|Skin in Health and Disease|
Skin products often contain nutrients with claims of benefits. While the skin is the visible organ of the body that displays evidence of food-related problems, malnutrition and advertises the presence of many diseases, nutrients applied on the surface have little no value. Adding nutrients to shampoos is probably the most absurd marketing practice, since hair is a non-living product of skin that has no ability to utilize nutrients. Nutrients required by skin cells should be delivered orally. The addition of nutrients to skin creams and shampoos makes little biological sense except for the addition of vitamin C to sun protective skin creams and the treatment of some skin conditions with creams containing analogues of vitamins A and D that have drug-like activity.
The skin provides visible evidence of malnutrition and suffers many food related diseases. The "three D's" of vitamin B3 deficiency, pellagra, are diarrhea, dermatitis, and dementia. Scurvy is expressed as easy bruising. Scurvy is perhaps the first vitamin deficiency to be recognized. British sailors would die often of scurvy on long ocean voyages until limes were added to ships’ rations. Easy skin bruising and petechiae are the most obvious signs of scurvy. Even in affluent patients vitamin C deficiency may occur in a concealed form. It is common for patients to report easy bruising to MDs, but many blood abnormalities are considered before nutrient deficiency. In a review of easy bruisability, Valente and Abramson suggested: “Children who only eat a limited diet (such as macaroni and cheese, chicken fingers and candy) can develop nutritional deficiencies,[leading to a coagulopathy, vascular fragility and/or bruising. If the patient is a thin teenage girl, she may be avoiding certain food groups (such as meat or fat) because of an eating disorder that would predispose her to bruising or bleeding. Middle-aged persons may also cut out specific nutrients or food groups; fad diets such as Atkins have gained popularity over the last few years and more people are eliminating fruits and vegetables and adding meats and cheeses to their diets, again leading to nutritional deficiencies over an extended period of time. An elderly person living alone or in a nursing home can develop nutritional problems as well due to poorly fitting or absent dentures, lack of access to certain foods or simply a decreased appetite. Lastly, consider the oral habits that may contribute to bleeding. Is the patient a heavy drinker, smoker or illicit drug user? Does the patient's occupation expose him/her to oral or inhaled toxins?”
A deficiency of riboflavin is expressed as soreness of the tongue and lips, painful cracks at the corners of the mouth, a red swollen tongue, and teary or bloodshot eyes. Vitamin B6 deficiency causes skin lesions around the eyes, nose and mouth, cheilosis (fissuring and scaling at the angle of the mouth), glossitis (inflammation of the tongue), and stomatitis (inflammation of the oral mucosa). Symptoms of biotin deficiency include hair loss and a scaly red rash around the eyes, nose, mouth, and genital area.
Glycation End Products
The effects of sugar modified proteins are of great importance in aging of all tissues. The effect is visible as skin aging. Sugar modification of protein was identified as an important cause of multi-organ disease in diabetes. These advanced glycation end products (AGEs) are formed by the random attachment of glucose and fructose to proteins. Increased accumulation of AGEs in human tissue is associated with end stage renal disease, chronic obstructive pulmonary disease, and, recently, skin aging. Glycated hemoglobin (hemoglobin A1C) is now used to measure glycemic control in diabetes. Nguyen and Katta provided a comprehensive review of AGEs: “Characteristic findings of aging skin, including decreased resistance to mechanical stress, impaired wound healing, and distorted dermal vasculature, can be in part attributable to glycation. Glycation is increased by sugar in the diet and the formation of AGEs through cooking. Certain methods of food preparation (i.e., grilling, frying, and roasting) produce much higher levels of AGEs than water-based cooking methods such as boiling and steaming… AGEs accumulate in various tissues as a function, as well as a marker, of chronological age. Proteins with slow turnover rates, such as collagen, are especially susceptible to modification by glycation. Collagen in the skin, in fact, has a half-life of approximately 15 years and thus can undergo up to a 50% increase in glycation over an individual's lifetime. Other cutaneous extracellular matrix proteins are functionally affected by glycation, including elastin and fibronectin. This further compounds dermal dysfunction as glycation crosslinked collagen, elastin, and fibronectin cannot be repaired like their normal counterparts. general cellular function may be compromised in the presence of high concentrations of AGEs. In vitro, human dermal fibroblasts display higher rates of premature senescence and apoptosis, which likely explains the decreased collagen and extracellular matrix protein synthesis observed in both cell culture and aged skin biopsies. Similarly, keratinocytes exposed to AGEs express increased levels of pro-inflammatory mediators, suffer from decreased mobility, and also undergo premature senescence in the presence of AGEs… Of interest, several culinary herbs and spices are believed to be capable of inhibiting the endogenous production of AGEs (specifically fructose-induced glycation). These include cinnamon, cloves, oregano, and allspice. Other dietary compounds that have been linked to inhibition of AGE formation based on in vitro data and preliminary animal models include ginger, garlic, α-lipoic acid, carnitine, taurine, carnosine, flavonoids (e.g., green tea catechins), benfotiamine, α-tocopherol, niacinamide, pyridoxal, sodium selenite, selenium yeast, riboflavin, zinc, and manganese. The cosmeceutical industry has taken notice of this data, and several have recently released topical products containing carnosine and α-lipoic acid, with claims related to anti-AGE formation.”
