In recent years, oral skin supplements have become increasingly popular in the world of skincare. These supplements are intended to provide the body with nutrients that may help improve the health and appearance of the skin from the inside out. Some key ingredients in these supplements include vitamin C, antioxidants, collagen, hyaluronic acid, omega 3 and probiotics. In this article, we will explore the benefits of these ingredients and their potential impact on the skin's health and appearance. The impact of topical ingredients on skin health is available here in this blog.
During the course of a normal lifetime, the skin is exposed to a number of challenges that can
affect structure, function and appearance, including:
Deterioration due to normal aging contributes to loss of elasticity and wrinkle formation.
Exposure to the elements leads to discolouration, dryness and accelerated wrinkling.
Chemical insults including exposure to oxidising beauty and cleansing products (hair dyes, soaps,
detergents, bleaches).
Direct injury, as in wounding and burning.
Skin aging can be classified into two distinct processes: intrinsic aging, which occurs naturally over time, and environmental aging. Lifestyle choices like smoking and exposure to environmental pollutants can accelerate environmental aging, leading to noticeable impacts on skin function and appearance. Additionally, prolonged exposure to UV radiation from sunlight is a major environmental factor that can cause premature skin damage. Environmental aging changes are typically layered on top of natural aging changes, making it challenging to differentiate between the two.
Without the influence of environmental aging, intrinsic aging is a gradual process that typically becomes noticeable only later in life. Advanced age is often associated with wrinkles, pale skin tone, reduced elasticity, and occasional exaggerated expression lines. The dermal layer of the skin thins, with fewer fibroblasts and mast cells, less collagen production, and reduced vascularization. Specifically, the extracellular matrix components, particularly elastin and collagen, undergo gradual degradation during intrinsic aging. This loss of elastin results in the reduced elasticity and capacity for recoil.
According to a sizeable observational study, perimenopausal and menopausal women frequently experience eczematous outbreaks, such as allergic contact dermatitis and eczema, more than any other skin conditions.
In older adults, dry skin is common, primarily due to a loss of glycosaminoglycans, which reduces the skin's ability to maintain moisture levels. The dermal-epidermal junction may also flatten, resulting in decreased surface area, increased skin fragility, and reduced nutrient transfer between the layers. Generally, the dermis undergoes greater age-related changes than the epidermis. However, the aged epidermis may have reduced barrier function and repair capabilities following injury. Additionally, aged skin may exhibit impaired antioxidant capacity, immune function, and melanin production. Intrinsic aging is largely unavoidable and may be influenced by genetic background and other factors. However, some mitigation of these effects may be possible by:
Limiting exposure to environmental risk factors such as smoking, poor nutrition, and chronic sunlight exposure.
Topical or systemic treatments that help regenerate the elastic fiber system and collagen may also potentially reverse skin damage.
The role of Vitamin C in the prevention of skin aging
The most compelling evidence supporting the role of vitamin C in protecting skin function comes from observations that deficiency leads to visible skin problems, such as skin fragility, corkscrew hairs, and poor wound healing, which are early signs of scurvy. Given that vitamin C deficiency impairs function, increasing intake is presumed to be beneficial. However, no studies have measured vitamin C levels or intake and associated aging changes. Vitamin C is rarely measured in the skin, and this information is necessary before we can improve our understanding of the level of intake that might be beneficial for skin health and protection against aging-related changes.
While no specific information is available on the relationship between vitamin C and skin aging, numerous studies have investigated the role of nutrition in general. A recent systematic review of studies focused on nutrition and appearance identified 27 studies that involved either dietary interventions or reported dietary intakes. The analysis suggested that, in the most reliable studies, intervention with a nutrient supplement (15 studies) or general foods (one study) was associated with improved measures of skin elasticity, facial wrinkling, roughness, and colour. Many of the nutrient interventions associated with benefits included a high intake of fruits and vegetables, which are significant dietary sources of vitamin C. This would indicate that the skin improvement was not through vitamin C supplementation alone.
