GDerm Summit – NYCGDerm Summit – NYC

Nutrition Strategies to Improve Skin Integrity in the Older Patient

Rick K Wilson MD The Cooper Clinic – Dallas

Board Certified – Dermatology and Phlebology; Secondary Certification: Age Management

Medicine/ HRT 4/11

The Convergence of Beauty The Convergence of Beauty and Healthcareand Healthcare

…… while the diet/dermatology connection Is nothing new it is truly gaining powerful momentum

Concept of active nutritional ingredients to promote skinhealth and beauty arose in the 1980’s

Continuing influx of innovative formulations – antioxidants

Nutraceuticals/ nutricosmetics – key to beautiful skin isa healthy body

Thrust is “ beauty from within” by use of various foods andantiaging cocktails containing botanical extracts, vitamins,minerals, antioxidants…

Madhere S, et al. A Market Overview of Nutricosmetics. Cosm Derm. 2010; 23(6): 268-274

$1.5 billion market in 2008

Primarily in Europe and Japan

“beauty foods” containing minerals,

vitamins, botanical extracts, andAntioxidants

Goal: combine aesthetic procedures,

topical skin care & nutricosmetics

Aesthetic Procedures

Topical Skin CareProducts

Nutricosmetics

Madhere S, et al. A Market Overview of Nutricosmetics. Cosm Derm. 2010; 23(6): 268-274

$1.5 billion market in 2008

Primarily in Europe and Japan

“beauty foods” containing minerals,

vitamins, botanical extracts, and

Antioxidants

Goal:combine aesthetic procedures,

topical skin care & nutricosmetics

Aesthetic Procedures

Topical Skin CareProducts

Nutricosmetics

..”the missing link to medical

aesthetics procedures”

Aging Skin

Effects of aging – observed in barrier function, mechanics, structure and appearance

Exposure to endogenous and exogenous stressors increases with chronological age

Theories of Aging – telomere, cross linkage(glycation), neuroendocrine decline, free radical/ oxidation

Primary emphasis: antioxidant quenching of excess free radicals (ROS)

to aid natural repair and defense mechanisms

Skin Aging and Oxidative Stress

Aging = multifactorial degnerative process deriving from both intrinsic and extrinsic factors

Oxidative stress: ~ strong scientific literature support ~ exact cause-and-effect linked not established ~ does not stand alone as the cause of organ dysfunction and aging

Extrapolation: ~ antioxidant quenching of ROS (free radicals) restores balance favoring natural repair & defense mechanisms

Skin Aging FactorsSkin Aging Factors

Extrinsic Factors: UV radiation smoking failure to maintain hormone balance environmental pollutants exercise, digestion poor nutrition

e.g., consumption of saturated/trans fats >>> lipid peroxide

free radicals which attack intima of coronary arteries

Skin Aging FactorsSkin Aging FactorsExtrinsic Factors: UV radiation smoking failure to maintain hormone balance environmental pollutants exercise, digestion poor nutrition

e.g., consumption of saturated/trans fats >>> lipid peroxide free radicals which attack intima of coronary arteries

< lipid peroxides and other endogenously derived free radicals also work at the skin level as well

e.g., UVR-induced ROS lead to oxidative damage observed as

wrinkling, laxity, mottled pigmentation, malignancy

Skin Aging and Oxidative Stress

What we do know: antioxidants function to neutralize the

deleterious effect of free radicals; mitochondrial level

Best Strategy: combine ingestion of oral antioxidants

with topical placement of antioxidants and other

products to maintain functional integrity of

the skin

Nutritional Approach to Healthy Nutritional Approach to Healthy SkinSkin

Standard American Diet ( “SAD”) – highly processed foods, excess

additives, HF corn syrup, excess animal protein and

calorie dense NOT nutrient dense convenience foods

Nutritional Approach to Healthy Nutritional Approach to Healthy SkinSkin

Standard American Diet ( “SAD”) – highly processed foods, excess

additives, HF corn syrup, excess animal protein and

calorie dense NOT nutrient dense convenience foods;

***largely devoid of whole food fruits and vegetables

AVOID:

* high glycemic (simple refined sugar, HFCS) foods which lead to

glycation inactivation/breakdown of key proteins - wrinkling

* saturated/trans fats - go for monounsaturated fats to improve

skin hydration and elasticity

Nutritional Approach to Healthy Nutritional Approach to Healthy SkinSkin

Consume instead:

