Got color?

 

A while back I was looking through some old picture files and found these two images; both were taken on a hot, July day about a year a part. I really had no idea how pale my skin had become from years of stuffing my body with mashed potatoes, cereal, milk, pasta, dinner rolls, butter, cheese, chicken, beef 'n noodles, pizza, etc. . . . until I saw these pictures. 

About six months into consistently eating high-nutrient foods, I clearly remember the day that I looked “tan” in the dead of winter in Indiana. I was recovering from major surgery in a hospital room; in fact, it was two days post surgery, and I had managed to stand up long enough to capture a glimpse of myself in a mirror. My body felt like it had just been plowed under by a bulldozer, but my skin looked alive, refreshed and glowing! Instead of an expected paleness, it had color! Surprisingly, with each shift of new nurses that were caring for me, the first question was always, “Where did you get your tan?”  

For many of us who live in the northern states, winter can be sort of colorless. Blahh. Leafless trees silhouetted against bleak, gray skies. Dead branches. Dark mornings and evenings. Brown grass peaking through melted, dirty snow. Dreary blahh.  

However, our food and our skin can be beaming with bright color! Not only do those plates of colorful vegetables and fruits nourish our bodies to optimal health and longevity, they add visual beauty to our otherwise, potentially colorless environment. They brighten up our kitchens and dining tables, and our skin even reflects the beauty of those colors. 

 

 

How about you? Got color?   

    

 

Related post by Dr. Fuhrman: The human mind prefers a healthy carotenoid glow over a suntan

 

 

Image credit:  vegetables by Esther Boller

Healthy Inside and Out

Congratulations to all who have committed to following Dr. Fuhrman’s Holiday Challenge! We tend to think of giving tangible gifts and purchasing presents for others this time of year, but if you have been sticking to the pledge to eat only healthful foods and avoid junk foods, you have been granting yourself the greatest gift of all: the gift of health. That is something to be proud of. The gift of health will stay with you for the rest of your life, a life that will be set free from the waves of chronic diseases and health problems that beset most Americans.  

Most whom embark on Dr. Fuhrman’s Holiday Challenge probably do not contemplate how eating heaping salads, hearty vegetable and bean dishes, and other satisfying natural plant foods effects our skin. Hence, this post is a reminder that following this powerfully disease preventative and figure slimming lifestyle enhances the beauty and clarity of our skin as well.    

In a blog post I wrote last year, I explained the science behind how food is an enormous contributor to whether or not we will attain healthy, blemish free complexions. Here I will summarize that article as a reminder of why politely declining that homemade, yet sugar loaded cookie your co-worker urges you to sample or resisting the saturated fat laden eggnog at a holiday party will result in gorgeous skin and prepare you for any spontaneous holiday picture taking that comes your way. 

The beauty of our skin is remarkably influenced by the amount of hormones circulating inside of our bodies. Insulin, in particular, is associated with the health of our skin. Insulin is most commonly known as the hormone for regulating blood sugar and is associated with diabetes, yet it also happens to increase oils that appear on the surface of our skin. Insulin levels fluctuate based on what we eat, and these fluctuations can affect other hormones such as testosterone that also promote acne and dull skin.

 

Processed foods made with white flour and sugar lead to blood sugar spikes, causing insulin levels to go into the dreaded “pimple-producing zone”. Sugar and processed foods are awful for our skin!

 

Dairy products are just as noxious skin foes as processed foods and sugar.  Research conducted at Harvard University School of Public Health showed that milk contains bioactive molecules that act on the glands where blackheads are formed. William Danby MD, a dermatologist at Dartmouth, noted in an editorial accompanying this study that 70 to 90 percent of all milk comes from pregnant cows and that the milk contains hormones such as progesterone, testosterone precursors and insulin-like growth factor releasing hormones, all linked to acne. High levels of these hormones are linked to breast cancer and prostate cancer so avoiding foods that lead to breakouts and dull skin also helps us prevent these cancers.

