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The market for skin health and appearance is, without a doubt, flooded with products that claim all sorts of extravagant benefits. But, as a member of the Undoctored Inner Circle, you will notice that we are interested in personally empowered health achieved as naturally as possible without drugs or procedures, without a collection of expensive cosmetics, injections, or fillers. And, in the Undoctored approach, improvements in skin health are typically paralleled by improvements in overall health. We therefore focus on strategies that fit into an overall health program with substantial skin benefits, rather than topical preparations that conceal or only provide local effects.


Overview

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In the Undoctored Protocol for Skin Health, we will discuss strategies that hold the potential to easily, naturally, and inexpensively (at least compared to the thousands of dollars people are willing to spend on various injections and surgeries) help restore skin smoothness, reverse inflammatory edema and redness, provide protection from the age-advancing ravages of photodamage, even reduce potential for melanoma, and thereby help restore a more youthful appearance. 

Bottom line: You can look better, look younger with skin that you are proud of, simply by following a handful of strategies that achieve effects including increased dermal moisture, reduced inflammation, increased production of structural tissue (collagen, glycosaminoglycans and proteoglycans, elastin), gradual reduction of wrinkles, prevention and reduction of “age spots.” As with many conditions that develop over decades, the sooner you incorporate these strategies, the greater the benefits will be.

Those of you who have followed our Wheat Belly, now Undoctored, social media conversations have witnessed dramatic age-reversing skin effects of the Undoctored Wild, Naked, Unwashed program of wheat/grain elimination, vitamin D restoration, thyroid status normalization, omega-3 fatty acid supplementation, and bowel flora cultivation.

As with all other Undoctored Protocols, the Undoctored Protocol for Skin Health therefore requires that you begin with the Wild, Naked, Unwashed program. Because skin is a mirror of overall health, the dramatic advantages in health obtained through the Undoctored Wild, Naked, Unwashed strategies are inevitably reflected in skin health and appearance. (For a more detailed discussion on how and why the basic program yields such extravagant benefits, see the Skin Health Basics discussion that follow this Protocol.)

Elimination of all wheat and grains alone that serves as the cornerstone of our dietary program can be hugely beneficial for skin health. People typically observe that facial skin is smoother, free of redness and seborrheic rashes, acne is reduced, eczema and other rashes reverse over time. Facial edema reverses sufficient to alter the contours of the face, a dramatic effect for some people that can dramatically change appearance. This is due to rapid reversal of skin inflammation, compounded by the reduction in exogenous glycation provided by the reduction in blood sugar and insulin that this lifestyle involves. While it is part of our basic program, do not discount the power of this starting strategy that builds momentum, the longer you adhere to it.

Restoration of vitamin D facilitates reversal of several skin conditions such as vitiligo, eczema, atopic dermatitis, psoriasis, and keloids, and reduces the risk of melanoma skin cancer and provides partial protection against photodamage from the sun. You will notice, for instance, that it takes longer before pinkness or redness of the skin develops with sun exposure. After all, skin is the organ responsible for vitamin D production that is activated upon exposure to sunlight. Contrary to conventional opinion in the dermatology community that advises complete avoidance of UV radiation from the sun, more recent data suggests that sun exposure and vitamin D actually reduce the risk of skin cancers, including melanoma, and can even improve treatment outcomes for melanoma, provided sunburn does not occur. (Sunburn should indeed be avoided.) Restoration of vitamin D reduces damage to skin cell DNA and reduces the effects of photoaging, i.e., aging effects from sun exposure.

Because of the reduction of inflammatory effects obtained through restoration of bowel flora, especially if dysbiosis or small intestinal bacterial overgrowth are reversed, skin health can demonstate further benefits from these efforts.

The starting Undoctored Wild, Naked, Unwashed strategies are so critical to skin (and overall) health that, without them, you simply cannot expect full skin health or appearance. Once you have incorporated all the starting strategies, only then is it time to consider adding one or more of these Undoctored Protocol additional strategies.


Many of the Effects of Skin Aging are Reversible

As we age, skin undergoes changes that involve increasing laxity through loss and destruction of structural connective tissue, dryness/loss of moisture, development of wrinkles, and discoloration/uneven pigmentation.

The dermis, the portion of the skin just below the exterior epidermis is largely made of collagen. The effects of aging, including that of photoaging from sun exposure, are largely due to fragmentation of collagen molecules. It is therefore wise to avoid becoming sunburned, as this activates matrix metalloproteinase enzymes in the dermis that break collagen down, increasing their activity hundreds of times over normal, an effect that lasts up to 72 hours after sun exposure. Excessive sun exposure also deactivates fibroblast cells that slow or stop production of healthy new collagen by as much as 80%. Even before sunburn occurs, the same aging phenomena also occur if skin is made pink by sun exposure. Obtaining sun is a healthy practice but, to not incur accelerated collagen breakdown, it is advisable to avoid becoming pink or reddened, certainly avoid being burned.

The amount of time required to cause skin pinkness/redness varies depending on skin tone, latitude, season, temperature, and vitamin D/carotenoid (discussed below) status, with ideal vitamin D and skin carotenoid status prolonging the time required to become pink or burn (but still typically not more than 20-25 minutes under a direct summer sun).

Here, we will primarily focus on strategies that you can institute on your own and yield health as well as skin benefits, consistent with the Undoctored approach. We will not refer to strategies that involve injections, drugs, or surgeries that can also play a role in some people but are outside of the scope of strategies we consider in the Undoctored approach.


