Enhancing Skin Growth Part 6: Is mTOR the Key to Speeding up Foreskin Restoration?
In part 3, we looked at the dartos fascia and its role in restoration. It appears that it takes a lot longer for the dartos fascia to expand than it does for the dermal layers, which is why foreskin restoration takes so much longer than regular skin expansion. This means that optimizing the expansion of the dartos fascia is most likely the key to quicker restoration.
The dartos fascia is primarily made out of collagen and smooth muscle cells. In part 2, we looked at collagen and how to increase collagen synthesis. Although increasing collagen is pretty straightforward, the same cannot be said for expanding smooth muscle cells. Because the dartos fascia is such a unique structure, there isn’t any scientific literature on how it repairs or proliferates. However, there is some research showing that vascular smooth muscle cells do proliferate via mitosis when exposed to mechanical stress.(1) This is good news for us restorers since it suggests that the smooth muscle cells in the dartos fascia would also proliferate under mechanical stress. This is also backed up by the fact that the dartos fascia appears to be fully functional in restored foreskin in that it contracts and tapers at the end like a natural foreskin.
So, how exactly do smooth muscle cells proliferate, and how can we optimize this process to speed up restoration? Fortunately, the research that has been done on vascular smooth muscle cells offers us some clues into answering these questions.
For patients with narrow arteries or veins, often times doctors will use treatments that mechanically stretch them open such as stents or balloons. Unfortunately for this situation, the mechanical stress also triggers the vascular smooth muscle cells to proliferate to where they will actually start growing and re-narrow the artery. To solve this problem, researchers have been looking at different drugs that inhibit proliferation of the smooth muscle cells. Interestingly, the most successful drugs are those that inhibit a protein called mTOR.(1) So, if inhibiting mTOR can stop proliferation of smooth muscle cells, can increasing mTOR speed up proliferation in the process of foreskin restoration?
First, we need to look exactly at what mTOR is. It stands for mammalian target of rapamycin, and it only has this name because the drug rapamycin was discovered first, and it was later found to inhibit this previously unknown pathway. The simple explanation of mTOR is that it regulates growth in the body. When activated, it helps to build tissues like muscle and fat, and when it is inhibited, it helps to break down old tissues and get rid of waste. Both of these functions are important, and we need both at different times. However, too much mTOR activation is associated with cancer growth, and not enough mTOR can lead to muscle loss and other undesirable effects. For these reasons, mTOR has been a main focus of antiaging research.
For foreskin restoration, we want to look at activating mTOR in order to build tissue. It is important to reiterate that mTOR is neither bad or good, and the risk of causing a serious disease like cancer is extremely low unless you are using extreme strategies like pharmaceutical drugs or hormones. There are some simple natural strategies that can be used to optimize mTOR that are safe, and are worth implementing to possibly speed up foreskin restoration.
Protein
Protein intake is one of the most researched factors in regulating mTOR. When dietary protein, and specifically the amino acid leucine, is low, mTOR is inhibited.(2) In order for mTOR to be activated as we want for foreskin restoration, protein intake needs to be sufficient. The minimum amount of daily protein that is most often cited is 1 gram per kg of body weight. The optimum amount of protein intake is a bigger debate that I won’t go into here, but I think it is better to aim for 1.5 to 2 grams per kg. It is also important to note that collagen has a low content of leucine and is not going to be effective for increasing mTOR, though it will still have benefits as outlined in part 2.
Exercise
The other major factor in activating mTOR is exercise. Strength training specifically is going to have the biggest impact on increasing mTOR.(3) What is interesting about exercise though is that is appears to only activate mTOR in the muscles, heart, and brain, but not other organs.(3) Whether or not exercise would have a systemic effect that would aid in restoration is unclear. It is hypothesized that there are mechanoreceptors in the muscles that are increasing mTOR when activated with exercise. This could be further evidence to support the theory that when we are applying tension to the dartos fascia in restoration, it is stimulating mechanoreceptors that then activate mTOR and proliferation of the smooth muscle cells.
Insulin like Growth Factor-1 (IGF-1)
IGF-1 is a hormone that aids in growth and regeneration in conjunction with growth hormone. It appears that one of the main mechanisms for how both protein intake and exercise activate mTOR is through increasing IGF-1.(4) In part 4, we looked at different growth factors and how they could enhance restoration. Not only can growth factors enhance skin health, but they may also have an impact on the dartos fascia through activating mTOR as well.
Conclusion
The impacts of mTOR on health go way beyond foreskin restoration, but it is important to understand the basics of it as it is one of the main ways our bodies regulate growth. It appears that mTOR is tightly regulated individually in different organs at different times. It is most likely that applying tension to the dartos fascia is activating mTOR locally. It is unknown if other strategies that broadly impact mTOR will also target the dartos fascia, but basic strategies like diet and exercise are good for your health anyway and are easy to add to your restoration plan.
References:
1. https://www.ahajournals.org/doi/epub/10.1161/CIRCINTERVENTIONS.110.957332
2. https://pubmed.ncbi.nlm.nih.gov/15878852/
3. https://www.sciencedirect.com/science/article/abs/pii/S1084952114002535
4. https://pubmed.ncbi.nlm.nih.gov/21590739/
Image: Charles betz, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons