The science to prove claims that oral supplements help reduce the signs of skin aging is lacking. But one dermatologist says she believes that supplementing with specific vitamins, oils and other nutrients plays an important role in anti-aging treatments - especially when patients do not get enough of these nutrients in their diets.
"I think oral supplements are even more important than topicals for aging skin, because they help not just to revitalize skin, but also the heart, lungs, brain - even the eyes," says Leslie Baumann, M.D., a Miami Beach, Fla., dermatologist and author of the textbook Cosmetic Dermatology (McGraw Hill 2009).
The challenge for dermatologists recommending them is that there is no evidence-based protocol for taking antioxidants, fish oil and more. Basic science research, according to Dr. Baumann, offers some insight, suggesting that telomere shortening plays a role in aging and that antioxidants may benefit telomeres. Telomeres are regions of repetitive DNA at the end of chromosomes, which protect chromosomes from destruction.
It is unclear whether the antioxidants that seem so crucial in an anti-aging diet, such as blueberries and pomegranates, can be effectively replicated in pill form. Dr. Baumann says, however, that she recommends certain antioxidant vitamins to patients whose diets fall short.
"What we know is antioxidants will reduce inflammation, reduce free radicals and may stop pigment formation (there is actually some data in the melasma world that taking antioxidants may help prevent pigmentation by chelating copper needed by tyrosinase). There are a lot of good reasons to take antioxidants and there are no bad reasons," she says.
After talking with patients about their diets, Dr. Baumann considers whether to recommend supplementation with vitamins E, C, coenzyme Q10 (CoQ10) and more.
When she does decide that antioxidant supplementation would help in a patient's anti-aging regimen, Dr. Baumann often recommends OPC Synergy (Standard Process). The dermatologist, who says she does not have financial interests in Standard Process, likes the way the company uses whole food to produce its antioxidant vitamin.
She also, at times, recommends that patients take CoQ10, which is a fat-soluble, vitamin-like substance. Studies suggest that CoQ10 might improve mitochondrial and antioxidant support, which makes it a likely candidate in anti-aging supplementation for those whose levels could be low, Dr. Baumann says.
"Studies suggest that people who are on statin drugs… have lower CoQ10 levels than those who are not on statins. There also is early research suggesting that people who have melanoma and have low CoQ10 levels metastasize more than people with high levels," Dr. Baumann says. "I put my patients on CoQ10, orally, if they are on statins."
Omega 3s are known for their anti-inflammatory properties.
"Many people believe that inflammation plays a role in aging, especially in heart disease. The American diet includes too much omega 6 fatty acid, so, it seems we need to increase our omega 3s to make up for diets rich in omega 6s," Dr. Baumann says.
Patients who get abundant omega 3s in their diets - for example, those who eat salmon or other omega 3-rich fish several times a week - do not need supplementation, Dr. Baumann says. She will recommend it, however, for patients who have the typical meat-and-potatoes American diet.
One word of warning: omega 3 can thin the blood and result in increased bruising from cosmetic procedures. Dermatologists should tell their patients to stop using the supplement two weeks prior to any surgical or filler procedure, she says.
Alpha-linoleic acid is an omega 6 fatty acid, or an essential fatty acid. The body does not make it on its own, according to Dr. Baumann, so people need to get it from external sources, such as food, topically or by supplementation.
"We need alpha-linoleic acid to make ceramides. Ceramides are important for the skin being able to hold in water," she says. "Sunflower and grape seed oil and other oils have alpha-linoleic acid and antioxidants. You can get linoleic acid as a supplement, as well."
Notes about resveratrol
Resveratrol, a phytoalexin found in red grape skin, is controversial but a promising addition to anti-aging regimens, according to Dr. Baumann. Researchers, she says, have found that resveratrol activates the enzyme sirtuin 1 (SIRT1), a protein marker associated with slowed aging.
"The problem is that the supplements that are currently on the market don't have enough resveratrol in them, but pharmaceutical companies are working on coming out with high-dose resveratrol," she says. Red wine is a good source of resveratrol.
Dr. Baumann often recommends that patients who get sun exposure take Polypodium leucotomos, which is essentially sunscreen in pill form, in addition to applying sunscreen. SunPill (XenaCare Holdings) manufactures a supplement with this extract of a South American fern.
"I am a golfer and it makes a huge difference in the sun exposure that I get on the course," Dr. Baumann says.
Some vitamins are better taken by mouth; others are better used topically.
"Stomach acid breaks a lot of things down. Sometimes that is a good thing; sometimes that is a bad thing - depending on absorption mechanics. Some things need a lower pH, or more acidity, to absorb, and those would be better going through your stomach," she says.
CoQ10 has been shown to absorb better in its topical form than when taken as a supplement, while vitamin C is more efficiently delivered by mouth. Oils and vitamin E supplementation seem equally effective whether taken orally or topically, according to Dr. Baumann.
"The main message here is that vitamins, as supplements, are not necessary if somebody has a really good, well-rounded diet. The problem is that most of us do not," Dr. Baumann says.
Disclosures: Dr. Baumann is an investigator for Ferrosan and a member of the advisory board for L'Oréal.