* whole food fruits and vegetables, nuts,& legumes ---

no additives and freshly picked before consumption

* Omega-3’s: best sources – walnuts, Wild Atlantic salmon;

important to correct unfavorable O-6/ O-3 ratio

which is proinflammatory; American ratio > 6-10/1

Nutritional Approach to Healthy Nutritional Approach to Healthy SkinSkin

Consume instead:

* Vitamin D – a critical prohormone; most Americans low;

supplementing with Vitamin D3 is best bet

* Probiotics – yogurt with live active cultures; optimal

digestive health immune boosting & suppressive

of allergic & inflammatory skin conditions –eczema

and psoriasis

Antioxidants in FoodAntioxidants in Food

Partial listing

•Vitamin A * Zinc

•Vitamin C * Selenium

•Vitamin E * Catechins

•Beta carotene * Anthocyanins

•Lutein * Ellagic acid

•Lycopene * Resveratrol

***Likely we will discover other antioxidants in foods

Antioxidant examplesAntioxidant examples:

Vitamins – C, E, B12, & carotenoids

Trace elements – copper, zinc, selenium

Amino acid complexes – glutathione

Flavenoids

Antioxidant functionsAntioxidant functions:

• prevent cancer cell formation

• prevent cardiovascular disease

• boost immunity to viruses and bacteria

• assist in DNA repair

• suppress degenerative changes

Great Nutrient Choices for Skin and Great Nutrient Choices for Skin and HairHair

“Pigment Power” – rainbow of colors

Journal of Agricultural and Food Chemistry, June 2004; major review-F&V antioxidants

…purple, blue, red, orange spectrum were highest antioxidant fruits

…. some key veggies: grape tomatoes, kale, broccoli, spinach, dark beans, carrots, artichoke

Great Nutrient Choices for Skin and Great Nutrient Choices for Skin and HairHair

“Pigment Power” – rainbow of colors

Journal of Agricultural and Food Chemistry, June 2004; major review-F&V antioxidants

…purple, blue, red, orange spectrum were highest antioxidant fruits

…. some key veggies: grape tomatoes, kale, broccoli, spinach, dark beans, carrots

Biggest Antioxidant Winner- Blueberries

The Slow Food MovementThe Slow Food Movement

Healthy Nutrition Trend

Movement away from excessive dependence on processed foods

More whole foods, more organic foods, more plant based foods and whole grains, locally grown for nutrient density

According to the Natural Resource Defense Council, most produce travels >1000 miles before being sold; significant loss of nutrient density due to failure of vine ripening and transit reduction of vital nutrients.

Web sites: slowfoodusa.org eatingwell.com

Vitamin D as Hormone and Vitamin D as Hormone and BenefactorBenefactor

** major player in cell physiology with receptors in all somatic cells

Broad spectrum beneficial effects:

* Ca and phos metab for bone health

* immune modulation

* renal and caridovascular disease

* cancer suppression ( ovarian, breast, colon, prostate, skin )

* diabetes

* psoriasis

* “SAD” – seasonal affective disorder

Listing of research literature @ vitamindcouncil.org

Nutraceutical exampleNutraceutical example

Vit A Vit C Vit E Biotin Zinc Selenium Copper Manganese

Lycopene Lutein Zeaxanthin L-cysteine Polypodium leucotomos Inositol L-methionine Horsetail

ConclusionConclusion

Nutritional Approach to Healthy Nutritional Approach to Healthy SkinSkin

Consume instead:

* whole food fruits and vegetables, nuts,& legumes ---

no additives and freshly picked before consumption

* Omega-3’s: best sources – walnuts, Wild Atlantic salmon;

important to correct unfavorable O-3/ O-6 ratio which

is proinflammatory; American ratio > 6-10/ 1

* Vitamin D – a critical prohormone; most Americans low;

supplementing with Vitamin D3 is best bet

* Probiotics – yogurt with live active cultures; optimal digestive health

immune boosting & suppressive of allergic & inflammatory

skin conditions –eczema and psoriasis

Additional ReferencesAdditional References

Linder, J (Review) Antioxidants: crucial additions to dermal photoprotection. Cosm Derm. 2010; 23(1): 40-44 Fisher GJ, Kang S, Varani J, et al. Mechanisms of photoaging and chrononlogical skin aging. Arch Dermatol. 2002; 138:1462-1470. Afaq F, Mukhtar H. Botanical antioxidants in the prevention of photocarcinogenesis and photoaging. Exp Dermatol. 2006;15:678-684. Pinnell SR. Cutaneous photodamage, oxidative stress, and topical antioxidant protection. J Am Acad Dermatol. 2003; 48: 1-19.