A man wiping his acne with a facial pad

Skin Health Nutrition

A man wiping his acne with a facial pad

 

A lot of people probably take their skin for granted.

 

Because they see it every day, many don’t give much attention to it except when there’s a problem.

 

Your skin is your body’s largest organ and, like any other body part, needs optimal nutrition to be its best both functionally and in appearance. Healthy functioning skin is also healthy-looking skin.

 

You might feel that worrying about skin and skincare is a woman’s ‘thing’ [although tell that to my dad who had 2 bouts of skin cancer] but it’s really just about health.

 

People will gladly accept the idea of eating a healthy diet and exercise to “love their heart” or to reduce their risk for dementia but a healthy lifestyle also applies to your skin as well.

 

When skin is healthy it not only looks good but works well too. Your skin’s primary role is to be a physical barrier to the outside world; protecting you from microbes, bacteria, etc. To learn more, click here.

 

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Your skin

Skin has three layers – all in need of nutritional support:

  • The epidermis: the outermost layer of skin. It provides a waterproof barrier and it creates your skin tone.
  • The dermis: beneath the epidermis. It contains tough connective tissue, hair follicles, and sweat glands.
  • The deeper subcutaneous tissue (hypodermis) is also made of connective tissue and fat.

Cross section of skin anatomy including epidermis, dermis and subcutaneous tissue

Skin conditions

Skin conditions like pimples and acne are not just for kids. People of all ages can be affected by them.

 

But it’s not just pimples that we have to contend with when it comes to our skin health. Other common skin conditions include:

  • Rosacea
  • Dry skin
  • Wrinkles
  • Eczema
  • Keratosis pilaris
  • Sunburn
  • Hives & rashes
  • Psoriasis
  • Vitiligo
  • Dermatitis herpetiformis (related to gluten intolerance and celiac disease)

As you can imagine, it can be very upsetting for anyone dealing with these kinds of conditions, especially if they haven’t found a solution. There’s nothing shallow about admitting that we all want to look good, e.g. be healthy-looking, and a poor complexion can affect our self-esteem. It’s just part of being human :).

 

Sadly, conventional medical wisdom dictates that there is no real connection between skin health, including appearance, and nutrition.

 

Curious.

 

Medical treatments are always topical such as lotions, steroid creams, lasers, nitrogen or peels. It’s true, these treatments are very effective where indicated but that doesn’t replace the role of nutrition when it comes to skin health.

 

Skin disease word cloud

 

Luckily there’s no shortage of solid research to the contrary. Nutrition, the food we eat, provides the very nutrients needed for the repair and maintenance of skin. As well, nutrition has a profound impact on blood sugar regulation and other hormones all of which impact your skin.

 

Several nutrients are needed for both the repair and maintenance of all 3 layers of your skin. No surprise there.

 

Also, nutrition plays a role in tempering the immune response which helps to lower inflammation and the subsequent reddening of the skin that’s seen with certain conditions, as well as, controlling outbreaks.

 

Undiagnosed food allergies, sensitivities, gluten intolerance or celiac disease also wreak havoc on the skin.  In fact, 80-90% of those with celiac disease are undiagnosed and dermatitis herpetiformis is a telltale sign of the disorder. This skin condition pictured below is often the first indication that something gut-related is lurking beneath the surface.

 

Dermatitis herpetiformis on the elbows

Photo credit

 

Nutrients of interest

While not exactly new news, what you eat and drink can significantly affect the health, appearance, and rate of aging of your skin. Vitamins, minerals, essential fatty acids, and other compounds all play a role. Eating nutrient-dense foods, and targeted supplementation is one of the most effective ways to treat skin conditions and at the very least, improve the look and feel of your skin.

 

FUN FACT: one of the first links between diet and skin health was with the discovery of vitamin B3 (niacin) deficiency a.k.a pellagra marked by “the three Ds”: dementia, diarrhea & dermatitis

 

It’s unfortunate that many doctors and dermatologists deny any real connection between diet and skin health. So many patients miss the opportunity to tweak their diet in order to make improvements in their skin. Below is a list of nutrients and foods that you can leverage to improve the health of your skin while boosting the effects of your current skincare routine!

