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The Role of Antioxidants in Sun Protection

Posted July 5, 2018

By: Dr. Colin O’Brien ND, Medical Director, Cyto-Matrix

The sun is shining and summer is officially here! This is great news for many of us Canadians that find the winters to always be a bit too long…but it’s not so great for our skin health if we aren’t well prepared.

Proper sunscreen application, skin coverage and avoidance of direct sun during peak UV hours (11am-3pm) are all important factors when it comes to sun safety and reducing your risk of sunburn and skin cancer. But few people acknowledge the role of diet and antioxidant protection in sun protection. What we put in our bodies matters, too.

For example, excessive alcohol consumption has been correlated with higher rates of sunburn, and interventional evidence confirms that alcohol consumption reduces the time it takes for your skin to become red after UV exposure. Essentially, alcohol decreases the efficiency of our antioxidant network in the skin, thereby decreasing the protection from UV rays. Not such great news for patio beers and summer drinks on the dock.

This all makes sense, though, when you consider that tanning or becoming sunburnt is simply damage caused by ultraviolet rays. Our skin darkens to naturally protect against future exposure to these same UV rays. As this process is occurring, tons of free radicals are produced in the body that need to be quenched. Antioxidants to the rescue!

In addition to a diet high in antioxidants and bioflavonoids from fruits and vegetables, specific natural health ingredients have been targeted and identified as beneficial for sun protection. Consider the following antioxidants for extra support:

 

  • Cocoa: As if you need more reason to consume regular amounts of dark chocolate, research has shown that a daily cocoa powder drink led to less redness after UV exposure at 6 and 12 weeks. Improved hydration and circulation of the skin was also noted in those consuming the flavanol-dense cocoa drink but not those in the control group.
  • Vitamin C and E: Multiple studies have explored the effects of these commonplace anti-oxidants in UV protection. It turns out that both topical application of vitamin C and oral supplementation of vitamin C in combination with vitamin E can provide numerous benefits. One study explored an oral combination of vitamin C, vitamin E, selenium, carotenoids and proanthocyanidins, finding that the blend led to a decrease in matrix metalloprotease levels after UV exposure, possibly explaining part of the mechanism involved in antioxidant photoprotection.
  • Carotenoids: Various carotenoids, alone and in combination, have shown promise for UV protection. A double-blind placebo-controlled trial of 20 women found that 30mg of beta-carotene per day, for 10 weeks prior to 13 days of sun exposure, led to less skin redness. Another study of 24mg of Beta-Carotene, in combination with 8mg Lutein and 8mg Lycopene showed benefit. A combination of lutein and zeaxanthan, orally and topically, also show benefits. Two poorly done studies found that mixed carotenoids allowed for greater tolerability of the sun and more time until redness ensued. It should be noted that other studies have found limited or no benefit for sun protection with carotenoids, but the vast majority show benefits.
  • Green Tea Extract: Although animal research and human study have only shown benefits for the topical application of green tea and its constituents, it stands to reason that regular oral consumption of the anti-oxidant powerhouse tea would be a good idea for the prevention and treatment of sun damage, too. At the very least, daily intake of green tea can be used to promote optimal metabolism and perhaps replace other bad habits!
  • EPA Omega-3 Fatty Acid: In a double-blind randomized study, either 4 grams/day of EPA or 4 grams/day of oleic acid was supplemented for 3 months. After 3 months of supplementation, those in the EPA group had an 8-fold increase in EPA skin content and, most importantly, significantly reduced sunburn sensitivity (meaning a greater resiliency or threshold until burning). Markers of DNA damage in the skin were also reduced.  

 

Animal research, anecdotal evidence and mechanistic data suggests that there are many other antioxidants to consider for UV protection of the skin such as astaxanthin, CoQ10 and resveratrol. Preliminary research also indicates that nicotinamide, a form of vitamin B3, is photoprotecive as well, and that quercetin and rutin may be effective when used topically. The recurring theme is antioxidant support and it seems that a blend is best. If you’re headed to the beach, be sure to get your fruits and veggies in!

A Final Note on Sunscreens: When it comes to sunscreens, it is important to mention that they are not all created equal. Here is a quick summary of what to look for in a sunscreen:

  1. Avoid retinyl palmitate and oxybenzone, as these compounds have been associated with hormone disruption and carcinogen activity
  2. Ensure there are active ingredients such as zinc oxide, titanium oxide, avobenzone and mexoryl SX.
  3. Choose lotions instead of sprays

Check out the Environmental Working Group (ewg.org) for more info.