The effects of UV exposure on the skin share similarities with the slower process of natural aging, but with a more acute onset. It has been established that vitamin C can limit the damage caused by UV exposure. This type of injury occurs due to a radical-generating process, and protection primarily stems from the antioxidant activity of vitamin C. Studies have shown that vitamin C, both topically and through dietary intake, can demonstrate this protective effect in vitro and in vivo. UV light depletes vitamin C content in the epidermis, indicating that it is targeted by the oxidants induced by UV exposure. Vitamin C can prevent lipid peroxidation in cultured keratinocytes following UV exposure and also protect keratinocytes from apoptosis while increasing cell survival. Sunburn, measured as the minimal erythemal dose (MED) in response to acute UV exposure, can be mitigated with vitamin C supplementation. However, vitamin C alone is minimally effective, and most studies showing a benefit involve multi-component interventions. Vitamin C and vitamin E have a synergistic effect, with the combination being particularly effective. These findings suggest that complete oxidant scavenging and recycling are necessary for effective protection against UV irradiation.
Among the various effects of vitamin C on skin health, its positive impact on wound healing is the most significant and consistent. This is directly related to its co-factor activity in collagen synthesis, and impaired wound healing is an early indicator of vitamin C deficiency. Vitamin C turnover at the wound site, due to local inflammation and increased collagen production demands, makes supplementation useful, with both topical application and increased nutrient intake showing benefits. In children with extensive burns, supplementation with both vitamin C and vitamin E improved the rate of wound healing. Studies have found that plasma vitamin C levels were positively associated with the rate of wound healing in non-smokers, abstaining smokers, and smokers. However, the extent of the benefits of supplemented vitamin C intake appears to depend on the individual's baseline nutritional status, with less apparent benefits if nutritional intake is already adequate.
Bell peppers, dark green leafy vegetables, broccoli, Brussels sprouts, citrus fruits, kiwi, guava, strawberries, and certain herbs are all excellent sources of vitamin C. When considering supplementation, it is important to tailor the dose based on individual risk factors for kidney stones, iron overload, gout, renal disease, and G6PD deficiency. To minimize the risk of side effects such as diarrhea and abdominal cramps, doses should be divided throughout the day or buffered forms of vitamin C can be used.
Collagen Supplements
Collagen is a critical building block in the extracellular matrix of various body parts, including the skin, hair, nails, joints, bones, tendons, and cartilage. Due to its importance in hair, skin, and nail structure, there is a growing interest in the potential dermatologic benefits of collagen supplementation. In recent years, the popularity of oral collagen peptide supplements has skyrocketed, largely due to the influence of social media and targeted marketing. There are over 8.5 million posts on Instagram alone with the hashtag "collagen," and countless videos and articles across the internet and social media platforms. Consumers frequently turn to the internet for information about collagen, with Google searches for oral collagen supplements rapidly increasing since 2015. Major retailers now offer a range of oral collagen supplements marketed for health and beauty. In a culture that places a strong emphasis on preventing or reversing visible signs of aging, collagen companies' promises of reducing wrinkles, improving skin hydration, and creating a more youthful appearance have captured the attention of many consumers. Many speakers and bloggers have claimed that collagen offers benefits beyond dermatologic effects. These claims include improvements in a range of physiological processes such as sleep and mood, gut health, joint and arthritis pain, metabolism, cardiovascular health, Alzheimer's protection, liver health, and reducing acid reflux.
A systematic review and meta-analysis of 19 studies involving a total of 1,125 participants aged between 20 and 70 years showed that supplementation with hydrolyzed collagen or collagen hydrolysate (CH) significantly improved skin hydration, elasticity, and reduced wrinkles compared to placebo. The study found that a 90-day period of collagen ingestion was sufficient to achieve these results. It is worth noting that the concentration and composition of bioactive collagen peptides should be taken into consideration when reviewing the literature.
Collagen hydrolysates consist of peptides of different lengths that are then broken down into biologically active dipeptides and tripeptides that are resistant to hydrolysis. Another systematic review of 11 randomized controlled trials evaluating the efficacy of collagen supplements in enhancing skin quality found evidence supporting the use of oral collagen supplements in wound healing and skin aging in both the short-term and long-term. However, it is worth mentioning that the studies reviewed were generally small, with participant numbers ranging from 8 to 120.
