The Role of Supplements, Hormones and Antioxidants in Skincare

By Dr Daniel L Sister / 01 Feb 2016

Dr Daniel Sister details the importance of supplement intake and hormone balancing in holding back ageing

I am a ‘pre-Botox baby’, which means I’ve witnessed the evolution of the aesthetics industry over the past 25 years. When I trained as a doctor, I was taught to look at a patient in their entirety – not at their different problems – but as one individual. During my career I’ve always promoted the idea of treating the ‘whole patient’. In practice this means looking at how what is happening on the inside is affecting what we can see on the outside.

The ageing process of the face is a complex chain of events between bone, muscle, fat and skin. But there are other key changes that occur within the body that affect the speed at which this chain of events occurs, which explains why we don’t all appear to age at the same speed. There are, as we all know, two different versions of age: chronological age; the age that is written on your ID or driving licence that you cannot change, and biological age; how one will age depending on factors such as genetics, lifestyle, stress, disease and diet. Biological age is something we can affect. In essence, what you put into your body is reflected in its outward appearance, and the skin is the most obvious place we can see this.

Biological ageing is not just something that happens. As medical professionals, we can help our patients understand that the choices they make and the lifestyles they lead will have an effect on their own specific ageing process. In my opinion, providing patients with advice on supplements, nutrition and hormones is of vital importance and should always be done in tandem with any anti-ageing treatments that we may recommend.

By combining nutritional advice, the addition of supplements to the diet, and hormone testing and re-balancing, I believe we can dramatically increase the effects that any aesthetic medical treatments will have on both a patient’s appearance and their general wellbeing. Not only does the addition of this advice make the patient feel better, but it will also ensure any treatments achieve the maximum effect.

The role of vitamins and mineral supplements

Diet
I always discuss diet with my patients. Sometimes deficiencies are obvious through a patient’s own description of their diet, but I also use blood tests to identify any issues and to look at specific levels. The skin and hair reflect what’s happening on the inside, therefore good nutrition is vital. Personally I am not an advocate of IV vitamin drips. To my knowledge, drips are rarely customised to meet the needs of a specific individual, but rather a choice of ‘ready-made cocktails’. I believe that sound dietary advice is much more valuable, and if necessary, blood tests to identify key areas of deficiency.

To my knowledge, drips are rarely customised to meet the needs of a specific individual, but rather a ‘ready-made cocktail’ – the equivalent of fast food versus a balanced meal. It’s far more valuable to discuss a patient’s diet in detail and, if necessary, arrange blood tests to identify key areas of deficiency.

Diets high in vitamin C and low in both fats and carbohydrates are associated with good skin. This was indicated in a study of 4,025 American women between the ages of 40 and 74 years old, where dermatologists reported that they had fewer wrinkles and agerelated dryness.

A 24-hour dietary recall was administered to each respondent by a trained dietary interviewer, with 3-dimensional food models, including household measures, to estimate food portions. A complete clinical dermatologic examination of the skin was undertaken to evaluate variations in texture and colour, certain manifestations of ageing, and all pathologic changes. Women with a wrinkled appearance had significantly lower intakes of protein, total dietary cholesterol, phosphorus, potassium, vitamin A, and vitamin C than women without a wrinkled appearance. Further studies have also indicated that women who eat more vegetables, and less fat tend to have younger looking skin.

Reducing overall sugar intake is beneficial to both elastin and collagen. Eating too much sugar over time ages the skin, making it dull and more prone to wrinkles. This is due to glycation, where sugar in the bloodstream attaches to proteins and forms advanced glycation end products (AGE).4 AGEs damage proteins, making cells stiffer, less flexible, and more prone to both damage and premature ageing. Collagen and elastin are particularly prone to this damage. The effects start at around the age of 35 and increase quickly thereafter. To clarify, the more sugar a patient eats, the faster their skin is ageing. In addition to the potential for poor diet, as we age the body becomes less effective at extracting key nutrients from what we eat. This is where supplements with the right quantities of key ingredients can make a big difference.