Vitamin A

Probably the best-known vitamin for skin health. Vitamin A (“retinal” or “retinol”) is front and center when it comes to maintaining the health of the largest organ of your body.

 

Vitamin A promotes healthy skin cell turnover, whereby old skin cells slough off (think of shedding 🙂 ) and new ones take their place. Vitamin A also stimulates new skin cell replication/production (1, 2).

 

Retinol helps to control oil glands activity, as well as, suppressing excessive androgen (sex hormone) production thereby reducing the formation of acne (1, 2).

 

While excess oil production is bad, too little isn’t good either. Because one of vitamin A’s main role is to maintain balanced oil production, a common sign of vitamin A deficiency is rough, dry and/or keratinized and scaly skin. Raised bumps on the back of the arms [hyperkeratosis pillaris] can be due to functional vitamin A deficiency (3). Keratosis pilaris affects about 40% of adults (4).

Vitamin C

While they didn’t know it at the time, when vitamin C was found to prevent scurvy, vitamin C prevented people from literally bleeding to death internally.

 

Vitamin C is needed for the production of collagen, a protein that is found throughout your body. Collagen is the structural protein of blood vessels. When vitamin C is lacking (scurvy), the quality of the blood vessel collagen is compromised leading to leaky vessels; people effectively bled out.

 

Well, collagen isn’t just found in your blood vessels. It’s also found in your skin, and there’s a lot of it. Without enough vitamin C, collagen production will be affected and over time, will affect the appearance of your complexion. This is just one-way smoking accelerates skin aging; as an antioxidant, vitamin C is depleted.

Bell Peppers 300x200 - Skin Health Nutrition

But it’s not just vitamin A deficiency that is a risk factor for “bumpy skin”. Both functional and overt vitamin C deficiencies contribute to hyperkeratosis pillaris formation due to collagen-starved damaged follicles. Some studies have found that vitamin C contributes to improved skin health and better appearance with less skin wrinkling (5, 6).

 

Wrinkles form in part when the skin’s structural proteins, collagen, and elastin, breakdown resulting in folds and crevasses. Vitamin C ensures optimal collagen production helping to slow this wrinkle formation.

 

Vitamin C may help prevent and treat ultraviolet (UV)-induced photodamage because its a potent antioxidant (7).  Vitamin C is also crucial for proper wound healing including optimal scar tissue formation (8).

 

Higher intakes of dietary vitamin C have been correlated with a decreased level of dry skin, and ascorbic acid may have effects on trans-epidermal water loss. (5)

Vitamin K2

A new vitamin for most, vitamin K2 used to be easily found in our diets of yesteryear when livestock were fed on pasture. Vitamin K2 would show up in foods like milk, butter, cheese, eggs, and organ meats.

 

Due to modern farming practices, this important vitamin is largely missing in our diets. No need to panic about the quality of the foods mentioned above. They’re still nutritious and full of protein, and other vitamins and minerals; just not vitamin K2.

 

One of the health benefits of vitamin K2 not often discussed is its role in ensuring healthy skin, and this vitamin is likely beneficial for preventing wrinkling and premature aging.

 

Vitamin K2’s superpower is to keep calcium out of soft tissue, like your arteries and skin and putting it in your bones and teeth where calcium belongs (9, 10, 11). This is why bone disease tracks with vitamin K2 deficiency and bone diseases, like osteoporosis is associated with more wrinkles. Wrinkling, in turn, may predict bone density in menopause (12).

 

Adequate dietary vitamin K2 prevents calcification of your skin’s elastin, the structural protein that gives skin the ability to spring back, smoothing out lines and wrinkles (13).

 

This is because K2 is necessary for the activation of specialized proteins (matrix proteins) that inhibit calcium from being deposited in elastin fibers. By doing so, keeps these fibers from hardening and causing wrinkles. In fact, recent research suggests that people who cannot metabolize vitamin K end up with severe premature skin wrinkling. (14)

Omega-3 fats

In a nutshell, these fats are rock stars when it comes to reducing inflammation. They may also reduce the risk for acne by reducing insulin-like growth factor (IGF-1) which appears to increase the formation of acne (15, 16, 17, 18).

 

Higher intakes of omega 3 fats have been shown to reduce hyperkeratinization of the skin [follicles] (19). Omega-3 supplements have been shown to improve atopic dermatitis and psoriasis too, likely by tempering excessive arachidonic acid production; a pro-inflammatory derivative of omega-6 fatty acid metabolism (20).

