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Eating for a lifetime of healthy skin

The idea that you can eat your way to healthy skin is a concept gaining traction in consumer circles due to intense media activity in this area. Skin vitamins, skin drinks, and skin nutritional supplements are widely available each purporting to contain those nutrients necessary for ‘‘healthy’’ skin. Certainly, dermatologists are asked frequently by patients for dietary advice and may have crafted answers based on their own beliefs regarding skin nutrition. While textbook chapters on skin health are limited primarily to nutritional deficiencies, limited knowledge exists on eating for superb skin health. The easiest patient answer regarding eating for healthy skin is to consume a well-balanced diet. However, it is unclear exactly what constitutes a ‘‘wellbalanced’’ diet. Early in humanity, the concept of three balanced meals was not a reality. Humans ate when food was available with intervening periods of fasting. Consequently, the human body is designed to function and withstand the challenges of intermittent feeding. Fat is stored when food in abundant for use as a fuel source during fasting. This survival mechanism has worked well until recently when modern agricultural practices in developed countries have provided a continuous food supply. The constant availability of food in the United States has led to an epidemic increase in childhood obesity, which will translate into a meteoric rise in type II diabetes within one generation. Diabetes is an interesting model of accelerated skin aging due to increased protein glycation. Protein glycation occurs when sugars crosslink to structural proteins in the body and DNA. Glycated proteins exhibit decreased elastic rebound causing decreased myocardial contraction and a decreased ejection fraction. Glycated proteins also account for the increased incidence of cataracts and renal disease found in diabetes. Finally, protein glycation leads to decreased skin elasticity and decreased arterial wall elasticity causing the development of leg ulcers. Current trends point toward accelerated rather than decelerated skin aging in the US youth. How could the current concepts of nutritional excellence lead to major health issues? The answer may lie in how the recommended daily allowances (RDA) were determined. The RDA was developed by consensus rather than evidence-based medicine. Experts in nutrition convened a meeting and set the RDAs based on personal observation and experience. The committee did an excellent job of determining the minimum nutritional standards as rickets, due to vitamin D deficiency, is no longer seen in the US and scurvy, due to vitamin C deficiency, is rarely seen. These standards represent the minimum, however, and not the optimum. Nutritional deficiencies can be compensated by the vigor of youth, but ill health effects can be observed with maturity. Thus, age-adjusted RDAs should be developed with new longevity predictions and a better understanding of agerelated nutritional deficiencies. Perhaps the best example of the need for age-adjusted nutritional standards is the present vitamin D controversy. Vitamin D is mislabeled as a vitamin and should be reclassified as a hormone, since it exhibits structural homology to testosterone. While vitamin D can be synthesized by UVB exposure, the synthetic ability decreases with age. Lower UVB exposure during the winter months, skin cancer concerns, and poor diet has led to epidemic vitamin D deficiency in mature individuals. Symptoms of vitamin D deficiency include lassitude, depression, muscle pain, bone loss, and increased cancer risk. These symptoms are also characteristic of menopause when bone loss increases exponentially. Indeed, the poor physical health associated with menopause may be in part due to vitamin D deficiency. The RDA for vitamin D is 400IU. This amount is sufficient for the prevention of rickets during childhood, but it is not sufficient for menopausal women. The RDA for vitamin D is probably closer to 1000IU for women in their 40s and maybe even as high as 2000IU for women in their 60s. It is difficult to consume this amount of vitamin D without increasing caloric intake. Whole milk is vitamin D enriched, but most mature women consume reduced fat or skim milk to minimize fat and caloric Editorial Echoes