Recently, the cases of nutrition-related health disorders have risen substantially, making gastrointestinal disorders—such as celiac disease, irritable bowel syndrome and Crohn’s disease—and inflammatory skin conditions—such as eczema, psoriasis, acne and rosacea—commonplace.
It is often implied that these disorders are correlated, with digestive dysfunction and nutrient imbalances, and invariably may present unsatisfactory responses to traditional treatments due to this. The prospects of genetically modified and irradiated food, along with the depletion of mineral-laden nutrients that were once present in soil, also contribute to the state of nutritional imbalances and deficiencies. The controversies surrounding nutrient deficits and health steadily mount as the world’s population continues to grow.
Worldwide, two billion people are affected by micronutrient deficiencies, including vitamins A, C, E and the minerals zinc, iron and iodine. The effects include poor growth, impaired intellect, increased mortality and susceptibility to infection. Micronutrients have a relationship to antibody formation and the development of the immune system. These ill effects are preventable by supplements, fortification and diet change.1
In regard to nutrition, a common doctrine exists among health care professionals: balance, consistency and quantity. Consuming food properly is a balancing act, and the recommendations for sustainable nutrition are generalized. Many nutrition protocols today are adapted to individual needs based on detected deficiencies though laboratory evaluation, symptoms, age, height, weight and medical conditions. Nutritional science has many facets that include vital biochemical and functional processes that the body requires to assimilate nutrients.
Bioavailability. Bioavailability is an essential transportation method for delivering nutrients that include the availability, absorption, retention and utilization of nutrients consumed. Largely, it refers to the proportion of a nutrient that is absorbed from the diet and used for normal body functions.2, 3 How those nutrients are delivered has consequential effects—including nourishment of the skin.
All vitamins and minerals vary in size, quantity and function. Nutrients feature active transports, or “viaducts,” that extrude the vitamin or mineral through the intestinal wall into the body where it may be directly released or connected to other molecules. (See Figure 1: Detail of the small intestine.) Absorption becomes a very specific task, because all nutrient exchanges require a great deal of energy for transport.
Malabsorption. Malabsorption is a widespread health condition that involves the inability of the body to completely absorb nutrients into the small intestines and is often concurrent with several gastrointestinal conditions. Medications, parasites, viruses, diabetes and other disorders can affect intestinal absorption. If a particular disorder disrupts the digestion of food or restricts nutrient uptake, the consequence is the malabsorption of nutrients.
Diffusion. Diffusion occurs throughout the body via the bloodstream and, without it, cells are void of nutrients. As a nutrient encircles a famished cell, the nutrient remains inside a blood vessel, whereas the cell itself is positioned outside. Spaces surrounding the cell and blood vessel create a concentration gradient instigating a transfer to diffuse the nutrient through the blood vessel wall and allow it to pass into the cell.
Perfusion. Perfusion refers to blood flow, and is the mechanism with which blood provides nutrients and removes cellular waste. Inadequate perfusion creates depleted oxygen, compromising the vitality of the tissue. The rate of blood flow through the skin is influenced by body temperature based on internal metabolism and external temperature. The epidermis is dependent on nutrients, water and oxygen transport via the dermis. If nutrients are lacking in the dermis, the skin cells will be undernourished.
Enzymes, flora and nutrient absorption. Enzymes are composed of amino acids and are released by the body to help catalyze many vital functions, including digestion, assimilation and absorption of food. More than 3,000 different enzymes have been identified, each having a specific task to build and rebuild the body—including energy production, absorption of oxygen and cellular nutrient transport.
Integumentary nutritional prerequisites
“Much of the role of nutrition in skin health focuses on the effects of deficiency, since the structural components of the skin are supported by a variety of nutritive factors, such as peptides, minerals and vitamins, which serve as enzyme cofactors, activators or inhibitors,” according to the Linus Pauling Institute—Micronutrient Research For Optimum Health at Oregon State University in Corvallis, Oregon.2
Nutritional support of the skin is dependent on the following to facilitate and utilize nutrients.
