Feature Wrinkle

A Wrinkle
is Not Just a
Wrinkle
The skin as a mirror of nutritional
quality, stress burden and internal
health through the aging process.
By Alan C. Logan, ND, FRSH

F ine lines, wrinkles, sagging, roughness, dark under

eye circles and uneven tone (colouration) are often
accepted as inevitable parts of the aging process, and are
thought to be a matter of genetics and lifetime ultraviolet
(UV) exposure. Research is beginning to unravel this
rather simplistic view. It is becoming clear that facial
skin represents an excellent surrogate marker for internal
health and lifestyle wellness through the aging process.

continued on page 55 >

Alan Logan is a consultant with Genuine Health, Alan Logan, ND, FRSH
a natural health products company. Genuine Health
Department of Research and Development

317 Adelaide Street West Suite 501

Toronto, Ontario, Canada M5V 1P9

54 IHP February/January 2010


Skin and Internal Health
The first hint that facial wrinkles might be a surrogate
marker for internal health came from a study of smokers.
The study involving over 1,000 community residents
demonstrated that smoking might even exceed sun exposure
in enhancing the risk of wrinkles. Interestingly, among
the male smokers over 50 years, those with the worst
wrinkle scores were also those who had a higher risk of
chronic diseases (intensity of smoking was unrelated).
Males over 50 years with the same smoking habits and the
least wrinkles did not have the same high risk of chronic
disease. Specifically, the low-wrinkle smokers were twice
as likely not to have a history of heart attacks and strokes
(or both) versus the high-wrinkle smokers (Daniell 1971).
Visual cues may indeed be a reliable marker for internal
health among older adults. In a unique aging study
involving 1,086 men, researchers asked clinicians to
estimate the patients’ ages based on only visual cues,
without any knowledge of health records. The researchers
had a full complement of blood work, including objective
measures of lung, kidney, cardiovascular and neurological
health on file for each patient. During follow-up, subjects
who were estimated to be older than their true age were
more likely to die during the 19 years of data collection.
The estimated age of those who died during the study
was four years older (on average) than actual age, while
survivors were reported to be 0.59 years younger (on
average) versus chronological age (Borkan 1982).
More recent investigations have noted that facial
appearance may indicate health status in older adults.
Using digital facial photographs of 100 sets of older adult
twins, Danish researchers asked 20 nurses (25-46 years
of age) to estimate the age of each twin. The individual
twin rated to be older looking was much more likely to
die first (73% of cases) (Christensen 2004). Moreover, a
Korean study was carried out in 264 healthy adults, 30
years of age and older, to determine whether there was
a relation between facial wrinkles and decreased renal
function. As an index of renal function, the estimated
glomerular filtration rate (eGFR) was determined. The
researchers also evaluated the presence and severity of facial
wrinkles lateral to the canthus of the right eye (“crow’s
feet” area) and blood markers of lipid peroxidation.
After controlling for smoking and alcohol consumption,
the researchers reported that those with the most severe
facial wrinkling were more likely to have suboptimal
kidney filtration rates (i.e., <90ml/min per 1.73m2). In
addition, a higher level of plasma lipid peroxidation was
correlated with both suboptimal kidney filtration and
the presence of severe facial wrinkling (Park 2008).
Feature Wrinkle
Diet and the Skin
Many studies have sought to investigate the influence
of nutrition on the skin. A multinational study involving
453 older adults (average age: 76) from Australia
(N=225), Sweden (N=159) and Greece (N=69) addressed
whether food and nutrient intakes were correlated
with skin wrinkling in a sun-exposed site. Swedish
patients had the least skin wrinkling in a sun-exposed
site. Correlation analyses suggested that there might
be less actinic skin damage with a higher intake of
vegetables (r(s)=-0.31, P<0.0001), fish (r(s)=-0.24,
P<0.0001) and legumes (r(s)=-0.16, P<0.0001), and
lower intakes of butter (r(s)=0.46, P<0.0001) and
sugar products (r(s)=0.12, P<0.01). A high intake of
vegetables and legumes appeared to be protective
against cutaneous actinic damage; a high intake of
meat and dairy appeared to be adverse. The study
showed that skin wrinkling may be influenced
by the types of foods consumed (Purba 2001).
Another study of 4,025 women (age 40-74) showed
that higher overall fat intake and higher overall
carbohydrate intake significantly increased the risk
of a wrinkled appearance. The researchers also