Skin Health Basics

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Staying young and beautiful involves a lot more than choosing better cosmetics; it begins with health because skin is the outward reflection of internal body processes. An essential program for looking your best begins with :

• The Undoctored Wild, Naked, and Unwashed diet—Grain and sugar elimination without limiting fat are key factors in skin health.
• Reducing skin glycation slows the process of aging, including skin aging.
• Adequate sleep, like diet, is a basic requirement for full skin health.
• Hydration, both oral and topical, is essential.
• Omega-3 fatty acids and vitamin D provide outsize health benefits but also provide protection against photo aging, i.e., accelerated skin aging from ultraviolet light exposure.
• Thyroid dysfunction is a common cause for poor skin health, easily corrected by starting with iodine and, when necessary, a combination of T4 and T3 thyroid hormones.
• Avoiding unhealthy ingredients, such as phthalates and parabens, helps avoid health problems from cosmetics and toiletries.

Do you remember the first time you laid eyes on a young child's face, flawless complexion that was soft, supple and beautiful? Imagine having that very same skin when you turned 40 years old, or even 50 and onwards.

Skin health does not come in just a bottle, tube, or eye cream. It comes from within. We believe that beauty starts working from the inside-out and is the outward reflection of internal health. Skin, after all, is the body’s largest organ, the barrier between the out-side world and the internal, an indicator of internal body processes. If health is poor, skin will look unhealthy. If diet is poor, skin will reflect it. The Undoctored approach to skin health and appearance involves several approaches essential for skin health and beauty that your cosmetologist, dermatologist, esthetician, or doctor likely failed to discuss with you or did not fully understand.

We are going to discuss a number of different strategies to help you maintain and/or restore beauty and skin health. Don’t be fooled: As simple as some of these strategies may sound, they are based on extensive science and experience and are effective. More so than applying a better brand of eyeliner, these strategies for restoring health from within may open your eyes to healthier and more youthful-looking skin.


The Undoctored Wild, Naked, Unwashed Dietary Program

The Undoctored nutritional approach yields an extraordinary panel of health benefits, from weight loss to reductions of blood sugar and inflammation, to relief from gastrointestinal complaints, to reversal of many autoimmune conditions. And it can transform skin health.   The foods we choose can affect the way we feel, the way we act, and the way we look—no facet of health or appearance is unaffected by diet. If you're feeling lethargic, bad-tempered or emotional, it's often due to food choices. Likewise, if we have skin rashes, redness, puffiness and other imperfections of skin health and complexion, think diet first.

To take advantage of all the wonderful health benefits of the Undoctored nutritional program, including improved skin health, you may have to rid yourself of some long-held misconceptions. Perhaps your mother told you, for instance, that “Eating greasy food will give you acne.” Diet does indeed have an effect on our skin health, but it’s not the “grease.” Foods trigger a variety of unwanted irritations, including skin rashes and eruptions. Many of us suffer from red, blotchy, inflamed skin, for instance, even an acne breakout, all from food. The path back to looking younger and more beautiful must therefore begin with diet.

The Undoctored approach to diet starts with the most powerful skin health and beauty strategy of all: elimination of all grains, particularly the most destructive of all grains, modern wheat. We need to recognize that all products created from high-yield, semi-dwarf wheat, a creation of genetics research, disrupts health from head to toe, an effect reflected in skin health and appearance. No wheat products are free from blame: white, whole grain, multigrain, sprouted, organic—it’s all the same with the same potential for disrupting skin and overall health. You may have to deal with the common withdrawal process, the first 5-7 days of nausea, headaches, low moods, and fatigue that can occur when “deprived” of the gliadin-derived opiates from modern wheat. This is an essential step to undo all the unhealthy effects of this food that all “official” agencies urge us to consume.

Despite the hurdles, wheat elimination alone can often yield astounding transformations in skin health and appearance, sometimes within the first week. This is so important to understand, as full skin health is often not possible as long as wheat products remain even an occasional part of your diet—complete elimination is key. Pay a visit to the “before” and “after” photos  on Undoctored (and Wheat Belly) social media pages showing the many people who have engaged in this approach. The transformations are often nothing short of miraculous: reduced edema (swelling) especially around the eyes, cheeks, and chin, improved definition of facial contours, less redness and discoloration, relief from the common seborrheic rash alongside the nose, reduced or complete relief from acne.

To go even further in health and skin benefits, eliminate all other grains beyond wheat, including rye, barley, corn, oats, triticale, bulgur, sorghum, millet, teff, and rice.

Beyond grain elimination, the Undoctored nutritional program does not restrict fats or oils and therefore also includes fish, poultry, meat, and wild game, and be sure to eat the fat and don’t be afraid to eat the skin, liver, and other organ meats, among the most nutritious of animal products. Be sure to save the bones (or purchase bones at the butcher shop) and boil them for soup or stock; when it cools, don’t skim off the gelatin or fat—it’s part of an overall skin, nail, and hair health program. We also advocate including plenty of deeply-colored (red, orange, yellow, green, purple) vegetables, healthy oils such as olive and coconut oils, and avocados.


Glycation and Skin Health

Every time we are exposed to elevated bloods sugars (even just a few points above normal of 90 mg/dl), the process of glycation occurs. This process underlies many of the phenomena of aging: skin wrinkles and discoloration, rigidity of arteries (hypertension), damage to joint cartilage (arthritis), damage to kidneys (kidney dysfunction), and damage to brain cells (dementia). In other words, glycation is, in many ways, aging itself.

There are a number of theories on why and how we age. Some argue that reductions in hormones, such as estrogen, progesterone, testosterone, and growth hormone, are behind the progressive deterioration in appearance and health. Others argue that cumulative damage to cells and DNA underlie changes associated with aging. One of the best substantiated theories of aging is the Advanced Glycation End-product theory of aging, the AGE theory of aging, suggesting that accumulation of the products of glycation—“AGEs”—underlie the phenomena of aging.

Glycation and the formation of AGEs involve the irreversible modification of proteins by blood sugars. (This is called endogenous glycation; this is to be distinguished from exogenous glycation that occurs by a different dietary route, but is likely less of a contributor to the phenomena of aging, and so we will confine our discussion to endogenous glycation with greatest implications for skin health.) Glycation occurs at a low level even when blood sugars are in their normal range with fasting blood glucoses of less than 90 mg/dl or hemoglobin A1c (HbA1c) of 5.0% or less.