- A viable support network of connective tissue, collagen and elastin.
- Adequate circulation and vascular integrity of the dermis.
- Cellular hydration and a healthy framework of the epidermis, including lipid functionality and transepidermal water loss (TEWL) ratios.
- Skin immune response and antioxidant potential for free-radical protection.
Carbohydrates. The primary fuel for skin cells, glucose, is obtained from carbohydrates and is considered the backbone structure utilized to process proteins and lipids contained in the extracellular epidermis.2 Consuming excessive sugar and carbohydrates can drastically affect blood-sugar levels by rapidly breaking down glucose, creating proinflammatory enzymes and developing glycosylates that result in glycation. Glycation is detrimental to the skin, because it develops advanced glycation end products (AGEs) that accelerate the aging process, and have far-reaching implications throughout the entire body.4
Another adverse effect of excessive carbohydrate consumption is the role it plays in the potential development of acne, due to a rise in insulin levels and insulin-like growth factor 1 (IGF-1) hormones, which may prompt estrogenic activity. Individuals with acne generally show an increase of the 5-alpha reductase deficiency for steroid metabolism, resulting in the aggressive development of androgen hormones, encouraging increased sebum production and hyperkeratolytic disorders.5
The 5-alpha reductase enzyme is converted through testosterone by isoenzymes. Isoenzymes are enzyme variants from normal sequencing; however, they may catalyze the same reaction. The result is the development of a more aggressive testosterone called dihydrotestosterone (DHT). DHT fuels the development of sebum and hyperkeratinization, leading to the development of acne. Studies have proposed that the increase of protein in the diet may reduce the activity of DHT and 5-alpha reductase.6, 7
Essential fatty acids (EFAs). A deficiency of EFA intake can produce severe cutaneous abnormalities, according to recent research, which has shown that abnormalities in EFA metabolism may play a role in atopic eczema, acne and psoriasis.8 Perhaps one of the most crucial factors in sustaining the health of the skin is the consumption and distribution of lipids and nutritive oils. According to Alexander Michels, PhD, of the Linus Pauling Institute: “Lipids, such as sterols and ceramides, are required for the development of the stratum corneum and are synthesized in the epidermis from amino acids, carbohydrates and phospholipids. Keratinocytes also utilize extruded fatty acids from fats that make up the mortar of the stratum corneum.”2
One of the most prolific testaments to optimum nutrition and its correlation to skin health was the research presented by Nicholas Perricone, MD, in his book The Wrinkle Cure (Grand Central Publishing, 2005), which praised the virtues of consuming omega-3 fatty acids. Although the thrust of the public’s awareness of EFAs—in particular omega-3s—is primarily centered on supplements, the quality of EFA nutrients resides in food sources for optimum bioavailability. Omega-3 fatty acids are unique in their chemical structure, because they feature double bonds that permit them to be flexible and interactive as fatty acids. It is important to note that the quality of omega-3 fatty acids is crucial, due to the fact that they are susceptible to free-radical damage through oxidation. In the case in consuming all types of fats—freshness and quality must take precedence. (See Common Essential Fatty Acids.)
Water and electrolytes. Water is considered the most important nutrient for the body because it:
- Assists in maintaining healthy metabolism;
- Lubricates organs and cells;
- Assists in thermoregulation, blood pressure and heart rate; and
- Is vital to the functionality of the skin and TEWL.
Electrolytes are catalysts required for the maintenance and repair of all tissue, and to enable the body to manufacture enzymes that assist in the digestion of food. They are considered the foundation of every physical and neurological function, and include calcium, chloride, magnesium, potassium and sodium. In the case of dehydration, the body is less likely to use nutrients from food and vitamins, as bioavailability is compromised.
