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DISCLAIMER: The following information is based on biomedical literature, research articles and other sources believed by the author to be reliable. However, the author is a scientist, not a medical doctor. None of the information below should be considered as a medical advice. Before any specific treatment, including taking any food supplements, consult your physician. NOTE: The information in the Skin and Nutrition Infopack is designed to supplement the content of the website SmartSkinCare.com. You may find some overlap between the articles on the website and in the infopack. This is done for the sake of completeness, so that the reader wouldn’t have to shift back and forth between the infopack and the website.

Skin and Nutrition Infopack

Copyright 2001-2006 by German Todorov, Ph.D. These materials may not be reproduced or otherwise

distributed without the written permission of the author.

Introduction Some people think that nutrition is far less important to the skin than how much you pay your plastic surgeon. Conversely, others believe nutrition makes all the difference in the world, and if you "eat right", you'll stay forever young. Food supplement and vitamin companies sell "skin pills" that are supposed to miraculously rejuvenate you skin from the inside in a couple of weeks. It appears that the truth lies somewhere between these two extreme views. It would be naïve to believe that changing your nutrition is going to wipe out all your wrinkles or completely stop skin aging. But it is just as naïve to think that you can eat (or neglect to eat) whatever you want without any effect on your skin. What you eat affects every organ in your body and skin is no exception. You may think that as long as you are using an expensive skin cream with a bunch of ingredients with scientific-sounding names, your skin will be properly nourished. Nothing can be further from the truth. While a skin cream may provide a number of important substances, it is never enough to ensure proper, all-round skin nutrition. In fact, skin cells receive most of their nutrients via bloodstream – and the levels of nutrients in the bloodstream depend on overall nutrition of the body at large. Advantages of nourishing the skin from within • Every cell in the human body needs dozens and dozens of nutrients and metabolites. Some, like vitamins,

minerals and essential amino acids need to come from food. Others are produced by the body provided it is healthy and properly nourished. No skin cream can replace all of that.

• Applying a cream with nutrients to the surface of you skin does not ensure that those nutrients actually

penetrate into your skin cells. They may just "sit there" until your next shower. How much of the active ingredients actually get into your skin cells depends on the skin's condition, concentration of the ingredients, manufacturing technology and many other factors. This doesn't mean that all topical preparations are useless -- but they are often unreliable. On the other hand, when the nutrients are ingested and absorbed into your bloodstream, they are sure to be delivered to your skin cells.

• Nutrition has some effect on the mechanisms of aging of the body as a whole. Inhibiting these

mechanisms slows down the overall aging process, including the aging of the skin.

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• Nutrients and foods that benefit your skin also tend to benefit other body systems and overall health. Limitations of nourishing the skin from within • Skin aging is a combination of the mechanisms of aging innate to human physiology plus the

environmental damage from sun, wind and pollution. Proper nutrition may help partly inhibit physiological aging but does little to protect the skin from the outside world. The latter must be achieved by limiting sun exposure, use of proper (UVA+UVB) sunblocks and other steps.

• It is impossible to safely achieve much-higher-than-normal concentration of active ingredients in skin cells through oral intake. Some skin treatments, particularly those striving to produce relatively quick and dramatic results, rely on creating unusually high concentration of active ingredients in the skin. In most cases, this can be achieved only through proper topical application or some special medical techniques (e.g. electrophoresis) - doing so through oral treatment is usually either impossible or unsafe. For instance, vitamin C topical treatments appear to be effective only at concentrations of 10% or more. Such concentration cannot be achieved by just bulking up on vitamin C supplements because vitamin C is quickly excreted via kidneys. Besides, excessively high doses of vitamin C may cause serious adverse reactions.

• Some potentially beneficial substances are reasonably safe for topical use but unsafe for ingestion. • Some substances, such as peptides and growth factors, are easily broken down by digestive enzymes.

They become inactive after going through the GI tract and therefore can be used only topically. • Some of the orally taken nutrients may not be properly absorbed via GI tract. This happens when a person

has certain digestive problems, such as the lack of stomach acid, or when nutrients come from poorly manufactured supplements. Care should be taken to ensure proper absorption.

A balanced nutrition of the body is important for maintaining healthy skin. It may not produce striking rejuvenation, but neglecting it will make your skin age considerably faster. Deficiencies of certain nutrients, such as vitamin A, B-complex, and essential fatty acids are known to cause various forms of dermatitis and other skin conditions. Mild deficiencies, which are very common and often go unnoticed, may not cause clinical manifestations but clearly impair the skin's ability to heal and renew itself. Improving nutrition in a person with subclinical nutrient deficiencies often results in a younger looking skin and partial reversal of some signs of aging. On the other hand, "cutting-edge" skin rejuvenation treatments are likely to be far less effective or even completely fail if your skin is deficient in one or more essential nutrients. (According to some estimates, up to a half of the population in the developed countries have subclinical deficiency of one or more nutrients.) Finally, some nutrients taken in doses higher than the minimal requirement (but still in the safe range) may produce skin benefits above and beyond what the basic balanced nutrition does. If you have any suggestions about the infopack or notice any errors or typos, please email to Dr. G. Todorov at drtodorov@smartskincare.com

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Optimal Diet for the Skin

General Guidelines As boring as it may sound, the diet optimal for overall health is close to optimal for skin health as well. The main reason is that the diet optimal for overall health slows down physiological mechanisms of aging in all tissues, including the skin. While we believe that it's in everyone's best interest to adopt the diet optimal for overall health, we should point out that some aspects of a healthy diet are more important for the skin than others. The key guidelines are outlined below. Balance and variety The recommendation to consume a balanced diet is plastered on every corner these days. But what exactly does it mean? By balanced diet, nutritionists usually imply a diet that contains all necessary nutrients within a certain optimal range. This range is usually selected in such a way as to prevent protein malnutrition and vitamin / mineral deficiencies. Thus, in a strict sense, balanced diet is a diet allowing to avoid malnutrition and nutrient deficiencies. And, for many people, especially junk-food lovers, adopting a standard balanced diet would already be a great improvement. Keep in mind, however, that in order to "beat nature" and derive significant anti-aging benefits, one may have to consume some nutrients in greater amounts than those found in a basic balanced diet. For most people, the simplest and probably the most practically feasible way to adhere to a balanced diet is to follow the recommendations of the Daily Food Guide developed by the US Department of Agriculture. Adults are advised to:

• Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and two-and-a-half cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level.

• Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.

• Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains.

• Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

To ensure than all essential nutrients are consumed in adequate amounts, it is desirable to consume a wide variety of foods. Fruits and vegetables You may have heard it from your grandma, but now it's official! Eating plenty of fresh fruits and vegetables is good for your health. Fruits and vegetables are particularly important for preventing premature skin aging because they contain a wide variety of antioxidants. Many of the pigments responsible for the color of fruits and veggies are -- among other things -- potent antioxidants. These antioxidants help protect skin cells from damage by free radicals which are especially rampant in the skin due to environmental exposure. To ensure that your fruits and veggies have all their antioxidants intact, make sure they are fresh and uncooked (or only minimally cooked) since heat inactivates most antioxidants. Also, some fruits and veggies are significantly richer in antioxidants than others. Fluids

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A well-moisturized skin is somewhat less prone to developing wrinkles. Drinking plenty of fluids throughout the day ensures proper hydration of the body and helps reduce skin dryness. Experts usually recommend drinking 6-8 glasses of water a day. Coffee and sodas are not a good substitute for water because they contain caffeine, which is a diuretic, i. e., a substance promoting the excretion of water via urine. Also, do not drink too much fluid 2-3 hours before going to bed. This may cause morning puffiness and excessively stretch your skin. Calories Except for frying oneself in direct sunlight at noon, the quickest way to get wrinkles is to put on a lot of weight and then lose it. The reason is obvious: when you gain weight, extra fat stretches the skin, then, when you lose weight and body fat goes away, the skin sags and crumples up. The degree of skin sagging after weight loss varies with the person's age (it tends to be worse the older you are), genetics and other factors. Let the desire to retain youthful skin be another incentive for you to watch your calories and avoid weight gain - even if you plan to lose weight later on. Also, keep in mind that gaining and losing weight in cycles may have negative effects not only on the skin but on your overall health as well. Cooking The central theme in cooking is heat-treatment of foods. As written in bold print in every college chemistry course, increasing temperature causes exponential increase in the rate of chemical reactions. What does this mean to us, the eaters? Every time a food is heated up, the rate of reactions of degradation and oxidation of nutrients jumps up dramatically. In other words, cooking depletes food of many essential nutrients and antioxidants and increases the content of oxidative by-products (free radicals). As a result, we consume less essential nutrients and more aging-promoting free radicals. True, complete avoidance of cooked foods is no fun. You don't have to stop eating cooked foods altogether to avoid most of the negative effects of excessively cooked foods. For starters, reduce cooking time and avoid deep frying, grilling and cooking in large amounts of oil or fat.

Dietary fat: The good the bad and the ugly

Fat is an important part of almost every diet, be it a healthy diet or a self-destructive junk food rampage. Consuming right kinds of fat in correct proportions is important for the health and longevity of your body, including the skin. There are three types of fat in most diets: saturated, monounsaturated and polyunsaturated. Saturated fat raises blood cholesterol and triglycerides promoting cardiovascular disease. Saturated fat also tends to promote inflammation. It appears that inflammation is among the causes of premature skin aging. Inflammation accelerates aging mainly because it increases the levels of free radicals. Skin inflammation can be triggered by pollutants, sunlight, acne, allergies and other factors. Moderate or severe skin inflammation is easily noticeable as redness and/or swelling. On the other hand, mild skin inflammation is usually impossible to notice and yet it is exceedingly common. Most experts recommend keeping total fat consumption to 30% of total calories, and saturated fat - no more than 10% (or in some sources 7%). Such an adjustment benefits both the heart and the skin. Avoiding excessive amounts of saturated fat is a smart and healthy decision. Some people simply switch from butter to margarine. Margarine, which is made from oil of various plants, usually has much less saturated fat than butter. However, the chemical process used in producing margarine leads to the formation of so-called trans-monounsaturated fat, which is as bad or even worse than saturated fat. Unsaturated fatty acids have two alternative structural forms: cis and trans. Virtually all unsaturated fat in nature is found in cis form. However, the process of oil hydrogenation used to produce margarine yields significant amount of trans-monounsaturated fat, which appears to be even more atherogenic (bad for arteries) than saturated fat. It is likely that trans-monounsaturated fat is just as proinflammatory as saturated fat, and therefore is not good for the skin. It is recommended to use margarine with little or no trans fat. If the information about trans fat content is missing on

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the label, call the manufacturer. Solid margarine brands tend to have more trans fat. Trans fat can also be hidden in processed foods. If the list of ingredients includes the term “vegetable shortening” (which is essentially low quality margarine), be aware that the product is likely to contain trans fat. Some people go to extremes using large amount of polyunsaturated fat (e.g. soybean, cottonseed and other light oils) in an attempt to avoid saturated and trans fat. However, polyunsaturated fat, especially when cooked or exposed to air for prolonged periods, increases free radical damage. This has a host of negative effects including damage to arteries, immune system and skin. Yet another fallacy is to embark on a very a low fat diet which may lead to the subclinical deficiency of essential fatty acids. Overall, among the three major classes of fat, monounsaturated fat appears to be the healthiest and should constitute the largest share of your total fat consumption. A rule of thumb is to consume about half of you total fat as monounsaturated. The best sources of monounsaturated fat are olive and canola oil. There is a special kind of unsaturated fat, called omega-3 fat, which appears to have a special therapeutic activity. Omega-3 fat is well known for its cardiovascular benefits. But it also possesses a variety of other positive effects, including the ability to reduce inflammation. Since inflammation seems to contribute to skin aging, experts recommend including omega-3 fat in skin-healthy diets. The best source of omega-3 fat is cold water fish (see below).