Whenever blood sugars rise above 90 mg/dl, and especially above 100 mg/dl, glycation accelerates and AGEs form. Any food that raises blood sugar above 100 mg/dl accelerates the process of AGE formation and thereby aging. What foods raise blood sugar above the normal range the most? Grains (due to amylopectin A), sugars, and starchy legumes, in that order. We thereby reduce the rate of glycation and AGE formation by eliminating grains and sugars. Grain and sugar elimination are the most powerful steps, but including some starchy legumes in your diet program is actually helpful if managed properly. Because starchy legumes also provide prebiotic fibers critical for nourishment of healthy bowel flora that also helps maintain youthfulness, we consume cooked beans, lentils, chickpeas, and hummus but keep quantities small, preferably no more than 15 grams of net carbohydrates (net carbohydrates = total carbohydrates minus fiber) per meal or per 6-hour period, generally no more than 1/4 to 1/2-cup per serving; this keeps blood glucose from rising and contributing to AGE formation, while still providing a modest quantity of indigestible prebiotic fibers for bowel flora health.

Unfortunately, once AGEs form, they cannot be undone. They accumulate as molecular debris and gum up organ function, causing skin wrinkles, discolorations/age spots, and blemishes. The key is therefore to begin this process of putting a stop to AGE formation as early as possible in life.


Manage Sleep

Have you ever noticed that, when you haven’t gotten enough sleep, you look awful—bags under the eyes, saggy skin, exaggerated wrinkles? Sleep is one of those things, like food, that we cannot do without. Sleep deprivation carries implications for weight control, mental health, daytime functioning, mood, even cardiovascular health, as well as skin health.

While sleep needs vary, most adults require 7 1/2 hours of sleep per night. Sleep tends to occur in 90-minute “packages,” i.e., 90-minute cycles of sleep: 6 hours, 7 1/2 hours, 9 hours. This can be especially important when setting a time to arise, as people feel more alert and function more effectively, as well as look better, when awoken at the end of a sleep cycle, rather than in the midst (as experienced when waking from a dream). Many biometric devices, such as FitBit and the Apple watch, as well as smartphone apps for sleep management, can help track sleep cycles and awaken you at favorables times.

Beyond obvious sources of sleep disruption, such as caffeine, consider the following strategies to make sleep more effective:

• Minimize alcohol consumption—While sleep may come easier, it is disrupted and less restful     •       Keep the room as dark as possible; avoid stimulating activities in bed, especially television.
• Progesterone for females can restore deeper levels of sleep.
• Consider melatonin, the hormone of circadian rhythm. Dose needs vary, but most obtain benefit with doses between 0.5 mg and 20 mg; try varying the dose to obtain the effect you desire without generating a “hangover” feeling in the morning. If falling asleep is the problem, melatonin is best taken 2-3 hours prior to sleep. If staying asleep is the struggle, take it at bedtime and consider a sustained-release preparation. Melatonin is also useful to reduce blood pressure during sleep. The only side-effect that many experience is that of vivid, colorful dreams, similar to those experienced during childhood. Interestingly, melatonin can modestly extend the duration of rapid eye-movement (REM) sleep, the deep restorative phase of sleep that helps maintain mental health and youthfulness.
• 5-HTP or tryptophan—Like melatonin, 5-HTP or tryptophan can be used as sleep aids that also can lift mood, since both increase brain serotonin. (5-HTP and tryptophan should not be taken if you are taking a prescription antidepressant to avoid excessive serotonin levels.) Like melatonin, dose needs vary. Most start with 50 mg 5-HTP or 500 mg tryptophan at bedtime (or earlier, if sleep onset is the problem), increasing 5-HTP by 50 mg up to 300 mg, as needed, or increasing tryptophan by 500 mg up to a maximum of 3000 mg, also as needed. 5-HTP and tryptophan like melatonin, also has potential to extend REM sleep. Either supplement can be safely taken with melatonin.

Omega-3 Fatty Acids

Were you one of those teenagers who would lie in the sun with foil behind your head, trying to get the brownest tan to make you look thin and gorgeous? Unfortunately, the tan was accompanied by an inflammatory reaction from ultraviolet (UV) radiation, effects that lead, over time, to premature skin aging, an effect called photo aging.

UV-ray exposure from the sun provokes an inflammatory reaction in the skin and accelerates the breakdown of collagen supportive tissue. (Shorter UVB wavelengths penetrate the superficial skin, while longer wavelength UVA penetrates deeper.) Over years of exposure, skin thinning, wrinkles, fine lines, sagging and uneven coloration and discoloration develop.

Omega-3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), protect skin from ultraviolet ray damage and exert protective and modulating effects to keep inflammation, autoimmune responses, and damage at bay, while also modestly increasing collagen content. Doses effective for skin health tend to be in the higher range (the range that, interestingly, also exerts beneficial effects for autoimmune conditions and cardiovascular health) of 3000 to 4000 mg per day of EPA and DHA (combined) taken orally. (When we discuss the skin, lipoprotein, and cardiovascular benefits of omega-3s, note that we are only referring to the EPA and DHA from fish oil, not the linolenic acid from flaxseed, chia, or other foods, nor are we referring to the relatively trivial quantities of omega-3s contained in krill oil.) For the same reasons, people with photosensitivity, i.e., abnormal rashes or other responses provoked with sun exposure, also experience partial relief with similar doses of omega-3 fatty acids.

Omega-3 fatty acids can be modestly beneficial in reducing the skin irritation and redness of eczema and dermatitis, as well. Though insufficient on their own, omega-3 fatty acids are one component of an overall program for skin health.