Supplements
Specific vitamin and mineral deficiencies that cannot be addressed through an improved diet should be tackled through the addition of good quality supplements. I would encourage any practitioner intending to recommend supplements to thoroughly research which brand they suggest to patients, in my opinion, not all supplements are equal. A nutritional supplement I developed contains a combination of amino acids and marine plant extracts, which aims to enhance the production of the patient’s own growth hormone. A double blind placebo controlled study, which used optical three-dimensional invivo measuring, has shown that taking a daily dose of a supplement containing collagen peptides can improve the skin’s pro collagen content by 65% after eight weeks.Hair is another area that suffers due to the ageing process. Hair growth is divided into three distinct cycles, anagen (the growing stage), catagen (the transitional stage) and telogen (the resting stage). As we age the length of the anagen phase shortens with every hair growth cycle, resulting in the hair becoming weaker and appearing less vibrant. A diet rich in protein is particularly important to the development of keratin, the key structural component of hair and nails.6 A supplement that I often recommend to patients is Viviscal Professional. This hair growth supplement contains the key active ingredient AminoMar C, a marine protein complex, plus biotin (vitamin B7) and apple extract, which aim to promote healthy hair growth without the use of hormones or drugs. I find this useful for patients who complain of hair loss, thinning and/or shedding brought about by hormonal change, ageing, stress, and poor diet. This supplement is supported by clinical trials, starting in 1992 and continuing to the present day,7,8 with a recent six-month double-blind placebo controlled trial which showed an 80% increase in terminal hairs and a 12% increase in hair diameter (thickness).9 Aside from this supplement, the only other recommendation I would make, that I have found to be is effective, is Platelet Rich Plasma (PRP) treatment. Of course there is a downside to recommending supplements. Patients rely on taking a tablet when, in fact, making positive changes to their diet would be a far better option. I also steer patients away from self-medicating with supplements. It is far better to seek a professional opinion on where they may need the addition of a vitamin or mineral, than to take a guess and end up contributing to a general imbalance.

How hormones play their part

It is well-known that hormones play a hugely important part in the ageing process. Generally women’s hormones begin to fluctuate at around the age of 40, during the perimenopause. This is when skin changes are often first noticed. Wrinkles, dryness and loss of elasticity can all result from a drop in sex steroid hormone levels. When hormones are balanced they enable the body to work efficiently and create energy, fight disease and regenerate tissue. With age, this balance often goes out of kilter. An imbalance of testosterone, for example, often causes significant skin issues. The correct amount of testosterone, balanced with a dose of oestrogen, will help regulate the skin’s oil gland activity. Women who take hormone replacement therapy (HRT), for instance, have been shown to have skin that is thicker than women who do not take hormones.10 In my opinion, using a blood test to check a patient’s hormone levels is vital, as it will provide information about how to treat them. I only prescribe bio identical hormones as they can be tailor-made for each patient. 

The role of antioxidants 

Despite our awareness of how to reduce the risk, skin cancer is on the rise with at least 100,000 new cases diagnosed every year in the UK.11 We should all be aware that reducing sun exposure will decrease our chances of developing skin cancer, however research shows that the majority of people do not use sunscreen effectively; for example, they do not use enough or remember to re-apply frequently.12 As such, I am interested in the role that antioxidants can play in protecting the skin.

While we know that antioxidants should not replace the role of sun protection (in the form of SPFs), we do know there is benefit in taking them alongside traditional methods. Research has indicated that taking 1g of vitamin C and 500 IU of vitamin E, for more than three months, can lead to a reduction in the effects of UVB damage.13 Supplements containing polypodium leucotomos, which comes from a Central American fern-plant, have also been reported to offer additional protection. A study in early 2015 conducted by the International Society of Dermatology found that this supplement provided ‘significant advantages’ such as a more uniform protective coverage over the whole body.14 I would suggest that patients who are prone to sun damage take an antioxidant supplement, such as Heliocare Oral Capsules. As far as I am aware, these are suitable for all patients.