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Carbohydrates and Carbohydrate Tolerance Blood sugar, or more accurately blood glucose level, is a very important aspect of human physiology because glucose is the primary fuel for the central nervous system. If the blood level of glucose drops below a certain point for a long enough period of time, a person will lose consciousness, fall into coma and die. Very high blood glucose seen in diabetes is also harmful, although the immediate consequences are usually less dramatic. It is less widely known that blood sugar has an important bearing on the aging process. Unfortunately, in addition to being a vital cellular fuel, glucose is also a substance that can cause damage to cells and tissues by randomly reacting with proteins, DNA and other vital molecules. (Scientists call this process glycation). Perhaps the worst consequence of glycation is cross-linking which is the formation of chemical bridges between proteins or other large molecules. A material that undergoes cross-linking usually becomes harder, less elastic and has a tendency to tear or crack. For instance, cross-linking is responsible for hardening of a rubber mat or a garden hose left in the sun. In an aging body, cross-linking causes hardening of arteries, wrinkling of the skin and stiffening of joints. Not surprisingly, diabetics, whose high blood glucose intensifies cross-linking, tend to have more skin damage (as well as vascular and other organ damage) than non-diabetics. However, even mildly high blood sugar promotes the aging process in the long run. This condition, called carbohydrate intolerance (or glucose intolerance) means that one's blood sugar tends to be higher than normal but not high enough to warrant the diagnosis of diabetes. Carbohydrate intolerance is extremely common, affecting up to fifty percent of the population in developed countries. In most carbohydrate intolerant people, fasting blood sugar is normal while blood sugar after meals is higher than it should be. Research indicates that correcting carbohydrate intolerance is one the most important steps one can take towards slowing down the aging process. The main risk factors for carbohydrate intolerance are being overweight and age over forty. Now, the question is how can a person find out whether she has carbohydrate intolerance. Overt diabetes is relatively easy to diagnose. A doctor simply takes your fasting blood glucose to see whether it is elevated. However, many people with carbohydrate intolerance have fasting blood glucose within the normal range. One alternative is to request a so-called glycated hemoglobin test (a.k.a. Hb A1c test). This test is a good indicator of the average level of one’s blood glucose over the last three month. The levels Hb A1c below 5.2% indicate a reasonably good carbohydrate tolerance. The levels of between 5.2 and 6% signal some degree of carbohydrate intolerance. The levels above 6% are usually found in borderline or overt diabetes. Another alternative to detect carbohydrate intolerance is oral glucose tolerance test or OGGT. First, your fasting blood sugar is measured. Then you are given a meal containing a standard amount of glucose, after which your blood glucose is measured every 30 minutes for 2 or 3 hours. This reveals how quickly your blood sugar returns to normal after a carbohydrate load.

Improving carbohydrate tolerance People who are carbohydrate intolerant can slow down their aging and reduce the risk of diabetes by taking steps to improve their carbohydrate metabolism. Furthermore, we believe that these steps are useful for anyone over thirty as they reduce the risk of developing carbohydrate intolerance or diabetes in the future. Reducing glycemic effect of meals As we ingest food, the enzymes in the gastrointestinal tract break it down into small molecules, such as simple sugars, amino acids and peptides. Many foods, from ice-cream to pizza to pop-corn, contain glucose or other sugars that are converted to glucose in the body. Usually, glucose is in the form of starch, a branched polymer made up of many glucose molecules, or sucrose, a sugar consisting of one glucose and one fructose molecule. As the food is digested, the glucose it contains is released and absorbed into the bloodstream, which causes blood glucose level to rise. (Scientists call this glycemic effect of food.) How dramatic such a

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rise would be depends on several factors: (1) how much glucose a meal contains; (2) in which form this glucose is (e.g. starch or sugar); (3) are there other food ingredients, such as fiber, that affect the rate of glucose absorption. Meals that produce less dramatic rise of blood glucose tend to be better for one's carbohydrate metabolism. Generally, among nutritionally equivalent alternatives, the food with smaller glycemic effect should be preferred. For instance, glycemic effect of a whole grain rye bread is 32 percent smaller than that of the equivalent amount of white bread. Guess which is better for your health and your skin! For more information on the glycemic effect of specific foods, see Appendix A. Fiber Over the past decades, research has promoted fiber from a nearly useless non-nutrient filler in plant-derived foods to an important food constituent conducive of health and longevity. Chemically, fibers are a diverse group of plant polymers based on polysaccharide chains. In contrast to starch, which is also a type of polysaccharide, fibers cannot be digested by humans, and pass through the gastrointestinal tract fully or partially intact. Large amounts of fiber in the diet make stools soft and bulky. Fiber came to the spotlight when physicians working in Africa noted a very low incidence of such typical "Western" conditions as heart disease, diabetes, obesity, colon cancer, diverticulosis and hemorrhoids. They also noticed that local population consumed a very high fiber diet -- their stool volume was several times greater than that of people in the West. A role of fiber in preventing diseases and obesity was hypothesized, which spawned abundant research on the subject. Some health benefits of fiber, such as colon cancer prevention, are still controversial. Others, including its ability of fiber to prevent and/or improve carbohydrate tolerance and type II diabetes, are confirmed by solid evidence. Fiber slows down the rate at which glucose is absorbed from food into the bloodstream. This gives the body more time to process carbohydrates, leading to lower blood sugar and better carbohydrate metabolism. It is estimated that a typical citizen of a developed country consumes about one third of the amount of fiber optimal for health and longevity. Luckily, it is not as difficult to increase one's fiber intake without supplements as many people think. Possible side effects of fiber are usually minor and easily manageable. When a person switches abruptly to a high fiber diet, she may experience abdominal discomfort and excess gas. To avoid this, the transition has to be made gradually. Fiber may reduce the absorption of some minerals by the body. This may occur because fiber increases the rate of GI transit, reducing the time of contact between food and the intestine, and also because fiber may bind certain minerals. Evidence shows that in people with adequate intake of nutrients, reasonable intake of fiber does not compromise nutritional status. However, fiber may worsen the situation in persons with low mineral intake. When on a high fiber diet make sure that you consume at least RDA of all nutrients, especially minerals. Fiber supplements, but not high fiber foods, may create intestinal obstruction, a serious problem sometimes requiring surgical intervention. If you choose to take fiber supplements, use those in powder form and take them with a lot of fluid. There is some variation in experts’ recommendations of fiber intake. Most sources recommend an intake of 20-35 grams per day, which is two to three times higher than what an average American consumes. However, it is not advisable to triple your fiber intake overnight. Increase your fiber intake gradually, over several weeks, allowing your GI tract to adapt. Drink plenty of fluids to help soften the fiber and allow a smooth GI transit. Try to get fiber from varied sources: fruits, vegetables, whole grain cereals, beans. Adhering to USDA Food Guide recommendations (see above) that include 2-3 serving of fruit, 3-5 servings of vegetables and 6-11 servings of breads and cereals a day, will easily provide the recommended fiber intake. Exercise Regular exercise is known to improve carbohydrate tolerance and provides a variety of other health benefits. (And it's fun too!). If exercising outdoors, make sure to protect you skin from excessive sun and wind exposure.