References: 

[1] Mukamal KJ. Alcohol consumption and self-reported sunburn: a cross-sectional, population-based survey. J Am Acad
Dermatol. 2006 Oct; 55(4): 584-9.
[2] Darvin ME et al. Alcohol consumption decreases the protection efficiency of the antioxidant network and increases the risk of
sunburn in human skin. Skin Pharmacol Physiol.2013; 26(1): 45-51.
[3] Heinrich U, Neukam K, Tronnier H et al. Long-term ingestion of high flavanol cocoa provides photoprotection against UV-induced
erythema and improves skin condition in women.J Nutr.2006;136:1565-1569
[4] Traikovich SS. Use of topical ascorbic acid and its effects on photodamaged skin topography.Arch Otolaryngol Head Neck
Surg.1999;125:1091-1098.
[5] Eberlein-Konig B, Placzek M, Przybilla B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-
alpha-tocopherol (vitamin E).J Am Acad Dermatol. 1998;38:45-48.
[6] Fuchs J, Kern H. Modulation of UV-light-induced skin inflammation by D-alpha-tocopherol and L-ascorbic acid: a clinical study using
solar simulated radiation.Free Radic Biol Med.1998;25:1006-1012.
[7] Greul AK, Grundmann JU, Heinrich F, et al. Photoprotection of UV-irradiated human skin: an antioxidative combination of vitamins
E and C, carotenoids, selenium, and proanthocyanidins.Skin Pharmacology and AppliedSkin Physiology.2002;15:307-315.
[8] Gollnick HPM, Hopfenmuller W, Hemmes C, et al. Systemic beta carotene plus topical UV sunscreen are an optimal protection
against harmful effects of natural UV-sunlight: results of the Berlin-Eilath study.Eur J Dermatol. 1996;6:200-205.
[9] Heinrich U, Gartner C, Wiebusch M, et al. Supplementation with beta-carotene or a similar amount of mixed carotenoids protects
humans from UV-induced erythema.J Nutr. 2003;133:98-101.
[10] Palombo P, Fabrizi G, Ruocco V, et al. Beneficial long-term effects of combined oral/topical antioxidant treatment with the
carotenoids lutein and zeaxanthin on human skin: a double-blind, placebo-controlled study.Skin Pharmacol Physiol.2007;20:199-
210.
[11] Lee J, Jiang S, Levine N, et al. Carotenoid supplementation reduces erythema in human skin after simulated solar radiation
exposure.Proc Soc Exp Biol Med. 2000; 223:170-174.
[12] Stahl W, Heinrich U, Jungmann H, et al. Carotenoids and carotenoids plus vitamin E protect against ultraviolet light-induced
erythema in humans.Am J Clin Nutr. 2000;71:795-798.
[13] Garmyn M, Ribaya-Mercardo JD, Russel RM, et al. Effect of beta-carotene supplementation on the human sunburn reaction.Exp
Dermatol.1995;4:104-111.
[14] Katiyar SK, Elmets CA, Agarwal R, et al. Protection against ultraviolet-B radiation-induced local and systemic suppression of contact
hypersensitivity and edema responses in C3H/HeN mice by green tea polyphenols.Photochem Photobiol.1995;62:855-861.
[15] Elmets CA, Singh D, Tubesing K, et al. Cutaneous photoprotection from ultraviolet injury by green tea polyphenols.J Am Acad
Dermatol.2001;44:425-432
[16] Lesley E. et al. Effect of eicosapentaenoic acid, an omega-3 polyunsaturated fatty acid, on UVR-related cancer risk in humans. An
assessment of early genotoxic markers,Carcinogenesis Vol 24(5); 2003: 919–925.

[17] Damian DL. Photoprotective effects of nicotinamide. Photochem Photobiol Sci.2010 Apr;9(4):578-85.
[18] Choquenet B et al. Quercetin and rutin as potential sunscreen agents: determination of efficacy by an in vitro method. J Nat
Prod.2008 Jun; 71(6): 1117-8.

Lesser-Known and Broad-Reaching Effects of Iron Deficiency

Posted May 1, 2018

By: Dr. Colin O’Brien ND, Medical Director, Cyto-Matrix

Every healthcare practitioner should be able to rhyme off the keynote symptoms of iron-deficiency: fatigue, weakness, dizziness and pallor (pale skin) probably come to mind first. This makes sense given that iron is the most commonly deficient nutrient in the world and a concern often seen in private practice. But the implications of suboptimal iron extend much further than low hemoglobin and low energy. Iron is needed for so much more.

Many practitioners, myself included, have likely missed opportunities to successfully treat patients with iron restoration therapies over the years because of more “atypical” signs and symptoms of inadequate iron. Yes, iron is classically needed in hemoglobin formation and, therefore, oxygen delivery and energy levels, but here are some other conditions and physiological functions that may warrant a more thorough exploration of iron levels:

 

Restless Leg Syndrome (RLS): Iron deficiency has been found to be a common cause of RLS occurring in about 25% of cases! Supplemental iron is certainly most effective in those with documented iron deficiency, however, some patients respond to iron supplementation even without anemia. Iron is thought to be beneficial for RLS through its ability to upregulate dopamine synthesis (it is needed to convert tyrosine into dopamine). If the RLS is refractory to iron therapy, consider deficiencies of magnesium, B12 and vitamin E instead.