Vitamin A and Analogues
Vitamin A is a set of biological activities produced by a family of molecules. Several substances contribute to the Vitamin A effect, including the fat soluble retinol group (pre-formed) and the water soluble carotene group (provitamin A). The fat-soluble group is strictly a product of animal metabolism, and must be obtained from animal-source foods. Fish-liver oils have been the standard Vitamin A supplements.
Retinol is the principal Vitamin A, and fills all the nutrient roles that Vitamin A plays metabolically. The activity of other members of the Vitamin A group is referred to retinol activity as an index of their biological potency (retinol equivalents). A cousin of retinol, retinal, is the substrate for the production of the visual pigment, rhodopsin. Deficiency of rhodopsin leads to night blindness, the best recognized symptom of vitamin A deficiency. Another cousin, retinoic acid, and its derivatives have become important drug-like Vitamin A used in the treatment of the skin conditions, cystic acne and psoriasis. Many Vitamin A effects are hormone-like, influencing the growth and differential of cells. Vitamin A may also be considered a biological response modifier. This effect is most noticeable in the skin where Vitamin A activity reduces the tendency of surface cells to pile up, producing thickened scaly skin. This "hyperkeritinizing" effect is characteristic of skin diseases such as psoriasis, acne, lichen planus, and dry-scaly skin (ichthyosis).
Naturally occurring, fat soluble Vitamin A (retinols) are toxic in overdose. The source is usually an animal product such as mammalian or fish liver or supplements such as cod liver oil. A single megadose of 1,500,000 IU produces brain swelling with headache, drowsiness, and vomiting. Sustained Vitamin A (retinol) doses over 50,000 IU may be toxic. In children, overdose results in loss of appetite, itching, irritability, swelling and tenderness of bones, and failure to gain weight. In adults other effects include sore mouth, brittle nails, increased blood calcium, liver enlargement, low-grade fever and headache. Clearly, Vitamin A intake should fit into an optimal range to achieve all its benefits, without its toxicity.
High doses of betacarotene from food sources have no known toxicity, although high dose supplements (10,000 IU or greater per day) of beta carotene are not required and are not supported by existing research. Beta carotene and related carotenoids are ingested in fruits and vegetables.
Over 1500 Synthetic Vitamin A analogues or retinoids have been developed. Isoretinoin (13-cis-retinoic acid) was marketed as "Accutane" for the treatment of severe acne ( discontinued in 2008). While this vitamin-drug is effective, it is so biologically potent that a pregnant woman taking Accutane is assured of a malformed fetus. A woman suffering severe acne can only take the drug if she takes adequate precautions to avoid pregnancy. Etretinate is similarly effective in the treatment of psoriasis and has benefits in the treatment of skin cancers. The toxicity of these compounds limits their use.
Tretinoin or Vitamin A acid has been marketed as a skin cream or gel for the treatment of acne. Observations suggest that Tretinoin reduces sun damage to skin, and reduces facial skin wrinkling. Topical application of Tretinoin in concentrations of 0.01 to 0.05% may produce redness and peeling of the skin; reduced concentration and frequency of application limit the side effects of this cream. Tretinoin may be the first effective anti-skin-aging substance.
Changes in the growth patterns of cells are characteristic of cancer, and Vitamin A activity seems to protect against cancer development. Each Vitamin A component may have different abilities as anti-cancer agents. The water-soluble plant pigment, beta-carotene is receiving the most intense study in this role. Many years ago W. Bollag in a review of Vitamin A activity stated: “The finding that retinoids may divert a cell from proliferation to differentiation may be a clue to a new approach for the prevention and treatment of cancer... Very many chemically or virally induced tumors are influenced by retinoids. It is possible to prevent or retard the development of tumors of various organ sites (e.g., skin, oral cavity, stomach, intestine, colon, pancreas, trachea, bronchus, urinary bladder, cervix, and breast) and induced by many different carcinogens. Some of the tumors even regress under treatment with retinoids."
Skin in Health and Disease
is a book about skin health, skin care that offers solutions to specific skin disorders through diet revision an improved nutrition. The good news for many suffers some chronic skin disorders is that complete diet revision will often improve and sometimes resolve skin symptoms. This book focuses on the most common skin disorders that can be controlled by changes in skin care, diet and the environment. Eczema, for example, is sometimes an expression of food allergy, or allergy to contact materials. Dermatologist may deny the food allergy causes, so that their patients often have to make independent decisions. In all aspects of medicine, we advocate responsible self-management and offer this book as primer and reference for self-managers with skin problems.
The book, Skin in Heath and Disease is intended to be used with the Alpha Nutrition Program. This text provides background knowledge, helpful in understanding skin disorders and the relevance of diet revision. Often a food holiday on Alpha ENF is the best way to begin recovery and the Alpha Nutrition program is an ideal way to design a safer, healthier long-term diet. If diet revision is appropriate to solve your Skin Disorders, you can order the the Starter Pack Option.
We recommend complete diet revision to people with
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