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Supplements Certain nutrients and botanicals have positive effect on carbohydrate metabolism. For instance, lipoic acid, discussed later in this infopack, is known to modestly lower blood sugar levels as well as ameliorate diabetic neuropathy. Some adaptogens were shown to improve carbohydrate tolerance or even reverse early stages of type II diabetes. Adaptogens are substances that promote successful adaptation of the body to various forms of stress and also normalize various physiological aberrations. Most known adaptogens are derived from plants and are reasonably safe at commonly used doses. In particular, several studies have shown American ginseng (Panax quinquefolius L.), taken 40 minutes before a meal, to reduce subsequent elevation in the blood sugar. Most studies used the doses between 1 ang 3g of the dried herb. Interestingly, the 1g dose of American ginseng appeared to be as effective as 3g. Other adaptogens, such as Siberian ginseng (Eleutherococcus senticosus) and golden root (Rhodiola Rosea) also showed promise in improving carbohydrate tolerance. Cinnamon Cinnamon has recently been shown to contain a potent sugar lowering substance called MHCP. Experts recommend adding anywhere from half to a teaspoonful of cinnamon a day (2 - 4 g) to one’s diet. This amount should be spread throughout the day. Basically, you can simply add a generous sprinkle of cinnamon powder to each of your major meals. If you do not like the taste of cinnamon in your food, you can get cinnamon extract tablets in a health-food store or on the web. Since the extracts are a more concentrated MHCP source that cinnamon powder, you need to take a proportionately smaller amount. Drugs Of course, there are drugs that lower blood sugar. Virtually all of them, however, can have substantial adverse effects. Using glucose-lowering drug in people with confirmed diabetes is a reasonable trade-off. These drugs are generally not used in people with mildly impaired carbohydrate tolerance. However, for some people with pre-diabetes (significantly impaired carbohydrate tolerance but not yet classic diabetes), drugs may be considered as a part of comprehensive diabetes-prevention strategy. If you think you may have pre-diabetes, talk to your physician about comprehensive prevention program.

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Antioxidants Free radical damage is one of the principal mechanisms of aging. Free radicals are highly and indiscriminately reactive chemicals that can damage any structure in living cells. The most common source of free radicals is normal burning of fuel that occurs in every cell every minute of every day. (Generally, the more free radicals a species produces, the shorter its life span.) Skin suffers additional free radical damage from sunlight and pollutants. Topical antioxidants provide some protection against environmental damage to the skin and may be somewhat effective in slowing down the skin aging. However, topical antioxidants are relatively unreliable. Their effect depends on skin permeability, other ingredients in the cream and many other factors. It appears that increasing oral intake of some antioxidants may additionally protect skin from free radicals. Keep in mind, however, that relatively little solid research has been done specifically on skin benefits of oral or topical antioxidants and much of the supporting evidence is indirect. A very important chemical property for an oxidant is its solubility in water and fat (or oil). Basically, living organisms have two types of internal media, watery extra- and intracellular space and oily membranes that serve as partitions enclosing individual cells and various intracellular compartments. Water-soluble antioxidants are effective mainly in extra- and intracellular fluid, whereas fat-soluble antioxidants protect biological membranes. Both types of antioxidants are needed to create an effective shield against free radicals for the entire body, and skin in particular.

Solubility of antioxidants

Water soluble

Fat soluble Water and fat soluble

Vitamin C Cysteine

Methionine Selenium

Glutathione

Vitamin E Vitamin A Carotenes Lycopene

Coenzyme Q10

Lipoic acid Melatonin

Some polyphenols Some flavonoids

Below we review some of the antioxidant nutrients and supplements which appear the most likely to produce skin benefits. Vitamin E Vitamin E is the principal fat-soluble antioxidant vitamin in the body. It protects cellular membranes, lipoproteins and other "oily" structures. Skin is high in unsaturated fatty acids ("oily" molecules especially susceptible to free radical damage), and can benefit from vitamin E protection (both oral and topical). RDA (recommended daily allowance) for vitamin E is 30 mg. Food sources of vitamin E include vegetable oil, nuts, wheat germ, whole grains, green leafy vegetables. The doses of vitamin E that showed health benefits in various clinical studies typically ranged from 400 to 1,000 IU a day. It is extremely difficult if not impossible to obtain such amounts from the diet. Recent studies indicate that typical supplements may be less than optimal since they contain only one form of vitamin E, alpha-tocopherol. For best results, a vitamin E supplement should contain mixed (alpha, beta, gamma and delta) tocopherols and tocotrienols. The source of vitamin E is also important. Natural vitamin E comprises only D forms of tocopherols and tocotrienols, while the synthetic one is an equal mixture of D and L forms. Isolating the D form from the mixture is expensive, so most manufacturers don’t bother. However, L form appears to be less effective in many ways than the natural D form, particularly when it comes to oral