Conclusion

In my personal experience I have seen many ‘miracle treatments’ come and go because they did not live up to their promises. I don’t rely on clever marketing from sales people, I believe in science and evidence-based research with case studies of large groups of patients, followed for a number of years. Crucially I focus on doing my research before using a treatment (whether it’s new or old). In conclusion, when I’ve correctly tested my patients and they have stuck to the programme they are given, they come back to me happy with their results. Most importantly they come back without being prompted, because they like how they feel. Much though we try, we cannot stop the ageing process. What we can do, however, is ensure that we age as well on the outside as on the inside. Treating one without the other is like applying cream to hide a wound; it’s no longer visible, but neither will it heal. Remember, your chronological age is not relevant if your biological age means you look and feel great.

References

  1. USA National Academy of Sciences, Dietary Reference Intakes: A risk assessment model for establishing upper intake levels for nutrients. 1999, National Academy Press; Washington
  2. Cosgrove, MC, et al. Dietary nutrient intake and skin aging appearance among middle-aged American women. Am J Clin Nutr 2007;86:1225-1231.
  3. Chisato Nagata, Kozue Nakamura, Keiko Wada, Shino Oba, Makoto Hayashi, Noriyuki Takeda and Keigo Yasuda (2010). Association of dietary fat, vegetables and antioxidant micronutrients with skin ageing in Japanese women. British Journal of Nutrition Volume 103 / Issue 10 / May 2010, pp 1493-1498
  4. Alison Goldin, BA; Joshua A. Beckman, MD; Ann Marie Schmidt, MD; Mark A. Creager, MD, Basic Science for Clinicians - Advanced Glycation End Products 2006; 114: 597-605
  5. Proksch E, et al, Oral intake of specific bioactive collagen peptides reduces skin wrinkles and increases dermal matrix synthesis. PubMed (2013) http://www.ncbi.nlm.nih.gov/pubmed/24401291
  6. Sinclair, R & Joliffe, V 2013, Fast Facts: Disorders of the hair and scalp. Ed 2, Oxford: Health Press
  7. Hornfeldt, C & Holland, M. (2015). The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments. The Journal of Drugs in Dermatology. 14 (9), s14-21.
  8. Lassus, A & Eskelinen, A 1992, A comparative study of a new food supplement, Viviscal, with fish extract for the treatment of Hereditary Androgenic Alopecia in young males, The Journal of International Medical Research, vol. 20, no. 6, pp. 445-453.
  9. Glynis Ablon, MD, Ablon Skin Institute Research Center, Manhattan Beach, CA; Steven Dayan, MD, A six-month randomized, double-blind placebo-controlled multi-center study evaluating the efficacy of a new oral supplement in women with self-perceived thinning hair. DeNova Research, Chicago, IL.
  10. Vaillant L1, Callens A, Hormone replacement treatment and skin aging PubMed, Jan-Feb;51(1):67-70.
  11. British Skin Foundation, Skin cancer, 2015, http://www.britishskinfoundation.org.uk/SkinInformation/SkinCancer.aspx
  12. British Association of Dermatologists, Sunscreen fact sheet, 2015
  13. http://www.bad.org.uk/for-the-public/skin-cancer/sunscreen-fact-sheet#applying-sunscreen
  14. Placzek M, et al. PubMed, Ultraviolet B-induced DNA damage in human epidermis is modified by the antioxidants and ascorbic acid and d-alpha-tocopherol. (2005) http://www.ncbi.nlm.nih.gov/pubmed/15675947
  15. El-Haj N, Goldstein N, PubMed, Sun protection in a pill: the photoprotective properties of Polypodium leucotomos extract, (2015) http://www.ncbi.nlm.nih.gov/pubmed/25040452

Comments

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  • Beverley Ashton 13 Mar 2018 / 11:08 PM

    Loved this article - very articulate and so so relevant to todays focus on external ageing