Tips for Discussing Nutrition with Patients

Hair, skin, and nails provide a real time snapshot of patients’ health. According to Zoe Diana Draelos, MD, FAAD, adjunct assistant professor of dermatology at Duke University School of Medicine in Durham, North Carolina, and chief medical editor for Dermatology Times®, dermatologists are uniquely qualified to observe the nutritional state of their patients.

Speaking at the American Academy of Dermatology Association 2022 Annual Meeting, held in Boston, Massachusetts, March 25 to 29, 2022, Draelos provided an overview of current understanding of nutrition and its impact on skin health and tips for dermatologists discussing the subject with their patients and helping them eat for optimal skin, hair and nail health1.

“The biggest challenge in helping patients understand nutrition’s impact on dermatological health is the misconception that vitamin and nutritional supplements can make up for a poor diet [except for vitamin D, which is a sex hormone and not a true vitamin],” Draelos told Dermatology Times®, in a follow up interview. “I tell people good nutrition is simple: eat something of color every day.” This is a straightforward way to set patients up to get the vitamins and minerals they need, she added.

Draelos told Dermatology Times® that the most common deficiency she observes in her patients is vitamin D among postmenopausal women. She also said that because skin is pure protein, a good source of protein is especially key for patients with skin disease.

As outlined below, Draelos prefers to offer her patients a rundown of the role of each vitamin and nutrient in skin health and in which foods to find it. She added that it is difficult to get vitamin deficiencies to show up on lab work, except for vitamin D. So “eating by color” is an important habit to help patients build since serum levels of vitamins can vary on tests, making metrics difficult to obtain.

How to Help Patients “Eat by Color” for Skin Health

Draelos laid out the connections between vitamins and food colors, why they matter for skin health and the foods she recommends optimizing her patients’ skin.

Yellow to Orange: Vitamin A

Vitamin E is necessary for vision and skin health activities of gene transcription and immune function, retinal is required for night vision, retinoic acid regulates skin gene transcription by binding to nuclear retinoic acid receptors (RARs) bound to DNA. Retinoic acid promotes T-cell differentiation and proliferation.

• Best source: 2/3 cup carrots (100 grams supplies 93% of RDA for an adult male).

Red to Orange: Vitamin C (Ascorbic Acid)

Vitamin C is necessary for tissue repair (collagen), enzymatic production of neurotransmitters, the immune system and as an antioxidant.

• Best source: One cup of tomatoes daily or a handful of cherry tomatoes to help patients reach the RDA of 90mg/day for males and 75mg/day for females (tomatoes contain 14mg per 100 grams).

Green: Vitamin E and Folic Acid (Vitamin B9)

Vitamin E is a fat-soluble antioxidant that protects cell membranes from oxidative damage and contains alpha, beta, gamma, and delta tocopherols, of which alpha is the most biologically active and gamma the most common in western diet.

• Best source: 1/4-1/2 raw avocado daily (to help reach the RDA of 15mg per day for adults). Olive oil also, helps improve absorption.

Folic acid is necessary for reproduction of DNA, RNA, and RBCs and thus associated with skin, hair, and nail health. It also converts homocysteine to methionine—high homocysteine levels associated with cardiac disease.

• Best source: Avocado to help reach the recommended 400mcg daily for adults.

Brown: Trace Minerals and Biotin

Trace minerals are very important for metal containing enzymes (matrix metalloproteinases [MMPs]) to function in the skin. Selenium is an important alternative antioxidant pathway. Electrolytes (potassium, chloride, phosphorus) and metals (copper, magnesium, molybdenum, manganese, iron, chromium) are also important.

• Best source: One Brazil nut. Dermatologists may also consider a supplement.

Biotin deficiency is rare, but if present an individual could have poor nail and hair growth. There is no established RDA for biotin.

• Best source: A handful of nuts per week. Almonds are an excellent source

Pink: Protein (Chicken and Fish)

Skin, hair, and nails are pure protein and individuals need a source of protein every day for amino acids for body repair. Many vegans experience problems with hair loss as first sign of nutritional issues.

• Best sources: Chicken and fish are complete proteins. Patients may use egg or milk proteins.

Blue/Purple: Antioxidants

The blue/purple skin of the blueberry contains the antioxidants, which are the anthocyanins (flavonoids of the polyphenol family) malvidin and delphinidin.Blueberries also contain flavonol antioxidants quercetin and myricetin.

• Best source: Blueberries.

Vitamin D Supplementation

Vitamin D is a sex hormone, not a true vitamin. According to Draelos, it is impossible to orally consume adequate amounts in diet, so this is one case where oral supplementation may be best. There is no age adjusted supplementation guidelines, but new recommendations are 800-1000IU for adults and 2000IU minimum post-menopausal women.

How do you optimize nutrition for healthy skin, hair & nails?

• Yellow/orange (Vitamin A): 2/3 cup carrots
• Red/orange (Vitamin C): one raw tomato daily
• Green (Vitamin E, Folic Acid): 1/2 raw avocado
• Brown (Trace Minerals, Biotin): 1 Brazil nut, almonds
• Pink (Protein): chicken, fish, collagen supplement
• Blue/purple (Antioxidants): 1 cup fresh blueberries
• Vitamin D: 1000-2000 IU daily supplement

Disclosures:

Draelos has received grants/research funding from Abbott Laboratories, Actavis, AGI Dermatics, Allergan, Inc., AmDerma Pharmaceuticals, LLC, Amgen, Amneal Pharmaceuticals, LLC, AstraZeneca, Avon Products, Inc., Bayer, Bayer Consumer Healthcare Pharmaceuticals, Beiersdorf, Inc., Boots, Celgene Corporation, Chattem, Inc., Colgate-Palmolive, Dermira, Dial Corporation, Eli Lilly and Company, Elizabeth Arden, Exeltis, Galderma Laboratories, L.P., GlaxoSmithKline, Glenmark Generics Inc., Guthy-Renker, Helix BioMedix, Johnson & Johnson Consumer Products Company, Kao Brands, Kimberly Clark, Kythera, L'Oreal USA Inc., La Roche-Posay Laboratoire Pharmaceutique, Lexington International LLC, Living Proof, Inc, Lumity, MakuCell, Inc., Maruho Co., Ltd, Medicis Pharmaceutical Corporation, Merck & Co., Inc., Merz Pharmaceuticals, LLC, Mimetica Pty. Limited, Neocutis, Neutrogena Corporation, Niadyne, Novartis Pharmaceuticals Corp., Nuskin, Oculus, Onset Therapeutics, Otsuka Pharmaceutical Co., Ltd., Pacific Biosciences, Perrigo Company, Pfizer Inc., Procter & Gamble Company, Promius Pharma, LLC, Quinnova Pharmaceuticals, Inc., Ranbaxy Laboratories Limited, RECKITT BENCKISER (ESPAÑA), S.L., Revance Therapeutics, Inc., Revision Skincare, Signum Biosciences, Inc., SkinMedica, Inc., Sun Products Corporation, Suneva Medical, Inc., Symrise, Syneron, Inc., Taro Pharm, Teva Pharmaceuticals USA, Tolmar, Valeant Pharmaceuticals International, Vichy Laboratoires – I(Grants/Research Funding)

Reference:

Draelos ZD. Optimizing Nutrition for Skin Health. Presented at: American Academy of Dermatology 2022 Annual Meeting; March 25-29, 2022; Boston, MA.