most of our skin sensitivities, like food sensitivities, are developed early in life. The biome that we have is formed during the early years. Microbes kind of get into our pores and live there and they're going to become part of that foundation forever.
But it does seem possible to change it. It's certainly possible to change it on a temporary basis, as in when you remove the oils from your skin, the microbes suddenly sort of just have no food. Whichever ones can live best on the newer, less oily surface you've created will thrive there. And when you put an anti-microbial deodorant under your arm, then you will kill things off.
So, to that degree, yeah, you can change the populations and they will change pretty quickly as you change your own behaviours. But I don't want to say that, you know, you use 10 products or more and that might just be absolutely fine or even good. We're just beginning to understand exactly how, you know, the new lines of skincare products that contain vitamins and essential oils and clay and things like that are affecting these microbes because they're sort of new to that level of biology. And there's hope, and at least some marketing, that makes us believe that they might actually be helping those microbes.
AB: Because you see these fads come around every four years, one time you're supposed to take charcoal supplements or then you can take college in sachets and all these different things. But do we is it that we don't actually know the effects of these? Are they marketed to us without us really understanding what they do?
JH: Yes, we think of these products more as cosmetics than as medications. But many of them do live in a kind of grey area where they're kind of promising to change the functioning of your skin and to feed it or to prevent flares of skin diseases.
That's where it's difficult for consumers to know what actually helps, because most products, at least in the U.S. I can speak to… There's only action at a regulatory level. Once the product has proved to be harmful to people, then it will get recalled. But up until that point, we assume that it's safe.
AB: If you take away kind of all the extra products that there are, if we get down to the basics, which is just fundamentally soap. How long have we been using soap? Is it something that humans have always found a way to wash themselves with this additive?
JH: Yeah. Throughout recorded history, there are references to things with soap-like products.
Well before the industrial revolution, before any sort of purposefully manufactured soap, there were homemade soaps. There were soaps made from plant roots. Basically, anytime you can find an oil, which you can take from a plant or animal and you can heat it up and combine it with a base, traditionally lye was used, then you get a soap.
And some of them are very basic soaps and they will burn your skin. But they have at least been used to, you know, help get bad stains out of clothing, to wash people when you're really covered in, you know, some sticky, gooey substance that you need to get off of you.
But it's really only a very recent invention that we would think that we should apply soaps to our whole body, every day, and simply remove all of the natural oils from our skin. To imagine that would be any benefit to doing that is that's a product of really genius marketing over the last hundred years.
AB: So, before that, it wasn't that people thought it was a necessity to wash ourselves, you know, now we do it daily. But was it before considered something that you still have to do?
JH: It was really culturally dependent. And a lot of this was shaped by religion. So Christianity in particular. There was a lot of concern about chastity and modesty, and people were advised not to bathe because it was considered immodest. You had to essentially get naked, especially before indoor plumbing.
You know, if you go back to Roman bathhouses, bathing meant a communal experience where you were around other naked people and there was also prostitution. Bathhouses were not places that were beloved by the church.
In other religions, there were doctrines about things like, you know, washing your hands before eating or before entering temple, and things that were mostly, you know, ritual. We didn't have an understanding of germ theory then. So, there really wasn't an idea that this was washing any particular thing off of your hands. But it might have been the case that it was observed to be good practice or that people who did this seem to get fewer illnesses and that may have informed some traditions.
But, yeah, any such customs were dictated by, you know, local culture or by religious doctrine.
AB: But as you've mentioned, if some of us have gone a few days without showering or using any deodorant, we you know, we start to smell. And surely our aversion to this bad smell implies that there's a reason, an evolutionary reason that we shouldn't actually smell bad. That that implies something about us?
JH: Yeah, well, that's a very complex question, you know, why from an evolutionary perspective, would there be any reason that we would become repulsive to other members of the species within a matter of hours or days if we don't use a large number of products?