 

Fillet of salmon with vegetables - by Doug Cook RD

 

Clinical results from omega-3 supplementation include an improvement in overall skin condition as well as a reduction in pruritis, scaling, and erythema. Omega-3 fatty acids have also been demonstrated to inhibit inflammation in the skin caused by UV radiation, and may even reduce the risk of skin cancer (21, 22, 23, 24).

 

Consuming foods rich in omega-3 fatty acids may lead to smoother, younger-looking skin with a visible reduction in inflammatory skin conditions like acne and psoriasis.

 

These fats are especially abundant in cold-water fatty fish such as sardines, salmon, mackerel, tuna, anchovies, etc. Whole foods provide all three omega-3s: EPA, DHA and the lesser appreciated DPA omega 3.

Selenium

Selenium might be best known for its anti-cancer properties including skin cancer.

 

It acts as an antioxidant and helps cells ‘talk’ to each other more efficiently reducing the risk for miscommunication that can lead to replication problems [i.e. cancer] (25).

 

Selenium is THE mineral needed by your cells to make the master antioxidant glutathione. Studies have shown that people with acne and other skin conditions have lower levels of both selenium and glutathione (and glutathione activity) (26, 27).

 

Studies have also found that selenium and vitamin E supplementation can improve the appearance of acne and increase levels of glutathione peroxidase in those with lower levels (28). Note, but not just any vitamin E supplement. Avoid those with only alpha-tocopherol, go for a high quality balanced one like AOR’s Total E.

Zinc

Zinc is a very versatile mineral that helps with protein synthesis including the supportive proteins of the skin (collagen and elastin).

 

It helps with wound healing, is anti-inflammatory, and is needed for a healthy and balanced immune system (28). A balanced immune system helps to reduce rashes, redness, and inflammation of the skin.

 

Zinc has been shown to help treat acne, as effectively as a commonly prescribed antibiotic, tetracycline (29) and appears to work with vitamin A to improve skin health. Getting enough zinc will increase your blood levels of vitamin A thereby supporting all three layers of your skin, a.k.a. synergy (31).

 

Lower levels of serum zinc have been found in both men and women with serious acne (32).

 

Pumpkin seeds 300x199 - Skin Health Nutrition

Vitamin E

A lot of confusion exists with vitamin E due to very poorly designed and talked about meta-analysis studies from the mid-2000s (33, 34, 35). None of these studies distinguish between naturally occurring alpha-tocopherol versus synthetic (and with vitamin E, it matters), nor did they consider or talk about what vitamin E really is: a family of 8 molecules and NOT just alpha-tocopherol.

 

It’s beyond the scope of this post but vitamin E, true vitamin E as it occurs in food or with a high-quality vitamin E supplement, can and does have many benefits, including skin health.

 

Vitamin E is the most abundant fat-soluble antioxidant in the skin. It’s found in the fat that makes up the skin cells and vitamin E is secreted on to the surface of the skin through the sebum (36).

 

It takes about 7 days for the vitamin E from food and supplements to make it’s way to the surface of the skin which is why getting a steady supply of vitamin E in your diet is crucial.

 

Vitamin E is a potent anti-inflammatory compound defending the skin against damage (37). Vitamin E works with selenium (mentioned above) to raise levels of glutathione (a potent antioxidant).

 

Vitamin E also balances the production of the essential fatty acid arachidonic acid which can aggravate inflammatory skin conditions such as atopic dermatitis and psoriasis (38, 39).

Carotenoids

Other considerations are the class of pseudo-nutrients called carotenoids or carotenes. Not technically nutrients in that they are essential for health like vitamins and minerals are but they are needed for optimal health; the difference between surviving and thriving.

 

Because they are fat-soluble, they safely accumulate throughout the skin which is why those who eat a beta-carotene rich diet can have a warm glow to their complexion. But it’s not just beta-carotene that offers skin health benefits.

 

The carotenoid beta-carotene enhances facial color, attractiveness, and perceived health, but not actual health, in humans

 

Carotenoids like beta and alpha-carotene, lutein and zeaxanthin, lycopene and astaxanthin have been shown to improve skin quality and reduce UV damage (40, 41).