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supplementation. Despite higher cost, it is best to use the natural form unless the manufacturer expressly states that the supplement contains D form only. It is not entirely clear what doses of mixed tocopherols and tocotrienols are optimal for health. Some experts recommend 100-400 IU/day of mixed tocopherols and 20-50 mg/day of mixed tocotrienols. Supplements are available where mixed tocopherols and tocotrienols are combined in the right proportions. Potential side effects of high doses: High doses may increase the action of anticoagulant drugs and interfere with the absorption of vitamin K, a vitamin important for blood clotting. Vitamin E supplements should not be taken before surgery. Flavonoids Flavonoids are a diverse group of plant pigments with antioxidant properties. These substances are responsible for color in many fruits, vegetables and flowers. In addition to providing color that attracts insects or animals, these pigments protect plants from environmental stress. In addition to being potent antioxidants, some flavonoids have antiallergic, anti-carcinogenic, anti-viral and anti-inflammatory activity. Over 4,000 flavonoids have been characterized and classified, but only a few have been researched. One can get the full spectrum of health benefits of the diverse class of natural compounds by consuming generous amounts of various fruits and vegetables. As far as skin benefits are concerned, two classes of flavonoids appear to be especially beneficial: proanthocyanins (found in grapes and pine bark) and polyphenols (found in green tea). Grape seed extract Grape seed extract is one of the best sources of proanthocyanins, potent water-soluble antioxidants that may help protect tissues, including the skin, from excessive free radical damage. For skin benefits, a dose of 100 mg per day is generally recommended. Green tea polyphenols Green tea is one of the most affordable and readily available sources of dietary antioxidants. It is rich in polyphenols, a type of flavonoids with very high antioxidant activity. High consumption of green tea may provide a wide array of health benefits, from reduced risk of some cancers, to protection of the liver from toxins, to prevention of heart disease, dental caries and gingivitis. Green tea polyphenols may also benefit the skin through both their antioxidant and antiinflammatory effect. We should emphasize the difference between green and black tea. Fresh tea leaves are naturally high in polyphenols, the compound responsible for most health benefits of tea or tea extracts. Green tea is prepared in such a way that polyphenols are preserved. In contrast, the technology of black tea production involves the oxidation of polyphenols. As a result, black tea has about six times less active polyphenols than green tea. Most evidence indicates that to obtain significant health benefits one should consume at least eight to ten cups of green tea a day. (It seems that people at increased risk for cancer, such as smokers, may benefit from amounts as little as 2-3 cups per day.) For some people a complete switch from coffee and soda to green tea may suffice to achieve the desired high green tea intake. Others may choose to take supplements of green tea extract, which are available in health food stores. Keep in mind that any tea, green or black, contains caffeine. The amount of caffeine in commercial green tea extracts is usually low. For skin benefits, a doses between 200 and 500 mg of green tea extract per day are generally recommended. Coenzyme Q10, Lipoic acid, Cysteine, Methionine

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Coenzyme Q10, lipoic acid, cysteine and methionine are potent antioxidants. But they also play other roles that are at least as important as their antioxidant activity. (See the section about conditionally essential nutrients for further details.)

General guidelines to improve your antioxidant intake • The safest and for many the most enjoyable way to obtain an array of antioxidants is to consume a diet

high in fruits and vegetables. This has a number of additional benefits as fruits and vegetables are rich in numerous other beneficial nutrients and phytochemicals. The diversity of antioxidants found in fruits and vegetables helps protect all tissues and cellular structures from various types of free radicals. Eating plenty of fruits and vegetables sounds like a boring, age-old advice. However, this advice is supported not only by grandma’s advice, but by scientific evidence as well. Many studies have consistently demonstrated that a diet high in fruits and vegetables reduces the risk of degenerative diseases, including cancer, heart disease, hypertension and diabetes. Current guidelines of National Cancer Institute and National Academy of Sciences suggest eating at least 2-4 servings of fruit and 3-5 servings of vegetables a day.

• Replace your coffee, black tea and sodas with green tea. Keep in mind that green tea also contains caffeine.

• If you choose to take antioxidant supplements, select one (or several) that is water-soluble, and another one (or several) that is fat-soluble. If you choose to take a single antioxidant, lipoic acid may be a good choice as it is both fat and water-soluble.

• Read as much quality information as you can on new research into antioxidants.

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Conditionally Essential Nutrients

