Skin and Internal Health
A Wrinkle is Not Just a Wrinkle
Article By: Alan C. Logan, ND, FRSH Source: www.ihpmagazine.com
Fine lines, wrinkles, sagging, roughness, dark under eye circles and uneven tone (colouration) are often accepted as inevitable parts of the aging process, and are thought to be a matter of genetics and lifetime ultraviolet (UV) exposure. Research is beginning to unravel this rather simplistic view. It is becoming clear that facial skin represents an excellent surrogate marker for internal health and lifestyle wellness through the aging process.
Skin and Internal Health
The first hint that facial wrinkles might be a surrogate marker for internal health came from a study of smokers. The study involving over 1,000 community residents demonstrated that smoking might even exceed sun exposure in enhancing the risk of wrinkles. Interestingly, among the male smokers over 50 years, those with the worst wrinkle scores were also those who had a higher risk of chronic diseases (intensity of smoking was unrelated). Males over 50 years with the same smoking habits and the least wrinkles did not have the same high risk of chronic disease. Specifically, the low-wrinkle smokers were twice as likely not to have a history of heart attacks and strokes (or both) versus the high-wrinkle smokers (Daniell 1971).
Visual cues may indeed be a reliable marker for internal health among older adults. In a unique aging study involving 1,086 men, researchers asked clinicians to estimate the patients’ ages based on only visual cues, without any knowledge of health records. The researchers had a full complement of blood work, including objective measures of lung, kidney, cardiovascular and neurological health on file for each patient. During follow-up, subjects who were estimated to be older than their true age were more likely to die during the 19 years of data collection. The estimated age of those who died during the study was four years older (on average) than actual age, while survivors were reported to be 0.59 years younger (on average) versus chronological age (Borkan 1982).
More recent investigations have noted that facial appearance may indicate health status in older adults. Using digital facial photographs of 100 sets of older adult twins, Danish researchers asked 20 nurses (25-46 years of age) to estimate the age of each twin. The individual twin rated to be older looking was much more likely to die first (73% of cases) (Christensen 2004). Moreover, a Korean study was carried out in 264 healthy adults, 30 years of age and older, to determine whether there was a relation between facial wrinkles and decreased renal function. As an index of renal function, the estimated glomerular filtration rate (eGFR) was determined. The researchers also evaluated the presence and severity of facial wrinkles lateral to the canthus of the right eye (“crow’s feet” area) and blood markers of lipid peroxidation. After controlling for smoking and alcohol consumption, the researchers reported that those with the most severe facial wrinkling were more likely to have suboptimal kidney filtration rates. In addition a higher level of plasma lipid peroxidation was correlated with both suboptimal kidney filtration and the presence of severe facial wrinkling.
Diet and the Skin
Many studies have sought to investigate the influence of nutrition on the skin. A multinational study involving 453 older adults (average age: 76) from Australia (N=225), Sweden (N=159) and Greece (N=69) addressed whether food and nutrient intakes were correlated with skin wrinkling in a sun-exposed site. Swedish patients had the least skin wrinkling in a sun-exposed site. Correlation analyses suggested that there might be less actinic skin damage with a higher intake of vegetables.
Another study of 4,025 women (age 40-74) showed that higher overall fat intake and higher overall carbohydrate intake significantly increased the risk of a wrinkled appearance. The researchers also reported that higher dietary vitamin C intakes were associated with a reduced likelihood of a wrinkled appearance and senile dryness; similarly, higher linoleic acid intakes were associated with a reduced likelihood of senile dryness and skin atrophy. An increase in fat (17g) and carbohydrate (50g) intakes increased the likelihood of wrinkled skin and skin atrophy. The associations were independent of sun exposure (Cosgrove 2007).
German researchers reported that total dietary antioxidant intake, lycopene in particular, was associated with a decreased depth and density of furrows and wrinkles in adult volunteers between 40 and 50 years (Darvin 2008a, Darvin 2008b). Most recently, a study of 252 healthy Spanish women (age 30-70) examined the impact of lifestyle factors on perceived age. Digital facial photographs were evaluated by 55 independent examiners who estimated the age of the subjects. Subjects estimated to be younger than actual chronological age were more likely to adhere to healthy dietary habits (the specifics of healthy diet were undisclosed by the researchers), have better sleep quality and unsurprisingly, avoid excessive sunlight (Mayes 2009).