Amino acids and proteins. Amino acids are essential for the production of both dermal and epidermal structures, because they produce the extracellular matrix proteins and enzymes needed for the synthesis of the epidermal barrier.2
The skin is dependent on a balanced ratio of amino acids—the structural makeup of protein. Without amino acids, protein molecules and the complex matrix of amino acids will not fabricate collagen. It is necessary for dietary protein sources to offer sufficient quality and quantity in order to provide adequate amounts of these elements.
Skin signs—nutrient deficiencies and antagonists
The following information has been correlated to nutrient deficiencies and skin problems. This information is not meant to diagnose, treat or cure any disease, or imply specific dietary recommendations. Work with the client’s physician to help identify possible causes and problematic behaviors that might be resulting in these skin concerns.
Acne. If a client is experiencing acne, nutritional deficiencies may include biotin; EFAs; niacin; potassium; vitamins A, E, B-2, B-6, C and K-2; and zinc. Potential antagonists to these deficiencies may include consuming excessive amounts of carbohydrates, carbonated drinks, dairy, iodine, organ meat, red meat, shellfish, sugar and wheat.
Eczema. Nutritional deficiencies that may be present for those with eczema include EFAs; folic acid; GLAs; iron; magnesium; selenium, vitamins A, B-2, B-6 and C; and zinc. Potential antagonists of these deficiencies may include alcohol, artificial food coloring, coffee, dairy, eggs, iodine, a low-fat diet, low hydrochloric acid, a low-protein diet, monosodium glutamate, nuts, red meat, shellfish, soy, sugar, sulfites, tea, white flour and baked goods.
Keratosis pilaris. Those who have keratosis pilaris may have nutritional deficiencies of EFAs, and vitamins A and K-2. Potential antagonists could be the body’s faulty conversion of beta carotene to vitamin A, hot showers, and high pH soaps and detergents.
Psoriasis. Nutrient deficiencies for those experiencing psoriasis may include EFAs; gamma linoleic acids (GLAs); vitamins A and B-12; and zinc. Potential antagonists for these deficiencies may include consumption of citrus fruits, chocolate, copper, corn, dairy, fried food, nuts, red meat, shellfish, soy and wheat.
Rosacea and inflammation. Clients who suffer from rosacea and skin inflammation may have nutritional deficiencies including EFAs, hydrochloric acid and malabsorption of B vitamins. A potential antagonist may be erythema, which could indicate a delayed allergy to a variety of foods.
A professional alliance
The esthetician’s scope of practice involves educating clients in regard to the principals of healthy skin, and the fundamental concepts of nutrition for maintaining general health and well-being. The specific recommendation of nutritional supplements, nutrition or dietary recommendations should be deferred to a physician, nutritional practitioner or licensed nutritionist. The professional alliance of the esthetician and the health practitioner together can support the client in combating problematic skin conditions, and addressing concerns related to nutritional imbalances for the common goal of attaining optimum health and skin vitality.
(All websites accessed Sep 5, 2014)
ER Braverman and CC Pfeiffer, The Healing Nutrients Within, Keats Publishing, New Canaan, CT (1987)
www.ncbi.nlm.nih.gov/pubmed/20200266 (Accessed Sep 5, 2014)
PA Balch, Prescription for Nutritional Healing, Fifth Edition: A Practical A-to-Z Reference to Drug-Free Remedies Using Vitamins, Minerals, Herbs & Food Supplements, Avery Trade, New York, NY (2010)
PA Balch, Prescription for Dietary Wellness, Avery Trade, New York, NY (2003)
SS Hendler and D Rorvik, PDR for Nutritional Supplements, PDR Network, Montvale, NJ (2008)
Erin Madigan-Fleck is a licensed esthetic instructor and esthetician with more than 30 years of experience in the esthetic and wellness industries She is a nationally certified natural health professional and holds a doctorate degree in naturopathic medicine. She is an educator at Institut’ DERMed College of Advanced Aesthetics in Atlanta.