So, I think it's more likely the case that our bodies and environments and microbiomes are just quite messed up by all that we do and all that we are, and our modern lifestyles and the ways in which we continue to mess with those populations leads to bacterial populations that are overgrown by the ones that are particularly offensive smelling.
But in my experience and in the experience of many others who have quit deodorant or, you know, cut back on showering, that situation does not last. You develop a smell. If you have microbes on your skin and your skin is alive and secreting oils, you will produce odours.
But you can get to a place where those populations are not, you know, extremely pungent and offensive. And I think that is, you know, that's attainable for most people when you break out of these cycles of washing.
AB: So, you don't go around worrying that you're secretly smelling and people are just too polite to tell you?
JH: I did. You know, for quite some time and I had to ask colleagues and friends and acquaintances and people who I knew would be honest with me to make sure this was not just me.
But no, the sort of body odour smell that we're all so familiar with as just really, you know, clearly offensive is not, that does not happen anymore. I have a smell to me, and my wife says it's just like identifiable. But she likes it. Other people say it's not bad.
For most of our history, we had smells that were part of how we communicated with other people. And that sense has been largely removed from our social biology of late, such that we either expect people to smell like nothing or smell like a perfume, cologne, you know, body wash or else it must mean that they smell offensive and bad. If there's any detectable human odour, it's negative. And I think that is a good kind of binary idea to break out of.
AB: So, we could actually communicate through smell. There was a time when we used smell for something other than just, well, I guess we don't use it till now to identify something about a person, apart from whether we think they're clean or unclean.
JH: Yeah. I think that, you know, it's one of the sensory inputs of which we communicate.
I don't think we alone we're going up, like dogs, and basing our sense of someone on their smell. But it was just one of our senses that played a role that now we tend to always cover up or drown out.
AB: So, when you say that you gave up showering five years ago, what does that actually mean? Do you still shower at all? Do you take baths instead? What's your routine like?
JH: In the book I say, you know, in a traditional sense. So I will still rinse off when I need to or want to, just with water. Just quickly. Especially I have bedhead or if I have visibly got dirt on me. But you can exfoliate, you can remove oils by kind of just scrubbing with your hands and combing your hair occasionally. And that's just about it.
I'm very vigilant about washing my hands. I brush my teeth. But that's the extent of it. It's gotten to be really simple. But it did not happen overnight.
AB: I mean, honestly, I really enjoy getting a facial. It's a real treat for me. But am I wasting my money? Am I doing more harm than good by doing it?
JH: I got facials for the book. And I did feel like I enjoyed it, and I looked better afterwards.
I think of it like gourmet cooking or, you know, consuming fine art. If you're not someone who's really into that, it can quickly seem like someone is really wasting their time and money.
But if you are, those things can, you know, provide joy and value to you, which no one can rightly say is wrong, not worth it, because it is really about how much that sensory experience does for you.
And if anything, in researching and reporting the book, I came to understand the many ways that these products and practices like facials, you know, enrich people's lives far beyond what, you know, the biology of the skin.
So, yeah, no know far be it for me to judge whether or not something like that is worth it to you, anymore than it might be for you to judge someone who spends five hundred dollars on a dinner because they love food, you know, and if you're not a foodie, that might seem ridiculous, but to them it was the highlight of their year.
AB: And are there any other changes that you had to make in addition? Do you have to wear different types of clothes or wash your clothes more often? Do you use abrasive flannels now instead?
JH: Oh, no. I dress the same as always. Which is pretty simple.
AB: That's reassuring. I don't have to go buy a new wardrobe if I decide to use less products.
JH: No, I don't think so. And I still wash my clothes, not after every wear, but when they seem like they need it.
AB: So, say I decided I was going to give this a go. What should I do next? What are my next steps? Am I going to have to throw away every expensive product, and start that way?
JH: I think you just pare down to what brings you value. Definitely keep brushing your teeth, washing your hands.
