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From the Townsend Letter for Doctors & Patients
May 2003

Women's Health Update:
Women and Skin Conditions
by Tori Hudson, ND
Professor, National College of Naturopathic Medicine and Bastyr University

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If you observe a middle-aged woman with great skin, here are the possible beneficial influences: She's lived in a rainy climate her whole life; she grew up in the fog; she protects herself from the sun; she's had good nutrition her whole life; she's never smoked; she has regular sleeping, eating, and exercise habits with good stress reduction skills; she has great skin genes; she has great skin care products; she has a great dermatologist and plastic surgeon; she's taking estrogen; or she's known the particular value of selected nutrients and essential fatty acids for skin health for many years now.

As women age, our skin changes in obvious ways. This is inevitable. Dryness, wrinkling, bruising, thinning, slow wound healing, aging spots, blotchiness, postmenopausal acne, and even pre-cancerous and cancerous growths are common changes. Other women have ongoing problems related to eczema and psoriasis that is not associated with aging but other factors.

Aging skin is most apparent in smokers and, in fact, smoking increases the number of facial wrinkles by 2-3 times in Caucasian men and women. Stress also sets off a cascade of responses that affect the skin. When under stress, our body sends blood to vital organs rather than to the skin, which can affect our tone and color and reduce the nutrients that the skin receives. Stress and anxiety can also cause chemical changes that trigger or worsen problems we already have with our skin such as acne, hives, eczema and psoriasis. And yes, frowning and worrying as manifested in a tense face will cause permanent wrinkling.

The decrease in collagen that occurs after women reach age 40 affects the elasticity and resiliency of our skin. The primary cause of this decrease in collagen is the drop in circulating estrogen. Women who take estrogen replacement therapy (ERT) can have a significant impact on increasing the concentration of Type III collagen in their skin. The drop in endogenous estrogens associated with menopause lead to an atrophying effect and is a major factor in the aging of skin. As women age, there is a decrease in the epidermis turnover rate which accounts for the doubling of time it might take to heal a wound. With age, the cell cycle slows down and cells cannot slough off quickly enough to make way for the new cells. This is what can cause the skin to become leathery and dull and more prone to the etching of wrinkles.

However, we can protect our skin, improve the health of our skin, slow the aging of our skin, revitalize it, and even cure some common skin diseases. Protective sun clothing and hats plus sunscreen can dramatically reduce the incidence of skin cancer. However, most of us get 50%-80% of our lifetime sun exposure before age 18 and by midlife, much of the damage has already occurred. The lesson here is to start protecting our skin at a much younger age. A product with at least an SPF of 15, providing protection from UVA and UVB rays is adequate. Make-up and lipstick and foundation are not reliable skin protections.

Alpha-hydroxy acids (AHAs) are naturally occurring fruit acids that exfoliate dead cells on the surface and leave behind the smoother, softer skin underneath. AHAs may also slough off age spots and reduce tiny wrinkles. Most dermatologists believe that a 5% acid content is adequate but products range from 0.5% to 15%.

Topical retinoids (vitamin A derivatives, i.e. Retin-A) can improve the texture of the skin and reduce fine lines. Retin-A causes the epidermal cells to slough off so that a smoother texture results.

Estrogen creams can significantly improve the skin's thickness, fine wrinkling, roughness and elasticity. A topical 0.3% estriol cream is a very weak (and safe) estrogen available by prescription. Stronger estrogen creams such as estradiol creams (Estrace) or equine estrogens (Premarin) cream is also available by prescription. As mentioned earlier, Oral ERT can slow skin aging by increasing the concentration of collagen and improving elasticity, thereby slowing aging of the skin and decreasing the onset and severity of wrinkles.

Chemical peels, Botox and collagen injections are more drastic measures mostly for cosmetic reasons and have potential side effects, some of them significant.

There are several key nutritional issues and natural substances that provide protection and treatment for skin problems not the least of which is a fundamentally healthy whole foods diet. Fruits, vegetables, whole grains, nuts, seeds, legumes, a small amount of low fat dairy and fish would be for most individuals, a well rounded optimal diet.

Treatment considerations for eczema and psoriasis include avoiding food allergens and concentrating on good oils. The manipulation of dietary fats is extremely important in the management of both these chronic skin diseases. Our bodies need a healthy ratio of saturated, monounsaturated and polyunsaturated fats. Some polyunsaturated fats are as essential as vitamins and minerals for the maintenance of good health - these are the essential fatty acids (EFAs), or "good" fats. Skin problems in general, are common in people who do not get enough essential fatty acids or who have an imbalance of EFAs in their diet.

Individuals with eczema appear to have altered metabolism of essential fatty acids and prostaglandins (beneficial hormone-like substances that are made from essential fatty acids). In eczema, there is a tendency for increased levels of linoleic acid and deficient levels of gamma linolenic acid (GLA), eicosapentaenoic acid (EPA), and docosahexanoic acid (DHA).