Nutritional Foods and Supplements
A number of nutrients and phytochemicals have been the subject of research with endpoints related to skin aging. Some of these nutrients are known to improve other aspects of internal health. For example, research in otherwise healthy middle-aged women has shown that cocoa antioxidants can improve parameters of aging skin. Cocoa and dark chocolate have been shown to improve risk factors associated with cardiovascular disease and type II diabetes (Balzer 2008). With regard to aging skin, the oral administration of 329mg cocoa flavanols (versus 27mg cocoa flavanols) significantly improved blood flow to the skin after two hours (Neukam 2007). A longer-term study showed that daily consumption of 329mg cocoa flavanols (versus 27mg flavanols daily) for three months reduced UV-induced erythema, improved hydration and decreased roughness and scaling of the skin in otherwise healthy middle-aged women (Heinrich 2006). Separate research in humans showed that 12-weeks consumption of dark chocolate containing 600mg of cocoa flavanols doubled the amount of UV radiation required to reach the minimal erythema dose (MED; i.e., enough UV to produce sunburn appearance) (Williams 2009). Since UV radiation is a primary factor in the development of the visible signs of aging, cocoa’s UV protective properties are of clinical relevance.
The internal UV-protecting properties of cocoa can also be found with other nutritional supplements. For example, fish oil rich in EPA has been shown to provide internal protection against UV damage (Rhodes 2004, Shahbakhti 2003), and improve skin elasticity in healthy women (Segger 2008). The collateral health benefits of omega-3 fatty acids are plenty, including decreased risk of cardiovascular disease, arthritis, mood disorders and other conditions encountered in aging (Riediger 2009). Lycopene is yet another nutritional supplement with internal UV-protecting properties. Consumption of oral lycopene supplements (9.6mg daily) for 12 weeks decreased UV-induced erythema by approximately 40% in healthy adult volunteers (Stahl 2006). As previously mentioned, cutaneous levels of lycopene are inversely associated with the depth and severity of furrows and wrinkles in humans.
The oral consumption of polyphenol-rich red wine has also been shown to provide internal UV protection and significantly enhance the MED in adult volunteers. Consumption of approximately 0.5L of high polyphenol red wine provided UV protection within 40 minutes of consumption (Moehrle 2009).
An additional consideration in nutritional supplementation is the green food category. Based on findings that a diet rich in fruits and vegetables (especially deep green leafy vegetables) may be protective against the skin aging process, and that a diet rich in meat, dairy and processed grains is associated with a greater degree of skin aging, the importance of acid-alkaline balance is worth mentioning. Fruits and vegetables provide an abundance of alkaline buffers, including bicarbonates, potassium and other alkaline minerals (Logan 2009). Meat, dairy and processed grains have an acidic influence in the human body, and in the absence of alkaline fruits and vegetables, an acid-heavy Western fast-food style diet (consumed for just nine days) has been shown to significantly elevate the stress hormone cortisol in humans (Maurer 2003). Elevations in the stress hormone cortisol may slow production and enhance breakdown of the primary dermal structure, collagen. The top-heavy acid diet has also been connected with osteoporosis due to enhanced loss of calcium and magnesium from the bones. Even relatively small losses of bone minerals and density in the facial bones can significantly accelerate the visible signs of aging via enhanced sagging and folding of the skin (Vleggaar 2008). Green food supplements, typically a mixture of antioxidant-rich plant foods and botanical herbs, can provide alkaline support (Berardi 2008). Green food supplements, therefore, have the potential to maintain bone integrity, provide internal antioxidants to the skin and mitigate elevations in circulating cortisol levels.
Lastly, consideration of internal nutrient factors for the maintenance of well-hydrated skin is important. The stratum corneum within the epidermal barrier contains important lipids known as ceramides. For years, synthetic ceramides have been a staple in the topical cosmetics industry, yet recent research shows that orally consumed ceramides, naturally derived from rice bran, konjac fiber and wheat grain, can improve the epidermal barrier and significantly enhance skin hydration (Asai 2007). Orally consumed combination supplements containing fermented dairy, green tea and borage oil have also been shown to improve skin hydration from the inside out (Puch 2008).
In sum, the visible signs of aging can provide a mirror to lifestyle habits – beyond the well-known factors of sun exposure and smoking history. Dietary patterns shown to protect against aging skin are the same dietary approaches generally advocated for the reduction of chronic illnesses such as cardiovascular disease, cancer and depression. For patients concerned about the appearance of skin aging, it may be worthwhile to discuss the connections between diet and stress. Changing lifestyle habits to address aging skin – improving dietary quality and managing stress via mind-body medicine – provides a “backdoor” approach to lower the risk of multiple chronic diseases of aging.