Dr Johanna Ward is a GP with a special interest in clinical dermatology and nutrition. She has worked in clinical dermatology and aesthetics for more than 10 years, having run a chain of skin and laser clinics. She is passionate about the power of preventative and nutritional medicine and lectures nationally and internationally on antiageing and nutrition. She is currently Women’s Health magazine’s resident doctor and is often asked to comment in the media on all things skin and nutrition related.
The skin is the body’s largest organ and has a huge physiological need for nutrition and nourishment. It exists in a state of constant renewal and is a complex and dynamic organ that responds to nutrition and protection from both outside and within.
High-quality topical skincare products can protect, nourish and fortify the skin; however, they cannot substitute for what the blood brings to the skin in terms of vitamins, minerals and essential fatty acids. Because of the skin’s dual needs, a new concept has emerged in skincare – one that embraces the synergy that exists between topical skincare and optimal cellular nutrition. This new way of thinking about the skin means that more and more people are embracing the idea of beautifying nutrition and are starting to understand the importance that good nutrition plays in skin health. It moves away from one dimensional, topical application of products and embraces the idea of creating synergy between topical and internal skincare. So, a two tiered, inside-out approach is fast becoming the go-to for anyone wanting to maintain long-term skin health and, as aesthetic practitioners, it’s important that we can understand what nutrients affect the skin and how to consult patients effectively.
We live in a modern age that exposes us to chemicals, radiation, pollution, toxins and pesticides on a daily basis. More than ever our cells need nutritional support to prevent oxidation, glycation and methylation – the three biochemical processes at the centre of cellular ageing.1
The skin is the last place to receive nutrition because the body will always preferentially feed the major organs such as the heart, brain, liver and kidneys.2 It makes sense, therefore, to tackle the skin from outside and within to maximise the skin’s cellular protection and support. In the last 50 years, the modern Western diet has totally changed, but we haven’t genetically evolved to keep up. Processed foods that are high in sugar and hydrogenated fats were never meant to be our cellular fuel. Unfortunately, these foods have become the norm in our diet, with most supermarkets filled with convenience meals and processed snacks – foods that are more like ‘food substitutes’ than offering real, nourishing meals.
Never before has it been so important to nourish the skin well with a healthy and varied diet. A study in 2007 published in the American Journal of Nutrition showed that accelerated ageing occurs in people with a high intake of bad fats and processed carbohydrates (such as white bread, biscuits, processed foods), while a diet rich in vitamin C was found to reduce skin ageing.3
As we age our bodies have a higher nutrient requirement. The body becomes less efficient at utilising key nutrients and therefore needs more nutrient-dense foods.4 There is also the major issue of gut health. Most people born post 1950s have been exposed to significant amounts of chemicals, processed foods, high sugar foods and numerous medicines, including antibiotic overuse – all of which affect gut health.5 Our digestive tracts contain trillions of beneficial bacteria with bacterial cells, far outnumbering human cells in our bodies. These gut bacteria keep our digestive tract aligned and are essential for good digestion and absorption of our foods.6 Maintaining a healthy balance between the good and the bad bacteria in our gut has huge implications for skin health7 and a healthy gut is needed for optimal absorption of nutrients. The great thing about choosing foods that are good for gut health is that they are also the foods that are good for skin and overall long-term health.
The skin depends on the blood supply to bring nutrients and oxygen to the dermis. The body requires an incredible number of delicately balanced nutrients to provide fuel for its cells. The best diet will include a wide selection of fruit and vegetables, nuts and seeds, oily fish and legumes and will be low in sugar, trans fats and additives. Mother nature has cleverly placed an abundance of vitamins, minerals and powerful skin-protecting antioxidants in healthy foods so that supplementation should only be minimally required if a good diet is followed. The problem is that most modern diets have deviated away from this kind of raw, organic, healthy eating and contain far too many sugars, carbohydrates and bad fats, so it’s up to practitioners to ensure our patients are educated about this.