reported that higher dietary vitamin C intakes were
associated with a reduced likelihood of a wrinkled
appearance (OR 0.89; 95% CI: 0.82, 0.96) and senile
dryness (OR: 0.93; 95% CI: 0.87, 0.99); similarly,
higher linoleic acid intakes were associated with a
reduced likelihood of senile dryness (OR: 0.75; 95%
CI: 0.64, 0.88) and skin atrophy (OR: 0.78; 95% CI
0.65, 0.95). An increase in fat (17g) and carbohydrate
(50g) intakes increased the likelihood of wrinkled skin
(OR: 1.28 and 1.36, respectively) and skin atrophy
(OR: 1.37 and 1.33, respectively). The associations
were independent of sun exposure (Cosgrove 2007).
German researchers reported that total dietary
antioxidant intake, lycopene in particular, was
associated with a decreased depth and density of
furrows and wrinkles in adult volunteers between
40 and 50 years (Darvin 2008a, Darvin 2008b).
Most recently, a study of 252 healthy Spanish women
(age 30-70) examined the impact of lifestyle factors
on perceived age. Digital facial photographs
were evaluated by 55 independent examiners
who estimated the age of the subjects. Subjects
estimated to be younger than actual chronological
age were more likely to adhere to healthy dietary
habits (the specifics of healthy diet were undisclosed
by the researchers), have better sleep quality and
unsurprisingly, avoid excessive sunlight (Mayes 2009).
February/March 2010 IHP 55
Feature Wrinkle
Nutritional Foods and Supplements
A number of nutrients and phytochemicals have been
the subject of research with endpoints related to skin
aging. Some of these nutrients are known to improve
other aspects of internal health. For example, research in
otherwise healthy middle-aged women has shown that
cocoa antioxidants can improve parameters of aging skin.
Cocoa and dark chocolate have been shown to improve risk
factors associated with cardiovascular disease and type II
diabetes (Balzer 2008). With regard to aging skin, the oral
administration of 329mg cocoa flavanols (versus 27mg cocoa
flavanols) significantly improved blood flow to the skin after
two hours (Neukam 2007). A longer-term study showed
that daily consumption of 329mg cocoa flavanols (versus
27mg flavanols daily) for three months reduced UV-induced
erythema, improved hydration and decreased roughness
and scaling of the skin in otherwise healthy middle-aged
women (Heinrich 2006). Separate research in humans
showed that 12-weeks consumption of dark chocolate
containing 600mg of cocoa flavanols doubled the amount of
UV radiation required to reach the minimal erythema dose
(MED; i.e., enough UV to produce sunburn appearance)
(Williams 2009). Since UV radiation is a primary factor
in the development of the visible signs of aging, cocoa’s
UV protective properties are of clinical relevance.
The internal UV-protecting properties of cocoa can
also be found with other nutritional supplements. For
example, fish oil rich in EPA has been shown to provide
internal protection against UV damage (Rhodes 2004,
Shahbakhti 2003), and improve skin elasticity in healthy
women (Segger 2008). The collateral health benefits of
56 IHP February/January 2010
omega-3 fatty acids are plenty, including decreased risk
of cardiovascular disease, arthritis, mood disorders and
other conditions encountered in aging (Riediger 2009).
Lycopene is yet another nutritional supplement with
internal UV-protecting properties. Consumption of oral
lycopene supplements (9.6mg daily) for 12 weeks decreased
UV-induced erythema by approximately 40% in healthy
adult volunteers (Stahl 2006). As previously mentioned,
cutaneous levels of lycopene are inversely associated with
the depth and severity of furrows and wrinkles in humans.
The oral consumption of polyphenol-rich red
wine has also been shown to provide internal UV
protection and significantly enhance the MED in adult
volunteers. Consumption of approximately 0.5L of
high polyphenol red wine provided UV protection
within 40 minutes of consumption (Moehrle 2009).
An additional consideration in nutritional supplementation
is the green food category. Based on findings that a diet
rich in fruits and vegetables (especially deep green leafy
vegetables) may be protective against the skin aging
process, and that a diet rich in meat, dairy and processed
grains is associated with a greater degree of skin aging, the
importance of acid-alkaline balance is worth mentioning.
Fruits and vegetables provide an abundance of alkaline
buffers, including bicarbonates, potassium and other
alkaline minerals (Logan 2009). Meat, dairy and processed
grains have an acidic influence in the human body, and
in the absence of alkaline fruits and vegetables, an acid-
heavy Western fast-food style diet (consumed for just nine
days) has been shown to significantly elevate the stress

