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Comprising a broad range of more than 8000 naturally-occurring compounds, polyphenols are secondary plant metabolites that exert varying degrees of antioxidant activity All of these diverse substances share a definitive structural component, a phenol or an aromatic ring with at least one hydroxyl group Polyphenols are an exceedingly important part of, and the most copious antioxidants in, the human diet, and found in a vast spectrum of vegetables, fruits, herbs, grains, tea, coffee beans, propolis, and red wine45,46 (Table 8-1) Flavonoids are the most abundant polyphenols in the human diet as well as the most studied polyphenols, and can be further divided into several categories These subclasses include flavones
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TABLE 8-1 Foods with Signi cant Polyphenol Levels45,46 VEGETABLES Artichokes Broccoli Cabbage Eggplant Lettuce Olives Onions Soybeans Spinach FRUITS Apples/pears Apricots Berries (various) Cherries Citrus fruits Currants (red and black) Grapes Peaches Plums MISCELLANEOUS Cocoa Coffee beans Flaxseed/ axseed oil Grains (eg, wild rice) Nuts Propolis Red wine Tea (green and black)
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TABLE 8-2 Subclasses of the Most Abundant Polyphenols, Flavonoids, and Food Sources of Each Class46 48 FLAVONES Celery Fresh parsley Sweet red pepper FLAVONOLS Apples Broccoli Olives Onions Tea (black and green) FLAVANONES Oranges Grapefruit ISOFLAVONES Soy FLAVANOLS (CATECHINS) Apples Cocoa Dark chocolate Tea (black and green) ANTHOCYANINS Blackberries Cherries Currants (black and red) Grapes Plums Raspberries Strawberries PROANTHOCYANIDINS Apples Dark chocolate Grapes Pears Red wine Tea (black and green)
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(eg, apigenin, luteolin); flavonols (eg, quercetin, kaempferol, myricetin, and fisetin); flavanones (eg, naringenin, hesperidin, eriodictyol); isoflavones (eg, genistein, daidzein); flavanols or catechins (eg, epicatechin, epicatechin 3gallate, epigallocatechin, epigallocatechin 3-gallate, catechin, gallocatechin); anthocyanins (eg, cyanidin, pelargonidin); and proanthocyanidins (eg, pycnogenol, leukocyanidin, leucoanthocyanin)46 48 (Table 8-2) Among the many other polyphenols there are stilbenes (eg, resveratrol, found in red wine), lignans (eg, enterodiol, found in flaxseed and flaxseed oil), tannins (eg, ellagic acid, found in pomegranates, raspberries, strawberries, cranberries, and walnuts), hydroxycinnamic acids, and phenolic acids, among which caffeic and ferulic acids are frequently found in foods A survey of the research associated with many of these compounds and their sources is beyond the scope of this chapter, as such a discussion could fill volumes Some of the most widely disseminated results involving polyphenols pertain to the identified efficacy of various topical applications of green tea catechins, ferulic acid, resveratrol, and other ingredients, which are discussed elsewhere in this textbook One recent experimental success with the oral ingestion of a polyphenolic compound resulting in benefits to the skin involved an as yet unmentioned food source In an investigation of the antiaging effects of red clover isoflavones, which in high levels in diets have already been shown to contribute to low incidence of menopausal symptoms as well as osteoporosis, researchers orally administered red clover extract containing 11% isoflavones to ovariectomized rats for 14 weeks Their findings revealed that collagen levels increased significantly in the treatment group as compared to the control group and epidermal thickness and keratinization was normal in the treated group, but diminished in the control group The researchers concluded that skin aging engendered by
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estrogen depletion can be mitigated by regular dietary consumption of red clover isoflavones49 (See the Pigmented vs Nonpigmented section below for additional studies on the cutaneous effects of orally administered polyphenols found in pomegranates and grapes)
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Nearly 25 years ago, investigators measured the omega-6 and omega-3 fatty acids (also known as n-6 and n-3 fatty acids, respectively) in the plasma phospholipids of 41 adults with atopic eczema and 50 normal controls and found the omega-6 linoleic acid (LA) to be significantly elevated, with all of its metabolites likewise reduced, and the omega-3 -linolenic acid (ALA) elevated, but not significantly, with all of its metabolites substantially decreased The researchers identified a link between atopic eczema and abnormal metabolism Oral evening primrose oil (EPO) treatment partly rectified the abnormal metabolism of omega-6, but did not alter omega-3 levels50 Subsequently, Galland noted data indicating an association between poor desaturation of linoleic and linolenic acids by delta-6 dehydrogenase and atopic eczema and other allergic conditions, as well as the alleviation of atopic eczema symptoms through dietary supplementation with essential fatty acids51 Twenty years ago, investigators conducting a 12-week, double-blind study of the effects of dietary supplementation with n-3 fatty acids in patients with atopic dermatitis found that the experimental group taking eicosapentaenoic acid (EPA) experienced overall less subjective severity and pruritus than the control group taking a placebo52 It appears that supplementation with n-3 fatty acids may ameliorate symptoms of eczema in the short term Notably, levels of n-3 fatty acids are depressed in vegetarians and vegans
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Not all physicians embrace the utility of dietary modifications in the treatment of eczema Of course, patient recommendations should include advice on bathing and skin moisturization (see s 11 and 32) as well as dietary recommendations The dietary research in the 1980s helped form the theoretical framework that undergirds current studies of suitable sources for adjunct or alternative therapies for atopic eczema, such as hemp seed oil (which is rich in omega-6 and omega-3 fatty acids),53 EPO,54 and borage oil,55 as well as the significance of varying levels of essential fatty acids for individuals with vegetarian or vegan diets as compared to omnivores An examination over a decade ago of lipid metabolism in 81 healthy lacto- and lacto-ovovegetarians and 62 nonvegetarians buttressed previous studies that revealed higher total serum polyunsaturated acid concentrations, particularly linoleic and linolenic acids, in vegetarians compared to nonvegetarians Significantly higher plasma levels of vitamin C, beta-carotene, and selenium as well as vitamin E-to-cholesterol and vitamin Eto-triacylglycerol ratios (indicators of LDL and fatty acid protection, respectively) were observed56 (See Table 8-3 for a summary of potential nutritional deficits according to diet style) In an interesting matched-pair study two decades ago, Melchert et al compared serum fatty acid content in 108 vegetarians (62 females, 40 males) and 108 nonvegetarians (70 females, 38 males) Palmitoleic (omega-7), vaccenic (omega-7), and docosahexaenoic (omega-3) acids were higher in nonvegetarians, and very low in vegetarians, and vegetarians exhibited higher levels of LA57 More supportive evidence was established in a study of essential fatty acids and lipoprotein lipids in female Australian vegetarians and omnivores, as investigators found that the vegetarians had significantly lower levels of n-6 and n-3 PUFAs and a lower ratio of n-3 to n-6 PUFAs58 It is also important to
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