 

The foods you should eat for radiant skin? Green vegetables, fruit, beans, nuts, seeds, avocadoes, starchy vegetables, and whole grains- all of the foods that are associated with longevity, disease prevention and succeeding on Dr. Fuhrman’s Holiday Challenge. These foods are loaded with thousands of potent phytochemicals like carotenoids and lycopene, substances that help our skin repair damage and remove and detoxify waste products and toxic compounds.  Skin damage occurs due to exposure to free radicals, which results in oxidative damage to our cells. By eating plenty of antioxidant loaded fruits and vegetables, our body becomes equipped with tiny chemical warriors that continuously fight free radical damage. The result is glowing, healthy looking skin. Now that is something worth being jolly about. 

 

Cheers to good health and I wish you much success and joy into the New Year!

 

The image at the top of the post is Talia a few years ago.  The second picture is Talia with her mother, Lisa Fuhrman, taken this past Thanksgiving. 

Preventing acne with diet

Healthy skin. Flickr: LukaIsntLuka

Acne is the most common skin condition in the U.S.  About 85% of people in the Western world experience acne during their teenage years, but it can occur at any age.  Acne is more than just pimples - it can leave permanent scars, and in many people, acne (even if it is not severe) can seriously affect quality of life, causing low self-esteem, withdrawal from social situations, anxiety, and depression.1

What causes acne? 

There are four major components of acne:  excessive production of oil by the skin, skin cells dividing excessively (hyperproliferation), bacteria, and inflammation.2 A pimple or lesion forms when a pore in the skin begins to clog with old, dead skin cells.  Usually these cells are simply shed from the surface of the skin, but if too much oil is being produced, the dead cells can stick together and become trapped inside the pore.  Bacteria also play a role – they can grow and multiply inside the pore, resulting in an inflammatory response.1 

Does what we eat really affect acne?

For years doctors have proclaimed that diet has nothing to do with acne.  That reflects the nutritional ignorance of physicians and their inexperience in treating disease with superior diet.  Scientific studies have demonstrated that the diet is very important, because what we eat can affect the hormones that contribute to the oil production, hyperproliferation, and inflammation that cause acne. The acne-promoting dietary factors that have been most extensively studied are dairy products and high glycemic load foods – these factors influence hormonal (increase IGF-1 levels) and inflammatory factors increasing acne prevalence and severity.3,4

IGF-1: an important hormone that influences acne

Hormonal influences that affect insulin-like growth factor 1 (IGF-1) levels are key.5  Elevated IGF-1 levels lead to changes in gene expression that cause inflammation, hormonal changes, increased oil production, and development of acne lesions.  Protein intake is the major factor that determines circulating IGF-1 levels, especially protein from dairy products. Read more in Dr. Fuhrman’s Healthy Times Newsletter on IGF-1.

Dairy products

A three-year prospective study of 9-15 year old girls found a 20% increase in acne prevalence in girls that had 2 or more servings of milk per day compared to less than 1 per week. This association held true for total, whole, low fat, and skim milk.6  The same researchers found a similar association in boys who drank skim milk (milk highest in protein).7  Furthermore, in the Nurses’ Health Study, dairy products eaten during high school were associated with acne during women’s teenage years.8

High glycemic load foods

Glycemic load (GL) is a measure of the effect of a certain food on blood glucose levels.  High-GL foods like refined carbohydrates produce dangerous spikes in blood glucose, leading to excessive insulin levels in the blood (hyperinsulinemia), which contribute to diabetes, heart disease, and several cancers.9,10  Hyperinsulinemia not only promotes inflammation but also raises IGF-1 levels, further contributing to acne.  A low glycemic load diet has been shown to improve acne symptoms, and decrease IGF-1 and skin oil production in several studies.11-13

Protective micronutrients

Blood levels of zinc, carotenoids, and Vitamin E are known to be lower in acne patients compared to those without acne, suggesting that maintaining micronutrient adequacy may help to prevent acne.14,15 Carotenoids are abundant in green and orange vegetables, and vitamin E is abundant in nuts and seeds.  Although pumpkin seeds and hemp seeds are rich in zinc, zinc absorption efficiency may be low on a plant-based diet, so a multivitamin and mineral supplement is recommended to assure optimal levels of zinc, iodine, Vitamin D and B12.

 

References:

1. American Academy of Dermatology: Acne. http://www.aad.org/skin-conditions/dermatology-a-to-z/acne. Accessed June 29, 2011.