Non-essential nutrients are the nutrients that can either be synthesized by the body or the ones the body can do without. Essential nutrients are the nutrients the body cannot produce but cannot do without. There is also another important but underappreciated class of nutrients called conditionally essential. Conditionally essential nutrients can be adequately synthesized by a healthy body working at optimal efficiency. However, under certain conditions (e. g. stress, disease, intoxication, advanced age, etc), the body may lose the ability to synthesize these nutrients in sufficient quantities and becomes dependent on obtaining them from food. It appears that insufficient synthesis and/or intake of some conditionally essential nutrients contributes to age-related decline in the function of many organs, including the skin. Supplementing conditionally essential nutrients may produce skin benefits in some people, particularly if their bodies do not produce enough of these nutrients due to stress, older age or health conditions. Lipoic acid Lipoic acid is a conditionally essential nutrient required by cells for generating energy from carbohydrates and some other fuels. It is also an effective antioxidant and heavy metal chelator. The body can synthesize lipoic acid in modest amounts but the production may fall short of requirements in many situations such as stress or illness. As with many key substances in the body, levels of lipoic acid decline with age. Lipoic acid is unique in its versatility among antioxidants. It is both water and fat soluble, capable of protecting all body tissues and compartments. It is effective against most types of free radicals, including superoxide anion, hydroxyl radical, singlet oxygen, and hydrogen peroxide. It also chelates (binds and neutralizes) the ions of metals that catalyze free radical formation (iron, copper, cadmium, lead and mercury). Yet another important effect of lipoic acid is it's ability to lower blood sugar. A unique combination of antioxidant, metal-chelating and glucose-lowering properties makes lipoic acid an inhibitor of glycation and cross-linking. (Glycation and cross-linking comprise one of the key mechanisms of aging, playing an important role in the formation of wrinkles). Indeed, preliminary research by a Yale dermatologist Dr. Nicholas Perricone indicates that creams with lipoic acid reduce fine lines and wrinkles. It is quite possible, although not proven, that dietary lipoic acid may also have some skin benefits. Unfortunately, the best dietary source of lipoic acid is red meat which is relatively high in saturated fat and cholesterol. Besides, it is virtually impossible to consume enough red meat to obtain enough lipoic acid to achieve noticeable skin benefits. Supplements may be a healthier way to increase one’s intake of lipic acid. In clinical studies where it was used to treat diabetic neuropathy, lipoic acid was given in doses up to 600 mg a day. For healthy people, the recommended dose range is 100-250 mg a day. Recent research indicates that one isomer (chemical form) of lipoic acid called R(+)-lipoic acid is more effective than others. All things being equal, pure R(+)-lipoic acid may deliver greater benefits than the mixture of different isomers. Unfortunately, as of the time of this writing, most lipoic acid products on the market contain the mixture of isomers. There are a few sources of pure R(+)-lipoic acid in capsules (e.g. http://www.r-lipoic.com ). Conezyme Q10 Conezyme Q10 (CoQ10) has two important roles: it is an essential part of the cellular respiration system located in the mitochondria, and it is an antioxidant. CoQ10 improves both the rate and efficiency of energy production in the cells, and at the same time protects mitochondria from free radicals. The body can produce CoQ10, but many factors, including age, illness, cholesterol-lowering drugs and malnutrition can impair that ability. CoQ10 is sometimes called a "biomarker of aging" because its level correlates so well with aging and degenerative diseases. In one study, CoQ10 supplementation increased life expectancy in mice by 50%. A large number of studies clearly demonstrated the efficiency of CoQ10 in congestive heart failure and other

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diseases of heart muscle. Other conditions that appear to be helped by CoQ10 include hypertension, decreased immunity, and muscular atrophy. Unfortunately, the studies of the benefits of CoQ10 specifically for the skin are lacking. It is likely, however, that the increased energy production facilitated by CoQ10 will benefit the skin as well. The doses of CoQ10 found effective in treatment of established heart disease range from 100 to 300 mg per day. In healthy people 30 - 100 mg a day is generally recommended. Cysteine and methionine Cysteine and methionine are sulfur-containing amino acids. In addition to being structural units of proteins, these amino acids act as antioxidants and facilitate the removal of heavy metals from the body. Cysteine is also a part of glutathione, which is the primary water soluble antioxidant inside cells. Methionine is an essential amino acid; it cannot be produced by the body and has to come from food. Cysteine can be synthesized in the body from methionine and is considered conditionally essential, meaning that it may become essential if the supply of methionine is limited. The content of methionine and cysteine in the body seems to decline with age. Supplementing diet with these amino acids increases life span in mice. Indirect evidence suggests that maintaining optimal levels of sulfur-containing amino acids in humans may provide some health and longevity benefits, including better skin health. Good sources of sulphur-containing amino acids include beans, fish, liver, eggs, brewers yeast and nuts. Cysteine and methionine are available over the counter in most health food stores.

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Vitamins and Minerals Vitamins and minerals are essential for proper function of every organ in the body - and the skin is no exception. Furthermore, deficiencies of some vitamins and minerals are particularly detrimental to the skin and may result in skin diseases and/or accelerated aging. While severe vitamin/mineral deficiencies are rare in the developed countries, mild deficiencies are surprisingly common. To maximize the effects of any skin rejuvenation program, one needs to consume adequate amounts of vitamins and minerals. This doesn't mean, however, that one needs to indiscriminately gobble up megadoses of vitamin/mineral supplements. In most cases, excessively high doses do not provide extra benefits. Furthermore, high doses of some vitamins and most minerals may be toxic. For those few vitamins when doses above RDA (recommended daily allowance) may provide extra benefits, one should not exceed safety limits. Below we focus on vitamins and minerals that are particularly important for skin health. B-complex The term B-complex usually refers to a group of vitamins that includes vitamin B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenate), B6 (pyridoxine), B12 (cyancobalamine) and folate. Vitamins B1 and B2 is critical for energy production in the cells. Overt deficiencies of vitamins B1 and B2 are known to cause special forms of dermatitis (along with many other problems). Mild deficiencies usually go unnoticed but still may produce some degree of skin damage. People who consume a diet based mainly on processed grains are particularly prone to developing such deficiencies. A few decades ago, the US government mandated that food manufacturers should add B1 and B2 to foods made of white flour. This markedly reduced the incidence of serious B1 and B2 deficiency in the US. Many other governments did the same. Still, mild deficiency (but enough to have some negative effects on the skin and some other organs) does occur, particularly in those who base their diets mainly on processes grains and potatoes. Balancing the diet or modest supplementation is helpful, while excessively high doses of B1 or B2 seem to provide little or no additional benefit. Individuals who do not consume a balances diet, may benefit from adding a supplement containing 1 – 2 times the RDA for B1 and B2. Most standard multivitamin supplements provide that (see label for RDA of ingredients). B12 (cyancobalamine) is essential for a variety of synthetic processes in the cells. The deficiency of this vitamin is particularly detrimental to neurons and rapidly dividing cells, including skin cells. Mild B12 deficiency often goes undiagnosed, producing no overt symptoms. Sometimes, depression may be the only symptom of B12 deficiency. B12 is unique among vitamins in that it is found almost exclusively in foods of animal origin such as meet, poultry, fish, eggs or dairy products. Contrary to some popular beliefs, no active form of B12 is found in algae such as spirulina or fermented soy products. Thus strict vegetarians are at risk of vitamin B12 deficiency. Healthy young and middle-aged people consuming a balanced non-vegetarian diet are usually not at risk for vitamin B12 deficiency. The absorption of vitamin B12 from food requires intrinsic factor, a protein produced by the stomach. Some older people do not produce enough intrinsic factor due to the atrophy of stomach glands. Certain autoimmune and digestive conditions, such as pernicious anemia, may also lead to poor absorption of B12. In people whose B12 deficiency is due to poor absorption, neither dietary changes nor oral supplements correct the problem. In such cases, B12 has to be administered as a nasal spray or injected. In contrast to many other vitamins, B12 doses higher than what's required to prevent deficiency may provide extra health benefits. If you are young or middle-aged, have no digestive or autoimmune conditions and consume foods of animal origin, you are not likely to be B12 deficient. Otherwise, you may benefit from an B12 supplement. For people with normal digestion and absorption, an oral supplement with 1xRDA (2 micrograms) of B12 should be adequate (most multivitamins contain at least that much of B12; look at the label). Otherwise, an intranasal spray or gel (available OTC) is a better alternative.

