Based on a presentation by Doris Day, MD
Watch the video of this Skincare Academy presentation featuring Dr. Day’ at https://jcad.tv/sca-doris-day-nutraceuticals-2023/
Dr. Day is with New York University Medical Center in New York, New York.
Many factors drive skin aging—sun exposure, stress, pollution, our diet, and genetics. Our overall inner health is reflected in our outer appearance, including the appearance of our skin. Oral supplements are gaining attention for their possible impacts on skin health. Chronic inflammation in connection to skin aging is a problem that has become a major focus of nutraceutical formulators. Inflammation leads to cascades of enzymes that cause the breakdown of collagen and subsequent accelerated aging of the skin. Nutraceuticals condense nourishing, bioactive elements of nature into drinks, pills, and powders. This has become a multibillion dollar industry and appeals to a broad spectrum of consumers. However, rampant adulteration and lack of clinical data for most supplements and nutraceuticals are problems that needs to be addressed. Many supplements on the market today can be ineffective or even dangerous for consumers.
To effectively evaluate a nutraceutical, you need to be able to collect information on the bioavailability, proper dosage, efficacy data, quality control methods, mechanism of action of the bioactive agents, possible interactions, and safety of the supplement and its components. There is a lot that we need to know and a lot that we are still learning.
One of my favorite supplements for skin health is vitamin B3—also known as niacinamide or nicotinamide. Niacinamide is found in meat, fish, eggs, and green vegetables. It helps support brain function and mitochondrial health. When applied topically, it helps to reduce redness and inflammation as well as boost collagen. Some data suggest that oral vitamin B3 can help protect against skin cancers. Though more research is needed in this area, I do recommend it to my patients with acne due to its anti-inflammatory effects.
Another well-established nutraceutical agent is polypodium leucotomos extract (PLE). You can find PLE in Heliocare® supplements (Ferndale Pharma Group, Inc.; Ferndale, Michigan) and the SunISDIN Daily Antioxidant Skin Supplement (ISDIN; Morristown, New Jersey). PLE has a few different modes of action. PLE is an antioxidant with immunoprotective, DNA repair, and anti-redness effects. The standard dosage is 240mg taken 30 minutes prior to sun exposure, but I recommend up to double that depending on the age of the person and their weight. I tell patients to take it at breakfast and lunch when they are spending time in the sun, or just at breakfast if they spend most of their time indoors. Importantly, I recommend PLE supplementation as an addition to, and not a replacement for, topical sunscreen. Small studies have been conducted and the results have demonstrated efficacy of PLE in reducing erythema induced by ultraviolet light (Middelkamp-Hup MA, Pathak MA, Parrado C, et al. Oral Polypodium leucotomos extract decreases ultraviolet-induced damage of human skin. J Am Acad Dermatol. 2004;51(6):910-918.). I am eager to see additional research on PLE with larger sample sizes and longer study periods.
Other nutraceutical agents that I really like are resveratrol and quercetin. Resveratrol is naturally found in the skin of raspberries, blueberries, and grapes. It can also be found in red wine, but you would have to drink such a large quantity of wine to achieve a significant dosage, the alcohol would do more damage than the benefits of resveratrol could mitigate. Resveratrol is antioxidant, anti-carcinogenic, neuroprotective, and reduces low-density lipoprotein cholesterol. Quercetin is a plant bioflavonoid and I learned about this from our colleague Dr. Haines Ely, one of the smartest people I have ever met. He discussed it as a treatment for psoriasis. He recommended patients with psoriasis supplement with quercetin and bile acids in a brilliant article titled, “Is Psoriasis a Bowel Disease?” which I recommend you look up (Ely PH. Is psoriasis a bowel disease? Successful treatment with bile acids and bioflavonoids suggests it is. Clin Dermatol. 2018;36(3):376-389.). In my clinical experience, I have seen patients with psoriasis take quercetin and bile acids and have their psoriasis completely disappear. These patients also abstained from alcohol during that time but were able to reintroduce it once their psoriasis was cleared. Regarding dosage, quercetin is a supplement that I recommend be pulsed, not taken continuously. I have my patients take it five days per week at 500 to 1,000mg daily.
An element of aging that we can possibly address is telomere shortening. I liken telomeres on the end of chromosomes to the plastic tips on the end of shoelaces. Telomeres prevent the ends of our chromosomes from degrading in the same way that the plastic on the end of shoelaces does. They are the chromosomal end caps that protect the genes and allow the cells to function and reproduce properly. They keep the chromosomes from degrading and allow cells to replicate appropriately, and they help prevent age-related decline. As we progress in chronological age and the cells in our bodies continue to divide repeatedly, these telomeres become increasingly shorter. When telomeres become too short, our cells cease to divide and become senescent, and thus biological aging occurs. Telomerase activator-65 (TA65), also known as cycloastrogenol, is a supplement that has been researched for its ability to lengthen telomeres. More research on this agent is warranted, but it is something that I personally take and carry in my office.
The two nutraceuticals that I think most dermatologists recommend for hair growth are Nutrafol (Nutraceutical Wellness, Inc.; New York, New York) and Viviscal (Church & Dwight Co., Inc.; Ewing Township, New Jersey). Viviscal contains AminoMar™, which the company describes as a marine collagen complex. Nutrafol is more of a cocktail of ingredients, including ashwagandha, curcumin, vitamin D, saw palmetto, and other ingredients that have been shown to improve hair growth.
Collagen supplements are a big trend right now. Collagen is one of the most abundant proteins in the human body, making up about 75 percent of skin’s dry weight. Collage is mainly formed by the amino acids glycine, proline, and hydroxyproline. Over 28 types of collagen exist, but collagen Types 1 and 3 are the most common in skin, bone, muscle, and blood vessels. Collagen plays a key role in wound healing, bone and blood vessel reparation, and scalp repair. Collagen loss in the body starts between 18 and 29 years of age, and after age 30, the human body can lose around one percent of its collagen per year, and this decline in collagen is associated with cutaneous aging. Furthermore, menopausal women lose about 30 percent of their collagen in the first five years after menopause. In these patients, I recommend hormone replacement therapy in addition to collagen supplementation. Collagen supplements are quite controversial; I’ve spoken with some colleagues that aren’t convinced of their efficacy, but I do think there’s a place for them. If anything, it’s a source of protein.
There are many collagen supplements available on the market. I like the marine sources of collagen best; these are usually derived from the scales of the fish. I think Skinade® 2kDal hydrolized marine collagen peptides (Bottled Science Inc.; Chantilly, Virginia) has some good studies behind it. I also recommend BioSil (Bio Minerals NV; Destelbergen, Belgium), and Nutrafol just came out with a collagen supplement that has additional ingredients like MSM, coQ10, and citrus flower acids.
In closing, when recommending a nutraceutical to your patients, consider what you’re trying to achieve and how these supplements can add to their treatment regimen. While many of these nutraceutical ingredients require stronger evidence before we can recommend them universally across the board, results from smaller studies support a possible benefits when taken in conjunction with a healthy diet, active lifestyle, and a regimen of more well-evidenced treatment modalities.