hormone cortisol in humans (Maurer 2003). Elevations
in the stress hormone cortisol may slow production and
enhance breakdown of the primary dermal structure,
collagen. The top-heavy acid diet has also been connected
with osteoporosis due to enhanced loss of calcium and
magnesium from the bones. Even relatively small losses
of bone minerals and density in the facial bones can
significantly accelerate the visible signs of aging via
enhanced sagging and folding of the skin (Vleggaar
2008). Green food supplements, typically a mixture of
antioxidant-rich plant foods and botanical herbs, can
provide alkaline support (Berardi 2008). Green food
supplements, therefore, have the potential to maintain
bone integrity, provide internal antioxidants to the skin
and mitigate elevations in circulating cortisol levels.
Lastly, consideration of internal nutrient factors for the
maintenance of well-hydrated skin is important. The
stratum corneum within the epidermal barrier contains
important lipids known as ceramides. For years, synthetic
ceramides have been a staple in the topical cosmetics
References:
Asai S, Miyachi H. Evaluation of skin-moisturizing effects of oral or
percutaneous use of plant ceramides. Rinsho Byori 2007;55:209-15.
Balzer J, Rassaf T, Heiss C, Kleinbongard P, Lauer T, Merx M, Heussen N, Gross
HB, Keen CL, Schroeter H, Kelm M. Sustained benefits in vascular function
through flavanol-containing cocoa in medicated diabetic patients a double-
masked, randomized, controlled trial. J Am Coll Cardiol 2008;51:2141-9.
Berardi JM, Logan AC, Rao AV. Plant-based dietary supplement
increases urinary pH. J Int Soc Sports Nutr 2008;5:20.
Borkan GA, Bachman SS, Norris AH. Comparison of visually estimated age with
physiologically predicted age as indicators of rates of aging. Soc Sci Med 1982;16:197-204.
Christensen K, Iachina M, Rexbye H, Tomassini C, Frederiksen
H, McGue M, Vaupel JW. “Looking old for your age”:
genetics and mortality. Epidemiology 2004;15:251-2.
Cosgrove MC, Franco OH, Granger SP, Murray PG, Mayes AE.
Dietary nutrient intakes and skin-aging appearance among middle-
aged American women. Am J Clin Nutr 2007;86:1225-31.
Daniell HW. Smoker’s wrinkles. A study in the epidemiology
of “crow’s feet”. Ann Intern Med 1971;75:873-80.
Darvin M, Patzelt A, Gehse S, Schanzer S, Benderoth C, Sterry W, Lademann
J. Cutaneous concentration of lycopene correlates significantly with the
roughness of the skin. Eur J Pharm Biopharm 2008(a);69:943-7.
Darvin ME, Patzelt A, Knorr F, Blume-Peytavi U, Sterry W, Lademann
J. One-year study on the variation of carotenoid antioxidant
substances in living human skin: Influence of dietary supplementation
and stress factors. J Biomed Opt 2008(b);13:044028.
Heinrich U, Neukam K, Tronnier H, Sies H, Stahl W. Long-term ingestion of
high flavanol cocoa provides photoprotection against UV-induced erythema
and improves skin condition in women. J Nutr 2006;136:1565-9.
Logan AC. Acid-alkaline balance. Integrated Health Pract 2009;50-5.
Maurer M, Riesen W, Muser J, Hulter HN, Krapf R. Neutralization of
Western diet inhibits bone resorption independently of K intake and reduces
cortisol secretion in humans. Am J Physiol Renal Physiol 2003;284:F32-40.
Mayes A, Martin-Herranz A, Gunn D, Murray P. Impact of lifestyle on
preceived age in Spanish women. J Am Acad Dermatol 2009;60: AB 23, P801.
Feature Wrinkle