Vitamin D

Vitamin D makes the world a brighter place. But, by the age of 40, we have lost a considerable portion of our ability to activate vitamin D through skin with sun exposure, our capacity nearly gone by our seventh decade. There is a laundry list of aging effects with vitamin D deficiency that includes increased potential for osteoporosis and risk for fractures, lower HDL levels, and a decrease in mental clarity and memory. Restoration of vitamin D to levels that are experienced by young people with summer sun exposure is therefore a marvelous way to minimize many of the phenomena of aging.

We have all been advised by the dermatology community to avoid sun exposure to reduce risk for skin cancers. Ironically, reduced sun exposure has been associated with a doubling of the mortality rate. If sun avoidance results in dire long-term health outcomes, but sun exposure via UV radiation results in accelerated photo aging, how do we obtain all the health benefits of vitamin D without paying a skin aging price? It means obtaining daily sun exposure of no more than 20 minutes per day during summer (though time varies depending on time of year, latitude, cloud cover, vitamin D and carotenoid status), preferably including areas beyond just the face, neck, and arms, and never allowing a burn, while making up for the difference with oral vitamin D3 supplementation. Because the amount of vitamin D activation in the skin varies with age and genetics, blood levels of 25-hydroxy vitamin D should be used to gauge the adequacy of your combination of sun exposure and vitamin D supplementation.

The full panel of benefits of vitamin D on skin health is presently being mapped out. We do know that some forms of dermatitis and eczema respond to vitamin D. We also know that vitamin D metabolism is active in skin tissue and that it, along with omega-3 fatty acids (above), provides protection from photo aging (Mason 2010). Skin texture, elasticity, and moisture improve with vitamin D. Many also report a change in skin color from that of a grayish vitamin D-deficient color to warmer, flesh-colored tones with vitamin D repletion.

Obtaining a 25-hydroxy vitamin D-3 level assessment is important. The Undoctored approach aims for levels between 60-70 ng/dL. For most of us, that means taking 4,000-8,000 units per day as a gel-based capsule of D3 (cholecalciferol). We also suggest monitoring 25-hydroxy vitamin D levels every 6-12 months. About 10-20% of people need to adjust their daily dose with season: more with winter, less with summer.


Thyroid Health

Hypothyroidism, or low thyroid hormone levels, is exceptionally common. Though it varies with age, genetic predisposition, and geographic location, hypothyroidism affects anywhere from 10 to 35% of the adult population to varying degrees, resulting in skin dryness, roughness, itchiness, and reduced moisture, as well as hair loss or thinning. Hypothyroidism is therefore a common cause for poor skin health, not to mention impaired overall health, failure to control weight, and increased risk for cardiovascular death.

The first step in correcting hypothyroidism is to correct iodine deficiency, especially in people who live away from coastal areas (since iodine is concentrated in the oceans). We have had best results with 500 mcg of iodine per day from iodine drops or kelp (dried seaweed) tablets. It requires 2-3 months of iodine supplementation to gauge effect.

Taking your first-upon-arising oral temperature is a way to determine whether hypothyroidism is present. Normal temperature is 97.3º F; consistent oral temperatures below this value suggest hypothyroidism, with the further away from 97.3º F, the greater the likelihood of hypothyroidism. (Consistent readings of 95.4ºF, for example, are more likely to signify hypothyroidism than 97.1º F.) To confirm, laboratory assessment is necessary; measures should include TSH, free T3, free T4, and reverse T3 levels; optionally, thyroid peroxidase and antithyroglobulin antibodies to assess for autoimmune thyroid conditions. For most people, a combination of the T3 and T4 thyroid hormones are required to restore ideal thyroid hormone statuse.g., Naturethroid, Armour Thyroid; a minority require only the T4 hormone (Synthroid, levothyroxine).


Beware Ingredients in Cosmetics/Skin Care and Toiletries

You have put everything else into action but don’t want to undo the benefits by causing skin irritation, rashes, acne, or even disruption of endocrine gland status by choosing the wrong cosmetics and toiletries. There are many potentially toxic chemicals in shampoos, cosmetics, moisturizers, toothpastes and other personal care products. Because they are in so many products, even air and water, in the modern world, complete avoidance is impractical, if not impossible, and we can only hope to minimize exposure, or at least keep exposure to levels below that associated with adverse skin and health effects. (This is especially important during pregnancy, when even minute quantities of such compounds, topical, oral, or otherwise, are suspected to have effects on the developing fetus.)

Some of these chemicals include:

Parabens are derivatives of benzene, a toxic industrial chemical, that are added as an-timicrobials to cosmetics and toiletries as methylparaben, ethylparaben, propylparaben, butylparaben, isobutylparaben, isopropylparaben, and benzylparaben. Parabens have been recovered from breast tumors, suggesting they may play a causal role, and are suspected to act as endocrine disrupters by mimicking estrogen.

Phthalates are another class of chemicals added to cosmetics and toiletries as pre-servatives, as well as a common component of plastics. Phthalates are found in an ex-tensive list of consumer products. If you drove a car today, made coffee from a coffee-maker, drank from a plastic cup or container, touched your children’s modeling clay or toys, or came in contact with latex gloves or plastic containers, you have likely been exposed to phthalates. Although ubiquitous, phthalates are present in especially high concentrations in virtually all fragrances/perfumes, as well as most nail polishes, cosmetics, and toiletries, and are responsible for much exposure in women. Phthalate exposure has been associated with impaired reproductive potency in males, asthma and allergies in children, though more far-reaching endocrine disruptive impact is suspected. Concerningly, children in particular appear to experience greater exposure than adults, with some children being exposed to 20-fold more than the tolerable limit.

Triclosan is widely used as an antimicrobial agent, and is therefore found in antibacterial handsoap and hand sanitizers, as well as in deodorants and toothpaste. Animal studies demonstrate that triclosan has potential for disrupting thyroid and reproductive function. A very concerning observation made recently is that, while triclosan does not persist in the environment for extended periods, its breakdown products can persist for years, potentially exerting effects on wildlife, especially fish and algae, and gain access to the groundwater. Minimizing its use may therefore provide health, as well as environmental, benefits.