2. Costa A, Lage D, Moises TA: Acne and diet: truth or myth? An Bras Dermatol 2010;85:346-353.

3. Ferdowsian HR, Levin S: Does diet really affect acne? Skin Therapy Lett 2010;15:1-2, 5.

4. Melnik BC, Schmitz G: Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Exp Dermatol 2009;18:833-841.

5. Danby FW: Diet and acne. Clin Dermatol 2008;26:93-96.

6. Adebamowo CA, Spiegelman D, Berkey CS, et al: Milk consumption and acne in adolescent girls. Dermatol Online J 2006;12:1.

7. Adebamowo CA, Spiegelman D, Berkey CS, et al: Milk consumption and acne in teenaged boys. J Am Acad Dermatol 2008;58:787-793.

8. Adebamowo CA, Spiegelman D, Danby FW, et al: High school dietary dairy intake and teenage acne. J Am Acad Dermatol 2005;52:207-214.

9. Barclay AW, Petocz P, McMillan-Price J, et al: Glycemic index, glycemic load, and chronic disease risk--a meta-analysis of observational studies. Am J Clin Nutr 2008;87:627-637.

10. Gnagnarella P, Gandini S, La Vecchia C, et al: Glycemic index, glycemic load, and cancer risk: a meta-analysis. Am J Clin Nutr 2008;87:1793-1801.

11. Smith R, Mann N, Makelainen H, et al: A pilot study to determine the short-term effects of a low glycemic load diet on hormonal markers of acne: a nonrandomized, parallel, controlled feeding trial. Mol Nutr Food Res 2008;52:718-726.

12. Smith RN, Braue A, Varigos GA, et al: The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci 2008;50:41-52.

13. Smith RN, Mann NJ, Braue A, et al: A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr 2007;86:107-115.

14. El-Akawi Z, Abdel-Latif N, Abdul-Razzak K: Does the plasma level of vitamins A and E affect acne condition? Clin Exp Dermatol 2006;31:430-434.

15. Amer M, Bahgat MR, Tosson Z, et al: Serum zinc in acne vulgaris. Int J Dermatol 1982;21:481-484.


 

The human mind prefers a healthy carotenoid glow over a suntan

In spite of the well-known damaging effects of the sun on our skin, many of us still perceive a tan as healthy-looking. But you don’t need to risk the health of your skin in the sun or a tanning bed to make it look healthy - the sun isn’t the only factor that can alter skin color.

Carotenoids are a group of 600 antioxidants including alpha-carotene, beta-carotene, lycopene, lutein, zeaxanthin, and astaxanthin. The richest sources of carotenoids are green, orange, and red vegetables and fruits. Many health-promoting phytochemicals, such as carotenoids, flavonoids, and phenols are pigment molecules that provide both attractive colors and health benefits. We are drawn to the vibrant colors of fresh produce that signal health benefits, and a new study has found that we can discern with our eyes how healthy the diet of a potential mate is.

 

Pigmentation in many species is perceived as a sign of health – birds for example. Carotenoids (both dietary and self-produced) are responsible for the bright feather colors of male birds, which make them more attractive to potential mates. There is evidence that in birds, dietary carotenoids do not merely serve this cosmetic purpose – increased carotenoid intake in birds may also improve color vision, sperm quality, and the health of offspring. [1]

The new study investigated people’s perception of skin ‘lightness’ and ‘yellowness’ – yellowness is influenced by both carotenoids and melanin (melanin increases in response to sun exposure). Researchers asked subjects to choose from sets of photos of two different skin colors – one whose yellowness was due to melanin, and one due to carotenoids – which skin color appeared healthier. Subjects consistently chose carotenoid coloration over melanin coloration. [2]

According to first author of the paper Ian Stephen, “We found that, given the choice between skin colour caused by suntan and skin colour caused by carotenoids, people preferred the carotenoid skin colour, so if you want a healthier and more attractive skin colour, you are better off eating a healthy diet with plenty of fruit and vegetables than lying in the sun.” [3]

There is a direct relationship between skin appearance and health – if your skin does not have an orange tinge, then you are not on a healthy diet. You can even quantify your skin carotenoid levels, which reflect dietary carotenoid intake, using a specialized scanner. [4, 5] I use one of these scanners in my medical practice to confirm that phytochemicals have accumulated in the skin of patients, affording them protection against cancer and other chronic diseases. Plus these phytonutrients in the skin offer protection from sun damage, aging of the skin and skin cancer from sun exposure. [6]

So eating carotenoid-rich food is not only a path to excellent health – it’s also a way to look good!