 

Lycopene offers protection against the damaging effects of the sun (42, 43). Studies have shown that as little as 8-16 mg of lycopene (2.5 to 5.5 ounces of tomato juice) could reduce redness following exposure to UV rays by 40-50% (44). Supplements have worked too (45).

 

Similar skin improvement has been studied with lutein and zeaxanthin (46, 47, 48) and astaxanthin (49, 50, 51).

 

Kale leaves on a shovel on a wooden table

 

Foods for skin health

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Fatty fish

Fatty fish such as salmon, herring, mackerel, sardines, and trout are all excellent sources of the omega-3 fats EPA, DPA, and DHA. These fats are excellent for healthy skin (52). Other good sources include shellfish and seafood, omega-3 fortified eggs, as well as, supplements from sustainable sources (fish, calamari/squid, and algae).

Bell peppers

Bell peppers are one of the best sources of vitamin C which is necessary first and foremost for collagen production but vitamin C is also a potent antioxidant. One-cup of chopped bell peppers has 230 mg of vitamin C. Other good sources include kiwi fruit, guavas, strawberries, oranges, tomatoes, and papaya.

Liver

Liver of all kinds (beef, chicken, turkey, lamb, veal, etc) is the best source of vitamin A (retinal/retinol). Just three ounces (28.5 g) has 3000 to 16,000 IU of preformed vitamin A. A little goes a long way.

 

As mentioned, carotenes are not the same as vitamin A, so it’s best to include food sources of retinol/retinal.  Other good sources of vitamin A include cod liver oil, cream, butter, egg yolks, and fatty fish.

Oysters

By far, the best dietary source of zinc. Two and a half ounces (75 g) of farmed oysters have 33 mg of zinc. Wild Eastern oysters have 55 to 136 mg of zinc per two and a half ounces (75 g). Three ounces (85 g) of canned smoked oysters have a whopping 54 mg of skin-loving zinc.

 

Other sources of zinc include beef, dark meat poultry, lamb, oysters, pork, clams, mussels, scallops, and other seafood, liver, pumpkin seeds, lentils, and tempeh. Zinc can be part of a comprehensive supplement protocol in addition to good food sources. You can try here, here or here.

 

Oysters - Skin Health Nutrition

 

Dark green vegetables & dark leafy greens

Dark green vegetables and dark green leafy greens have a lot of skin-loving nutrients. They’re rich in beta-carotene, as well as, lutein and zeaxanthin.

 

Some dark orange vegetables (carrots, sweet potatoes, pumpkin, squash, etc) contain another skin-loving carotene called alpha-carotene. It’s best to get a vareity of both the green and the orange stuff.

 

If going for a lutein supplement, be sure it contains a good amount of zeaxanthin too like this one. Or even go for one with added astaxanthin for extra skin health-promoting benefits like this one or this one.

Tomato products

Tomatoes contain lycopene, one of the carotenoids mentioned above. All tomatoes are great but you’ll absorb heaps more lycopene from cooked tomatoes/tomato products such as tomato juice, paste, and sauce.

 

This goes for cooked fresh tomatoes too. If you simmer tomatoes for a stew or roast some cherry tomatoes, you’ll get more lycopene into your skin compared to raw tomatoes. Don’t take this to mean that raw tomatoes aren’t good, include both cooked and raw.

Aged cheeses

One of the easiest and tastiest ways to get your daily dose of vitamin K2. Go for ageda cheddars, Gouda, Emmental, Brie, or Jarlsberg for starters.

 

Other good sources include goose liver pate, butter from 100% grass-fed and finished cows, or the Japanese favourite, natto. Vitamin K2 supplements work like this one works well too. Or you can try here, here or here.

 

Soft and hard cheeses

Sunflower seeds

These humble seeds are a home run for vitamin E and selenium with a decent amount of zinc to boot. But with selenium in mind, other great sources are Brazil nuts, oysters, tuna, pork, beef, lamb, turkey, chicken, and crimini mushrooms.

Almonds & walnuts

Some of the best whole food sources of vitamin E are nuts and seeds. Almonds have lots of alpha-tocopherol whereas walnuts are richer in gamma-tocopherol.