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Folate participates in many of the same biochemical cascades as B12. Just as B12, it is particularly important for rapidly dividing cells, including skin cells. Mild folate deficiency often goes unnoticed. Sometimes, depression may be the only symptom of folate deficiency. Vegetables are the most abundant sources of folate, particularly green leafy vegetables and beans. The only food from animal source rich in folate is liver. Folate can be destroyed during cooking and prolonged storage. The best way to obtain enough folate from the diet is to eat generous amounts of fresh or slightly cooked vegetables. Diet lacking vegetables and fruits puts you at risk for folate deficiency. Certain prescription and over-the-counter drugs interfere with absorption of folate and may cause deficiency. RDA for folate is 180 mcg (micrograms) a day for women and 200 mcg for men. Clinically proven deficiency is usually treated with 1,000 mcg of folate per day. To correct a possible deficiency, experts usually recommend taking 400 mcg of folate a day. Most multivitamins contain 400 mcg of folate or more (check the label). Vitamin A Vitamin A is critical for normal life cycle of skin cells. Vitamin A deficiency causes skin to become dry, fragile and prone to wrinkles. If a person is vitamin A deficient, no skin treatment will work properly. Severe vitamin A deficiency is rather common in the third world and causes a variety of serious health problems. In developed countries, milder forms of vitamin A deficiency predominate. The main sources of vitamin A are foods of animal origin, particularly eggs, organ meats and whole milk dairy products. Unfortunately, these foods tend to be high in saturated fat and cholesterol. Some plants, such as carrots or broccoli, supply carotenoids, which can be converted into vitamin A by the body. Diets lacking foods of animal origin and carotenoid-rich plants may lead to vitamin A deficiency. On the other hand, excessive vitamin A intake (from taking high dose supplements or eating large amounts of liver) may cause serious toxicity and should be avoided. People consuming poorly balanced diet, may benefit from vitamin A supplements. However, vitamin A is toxic in high doses and should be used with caution. Doses above 10,000 IU taken for more than 2 months are not recommended. Pregnant women and children are at a special risk of vitamin A toxicity and should not take supplements exceeding RDA without a doctor’s supervision. Vitamin C, iron and copper We mention vitamin C, iron and copper together because all three are important for the synthesis of collagen, a key structural protein in the skin. Deficiency of each of these nutrients reduces skin resilience and ability to heal (in addition to other health problems). Vitamin C is abundant in fresh fruits and vegetables. Iron is found in whole grains and meat products. Copper is found in a variety of foods and its deficiency is uncommon except in people taking zinc supplements. Iron deficiency is far more common in women than in men due to menstrual bleeding. An overt iron deficiency usually manifests itself as anemia (low red blood cell count and low blood hemoglobin). A subclinical deficiency is harder to detect. High blood levels of the protein called transferrin usually indicate depleted iron reserves. In such event, your doctor will recommend an iron supplement. Keep in mind that indiscriminate use of high dose iron supplements is dangerous and provides no health or skin benefits in a person with normal iron status. Copper supplementation is generally unnecessary in a balanced diet. If supplements are taken, the dose should not exceed the RDA (2 mg). High doses of copper are toxic. It has been argued in lay literature that large oral doses of vitamin C boost collagen production in the skin. So far, there is no evidence to confirm that. In fact, topical high strength vitamin C serums are likely to be far more effective. On the other hand, vitamin C deficiency definitely hurts collagen synthesis. For people lacking fresh fruit and vegetables in their diet, a supplement of 250 – 500 mg of vitamin C per day is a good way to ensure a good vitamin C status.

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Please note that most good multivitamins contain enough of vitamin C, copper and iron to prevent deficiency in healthy people (read the label!).

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Skin and Specific Foods Cold water fish Fish is an excellent “skin food” for a number of reasons. Most importantly, fish is a particularly rich source of omega-3 fat, a kind of fat with anti-inflammatory properties (see above). Inflammation is believed to be an important factor in skin aging in some people. Eating fish several times a week works towards keeping excessive inflammation in check. Keep in mind that cold water fish, such as salmon or trout, is particularly high in omega-3 fatty acids. Also, fish is a very good source of high quality, easily digestible protein. Adequate intake of protein is important for the normal production of collagen and elastin, the key structural components of the skin.