 

References:
1. Carotenoids Are Cornerstone of Bird's Vitality. ScienceDaily, 2009.
2. Stephen, I.D., Coetzee, V., Perrett, D.I., Carotenoid and melanin pigment coloration affect perceived human health. Evolution and Human Behavior, 2010.
3. Looking good on greens. Eurekalert!, 2011.
4. Ermakov, I.V. and W. Gellermann, Validation model for Raman based skin carotenoid detection. Arch Biochem Biophys, 2010. 504(1): p. 40-9.
5. Ermakov, I.V., et al., Resonance Raman detection of carotenoid antioxidants in living human tissue. J Biomed Opt, 2005. 10(6): p. 064028.
6. Nichols, J.A. and S.K. Katiyar, Skin photoprotection by natural polyphenols: anti-inflammatory, antioxidant and DNA repair mechanisms. Arch Dermatol Res, 2010. 302(2): p. 71-83.

 

Radiant Skin 101

As a young person living in America, the superficial society that it is, I have an aversion for any blemish, pimple, or mark that threatens to make its presence known on my face. Glowing, blemish free skin is the ideal and a sign of good health.    Every girl is entitled to radiant, clear skin and avoidance of the bad mood that occurs as a consequence of the appearance of a gargantuan pimple. Granted, I do realize that there are infinitely worse scenarios that can be inflicted upon a person, but at the same time one should not have to face the awfulness of pimples or a dull complexion amidst all the other chaos in one’s life.

Thankfully, as the daughter of Dr. Fuhrman, I know that diet plays a huge role in maintaining healthful, as well as youthful, looking skin. The same nutrient dense diet that keeps us healthy and prevents chronic diseases naturally helps prevent pimples, acne, and the like. Welcome to Radiant Skin 101, my one article class on the ins and outs of how to attain and maintain healthy, radiant skin:

skin

Radiant Skin 101:

1)     The hormones inside our bodies are important contributors to what cause pimples to appear on the outside. In particular, the hormone insulin an important modulator of breakouts. Insulin is most commonly known as the hormone for regulating blood sugar and is associated with diabetes, yet interestingly it also increases   oils that appear on our skin. Who would have thought? Insulin levels fluctuate based on what we eat, and these fluctuations can affect other hormones such as testosterone that also promote acne.

2)     Processed foods made with white flour and sugar lead to blood sugar spikes, causing insulin levels to go into the hateful “pimple-producing zone”. Sugar and processed foods are nada good for our skin. 

3)     Of course this is more complicated than just sugar and insulin. The peeps at Harvard say milk is not skin-friendly food. The Harvard School of Public Health conducted a study in which the diets of 6,084 teenage girls were analyzed. Girls who drank two or more servings of milk per day were 20 percent more likely to have acne. Milk contains bioactive molecules that act on the glands where blackheads are formed. William Danby MD, a dermatologist at Dartmouth, noted in an editorial accompanying the study that 70 to 90 percent of all milk comes from pregnant cows and that the milk contains hormones such as progesterone, testosterone precursors and insulin-like growth factor releasing hormones, all linked to acne.

4)     The foods you should eat for radiant skin? Green vegetables, fruit, beans, nuts, seeds, avocadoes, starchy vegetables, and whole grains, of course. These foods are loaded with antioxidants, substances that help our skin repair damage. Plant foods also contain an array of phytochemicals. The foods rich in carotenoids are super foods for your body, not just your face. They supercharge the immune system’s defensive capabilities and help prevent many diseases, including heart disease and cancer. Many thousands of these chemicals are found in brightly colored plant foods. So in regards to the health of our skin, the more carotenoids and phytochemicals that are present, the faster our skin can repair damage, and remove and detoxify waste products and toxic compounds. 