As far as we are aware, there is currently no published clinical trial investigating the impact of collagen supplementation on hair health. There is only one clinical trial published in the literature that has examined the role of collagen in nail health. However, the assessment relied on subjective reporting.
Collagen supplementation is generally considered safe and well-tolerated, with no adverse effects reported in any of the randomized controlled trials. However, individuals with allergies to animal sources should avoid collagen supplementation. It is worth noting that like all nutritional supplements, collagen supplements are regulated by the U.S. FDA as a food, which means that there is limited oversight regarding marketing claims, warning labels, safety, quality, dosing regimens and additives.
Hyaluronic Acid
Hyaluronic acid (HA) is a crucial component of the skin's extracellular matrix and plays a significant role in dermal metabolism. Because of its hydrophilic nature, it is known as nature's moisturizer. However, as individuals age, the HA content in the epidermis decreases, with levels dropping from 0.03% in women aged 19 to 47 years to 0.015% in women aged 60 years, and halving again to 0.007% in women aged 70 years. Additionally, while HA is still present in the dermis of aged skin, it disappears entirely from the epidermis. Moreover, the HA polymers in senescent skin are less capable of taking on the water of hydration, resulting in a loss of skin moisture.
A double-blind, randomized, placebo-controlled trial of daily HA intake for 12 weeks among 40 healthy Asian men and women aged 35-64 years showed significant improvement in wrinkles, water content and elasticity through image analysis. These findings suggest that oral ingestion of HA may reduce wrinkles and improve skin condition. There were no significant adverse reactions and HA appears to be consistently well absorbed amongst participants.
Antioxidants
The primary defence of our skin against UV radiation (UVR) is its natural protection through melanin and enzymatic antioxidants, along with the antioxidants we consume through our diet, such as vitamin A, C, and E. Dietary antioxidants play a crucial role in maintaining the oxidative balance and overall skin health. Various micronutrients, including carotenoids, polyphenols, and selenium, have been studied for their antioxidant properties in the human diet. Exposure to UVR can lead to a depletion of skin antioxidants.
Polyphenols are a group of naturally occurring compounds found in plant-based foods such as fruits, vegetables, herbs, spices, tea, dark chocolate, and wine.
There are four categories of polyphenols:
1. Flavonoids make up approximately 60% of all polyphenols and include compounds such as quercetin, kaempferol, catechins, and anthocyanins. They are commonly found in foods such as apples, onions, dark chocolate, and red cabbage.
2. Phenolic acids account for around 30% of all polyphenols and include stilbenes and lignans. These are mostly present in fruits, vegetables, whole grains, and seeds.
3. Polyphenolic amides include capsaicinoids in chili peppers and avenanthramides in oats.
4. Other polyphenols comprise resveratrol in red wine, ellagic acid in berries, curcumin in turmeric, and lignans in flax seeds, sesame seeds, and whole grains.
Early research to look at whether a mixture of antioxidants supplement of vitamin C, E, beta-carotene, selenium and zinc would reduce skin cancer risk showed mixed results. The incidence of melanoma was higher in women taking antioxidants but neutral in men. This may be because melanoma develops differently from other types of skin cancers and antioxidants have a dichotomous impact on melanoma cancers. There is also a sex difference in antioxidant levels due to dietary habits and a larger reservoir of beta-carotene in women.
More recent reviews focus on the ability of antioxidants to reduce UV damage, pigmentation and wrinkles. Rosmarinic acid is a plant-derived antioxidant with human trials showing a specific dose for 8 weeks protected the skin from UVB and improved skin elasticity but not wrinkle depth.
Polypodium leucotomas is derived from a tropical fern. Trials with the oral supplement in a small number of participants showed a reduction in redness after UVR.
Another plant antoxidant, pycnogenol is derived from pine bark. In women with melasma, a chronic pigmentary disorder, 30 day intake of pycnogenol reduced pigmentary intensity. In another study, pycnogenol had positive effects on blood cholesterol and cognitive health such as working memory.