You know, if you want to quit deodorant, people tend to like to do that by transitioning to milder forms. And generally with shampoos and body washes to just kind of gradual use less and less.
Taking shorter showers, taking cooler showers, using less product per shower. And then gradually doing it less frequently. And you get to a point then where you can just do so when you feel like it, as opposed to feeling tethered to doing something every single day and spending large amounts of time and using a lot of product. So you should never have to feel significantly uncomfortable or deprived. And if you're really missing it, you know, bring it right back. No harm done.
AB: You talked about washing hands and things like that, which we're all being told to do, and also now I am using much more antibacterial gel. So, I'm kind of constantly using hand sanitiser. What's that actually doing to my skin?
JH: Yeah, well, the hand sanitiser is a really effective tool that should destroy the microbial particles on your hands. And it does so in a blanket way. It sort of clearcuts the forest, which in times of pandemic is good. It might dry out your hands, it will kill some normal microbes on your hands. But that's worth it. We deem that worth it because we don't have a precise, you know, anti-coronavirus gel we can rub on our hands that will leave other things intact.
But I think that hand sanitiser is a great example of something that you take for granted as something you only would do on your hands, because why would you dump it all over your hair and your back? And that sounds ridiculous, but that's essentially what we think is for some reason beneficial to do with soap.
AB: That's a really good way of thinking about it. Does it depend on location? Because I know I feel grimier when I've been in London, getting on and off the tube and rushing around and when I'm out in the countryside.
JH: Yeah, exactly. And I think what you're probably getting that there, too, is the effect of lifestyle, which we've all seen. When you're stressed out and, in your workaday life and probably not eating as much as you should, not sleeping as much as you should, just consumed by work versus when you're out in the country on vacation and relaxed and sleeping and eating and outdoors. Before you know it, you've gone a few days and haven't showered and you don't really feels bad or smell bad. And I think that's a great reminder that so much of our skin health, our skin's functioning and appearance, are coming from inside, that we have a culture that has taught us to put things on or try to wash things off to do these topical approaches with quick fix products, when, in fact, it's also sort of teaching us to overlook the lifestyle drivers of how our skin functions and looks.
When you start thinking about that, then you have overall health benefits for the rest of your organs as well, not just your skin.
AB: In terms of your day job, are you a skin specialist? Is this what you do on a daily basis, helping people with skin problems?
JH: No, I'm a journalist and public health professor.
AB: So is it that you'll tackle another organ next?
JH: Well, I've been pretty consumed by covering the pandemic. So, hopefully that is something that we don't have to think about in the not too distant future. But I'm not sure when that will be.
AB: Mm hmm. Have you noticed that the pandemic has changed people's attitudes towards hygiene in a positive or negative way?
JH: Very positive. So, people have focussed on things like hand washing and sanitising high-touch surfaces and wearing masks, which are evidence-based ways of preventing disease.
And at the same time, a lot of people been working from home, they have felt the freedom to do less of the things that they didn't want to be doing or they were doing just because they socially felt like they had to. And that sometimes means less showering, sometimes means fewer products. And I think in both ways that's healthy, kind of prioritising the things that are really medically important and feeling empowered to let go of the ones that aren't and that weren't bringing you any particular joy.
AB: And these changes in, you know, our public health and our public hygiene. Do you think they will be sustained after the pandemic? Do you have hope in that?
JH: I do. But, you know, hand-washing has never been something that the whole species has been great at, so my expectations are tempered. But I know I think a lot of people are doing better now than ever before.
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Listen to more episodes of the Science Focus Podcast:
- Dr Monty Lyman: What does our skin tell us about ourselves?
- Phillippa Diedrichs: Is body positivity the answer to body image issues?
- Dean Burnett: The neuroscience of happiness
- Pete Etchells: Are video games good for us?
- Sue Armstrong: Can we slow down the ageing process?
- Helen Russell: What does it mean to be happy?