So, in summary, consumption of micronutrient-rich natural plant foods leads to radiant, pimple free skin and processed foods and dairy are blackhead friendly.   How many more teenagers would eat a cancer-protective diet, if they knew it would repair their skin and keep them looking good? Avoiding dairy and junk food is easy when there are so many healthier, just as tasty, food options available. I’m a huge fan of soymilk and almond milk, for example. To me, faux milks taste better than actual cow’s milk. Resisting processed foods becomes pie in the sky when I know I can have a delicious fruit smoothie instead. Instead of poppin’ M and M’s, pop blueberries and cherries. Great skin and tasty food? Check!  

Staying safe in the sun

The weather is warm, school is out, and summer is upon us. Because of depletion of the ozone layer that protected against harmful radiation in earlier times, today’s sun exposure is not truly natural, and is more damaging. As we plan to spend more time outdoors, we must also avoid excessive sun exposure to protect ourselves from the free radical damage and wrinkling that can ensue and to minimize the risk of skin cancer. First we should be sure to seek shade often, wear protective clothing, and avoid noon time sun. When choosing a sunscreen or sunblock is important to use the safest and most effective methods of sun protection – the SPF number does not tell the whole story.

Exposure to sunlight triggers vitamin D production. However, according to the American Academy of Dermatology there is no safe amount of unprotected UV exposure that can allow for sufficient vitamin D production without increasing the risk of skin cancer. Supplementation is the safest method of maintaining sufficient vitamin D levels.1

 

 

Melanoma, the deadliest form of skin cancer, has been steadily on the rise since, its prevalence increasing approximately 2.9% per year since 1981.It is essential to protect your skin from the sun’s rays.

UVA and UVB rays

UVB rays are the rays that cause sunburn. They bind DNA and can cause mutations that lead to skin cancer. UVA rays penetrate more deeply into the skin, causing oxidative damage that can lead to skin aging and skin cancer.3

Both types of radiation are believed to contribute to melanoma, but many sunscreens block only UVB.

Types of sun protection

  • Sunscreen absorbs and deflects the sun’s rays away from the skin through a chemical reaction. Sunscreens vary in their ability to protect against UVB and UVA rays depending on the ingredients used. Common sunscreen ingredients include oxybenzone, octisalate, and avobenzone.
  • Sunblock creates a physical barrier between the UVA and UVB rays and the skin.4 Titanium dioxide and zinc oxide are the most common sunblocks. Physically blocking sunlight from penetrating the skin is the most effective way to block UVA radiation.

Which type of sun protection is safer? Which is more effective?

Many sunscreens do not protect against UVA rays. The SPF listed on these products refers only to UVB protection. The FDA has no standards for measuring how well a sunscreen blocks UVA rays. Ironically, a product with a high SPF, and no UVA protection, could promote unsafe sun exposure behaviors – you may falsely believe that you can safely stay in the sun longer, overexposing yourself to UVA rays even though you avoid sunburn from the UVB rays.5

The Environmental Working Group has reported this troubling news about sunscreens: Vitamin A is often listed on sunscreen labels as an antioxidant that can fight skin aging. Vitamin A is an antioxidant, but in isolation it could be dangerous, both in supplements and for the skin. Sunscreens may actually promote the progression skin cancer if they contain vitamin A – vitamin A applied to the skin has been shown by FDA studies to accelerate the growth of skin tumors in animals.6

Sunscreens may also damage your skin. Common sunscreen ingredients can generate free radicals, causing oxidative damage. The sunscreen itself and how often it is applied determines whether it releases or absorbs more free radicals.7

Chemical sunscreen ingredients, including oxybenzone, can potentially disrupt hormonal systems in the body, which could have long-term health implications.8

In addition, a number of studies have linked allergic reactions to chemical sunscreens, particularly oxybenzone.9 Little is known about the potential harm of chronic sunscreen use and the systemically absorbed chemicals deposited after topical application.10

These sunscreen ingredients are potentially harmful and should be avoided:11

  • Oxybenzone (found in 60% of sunscreen products)
  • Octisalate (found in 58% of sunscreen products)
  • Octyl methoxycinnamate (OMC; found in 40% of sunscreen products)
  • Padimate O

Mineral sunblocks contain either titanium dioxide or zinc oxide, and these are preferable to chemical sunscreens. These minerals do not penetrate as deeply into the skin as chemical sunscreens. They lie on top of the skin and penetrate only into superficial layers, reflecting UV rays before they cause damage. Mineral sunblocks are the only method of sun protection that blocks UVA rays.