Carotenoids are pigments found in plants, fungi, algae, and certain bacteria. In plants, they serve important functions such as antioxidation, light absorption, providing color, and photoprotection. Since carotenoids are powerful antioxidants and are not synthesized by the human body, their supplementation becomes necessary when the intake of carotenoids in the diet is inadequate.
Astaxanthin is a red pigment that is produced by plants, microorganisms, and algae. It possesses higher antioxidant properties than beta-carotene, zeaxanthin, and lutein. Studies have shown that supplementing with astaxanthin can lead to an improvement in skin surface lipids in humans.
Lutein and zeaxanthin are carotenoids, which are lipophilic molecules that tend to accumulate in the luteal macula of the eye. Unlike other carotenoids such as beta-carotene and lycopene, which accumulate in the skin, lutein and zeaxanthin have a specific affinity for the macular region of the eye. Supplementation with lutein and zeaxanthin has been shown to improve skin luminescence and lighten the skin in a small group of 50 volunteers after 12 weeks.
Punica granatum L. extract contains various constituents like anthocyanins, polyphenols, and tannins, which are known to have several health benefits. This plant is typically found in tropical and subtropical regions and is commonly used to treat hypertension and atherosclerosis. Although a 12-week trial with female volunteers revealed protection against UVB, there was no significant improvement observed in skin hydration or pigmentation.
Orthosilic acid (monomeric) is utilized to replace silicon in the human body due to its high oral bioavailability. Silicon is present in small amounts in the human body and its levels tend to decrease with age. Supplementation with orthosilic acid has been linked to improved synthesis of collagen and elastin in the body. In a study involving 22 male and female volunteers between the ages of 20-60, a combination of orthosilic acid with hydrolyzed collagen or a placebo was administered. After 90 days, the treatment group showed increased skin elasticity and hydration, as well as reduced wrinkles. However, it is challenging to determine if this effect was solely due to orthosilic acid.
Note:
Despite some promising results using antioxidants for UV protection, dermatologists and medical experts still advise using sunscreen as the gold-standard for prevention. You can read more about how to do this here.
Omega 3 (O3FA)
Fish oil has been widely studied as a potential supplement for improving certain skin disorders, including photoaging, skin cancer, allergy, dermatitis, cutaneous wounds, and melanogenesis. There has been growing interest in the relationship between fish oil and skin protection and homeostasis, particularly with regard to the omega-3 polyunsaturated fatty acids (PUFAs), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Other PUFAs, such as α-linolenic acid (ALA) and linoleic acid (LA), also have a beneficial effect on the skin. PUFAs attenuate cutaneous inflammation and act as regulators that affect the synthesis and activity of cytokines to promote wound healing.
According to the National Institute of Health, a daily intake of 1100 to 1600 mg of ALA is recommended to facilitate the body's conversion of EPA and DHA. However, statistics from Statistics Canada indicate that only 3% of Canadians have a sufficient serum level of O3FA to meet these standards. Therefore, the most practical approach to increasing levels of these active metabolites for their reported health benefits is to significantly increase fish consumption or modify one's diet through O3FA supplementation.
Research investigating the risk of skin cancer has shown that individuals with a higher dietary intake of omega-3 fatty acids (at least 450mg per day) had a 30% lower risk of developing skin cancer compared to those with a lower intake.
Several high-quality studies have identified a statistically significant improvement in outcomes associated with a number of dermatologic uses, providing compelling evidence for the role of O3FA in skin health. Additionally, similar reviews have reported that O3FA has a high safety profile in a variety of diseases such as skin ulcers, psoriasis, atopic dermatitis and photosensitivity.
One of the most commonly expressed concerns regarding the administration of omega-3 PUFA is the potential for an increased risk of bleeding due to its anti-platelet effect. Some cases have also reported gastrointestinal disturbance caused by dietary fish oil. Therefore, it is important to exercise caution when optimizing the benefits of fish oil or omega-3 fatty acids to ensure a balance between their effectiveness and any potential harm or toxicity.