 

Female Infertility: Case reports have found that iron supplementation resulted in pregnancy within 28 weeks in infertile woman with borderline low ferritin levels (14-40 ng/mL). Certainly, this is not to say that iron is the ‘silver bullet’ for female infertility, but it deserves attention amidst all other factors.

 

Diffuse Hair Loss: General hair loss can be a symptom of iron deficiency, even before anemia sets in. Restoring optimal iron levels has been shown to offset this symptom and iron supplementation can also be useful in cases of brittle, dry and splitting hairs (if you’re having compliance issues with iron supplements in iron-deficient female patients, this may be worth mentioning!)

 

Poor Immune function: Iron is needed for proper immune function through cytokine production in macrophages and an iron-deficient state may lead to an insufficient immune response. For example, one study in individuals with oral candidiasis found that iron restoration led to lower salivary candida counts and reduced oral lesions.

 

Thyroid Function: We classically discuss the need for selenium to convert T4 into the more bioactive T3, but iron is another mineral that is necessary to promote this conversion through deiodinase activity (and iron is also needed for thyroid peroxidase action). To make matters worse, low thyroid function can lead to worse iron absorption. In cases of hypothyroidism with concomitant iron deficiency, combination treatment with iron and levothyroxine has been shown to be superior over each therapy alone.

 

Menorrhagia (heavy menstrual bleeding): Substantial blood loss can obviously lead to iron deficiency. However, few people are aware that an iron deficiency can actually cause a recurring state of heavy menstrual bleeding through weakened uterine muscles that cannot properly clamp down on blood vessels (iron is a cofactor for cytochrome oxidase, an enzyme necessary for muscle contraction). Ultimately, interventional trials confirm that iron supplementation is necessary not only for symptom control but also to reduce the heavy bleeding itself.

 

Cognition, Mood & Intelligence: It is well-documented that children and adults perform poorer on mental function tests in states of iron deficiency, with areas such as attention, memory and concentration being affected. This is the case even in the absence of outright anemia. Mechanistically, inadequate iron supply leads to a dysregulation of dopamine and serotonin metabolism. Both animal trials and human studies have shown that severe iron deficiency during infancy may have long-standing implications on brain health that persist well into adulthood, regardless of adequate iron intake later on in life.

 

As clinicians, it is easy to start down a rabbit-hole to find a medical explanation for complex issues. Yet, it’s generally best to follow the principle of ‘Occam’s razor’: the simplest solution is typically the correct solution. If a patient is vegan, has heavy bleeding or any of the conditions listed above, get back to the basics and test their hemoglobin, ferritin and other blood markers. A well-absorbed iron might be the simple answer that you and your patients are looking for. 

 

Select References:

  1. Earley, C. J. (2009). The importance of oral iron therapy in restless legs syndrome. Sleep Medicine, 10(9), 945-946.
  2. Rushton DH, Ramsay ID, Gilkes JJH, Norris MJ. Ferritin and Fertility. Lancet 1991; 337:1554.
  3. Hard S. Non-anemic iron deficiency as an etiological factor in diffuse loss of hair of the scalp in women. Acta Derm Venereol 1963; 43:562-569.
  4. Sato S. Iron deficiency : structural and microchemical changes in hair, nails and skin. Semin Dermatol 1991; 10:313-319.
  5. Ganz T, Nemeth E. Iron homeostasis in host defence and inflammation. Nat Rev Immunol. 2015 Aug;15(8):500-10.
  6. Higgs JM. Chronic mucocutaneous candidiasis: iron deficiency and the effects of iron therapy. Proc R Soc Med 1973; 66:802-804.
  7. Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N. Chronic anemia and thyroid function. Acta Biomedica. 2017 Apr 28;88(1):119-127.
  8. Ravanbod M, Asadipooya K, Kalantarhormozi M, et al. Treatment of iron deficiency anemia in patients with subclinical hypothyroidism. Am J Med. 2013;126(5):420-4.
  9. Taymor, ML, Sturgis SH, Goodale WT, Ashbaugh D. Menorrhagia due to chronic iron deficiency. Obstet Gyneacol 1960; 16:571-576.
  10. Cinemre H, Bilir C, Gokosmanoglu F, Bahcebasi T. Hematologic effects of levothyroxine in iron-deficient subclinical hypothyroid patients: A randomized, double-blind, controlled study. J Clin Endocrinol Metab. 2009;94(1):151-156.
  11. Taymor ML, Sturgis SH, Yahia C. The etiological role of chronic iron deficiency in production of menorrhagia. JAMA 1964; 187:323-327.
  12. Beard J. Iron deficiency alters brain development and functioning. J Nutr. 2003; 133(5), 1468S-1472S.
  13. Walter T. Impact of iron deficiency on cognition in infancy and childhood. Eur J Clin Nutr 1993; 47:307-316.