Nanoparticles in sunscreens

There are concerns about certain sunblock products that use small particles of titanium dioxide and zinc oxide produced via nanotechnology. The purpose is to make the sunblock more easily absorbed by the skin and therefore more transparent. These tiny nanoparticles, however, can penetrate biological membranes and easily reach cells. Nanoparticles are smaller than anything humans have put into commercial products before.  Preliminary investigations have found only a limited ability of mineral nanoparticles to penetrate the skin12, but oxidative stress and DNA damage to skin cells have been observed. Also, upon inhalation these particles reach the bloodstream and several organs.11,13 Additional studies are needed in order to definitively determine whether these products are safe.

Mineral sunblock is the safest choice.

Overall, the physical sunblocks, with titanium dioxide and zinc oxide, are the safest choices for sun protection. They are the least irritating, and they safely provide protection against both UV-A and UV-B rays. According to the Environmental Working Group, mineral sunblocks containing nanoparticles are still a safer option than chemical sunscreens. Unfortunately, sunblock labels most often do not disclose whether the product contains nanoparticles. We've done our research and found a product-line which uses nonmicronized zinc oxide that is safe and effective. Our GreenScreen line protects against both UV-A and UV-B without the use of nanoparticles or harmful chemicals.

Remember, sun protection products must be applied liberally to insure you receive the SPF protection claimed on the label. Most people apply 25-75% less sunscreen than the amount used when the manufacturers test their products.14

Make the summer sunshine a safe, fun, and healthy experience for you and your family!

4. Levy S. "Sunscreens and Photoprotection." www.emedicine.com (accessed June 20, 2007).

5.  Autier P. Sunscreen abuse for intentional sun exposure. Br J Dermatol. 2009 Nov;161 Suppl 3:40-5.

8. Schlumpf M, Schmid P, Durrer S, et al. Endocrine activity and developmental toxicity of cosmetic UV filters--an update. Toxicology. 2004 Dec 1;205(1-2):113-22.

Schlumpf M, Cotton B, Conscience M, et al. In vitro and in vivo estrogenicity of UV screens. Environ Health Perspect. 2001 Mar;109(3):239-44.

9. Szczurko C, Dompmartin, Michel M, et al. "Photocontact Allergy to Oxybenzone: 10 years of Experience." Photodermatol PhotoimmunolPhotomed 1994;10(4):144-7.

Schauder S, Ippen H. "Contact and Photocontact Sensitivity to Sunscreens: Review of a 15-year Experience and of the Literature." Contact Dermatitis 1997;37(5):221-32.

10. Hayben H, Cameron, M. Roberts H, et al. "Systemic Absorption of Sunscreen after Topical Application." The Lancet 1997;350:9081.

Gustavsson G, Farbrot A, Larko O. "Percutaneous Absorption of Benzophenone-3, a Common Component of Topical Sunscreens." ClinExp Dermatol 2002;27(8):691-4.

11. Environmental Working Group. Nanomaterials and hormone disruptors in sunscreens.

http://www.ewg.org/2010sunscreen/full-report/nanomaterials-and-hormone-disruptors-in-sunscreens/

12. Filipe P, Silva JN, Silva R, et al. Stratum corneum is an effective barrier to TiO2 and ZnO nanoparticle percutaneous absorption. Skin Pharmacol Physiol. 2009;22(5):266-75.

13. Consumer Reports - July 2007 " Nanotechnolody Untold promise, unknown risk."

14. "Sunscreens: Some are short on protection." Consumer Reports July 2007.

Robyn Loses Weight and Her Headaches...

Too many people get fat and stay fat, but others actually do something about it. Like David, he dropped the weight and then started running marathons. And Robyn, she used to be confused about diet and ate all the wrong things, but today she’s looking good and living headache-free:

My headaches are gone, I don't feel hungry between meals, and rarely have food cravings — and when I do, it's for leafy greens! It is so much more pleasurable to eat when you are really hungry, which now occurs much less frequently.

Eight months later, I was 65 pounds lighter. I am content eating pleasurably and healthfully and just feel so much better. I now have the energy to exercise again and enjoy it. Not only do I feel better, but my hair, skin and nails are in the best shape ever…continue reading.

Image credit: DrFuhrman.com