industry, yet recent research shows that orally consumed
ceramides, naturally derived from rice bran, konjac fiber
and wheat grain, can improve the epidermal barrier and
significantly enhance skin hydration (Asai 2007). Orally
consumed combination supplements containing fermented
dairy, green tea and borage oil have also been shown to
improve skin hydration from the inside out (Puch 2008).
Clinical Implications
In sum, the visible signs of aging can provide a mirror to
lifestyle habits – beyond the well-known factors of sun
exposure and smoking history. Dietary patterns shown to
protect against aging skin are the same dietary approaches
generally advocated for the reduction of chronic illnesses
such as cardiovascular disease, cancer and depression. For
patients concerned about the appearance of skin aging,
it may be worthwhile to discuss the connections between
diet and stress. Changing lifestyle habits to address aging
skin – improving dietary quality and managing stress via
mind-body medicine – provides a “backdoor” approach
to lower the risk of multiple chronic diseases of aging.
Moehrle M, Dietrich H, Patz CD, Häfner HM. Sun protection
by red wine? J Dtsch Dermatol Ges 2009;7:29-33.
Neukam K, Stahl W, Tronnier H, Sies H, Heinrich U.
Consumption of flavanol-rich cocoa acutely increases
microcirculation in human skin. Eur J Nutr 2007;46:53-6.
Park BH, Lee S, Park JW, Kim KA, Kim HU, Lee JH, Koh DH,
Youm JH, Yoo N, Park SK, Kwon KS. Facial wrinkles as a predictor
of decreased renal function. Nephrology 2008;13:522-7.
Puch F, Samson-Villeger S, Guyonnet D, Blachon JL, Rawlings AV, Lassel T.
Consumption of functional fermented milk containing borage oil, green tea
and vitamin E enhances skin barrier function. Exp Dermatol 2008;17:668-74.
Purba MB, Kouris-Blazos A, Wattanapenpaiboon N, Lukito W,
Rothenberg EM, Steen BC, Wahlqvist ML. Skin wrinkling: Can
food make a difference? J Am Coll Nutr 2001;20:71-80.
Rhodes LE, Shahbakhti H, Azurdia RM, Moison RM, Steenwinkel MJ,
Homburg MI, Dean MP, McArdle F, Beijersbergen van Henegouwen
GM, Epe B, Vink AA. Effect of eicosapentaenoic acid, an omega-3
polyunsaturated fatty acid, on UVR-related cancer risk in humans. An
assessment of early genotoxic markers. Carcinogenesis. 2003;24:919-25.
Riediger ND, Othman RA, Suh M, Moghadasian MH. A systemic review of the
roles of n-3 fatty acids in health and disease. J Am Diet Assoc 2009;109:668-79.
Segger D, Matthies A, Saldeen T. Supplementation with
Eskimo Skin Care improves skin elasticity in women. A
pilot study. J Dermatolog Treat 2008;19:279-83.
Shahbakhti H, Watson RE, Azurdia RM, Ferreira CZ, Garmyn M,
Rhodes LE. Influence of eicosapentaenoic acid, an omega-3 fatty acid,
on ultraviolet-B generation of prostaglandin-E2 and proinflammatory
cytokines interleukin-1 beta, tumor necrosis factor-alpha, interleukin-6 and
interleukin-8 in human skin in vivo. Photochem Photobiol 2004;80:231-5.
Stahl W, Heinrich U, Aust O, Tronnier H, Sies H. Lycopene-rich products
and dietary photoprotection. Photochem Photobiol Sci 2006;5:238-42.
Vleggaar D, Fitzgerald R. Dermatological implications of
skeletal aging: A focus on supraperiosteal volumization for
perioral rejuvenation. J Drugs Dermatol 2008;7:209-20.
Williams S, Tamburic S, Lally C. Eating chocolate can significantly
protect the skin from UV light. J Cosmet Dermatol 2009;8:169-73.
February/March 2010 IHP 57