 

These two nuts are a great staple to have on hand for skin health. Of course, other nuts and seeds shouldn’t be shunned. You can also use a highly-quality balanced supplement, taken every 3 days or so, like AOR’s Total E

Other considerations

Low glycemic load diet

Studies have shown that diets high in added sugars are predictive of overweight and obesity, as well as, insulin resistance leaky gut and inflammation (53).

 

Added sugars have been shown to increase markers of inflammation and insulin resistance (54).

 

Sugary drinks have been shown to be problematic. They can spike inflammation levels which remain elevated up to 2 hours afterward (R). Higher glycemic load diets, diets that are higher in carbohydrates, especially from refined carbs, are linked to increased inflammation too (55, 56, 57, 58, 59).

 

Glucose dysregulation can be further compounded if a diet is low in nutrients known to improve blood sugar and insulin metabolism such as vitamin D3, chromium, and magnesium.

 

Low carb diets such as LCHF, keto or those that are markedly lower in added sugars, total carbs and starches a.k.a. low glycemic load, have been shown to improve acne and other skin conditions (60, 61, 62).

Gut inflammation & leaky gut

Gut health has a huge impact on your overall health including your skin. While not fully defined, gut health is considered with the following in mind:

  • the health of the muscles in your digestive tract
  • having a strong immune system, most of which is found in your digestive tract
  • having a diverse, plentiful and robust bacteria population or microbiota
  • your gut’s nervous system (a.k.a the enteric or intrinsic nervous system)
  • having a functioning gut barrier; the divide between the contents of your digestive tract and your circulation

In general, a healthy gut is free from inflammation and its barrier, the gut lining, does its job keeping unwanted food proteins, viruses, bacteria, yeasts, and other toxins from entering your bloodstream.

 

If this delicate balance becomes disrupted, the resulting inflammation can take its toll on your skin. There are any number of potential contributors to an unhappy gut and, in turn, unhappy skin:

  • undiagnosed food sensitivities and allergies
  • dysbiosis (or imbalanced gut bacteria)
  • maldigestion of common fibers and sugars in food (FODMAPs)
  • SIBO a.k.a. small intestine bacterial overgrowth

 

A study found that those with acne rosacea are 10x more likely to be suffering from SIBO compared to healthy controls (63). Further, resolution of SIBO in those with Crohn’s, ulcerative colitis and celiac disease also saw resolution of their skin problems when the SIBO was treated and the gut healed (64).

 

Those with celiac disease can also suffer more alopecia and vitiligo (65, 66, 67).

 

Leaky gut is also strongly linked with acne (68), as is the health of your gut microbiota as the link between the inner contents of your digestive track and the rest of your body (69, 70, 71, 72, 73).

Bottom line

Your skin is your largest organ.

 

Like any organ, your skin needs good quality nutrition to look and be its best. Love your skin by feeding it what it needs.

 

A nutrient-dense, whole foods diet, with particular attention paid to certain vitamins, minerals, and other compounds, is a powerful tool in the treatment of skin disease.

 

It’s unfortunate that many mainstream doctors and dermatologists typically deny any connection between diet and skin health, and many patients miss the opportunity to make major improvements in their skin simply by changing what they eat.

 

Simply being told by doctors and dermatologists that diet has no impact on skin health helps no one; consider changing what you eat before automatically reaching for another prescription of antibiotics or topical steroid cream.

 

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Doug Cook RDN is a Toronto based integrative and functional nutritionist and dietitian with a focus on digestive, gut, mental health.  Follow me on FacebookInstagram and Twitter.

Comments 4

  1. Caroline
    November 18, 2019

    Great article!!

    Wondering if you can advise of amounts needed for age groups , wondering how much to take for its benefits .

    1. Doug Cook RDN MHSc
      November 19, 2019

      I really can’t, there are no official recommendations for different age groups that have been derived from research, the goal is to increase all nutrients as much as possible, some of the references have specific intakes found to be beneficial for different conditions

  2. Robert
    November 28, 2019

    It’s great to just have a reminder about your skin as an organ; you wear it well! We know it and have been told this many times. Then to also get info on how to keep it healthy gives us something really useful – Thank you!

    1. Doug Cook RDN MHSc
      November 29, 2019

      Ya, it’s not just a barrier, it’s hard working like any other organ!

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