There is a long list of other chemicals in cosmetics and toiletries with potential for a variety of adverse effects, though the scientific validation of these effects lag. Among other chemicals to be wary of are polyethylene glycol, sodium lauryl sulfate, and BHA (butylated hydroxyanisole) and BHT (butylated hydroxytoluene). (One of the great difficulties in determining what is safe and what is not safe as consumers is that much of the “research” and analyses of the research are provided by agencies supported by the cosmetic industry and/or employ experts with ties to the cosmetic industry, similar to the potential for conflict of interest in the pharmaceutical industry. So buyer beware is a wise rule to follow.)

You can appreciate that most cosmetics and toiletries on the market today have one, if not several, problem ingredients. It means, whenever possible, to choose naturally sourced ingredients. Among the manufacturers who use natural ingredients without the problem ingredients listed above are Jane Iredale, Mirabella, Alterna Haircare, Avene, Laura Mercier, Repechage, and Glytone. Note that not all products within each line are free of potential problem ingredients, so check each product or check with the manufacturer regarding any specific product.

Gluten-free cosmetics have become increasingly more popular. If you've noticed your skin developing inflammation, redness, or itching, consider finding a product line that is gluten-free and, even better, cornstarch-free also, as well as fragrance-free and free of the biggest problem ingredients listed above. (Most of the brands listed above also have gluten-free products.) Because of variation in individual sensitivities, a skin care line or product that works for one person may not work for another.

Also, consider looking for skin care products and cosmetics that have a built in sunscreen if prolonged sun exposure is anticipated, preferably one with a broad spectrum sunscreen of 30 SPF or higher. One application of sunscreen will not last throughout the day and you may have to reapply.


Undoctored Strategies to Improve Skin Health and Appearance

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Collagen hydrolysates

Oral supplementation of collagen hydrolysates is one of the most powerful strategies you can adopt for augmentation of skin health: reduction of wrinkles, increased (dermal) hydration, increased supportive connective tissue (increased collagen production, fibrin, elastin, glycosaminoglycans, hyaluronan) and reduced matrix metalloproteinase breakdown of collagen.

Collagen proteins comprise 30% of the proteins in the human body. We should obtain plentiful quantities of collagen proteins from diet by eating organ meats, skin, soups/broths in which meat, organs, and bones have been boiled, and tougher cuts of meat rich with connective tissue. Most modern people, of course, avoid organs, choose easy-to-chew non-tough cuts, avoid the skin (e.g., chicken skin), and do not make soups or broths and are thereby ingesting less collagen protein than wild-living people. To increase dietary intake of collagen proteins, you can start by including occasional organ meats, eating the skin, making soups and broths, and slow-cooking tougher cuts of meat to tenderize them. Adding a collagen supplement to your program can add further, especially in the form of collagen hydrolysates.

Gelatin, i.e., collagen proteins derived from the connective tissue of animals, yields benefits for skin health. However, a form of collagen produced by acid hydrolysis that yields specific and unique di- and tripeptides (two and three amino acid-long peptides) appear to underlie some unique effects of collagen hydrolysates that are likely not provided by the digestion of gelatin. Because clinical studies have demonstrated consistent and dramatic benefits with the collagen hydrolysate form, we focus on this form of collagen proteins.

The effects of collagen hydrolysates are not just cosmetic, but effect dramatic changes in gene expression that reverse many of the effects of skin aging. Genes for skin protein production are increased in expression, for example, while genes for enzymes that degrade skin proteins, such as matrix metalloproteinase, are decreased. As discussed in the Undoctored Protocol for Arthritis and Joint Pain, collagen hydrolysates also yield substantial improvements in cartilage and joint health over time sufficient to reduce the pain and inflammation of arthritis and reliance on anti-inflammatory medication, and may yield benefits in muscle growth, may block the effects of menopausal weight gain, enhance growth of muscle when a program of strength training is followed, and yield modest benefits in reducing blood pressure and improvement in pulse wave velocity (a measure of cardiovascular health). In other words, collagen hydrolysates yield effects consistent with overall health and youthfulness, not just skin health.

Collagen hydrolysates are most effective in stopping the effects of skin aging, somewhat less effective in reversing established changes. It is therefore most effective to supplement collagen hydrolysates to prevent aging effects before they occur. However, if substantial skin aging effects have already occurred, partial reversal is still achievable with greater effects obtained with long-term use. The key to obtaining full benefit of collagen hydrolysate is therefore consistent, long-term use as early in life as possible, along with the dietary modifications that increase collagen intake.

While skin benefits of collagen hydrolysates begin at low doses of 2.5 grams per day, most studies have used a dose of 10 grams per day with visible improvements in skin health and appearance starting within 4 weeks, more marked changes by 8 weeks, with additional changes over longer time periods. Because of the relatively large volume of 10 grams of collagen hydrolysate powder, this supplement is best as a powder added to coffee or other liquids, smoothies/shakes, or added to foods, rather than capsule form. The Great Lakes Gelatin products (available as collagen hydrolysates and gelatin) are excellent sources. In coffee or tea, collagen hydrolysates yield a slightly “off” flavor that is effectively concealed with sweeteners such as stevia/monkfruit, coconut milk/oil, cream, etc. Unlike gelatin, collagen hydrolysates will not gel or thicken liquids.

Collagen hydrolysates cause an increase in skin (and joint) hyaluronan, one of the polysaccharide components of many tissues that retains moisture and provides structure and lubrication. Hyaluronan supplementation can also provide modest skin benefits, though not as prominently as collagen hydrolysates. But hyaluronan is included in some combination nutritional supplement preparations and may add an additional benefit.


Carotenoids

Carotenoids are constituents of orange- or red-colored foods such as carrots, red peppers, and tomatoes and have been shown to provide modest protective effects against sun damage. Carotenoids are better viewed as nutrients that prevent UV-induced skin damage but not a food component or supplement that rebuilds collagen or other skin component as much as collagen hydrolysates.