With psoriasis, blood levels of free-fatty-acids are typically abnormal. Nutritional supplementation with fish oils and specific seed oils that supply some of these essential fatty acids is one of the most important tools in treating eczema and psoriasis as well as moisturizing the skin and protecting it from environmental oxidative damage. In eczema, supplementing the diet with evening primrose oil, borage or black currant oil can provide gamma linolenic acid (GLA) that will correct the underlying metabolic defect. There have been many scientific studies using GLA with excellent benefits in improving the symptoms of eczema.1-4 Dosages in the range of .5 to 3 grams of GLA are appropriate. Both evening primrose oils and borage oil have been used in these studies but borage oil is a much richer source of GLA and therefore more effective. Borage oil typically contains 20-24% GLA and evening primrose oil only 8-10% GLA.

Fatty acid research for psoriasis has focused on the fish oils and borage oil. Several double-blind clinical studies have demonstrated that supplementing with 10-12 grams of fish oils rich in EPA and DHA (providing 1.8 grams of EPA and 1.2 grams of DHA) can result in significant improvement in psoriasis lesions.5-7 Individuals who have psoriasis produce many times more leukotrienes, which are inflammatory compounds. Fish oils bind to receptor sites and inhibit the production of these inflammatory compounds, thereby reducing the buildup of skin cells that have replicated too rapidly in psoriasis individuals. Seed oils containing high amounts of GLA such as borage oil may also be helpful for psoriasis patients.

Essential fatty acid supplementation should also be considered to provide the skin with the proper oils and moisture thereby preventing and reversing dry skin, preventing and reversing sun and age damage, and other environmental oxidative damage. The skin needs essential fatty acids, particularly when stressed by the damage that occurs with sunburn. Experiments have shown that UV rays cause a significant release of fatty acids from the cell membranes. The cell uses these fatty acids to regulate the inflammation, swelling and pain. GLA from borage, evening primrose and black currant oils has been found to reduce redness, swelling and pain from ultraviolet damage. In case of sunburn, you can take up to 8 capsules of borage oil daily until symptoms subside. Borage oil can also be applied topically to the burned area two or three times daily. When going on a sunny weather vacation, it would be smart to use 1-2 capsules of borage oil daily for 4-6 weeks before departure as a protective measure. Supplementing with fish oils, flax oils, borage, evening primrose and black currant oil can correct long term deficiencies and imbalances in fatty acids. These imbalances result in not only chronic skin problems and excessive skin aging, but immune diseases, heart disease, arthritis, cancer, depression, diabetes, and neurological disorders.

Vitamin C and other antioxidants such as vitamin E, A and selenium, as well as vitamin D may also be able to prevent environmental damage from UV rays and free radicals. Topical preparations of vitamin C stimulate collagen synthesis, improve the skin's texture, and help prevent additional damage. Vitamin C topically may also act as a natural sunscreen. Zinc supplementation may be indicated in treating eczema. Low zinc levels are common in some eczema patients and zinc is important in proper essential fatty acid metabolism. Herbal therapies including licorice appear to be helpful as topical preparations for eczema and have significant anti-inflammatory and anti-allergic effects when taken internally. Topical licorice preparations have been shown to be effective in reducing the inflammation and itching associated with eczema and allergic skin reactions.

Eczema and psoriasis are preventable and treatable skin conditions, but aging changes in our skin are inevitable, although they can certainly be minimized through preventive measures and supplementation. Remember the basics: protection from the sun, proper diet, avoid smoking, and stress reduction and management. Some individuals may need or want to consider supplementing with key nutrients and essential fatty acids, other individuals may want to consider topical or oral ERT. Some of us are fortunate because of good skin genes, but how good our skin looks and how healthy it remains also depend largely on sun exposure, lifestyle habits, and good nutrition.

Women's Health Update
by Tori Hudson, ND
Professor, National College of Naturopathic Medicine and Bastyr UniversityMedical Director, A Woman's Time
Author, Women's Encyclopedia of Natural Medicine
2067 N.W. Lovejoy
Portland, Oregon 97209 USA

1. Morse P, Horrobin D, Manku M. Meta-analysis of placebo-controlled studies of the efficacy of Epogam in the treatment of atopic eczema. Relationship between plasma essential fatty acid changes and clinical response. British J Derm 1989; 121:75-90.
2. Yasumoto R, Fujita H, Yamamoto T. The effectiveness, safety and usefulness of borage oil on atopic dermatitis. Acta Dermatologica 1996;92(2):249-251.
3. Pullman-Mooar S, Laposata M, Lem D, et al. Alteration of the cellular fatty acid profile and the production of eicosanoids in human monocytes by gamma-linolenic acid. Arthritis and Rheumatism 1990;33(10): 1526-1533.
4. Andreassi M, Forleo P, DiLorio A, et al. Efficacy of gamma-linolenic acid in the treatment of patients with atopic dermatitis. J International Medical Research 1997; 25:266-274.
5. Bittiner S, et al. A double-blind, randomized, placebo-controlled trial of fish oil in psoriasis. Lancet 1988; I:378-380.
6. Grimmunger R, et al. A double-blind, randomized, placebo-controlled trial of N-3 fatty acid based lipid infusion in acute, extended guttate psoriasis. Clin Invest 1993;71:634-643.
7. Maurice P, et al. The efects of dietary supplementation with fish oil in patients with psoriasis. Br J Dermatol 1987;1117:599-606.

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