GDerm Summit – NYC

1. GDerm Summit – NYC • Nutrition Strategies to Improve Skin Integrity in the Older Patient Rick K Wilson MD The Cooper Clinic – Dallas Board Certified – Dermatology and Phlebology; Secondary Certification: Age Management Medicine/ HRT 4/11

2. The Convergence of Beauty and Healthcare …… while the diet/dermatology connection Is nothing new it is truly gaining powerful momentum Concept of active nutritional ingredients to promote skin health and beauty arose in the 1980’s Continuing influx of innovative formulations – antioxidants Nutraceuticals/ nutricosmetics – key to beautiful skin is a healthy body Thrust is “ beauty from within” by use of various foods and antiaging cocktails containing botanical extracts, vitamins, minerals, antioxidants…

3. Madhere S, et al. A Market Overview of Nutricosmetics. Cosm Derm. 2010; 23(6): 268-274 $1.5 billion market in 2008 Primarily in Europe and Japan “beauty foods” containing minerals, vitamins, botanical extracts, and Antioxidants Goal: combine aesthetic procedures, topical skin care & nutricosmetics Aesthetic Procedures Topical Skin Care Products Nutricosmetics

4. Madhere S, et al. A Market Overview of Nutricosmetics. Cosm Derm. 2010; 23(6): 268-274 $1.5 billion market in 2008 Primarily in Europe and Japan “beauty foods” containing minerals, vitamins, botanical extracts, and Antioxidants Goal:combine aesthetic procedures, topical skin care & nutricosmetics Aesthetic Procedures Topical Skin Care Products Nutricosmetics ..”the missing link to medical aesthetics procedures”

5. Aging Skin Effects of aging – observed in barrier function, mechanics, structure and appearance Exposure to endogenous and exogenous stressors increases with chronological age Theories of Aging – telomere, cross linkage(glycation), neuroendocrine decline, free radical/ oxidation Primary emphasis: antioxidant quenching of excess free radicals (ROS) to aid natural repair and defense mechanisms

6. Skin Aging and Oxidative Stress Aging = multifactorial degnerative process deriving from both intrinsic and extrinsic factors Oxidative stress: ~ strong scientific literature support ~ exact cause-and-effect linked not established ~ does not stand alone as the cause of organ dysfunction and aging Extrapolation: ~ antioxidant quenching of ROS (free radicals) restores balance favoring natural repair & defense mechanisms

7. Skin Aging Factors Extrinsic Factors: UV radiation smoking failure to maintain hormone balance environmental pollutants exercise, digestion poor nutrition e.g., consumption of saturated/trans fats >>> lipid peroxide free radicals which attack intima of coronary arteries

8. Skin Aging Factors Extrinsic Factors: UV radiation smoking failure to maintain hormone balance environmental pollutants exercise, digestion poor nutrition e.g., consumption of saturated/trans fats >>> lipid peroxide free radicals which attack intima of coronary arteries < lipid peroxides and other endogenously derived free radicals also work at the skin level as well e.g., UVR-induced ROS lead to oxidative damage observed as wrinkling, laxity, mottled pigmentation, malignancy

9. Skin Aging and Oxidative Stress What we do know: antioxidants function to neutralize the deleterious effect of free radicals; mitochondrial level Best Strategy: combine ingestion of oral antioxidants with topical placement of antioxidants and other products to maintain functional integrity of the skin

10. Nutritional Approach to Healthy Skin Standard American Diet ( “SAD”) – highly processed foods, excess additives, HF corn syrup, excess animal protein and calorie dense NOT nutrient dense convenience foods

11. Nutritional Approach to Healthy Skin Standard American Diet ( “SAD”) – highly processed foods, excess additives, HF corn syrup, excess animal protein and calorie dense NOT nutrient dense convenience foods; ***largely devoid of whole food fruits and vegetables AVOID: * high glycemic (simple refined sugar, HFCS) foods which lead to glycation inactivation/breakdown of key proteins - wrinkling * saturated/trans fats - go for monounsaturated fats to improve skin hydration and elasticity

12. Nutritional Approach to Healthy Skin Consume instead: * whole food fruits and vegetables, nuts,& legumes --- no additives and freshly picked before consumption * Omega-3’s: best sources – walnuts, Wild Atlantic salmon; important to correct unfavorable O-6/ O-3 ratio which is proinflammatory; American ratio > 6-10/1

13. Nutritional Approach to Healthy Skin Consume instead: * Vitamin D – a critical prohormone; most Americans low; supplementing with Vitamin D3 is best bet * Probiotics– yogurt with live active cultures; optimal digestive health immune boosting & suppressive of allergic & inflammatory skin conditions –eczema and psoriasis

14. Antioxidants in Food • Partial listing • Vitamin A * Zinc • Vitamin C * Selenium • Vitamin E * Catechins • Beta carotene * Anthocyanins • Lutein * Ellagic acid • Lycopene * Resveratrol • ***Likely we will discover other antioxidants in foods

15. Antioxidant examples: Vitamins – C, E, B12, & carotenoids Trace elements – copper, zinc, selenium Amino acid complexes – glutathione Flavenoids Antioxidant functions: • prevent cancer cell formation • prevent cardiovascular disease • boost immunity to viruses and bacteria • assist in DNA repair • suppress degenerative changes

16. Great Nutrient Choices for Skin and Hair “Pigment Power” – rainbow of colors Journal of Agricultural and Food Chemistry, June 2004; major review-F&V antioxidants …purple, blue, red, orange spectrum were highest antioxidant fruits …. some key veggies: grape tomatoes, kale, broccoli, spinach, dark beans, carrots, artichoke

18. Great Nutrient Choices for Skin and Hair “Pigment Power” – rainbow of colors Journal of Agricultural and Food Chemistry, June 2004; major review-F&V antioxidants …purple, blue, red, orange spectrum were highest antioxidant fruits …. some key veggies: grape tomatoes, kale, broccoli, spinach, dark beans, carrots Biggest Antioxidant Winner-Blueberries

19. The Slow Food Movement Healthy Nutrition Trend • Movement away from excessive dependence on processed foods • More whole foods, more organic foods, more plant based foods and whole grains, locally grown for nutrient density • According to the Natural Resource Defense Council, most produce travels >1000 miles before being sold; significant loss of nutrient density due to failure of vine ripening and transit reduction of vital nutrients. Web sites: slowfoodusa.org eatingwell.com

20. Vitamin D as Hormone and Benefactor ** major player in cell physiology with receptors in all somatic cells Broad spectrum beneficial effects: * Ca and phos metab for bone health * immune modulation * renal and caridovascular disease * cancer suppression ( ovarian, breast, colon, prostate, skin ) * diabetes * psoriasis * “SAD” – seasonal affective disorder Listing of research literature @ vitamindcouncil.org

21. Vit A Vit C Vit E Biotin Zinc Selenium Copper Manganese Lycopene Lutein Zeaxanthin L-cysteine Polypodium leucotomos Inositol L-methionine Horsetail Nutraceutical example

22. Conclusion

23. Nutritional Approach to Healthy Skin Consume instead: * whole food fruits and vegetables, nuts,& legumes --- no additives and freshly picked before consumption * Omega-3’s: best sources – walnuts, Wild Atlantic salmon; important to correct unfavorable O-3/ O-6 ratio which is proinflammatory; American ratio > 6-10/ 1 * Vitamin D – a critical prohormone; most Americans low; supplementing with Vitamin D3 is best bet * Probiotics– yogurt with live active cultures; optimal digestive health immune boosting & suppressive of allergic & inflammatory skin conditions –eczema and psoriasis

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