MORE THAN SKIN DEEP: THE IMPACT OF NUTRITION ON SKIN HEALTH

Diet and skin health have been linked since ancient times. For example, ancient texts of Ayurvedic medicine describe many herbs, minerals, and fats that could help maintain the health and beauty of skin. In the last few decades, a robust body of research has outlined this relationship more clearly. Population studies have examined the long-term effects of dietary patterns on skin health. For example,

in a cross-sectional study of nearly 3,000 elderly Dutch individuals, women with better adherence to healthy dietary guidelines had fewer wrinkles than those with a red meat and snack-dominant pattern of eating.1 Human intervention studies have also identified the effects of specific dietary patterns, foods, and nutrients on the skin. In one small study, volunteers ingesting tomato paste providing 16mg lycopene daily for 10 weeks showed better resistance to the effects of UV radiation, with less skin erythema after UV exposure.2 Researchers have identified multiple other compounds displaying similar photoprotective properties, including vitamins and phytonutrients such as polyphenols from green tea and cocoa.3 Animal and laboratory research has further increased the understanding of how these patterns, foods, and nutrients affect the skin on a biochemical and cellular level.

Studies have also looked at the effects of diet on specific skin diseases and processes. Multiple human studies, for example, have found that low glycemic load diets may improve acne.4 Research has also highlighted the potential benefits of prebiotics and probiotics for preventing or treating atopic dermatitis.5 Additionally, consuming a diet rich in antioxidants, but not anti-oxidant supplements, may reduce risk of developing skin cancer.6,7 Although research is ongoing, these results can guide clinicians as they counsel patients.8

The Biochemical Processes Linking Diet to Skin Health

The three main processes impacting skin health are oxidation, major and minor inflammation, and glycation.9

In much the same way as hail pounding on a roof can cause damage over time, the free radicals produced by oxidation can cause skin damage over time. When exposed to UV radiation, the body produces free radicals. These radicals can damage proteins, lipids, and DNA; ultimately resulting in collagen damage and increasing carcinogenesis risk.

In chronic inflammation, the cytokines and inflammatory mediators produced can cause skin damage. For example, the enzymes collagenase and elastase, produced during the inflammatory cascade, act to “snip away” at the collagen and elastic fibers that support the skin.

The final process is one that can be likened to termites eating away at the structural framework of a house. Glycation is a non-enzymatic process whereby proteins and sugars combine to form advanced glycation end products (AGEs). AGEs cause damage to the collagen framework of the skin, resulting in a loss of elasticity colloquially known as sugar sag.10

Translating the Science to the Dinner Plate

Dietary choices can combat forces that damage the skin. For patients, I recommend three core principles:

1. Focus on Nutrient-Dense Plant Foods.
   • Foods and beverages rich in antioxidants, such as fruits, vegetables, tea, and others, can help replenish the antioxidants in skin.
   • Herbs and spices exhibit powerful antioxidant, anti-inflammatory, and anti-glycation properties.11
   • Nutrient-rich carbohydrates and fats provide additional compounds to support skin health. Beans, for example, are a source of fiber, resistant starch, vitamins, minerals, and phytonutrients, while walnuts contain antioxidants, vitamins, minerals, and anti- inflammatory omega-3 fatty acids.
   • Prebiotics and probiotics support the gut microbiome. “Good” gut microbes transform fiber into short-chain fatty acids, which can help strengthen skin barrier function.12
2. Control Blood Sugar Levels. AGEs are produced in the setting of elevated blood sugar levels. Maintain steady blood sugar levels by focusing on glycemic control, so try to reduce added sugar intake and consume high-fiber foods and complex carbohydrates.13

    

3. Choose Foods that Support Collagen Framework. AGEs are produced by the body, but they are also present in certain foods. Research found some of the highest levels of AGEs in fried, grilled, and broiled meats. The highest levels of all are found in bacon.14

The link between nutrition and skin health is robust and complex and is the subject of ongoing research. This research can guide practitioners in counseling patients and clients about the importance of dietary choices in maintaining skin health.

REFERENCES

1. Mekić S, Jacobs LC, Hamer MA, et al. A healthy diet in women is associated with less facial wrinkles in a large Dutch population-based cohort. J Am Acad Dermatol. 2019;80(5):1358-1363.e2. doi:10.1016/j.jaad.2018.03.033
2. Stahl W, Heinrich U, Wiseman S, Eichler O, Sies H, Tronnier H. Dietary tomato paste protects against ultraviolet light-induced erythema in humans. J Nutr. 2001;131(5):1449-1451. doi:10.1093/jn/131.5.1449
3. Parrado C, Philips N, Gilaberte Y, Juarranz A, González S. Oral Photoprotection: Effective Agents

   and Potential Candidates. Front Med. 2018;5:188. doi:10.3389/fmed.2018.00188

4. Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007;57(2):247-256. doi:10.1016/j.jaad.2007.01.046
5. Chang YS, Trivedi MK, Jha A, Lin YF, Dimaano L, García-Romero MT. Synbiotics for Prevention and Treatment of Atopic Dermatitis: A Meta-analysis of Randomized Clinical Trials. JAMA Pediatr. 2016;170(3):236-242. doi:10.1001/jamapediatrics.2015.3943
6. Katta R, Brown DN. Diet and Skin Cancer: The Potential Role of Dietary Antioxidants in Nonmelanoma Skin Cancer Prevention. J Skin Cancer. 2015;2015. doi:10.1155/2015/893149
7. Hercberg S, Ezzedine K, Guinot C, et al. Antioxidant Supplementation Increases the Risk of Skin Cancers in Women but Not in Men. J Nutr. 2007;137(9):2098-2105. doi:10.1093/jn/137.9.2098
8. Katta R, Kramer MJ. Skin and Diet: An Update on the Role of Dietary Change as a Treatment

   Strategy for Skin Disease. Skin Ther Lett. 2018;23(1):1-5.

9. Katta R, Sanchez A, Tantry E. An Anti-Wrinkle Diet: Nutritional Strategies to Combat Oxidation,

   Inflammation and Glycation. Skin Ther Lett. 2020;25(2):3-7.

10. Nguyen H, Katta R SV 20. Sugar Sag: Glycation and the Role of Diet in Aging Skin. Skin Therapy Letter. Published December 1, 2015. Accessed July 23, 2019. https://www.skintherapyletter.com/aging-skin/glycation/
11. Dearlove RP, Greenspan P, Hartle DK, Swanson RB, Hargrove JL. Inhibition of protein glycation by

    extracts of culinary herbs and spices. J Med Food. 2008;11(2):275-281. doi:10.1089/jmf.2007.536

12. Parke MA, Perez-Sanchez A, Zamil DH, Katta R. Diet and Skin Barrier: The Role of Dietary Interventions on Skin Barrier Function. Dermatol Pract Concept. 2021;11(1):e2021132. doi:10.5826/dpc.1101a132
13. Kastorini CM, Panagiotakos DB. Dietary patterns and prevention of type 2 diabetes: from research to clinical practice; a systematic review. Curr Diabetes Rev. 2009;5(4):221-227.
14. Uribarri J, Woodruff S, Goodman S, et al. Advanced glycation end products in foods and a practical guide to their reduction in the diet. J Am Diet Assoc. 2010;110(6):911-916.e12. doi:10.1016/j.jada.2010.03.018