Beta carotene, 30 mg per day (approximately the beta carotene content of two cups of cooked carrots), has been shown to provide a photoprotective effect and modestly increase skin collagen and reduce matrix metalloproteinase collagen breakdown. Interestingly, while this dose of beta carotene was beneficial, higher doses of 90 mg per day, had a paradoxic effect of increasing collagen breakdown.

Lycopene, the primary carotenoid of tomato, has also been shown to provide skin protection. For example, 2 1/4 tablespoons (40 g) of tomato paste (that concentrates lycopene and makes it more bioavailable compared to tomato sauce or whole tomatoes) that provides 16 mg of lycopene ingested daily for 10 weeks reduced skin redness on UV exposure by 40%.

Astaxanthin, zeaxanthin, and lutein are other carotenoids that occur in food, though less commonly than beta carotene and lycopene. Astaxanthin is the pigment contained in shrimp, crabs, lobsters, salmon, and some species of algae. Zeaxanthin is found in red peppers, corn, paprika, and green leafy vegetables such as kale and spinach. Rich sources include orange pepper with 1700 mcg per cup; raw spinach with 185 mcg per cup; collard greens with 170 mcg per 1 cup cooked; Romaine lettuce with 104 mcg per cup. Higher quantities of zeaxanthin are available in nutritional supplement form. Lutein is found in green vegetables and yellow-pigmented animal products such as egg yolks and chicken fat.

Astaxanthin doses have ranged widely in clinical studies, from 1 mg per day to 40 mg per day, though most studies have used 6-12 mg. Note that astaxanthin is not a necessary nutrient and not generally obtained through the diet in any substantial amount. Astaxanthin is the carotenoid found in krill oil supplements (though do not rely on krill oil as a source for omega-3 fatty acids, as the quantity contained is too small). Lutein doses used are typically 3-10 mg per day. Zeaxanthin effects occur at 2 to 2.5 mg (2000 to 2500 mcg) per day. (Lutein and zeaxanthin have also been shown to reduce potential for the eye conditions, macular degeneration and cataracts.)

Comparisons among the carotenoids have not been sufficiently explored. At the very least, it is beneficial for overall health to obtain plentiful quantities of deeply-colored vegetables for their carotenoid content such as tomato products, green leafy vegetables, peppers, carrots, small servings of sweet potatoes (watch the carbs), Brussels sprouts, turnip greens.

The evidence for zeaxanthin as a skin health supplement are among the most robust. While providing protection against UV wavelengths, as do omega-3 fatty acids and vitamin D, zeaxanthin also provides protection against blue wavelengths that are believed to be associated with full thickness skin photo aging (as compared to the superficial aging effects of UVB), as well as protection against deterioration of vision and macular degeneration. When taken orally over 12 weeks, 0.6 mg (600 mcg) zeaxanthin combined with 10 mg of lutein doubled skin moisture content, increased elasticity, reduced inflammation, and increased skin lipid (fat) content four-fold. Women taking oral zeaxanthin (without lutein) experience increased skin smoothness, reduced redness, and increased suppleness.

Should you choose a carotenoid nutritional supplement, it is not necessary to obtain all of the above carotenoids, but more practical to choose a strategy and obtain one or more carotenoids consistently, e.g., make tomato products a frequent component of diet along with a beta carotene or astaxanthin supplement. However, anecdotally, we have observed the most dramatic effects with supplementation of zeaxanthin, 2.5 mg per day, as provided in the Bend Anti-Aging supplement listed below in Resources. People with concerns over their risk for macular degeneration may want to choose a supplement that provides lutein and zeaxanthin to obtain the eye health benefits.

Note that, for all carotenoids, ingestion with food, especially fats/oils, improves absorption substantially. For example, consuming tomato products such as salsas, tomato sauce, or salad dressings or homemade ketchup made from tomato paste along with plentiful olive oil substantially enhances lycopene absorption.


Bioflavonoids/Proanthocyanidins and Pycnogenol

This strategy is most useful for reduction of “age spots” and mottling, less useful for skin smoothness and elasticity.

Like carotenoids, bioflavonoids are another component of many foods such as green tea, vegetables, and fruit that have been shown to exert modest benefits on cardiovascular risk, weight loss, and blood sugar. This strategy yields benefits presumably because modern foods such as iceberg lettuce and greenhouse-raised/commercially-produced vegetables have reduced flavonoid content compared to wild or organic, naturally-raised counterparts. However, most studies examining the use of bioflavonoids, either topical or oral, for skin health have yielded small to no effect. Green tea extracts, for example, both topically and orally, yielded a small increase in structural tissue but no visible changes in skin health.

Pine bark extract, or pycnogenol, is the exception, as it contains a highly-concentrated form of bioflavonoids called oligometric proanthocyanidins, a class of compounds found in deeply-colored foods such as grapes, cranberries, cocoa beans and wine. Several studies have demonstrated reduction of “age spots” or “liver spots,” called solar lentigines, with oral doses of pine bark extract of 40-100 mg per day. Visible reduction in spots and skin smoothness begins at 4 weeks and continues for as long as studies have tracked results, 18-24 months. Additional studies have demonstrated that pine bark extract modestly reduces matrix metalloproteinase activity, increases skin elasticity, and increases collagen. However, not everyone experiences benefit with less than half of people experience improvements in age spots over 18 months, as few as 20% experience decreased roughness and wrinkles. Pine bark extract has also been shown to reduce blood sugar/HbA1c, blood pressure, and LDL cholesterol, as well as discomfort associated with menstrual cycles.


Progesterone

Progesterone is the one health strategy that cannot be managed without the involvement of a healthcare provider. We discuss it here, however, because it can be an important component of an overall health strategy that also benefits skin health and appearance.