A note of caution: Due to the environmental impact of human industrial activity, certain kinds of fish may contain unacceptably high levels of mercury. Mercury is highly toxic; it promotes the formation of free radicals, inflammation and nerve damage. Consuming significant amounts of mercury-contaminated fish is potentially detrimental to both general and skin health. Generally, large oceanic fish tend to have higher levels of mercury due to their longer lifespan. Recent studies reported high levels of mercury in shark, swordfish, king mackerel and marlin. Lesser but still somewhat alarming levels were reported in some batches of tuna. On the other hand, fish such as salmon or small oceanic fish is far less likely to be significantly contaminated.

Olive oil It may sound a like cliché, but as far as health is concerned, olive oil is the best among common dietary fats. The main reason is that olive oil contains primarily monounsaturated fat. Monounsaturated fat gives you the best of both worlds. First, it doesn’t promote inflammation and elevate cholesterol levels like saturated fat does. Second, monounsaturated fat isn’t as easily oxidized as polyunsaturated fat, and so it doesn’t facilitate the production of destructive free radicals. The bottom line: when cooking, try to cook lightly and use olive oil in place of other cooking fat. Use olive oil to dress your salads (unless you are cutting calories). Replace, within reason, other fats with olive oil in your menu. Red meat Red meat is generally high in saturated fat. Saturated fat is well known for its ability to elevate cholesterol and triglyceride levels, which promotes cardiovascular disease. It is less known that saturated fat also tends to promote inflammation. Since inflammation seems to contribute to skin aging, consider limiting red meat consumption to no more than once a week. Keep in mind that if meat is your main source of protein, simply curtailing your meat intake may cause protein malnutrition, which is potentially detrimental to your body and your skin. Better alternatives for health and skin include fish, poultry, egg whites, tofu, and low fat dairy products. Eggs Healthwise, eggs have both pros and cons. Eggs whites are an excellent source of high quality protein. Egg yolks contain many vitamins and are rich in sulfur-containing amino acids, cysteine and methionine (see above). Unfortunately, egg yolks are also high in saturated fat and cholesterol. Experts generally recommend limiting the consumption of whole eggs to about 3 a week. One can add additional egg whites if extra protein intake is desired. Sugar, sweets, white bread, potatoes

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What do these foods have in common besides the fact that most people like them? All of them cause a rather sharp rise in blood sugar after a meal. High blood sugar has well known negative effects on the cardiovascular, immune and other key body system (as discussed earlier). It is bad for the skin as well. Excess sugar (glucose) in the bloodstream increases cross-linking of collagen and elastin in the skin leading to wrinkles and loss of skin tone. Limit you intake of sugar and sweets. Eat you sweets after a regular meal rather than as a “stand-alone” snack. Reduce your consumption of potatoes. Also, switch to whole-boiled red potatoes, which have smaller effect of the blood sugar. See Glycemic Index Table in Appendix A for more information about the effect of different foods on blood sugar.

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Sample daily menu

Breakfast A bowl of regular oatmeal Plain low fat yogurt Fresh fruit (e.g. an apple) Lunch Salad (mixed green veggies and tomatoes) dressed with olive oil Broiled salmon with ½ cup of steamed broccoli Dinner Broiled chicken ½ cup of cooked beans A slice of whole grain rye bread Squash, steamed or lightly broiled Snacks (optional) Nuts, e.g. almonds or walnuts (unsalted) Moderately sweet fruit, e.g. apple, apricot or peach. Plain low fat yogurt

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Appendix A

Glycemic index of some foods Gycemic index values are adjusted so that the index of white bread is 100. Glycemic index is defined as the blood glucose response to a food portion containing 50-g of available carbohydrates expressed as a percentage of the response to the same amount of carbohydrate from a standard form, in the case white bread. (From Wolever, T.M.S.:World Rev. Nutr. Diet., 62:120-185,1990.) Food Mean Food Mean Breads Rye (crispbread) Rye (wholemeal) Rye (whole grain, i.e. pumpernickel) Wheat (white) Wheat (wholemeal) Pasta Macaroni (white, boiled 5min) Spaghetti (brown,boiled15 min) Spaghetti (white, boiled 15 min) Star pasta (white, boiled 15 min) Cereal grains Barley (pearled) Buckwheat Bulgar Millet Rice (brown) Rice (instant, boiled 1 min) Rice (polished, boiled 5 min) Rice (polished, boiled 10-25 min) Rice (parboiled, boiled 5 min) Rice (parboiled, boiled 15 min) Rye kernels Sweet corn Wheat kernels Breakfast cereals “All bran” Cornflakes Muesli Porridge oats Puffed rice Puffed wheat Shredded wheat “Weetabix” Cookies Digestive Oatmeal “Rich tea”

95 89 68

100 100

64 61 67 54

36 78 65

103 81 65 58 81 54 68 47 80 63

74 121 96 89

132 110 97

109

82 78 80

Legumes Baked beans (canned) Bengal gram dal Butter beans Chick peas (dried) Chick peas (canned) Green peas (canned) Green peas (dried) Garden peas (frozen) Haricot beans (white, dried) Kidney beans (dried) Kidney beans (canned) Lentils (green, dried) Lentils (green, canned) Lentils (red, dried) Pinto beans (dried) Pinto beans (canned) Peanuts Soya beans (dried) Soya beans (canned) Fruit Apple Apple juice Banana Orange Orange juice Raisins Sugars Fructose Glucose Honey Lactose Maltose Sucrose Dairy products Custard Ice cream Skim milk Whole milk Yogurt

70 12 46 47 60 50 65 65 54 43 74 36 74 38 60 64 15 20 22

52 45 84 59 71 93

26 138 126 57 152 83

59 69 46 44 52

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Plain crackers (water biscuits) Shortbread cookies Root Vegetables Potato (instant) Potato (mashed) Potato (new/white boiled) Potato (Russet, baked) Potato (sweet) Yam

100 88

120 98 80

116 70 74

Snack foods Corn chips Potato chips

99 77