A healthy intake of all vitamins will have a beautifying, antiageing and positive impact on the skin. They all exist in a state of delicate interplay and even small deficiencies can cause skin dryness, fragility and impaired healing.8 Notably, important vitamins for skin health are vitamin C, vitamin A and vitamin E – these all have duality in the skin in that they act as the skin’s first line of defence through their antioxidant activity, and they also have their own individual roles.10-16 Literature has suggested that antioxidants work best in synergy both orally and topically so a good intake of a variety of fruit, vegetables, nuts and seeds will ensure plentiful natural antioxidants to help the skin remain healthy, supple and youthful.9
Vitamin C is an important co-factor for collagen production and one of the skin’s most important and natural antioxidants. Deficiencies in vitamin C cause collagen impairment and skin fragility, as seen in scurvy. Humans cannot manufacture vitamin C so it must be taken in adequate amounts daily in the diet.10 Vitamin C is vitally important for the protein collagen. It is an essential cofactor for the proline and lysine hydroxylases that stabilise collagen and promote collagen gene expression.11 The dependence of the collagen hydroxylase enzymes on vitamin C has been demonstrated in countless clinical studies with fibroblast cells in vitro where vitamin C absence causes decreased total collagen synthesis and decreased cross-linking.12,13 A diet rich in vitamin C has been shown to prevent skin ageing and wrinkling.14,15
Vitamin A is a fat-soluble vitamin. Deficiency rapidly leads to dry, scaling skin with follicular thickening. Vitamin A deficiency is becoming more of a problem in low income countries with an estimated half of all countries reporting it as a public health issue.16 There are two types of vitamin A found in foods. Active vitamin A is retinol – it does not need to be converted by the body and can be used immediately. It can be found in animal proteins, liver and fish, and organic dairy. Beta-carotene is the inactive pre-vitamin A that requires good gut health, well-functioning bile and specific enzymes to convert it. The best way to ensure optimal vitamin A is to eat a wide selection of vitamin A-rich foods such as eggs, meat, liver, fish and colourful vegetables.16
Vitamin E is a powerful skin antioxidant and functions primarily to neutralise free radicals in the skin. Free radicals are unstable molecules that form as by-products of oxygen use in the body. If they remain unpaired they can damage a cell’s DNA and cause accelerated ageing. A diet rich in antioxidants and vitamin E and C will help reduce skin ageing caused by oxidation. Smart dietary choices will ensure optimal vitamin E and can be found in foods such as spinach, broccoli and nuts (especially pecans, almonds and walnuts) olive oil, sunflower seeds and numerous legumes.17
Vitamin Bs work as a collective to provide many of the behind-the-scene daily cellular functions. Particularly important for the skin are B3 (nicotinic acid) and B5 (pantothenic acid). Research has suggested that optimising B3 and B5 can have a beneficial impact on acne through reduction of sebum output and anti-inflammatory effect.18 B3 also has an impact on wrinkles, pigmentation and skin smoothness.19 It is therefore worth optimising in your diet with a good intake of B3 from tuna, turkey, liver, peanuts, mushrooms or green peas.
Vitamin D is not just needed for strong muscles and bones. It has important immune function and deficiencies exacerbate eczema, psoriasis and acne.20 Research has suggested that optimising vitamin D can help these skin conditions and with 40-50% deficiency rates being reported in the UK this is an easily preventable vitamin deficiency.21 Between the months of October to early March in the UK we cannot make enough vitamin D from sun, so Public Health England recommends all ages supplement with vitamin D.22
Magnesium is the fourth most abundant mineral in the body and plays an important role in cellular detoxification metabolism. To age well, it is important to receive enough magnesium so that cells detoxify and revive.23 A toxic cell will age rapidly. Magnesium helps minimise damage from environmental pollution and heavy metals.24 Even glutathione, the body’s master antioxidant, relies on magnesium for its production. Scientists have discovered more than 3,750 magnesium binding sites on human proteins, so this reminds us of the importance of adequate magnesium intake for protein function, with collagen being the most important protein for skin health and vitality.25 Foods rich in magnesium include spinach, avocados, pumpkin and sunflower seeds.
Zinc plays an important role in skin health. It is needed for protein synthesis, wound healing and is a vital antioxidant. It also helps break down substance P, transports vitamin A from the liver and helps in the metabolism of omega 3s. Even mild deficiencies in zinc can impair collagen production, fatty acid metabolism and wound healing.26 The World Health Organisation has estimated that 30% of the world’s population are now zinc deficient.27 Zinc rich foods include animal protein, oysters, egg, shellfish and nuts. Vegetarians and vegans are particularly prone to zinc deficiency and may benefit from zinc supplementation.28
Selenium is another essential mineral that works to slow the signs of skin ageing. Like vitamin E, it has a key role in neutralising free radicals and works to safeguard cell membranes protecting against inflammation, UV cell damage and pigmentation. It is found plentifully in Brazil nuts but also in seafood (shrimp, crab, salmon), vegetables, beef and poultry. The selenium content in vegetables, grains and animal products are dependent on the amount of selenium in the soil – which, in recent years, has depleted.
Omega 3s are long chain fatty acids that have a powerful anti-inflammatory effect. They have been shown to help protect cardiovascular and brain health (the brain is 60% fat) as well as having a profound effect on skin health. Deficiencies in essential fatty acids cause skin dryness (snowflake skin) because lipid-depleted cell membranes cannot maintain their water content.29 Supplementation of omega 3 in clinical trials has been shown to be helpful in the treatment of acne, eczema and psoriasis.30 Studies have also shown that omega 3 healthy fats protect skin cells against sun-induced inflammation and help control how the body responds to UV rays mitigating sun damage.31 The best food source of omega 3s are oily fish like salmon, mackerel and sardines. If using supplements, then one with a high eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content works best as these are the most bioavailable. For vegans, flaxseeds are high in alpha-linolenic acid (ALA) and can be converted to EPA and DHA in the body. However, some people convert ALA weakly so then an algal oil supplement is ideal.32
For practitioners who are invested in promoting good skin health for their patients, it is a good approach to nourish it using not just good quality topical skincare, but also good levels of nutrition.
What patients put into their mouths can have a huge and powerful impact on their skin’s health and the right foods can help to fight free radicals, reduce redness, reduce inflammation, reduce dryness and fight the ageing process. Encouraging patients to change their diet to incorporate healthy, skin-loving foods is one of the easiest ways to influence patient’s skin health and overall wellbeing. However, if patients cannot get enough nutrients in their daily diet then supplementation with highly bioavailable ingredients can be beneficial for promoting skin health and it is certainly better than depriving the body of key, vital cellular nutrients. This way, you will be able to treat them from the outside in.
Disclosure: Dr Johanna Ward is the director and founder of nutrition and skincare brand ZENii.
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