Progesterone levels decline in females starting in their late 30s and into their 40s and 50s, a phenomenon that is associated with declining energy, disruption of sleep, and accelerated skin aging. Progesterone replacement is therefore a widely used strategy to counter these effects. Unlike estrogen replacement alone that can be associated with undesirable health consequences (such as endometrial hyperplasia, or abnormal growth of uterine lining tissue), progesterone replacement has not been associated with any adverse effects except mild headache and resumption of uterine bleeding.

Progesterone replacement has been shown to increase skin firmness and elasticity while reducing the prominence of wrinkles, including reducing the depth of the nasolabial folds that extend along the sides of the nose and mouth, though without change in skin moisture or fat content. There is debate regarding the absorbability of various preparations of progesterone, but with evidence suggesting that absorption is best gauged using salivary, rather than serum, blood, or urine levels.

Progesterone is best administered by a healthcare provider familiar with the use and individualization of bioidentical hormones. Because most primary care and gynecologists are only familiar with drugs provided by the pharmaceutical industry and typically prescribe them in a one-size-fits-all manner, finding a savvy practitioner to work with and assess your individual needs is essential. Compounding pharmacies can provide both topical and oral preparations that can be tailored to your healthcare practitioner’s prescription.


Lactobacillus reuteri Yogurt

Among the many fascinating benefits of consuming Lactobacillus reuteri yogurt is an explosion in dermal collagen.

Collagen is the structural protein that provides skin with sturdiness, flexibility, and smoothness. You can see the effects of plentiful dermal collagen in the skin of babies, children, and young people: thick, moist, smooth, supple. Pinch the skin on a young person and it springs back. This is largely due to plentiful collagen.

As we age, we lose collagen in the dermal layer of skin just beneath the surface. The process is accelerated by excessive sun exposure. You have surely seen this in people who have enjoyed excessive tanning: accelerated skin thinning, fine wrinkles, amounting to premature aging of the skin due to loss of collagen. Even without sun damage, you can eventually see this on everyone’s face as thinned skin, loss of moisture, loss of suppleness when pinched, along with fine wrinkles such as “crow’s feet” around the eyes and mouth.

You can reverse the process and increase dermal collagen that thereby increases skin thickness and reduces wrinkles. One method is to apply topical retinoids that provoke collagen production in the area to which it is applied. Another option: Supplement collagen hydrolysates that, over a long time period measured in months to years, increase dermal collagen modestly throughout the body, facial skin included. Yet another, exceptionally powerful, option: Provoke oxytocin release from the hypothalamus that, in turn:

• Triggers a huge increase in dermal collagen, far greater than that provoked by collagen hydrolysates
• Increases overall skin thickness
• Increases production of sebum, the skin lubricant that makes the skin moist and waterproof
• Accelerates skin healing—with more assured scar formation richer in collagen with less inflammation (accelerated clearance of inflammatory neutrophils and accelerated entry of CD4+ immune-mediating lymphocytes)

Interestingly, higher oxytocin levels also accelerate growth of hair, fingernails and toenails, as well as moister hair, given the increased sebum production.

We trigger increased oxytocin release by consuming Lactobacillus reuteri yogurt. Unlike something like retinoid creams that yield greater collagen to the area applied and nothing more, the increased collagen that results from boosting oxytocin is a body-wide process. It means that there is greater collagen deposition in the skin of the neck, scalp, arms, chest, back, legs.

We are indeed witnessing these effects on the faces of people consuming L. reuteri yogurt: reduced fine lines around the eyes and mouth, moister skin, etc. with effects that typically become noticeable within 4-8 weeks. (Be sure to take “before/after” selfies, as the day-to-day changes are modest, more noticeable over longer time periods.) And, of course, boosting oxytocin with L. reuteri yogurt also restores youthful muscle mass and strength, preserves bone density, increases libido, boosts testosterone in males, reduces appetite, circumvents the adverse effects of high cortisol and leptin resistance, enhances immune responses, provides upper gastrointestinal tract probiotic properties (unlike virtually all other probiotic organisms), and cultivates feelings of empathy and connectedness. Recall that L. reuteri is a component of the human microbiome that modern people have largely lost, now present in about 5% of people despite being present in the majority up until recent times. We are therefore restoring a lost bacterial species that is providing some astounding health effects, including winding back the clock on skin aging.

While speculative, it is likely that combining L. reuteri yogurt with collagen hydrolysates yields a synergistic effect on increasing skin collagen and smoothness. To therefore stack the odds in favor of reducing wrinkle depth and enjoying smoother, moister skin, incorporate both strategies into your daily routine.



Resources:

Collagen hydrolysates and gelatin

Great Lakes Gelatin
www.greatlakesgelatin.com
Great Lakes Gelatin is an excellent source with collagen/gelatin sourced from pasture-raised livestock.

Bend Beauty
www.bendbeauty.com
Bend provides a fish-sourced form of collagen hydrolysates, 4.5 grams per tablespoon. It is naturally strawberry flavored. Be aware that there is a very small quantity of maltodextrin contained.

Carotenoids

Zeaxanthin
The Bend Beauty Anti-Aging product provides 2.5 mg zeaxanthin per teaspoon, along with a substantial quantity of omega-3 fatty acids, EPA + DHA, in the better absorbed triglyceride form, and 5 mg of lutein.

There are numerous suppliers of carotenoid supplements as beta carotene, lycopene, astaxanthin, and zeaxanthin.

NOW Brand Lutein & Zeaxanthin
Contains 25 mg lutein, 5 mg zeaxanthin in an oil-based gelcap for enhanced absorption.

Vitacost Lutein with Zeaxanthin
Contains 40 mg lutein, 1.6 mg zeaxanthin in an oil-based gelcap for enhanced absorption.

Pycnogenol

NOW brand pycnogenol
The NOW brand contains 240 mg of pycnogenol and 100 mg of green tea extract with no undesirable ingredients.

Natrol Pycnogenol
There are only 50 mg pycnogenol per capsule, so two capsules per day are required for full effect.