However, no study exists recommending the optimal therapeutic dosing of O3FA supplementation for improved skin health and supplementation should be individualised. The omega-3 index is an in-office blood test that is used to determine EPA and DHA levels in the blood and can be utilised to determine an individual's dietary and/ or supplementation needs.
You can contact us for more information on this test.
Probiotics
Oral or topical probiotics are crucial in the management of common cutaneous disorders such as atopic dermatitis, acne, rosacea, and psoriasis by modulating the skin microbiome and gut-skin microbial interactions.
The body of evidence supporting the relationship between the intestinal microbiome and skin health is growing. Researchers have begun exploring these interactions, specifically focusing on conditions related to atopy. Several studies have emerged on the therapeutic use of probiotics for eczema and reactive skin. Further studies are investigating the anti-inflammatory, anti-infectious, photoprotective, and reparative effects of different probiotic strains on skin health, and are delving deeper into the underlying theories and mechanisms of action. The fundamental premise is that probiotic supplementation alters the intestinal microbiome, leading to improved skin permeability and barrier function, and modulating the immune response, thus describing the gut-skin axis.
Similar to the gut microbiome, the skin microbiome has a crucial function in shielding us from external pathogens, regulating immune responses, and catabolite repression. The skin microbiome is not a fixed and constant entity but is continually impacted by factors such as aging or changes in physiological structure.
The strains Lactobacillus rhamnosus and Bifidobacterium animalis subsp lactis HNO19 have been found to reduce the likelihood of eczema development in children. It's worth noting that the efficacy and safety of oral probiotics in humans are dependent on the species and strain involved. Therefore, it's advisable to consult with your healthcare provider regarding your specific skin or health concerns to identify the most appropriate probiotic strain for your individual needs. In addition, to attain the anticipated health advantages, it is essential to ingest an adequate quantity of probiotics. The immune system can only be stimulated when the concentration of probiotic cells in the solution reaches over 10^6 cfu/mL. During the production process of probiotic items, the number of bacterial cells is continuously monitored, and this data is used to formulate multi-strain products. Hence, precise counting is crucial for assessing the therapeutic effects of probiotics and ensuring the quality of the products.
The 16S rRNA gut microbiome test is an in-office or home stool test that can be utilized to analyze the abundance and diversity of bacterial species present in the gut. Individuals with poor health tend to exhibit reduced bacterial distribution and diversity within their intestines, which is referred to as intestinal dysbiosis. Such a condition can heighten the likelihood of developing various associated illnesses, such as obesity, skin allergies, and diarrhea. Upon detecting an instance of dysbiosis, customized probiotic strains can be recommended for a particular condition. These will need to be taken in conjunction with lifestyle modifications for a specified duration. While the distribution of the gut microbiome in the body typically remains within a similar range over a short time frame, modifications in lifestyle and dietary habits over an extended period (e.g., consumption of probiotics, antibiotic use, etc.) can result in a significant alteration of the gut microbiome.
For further information on personalised probiotic prescribing please contact us for a consultation.
Rosacea is a prevalent skin condition that is more commonly observed in women than in men. There is limited literature exploring the connection between menopause and rosacea; however, menopausal flushing is recognized as a contributing factor in triggering or worsening rosacea symptoms. Additionally, the presence of Helicobacter Pylori, a type of bacteria found in the stomach, is often linked to the development of rosacea, as well as gastric reflux, stomach ulcers, and gastric cancer. See your doctor for specific diagnosis and management of this condition.
In conclusion, oral skin supplements have gained popularity in recent years as an alternative approach to enhance one's skin health and appearance. While scientific research on the efficacy of oral skin supplements is still limited, some supplements have undergone human trials with small sample sizes. Overall, these supplements were found to be generally safe, but their effectiveness may depend on specific doses, extracts, probiotic strains, and duration of intake. It is crucial to consult with a healthcare professional before incorporating any oral skin supplements into your routine, as they may interact with other medications or have adverse effects in certain individuals.
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