Selected references:

Photoaging, skin collagen, and matrix metalloproteinases Fisher GJ, Wang ZQ, Datta SC et al. Pathophysiology of premature skin aging induced by ultraviolet light. N Engl J Med 1997 Nov 13;337(20):1419-28.

Fisher GJ, Varani, Voorhees JJ. Looking older: fibroblast collapse and therapeutic implications. Arch Dermatol 2008 May;144(5):666-72.

Vitamin D and skin health Dixon KM, Deo SS, Wong G et al.Skin cancer prevention: a possible role of 1,25dihydroxyvitamin D3 and its analogs. J Steroid Biochem Mol Biol 2005 Oct;97(1-2):137-43.

Gordon-Thomson C, Tongkao-on W, Song EJ et al. Protection from ultraviolet damage and photocarcinogenesis by vitamin D compounds. Adv Exp Med Biol 2014;810:303-28.

Reichrath J, Reichrath S. Sunlight, vitamin D and malignant melanoma: an update. Adv Exp Med Biol 2014;810:390-405.

Collagen hydrolysates Chiang TI, Chang IC, Lee HH et al. Amelioration of estrogen deficiency-induced obesity by collagen hydrolysate. Int J Med Sci 2016 Oct 19;13(11):853-57.

Oba C, Ito K, Ichikawa S et al. Effect of orally administered collagen hydrolysate on gene expression profiles in mouse skin: a DNA microarray analysis. Physiol Genomics 2015 Aug;47(8):355-63.

Proksch E, Schunck M, Zague V et al. Oral intake of specific bioactive collagen peptides reduces skin wrinkles and increases dermal matrix synthesis. Skin Pharmacol Physiol 2014;27(3):113-9.

Zague V, de Freitas V, da Costa Rosa M et al. Collagen hydrolysate intake increases skin collagen expression and suppresses matrix metalloproteinase 2 activity. J Med Food 2011 Jun;14(6):618-24.

Zdzieblik D, Oesser S, Baumstark MW et al. Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: a randomised controlled trial. Br J Nutr 2015 Oct 28;114(8):1237-45.

Carotenoids

Cho S, Lee DH, Won CH et al. Differential effects of low-dose and high-dose beta-carotene supplementation on the signs of photoaging and type I procollagen gene expression in human skin in vivo. Dermatology 2010;221(2):160-71.

Juturu V, Bowman JP, Deshpande J. Overall skin tone and skin-lightening-improving effects with oral supplementation of lutein and zeaxanthin isomers: a double-blind, placebo-controlled clinical trial. Clin Cosmet Investig Dermatol 2016 Oct 7;9:325-32.

Kopcke W, Krutmann J. Protection from sunburn with beta-Carotene--a meta-analysis. Photochem Photobiol 2008 Mar-Apr;84(2):284-8.

Stahl, W, Sies H. Photoprotection by dietary carotenoids: concept, mechanisms, evidence and future development. Mol Nutr Food Res 2012 Feb;56(2):287-95.

Stahl W, Heinrich U, Wiseman S et al. Dietary tomato paste protects against ultraviolet light-induced erythema in humans. J Nutr 2001 May;131(5):1449-51.

Suanuma K, Nakajima H, Ohtsuki M, Imokawa G. Astaxanthin attenuates the UVA-induced up-regulation of matrix-metalloproteinase-1 and skin fibroblast elastase in human dermal fibroblasts. J Dermatol Sci 2010 May;58(2):136-42.

Yoon HS, Cho HH, Cho S et al. Supplementating with dietary astaxanthin combined with collagen hydrolysate improves facial elasticity and decreases matrix metalloproteinase-1 and -12 expression: a comparative study with placebo. J Med Food 2014 Jul;17(7):810-6.

Bioflavonoids/proanthocyanidins and pycnogenol

Chiu AE, Chan JL, Kern DG et al. Double-blinded, placebo-controlled trial of green tea extracts in the clinical and histologic appearance of photoaging skin. Dermatol Surg 2005;31(7 Pt 2):855-60.

Grimm T, Schafer A, Hogger P. Antioxidant activity and inhibition of matrix metalloproteinases by metabolites of maritime pine bark extract (pycnogenol). Free Radic Biol Med 2004 Mar 15;36(6):811-22.

Kohama T, Suzuki N, Ohno S, Inoue M. Analgesic efficacy of French maritime pine bark extract in dysmenorrhea: an open clinical trial. J Reprod Med 2004 Oct;49(10):828-32.

Zibadi S, Rohdewald PJ, Park D, Watson RR. Reduction of cardiovascular risk factors in subjects with type 2 diabetes by Pycnogenol supplementation. Nutr Res 2008 May;28(5):315-20.

Progesterone

Du JY, Sanchez P, Kim L et al. Percutaneous progesterone delivery via cream or gel application in postmenopausal women: a randomized cross-over study of progesterone levels in serum, whole blood, saliva, and capillary blood. Menopause 2013 Nov;20(11):1169-75.

Holzer G, Riegler E, Honigsmann H et al. Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study. Br J Dermatol 2005 Sep;153(3):626-34.

O’Leary P, Feddema P, Chan K et al. Salivary, but not serum or urinary levels of progesterone are elevated after topical application of progesterone cream to pre-and postmenopausal women. Clin Endocrinol (Oxf.) 2000 Nov;53(5):615-20.

Plu-Bureau G, Le MG, Thalabard JC et al. Percutaneous progesterone use and risk of breast cancer: results from a French cohort study of premenopausal women with benign breast disease. Cancer Detect Prev 1999;23(4):290-6.

Ruiz AD, Daniels KR. The effectiveness of sublingual and topical compounded bioidentical hormone replacement therapy in postmenopausal women: an observational cohort study. Int J Pharm Compd 2014 Jan-Feb;18(1):70-7.

Stanczyk FZ, Paulson RJ, Roy S. Percutaneous administration of progesterone: blood levels and endometrial protection. Menopause 2005 Mar;12(2):232-7.

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