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Vitamin E includes the tocopherols and the tocotrienols It is the most significant lipid-soluble antioxidant and it is found naturally in many vegetables, especially spinach, avocados, corn, vegetable oils, sunflower seeds, soy, whole grains, nuts, and margarine Usually referred to as alpha-tocopherol, its most biologically active form, vitamin E is also found in some meat and dairy products In humans, vitamin E naturally occurs in the membranes of cells and organelles It protects cell membranes from peroxidation and scavenges free radicals Consequently, vitamin E is thought to help prevent cardiovascular disease and the aging of the arteries It is also effective in mitigating skin dryness, particularly in those taking oral retinoids Vitamin E has also been shown to exert anti-inflammatory effects on the skin through the inhibition of chemical mediator synthesis and release In addition to stabilizing lysosomes, vitamin E influences prostaglandin E2 production (decreasing it) as well as interleukin-2 production (increasing it) Anti-inflammatory and immunostimulatory effects are the result151 An important component of sebum, vitamin E is found in greater supply in individuals with oily skin This may correlate with less skin aging and less skin cancer The lips, which have no oil glands and are thus devoid of vitamin E, are more susceptible to skin cancer than many other areas of the skin
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surface Antitumorigenic, photoprotective, and skin barrier-stabilizing activities have been associated with topical and oral vitamin E169 In a hairless mouse model of photocarcinogenesis induced by UVB expression, investigators showed that oral administration of alpha-tocopherol resulted in significant inhibitory effects on tumor incidence and number170 However, in a study assessing the capacity of orally administered vitamin E and beta-carotene to diminish markers of oxidative stress and erythema in response to UV exposure in 16 healthy participants who took either of the lipid-soluble antioxidants for 8 weeks, results revealed that such supplementation had no effect on skin sensitivity, though the vitamin E group experienced significant decreases in cutaneous malondialdehyde No other measures of oxidative stress in basal or UV-exposed skin were influenced by the supplementation, suggesting that neither conferred photoprotection171 While results remain conflicting over the relative photoprotective effects of oral vitamin E, the evidence strongly indicates significant photoprotective effects from the orally administered combination of vitamins C and E In a single-blind controlled clinical trial examining the photoprotective effects of vitamins C and E, 45 healthy volunteers were divided into three groups, one receiving oral vitamin C, one receiving oral vitamin E, and one receiving an oral mixture of the two antioxidants Daily treatments lasted 1 week The MED was ascertained before and after treatment, with the median MED increasing the most in the combination group, suggesting that d-alpha-tocopherol combined with ascorbic acid yielded better photoprotective effects than either of the antioxidants alone172 For more information on just a few of the several reports on the success of this combination, see section Vitamin C above This combination of antioxidants currently represents one of the skin s best defenses against photodamage, including photocarcinogenesis and photoaging Vitamin E is an important part of any diet, but there is a risk from taking too much The author recommends 400 IU, in gel cap form, per day Vitamin E can increase the likelihood of bruising if taken in large doses Indeed, doses greater than 3000 mg daily when taken over a long period may cause such side effects Patients undergoing surgical procedures should avoid doses of vitamin E greater
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CHAPTER 8 NUTRITION AND THE SKIN 59
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than 4000 IU151 In addition, vitamin E should be discontinued 10 days prior to surgical procedures, soft tissue augmentation, or Botox injections in order to minimize the risk of bruising
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Various enhanced water products have been recently introduced onto the market As an occasional treat, they represent a much better choice than soda, which offers no health benefits At least these products provide a few vitamins Ersatz water products are not a substitute for a good multivitamin, however, and do not include common supplements such as glucosamine or biotin In addition, these products often contain high levels of sugar, which can contribute to various health outcomes and, in the cutaneous realm, foster wrinkling caused by glycation as well as acne eruptions The appeal of this market has resulted in the emergence of sugar-free and nutrient-added formulations For example, Coca-Cola recently launched a product called Enviga, a sugar-free beverage that contains green tea, one of the most potent and best-researched antioxidants available In addition, the Borba product line features nutrient-fortified waters specifically formulated for the skin (These have no added sugar and zero calories) Not surprisingly, only proprietary in-house studies are available on such products While it remains to be seen whether these products confer any health benefits, there is no reason to think that they would be harmful or unhealthy Another way to derive cutaneous benefits from liquid nutrients, other than red wine and green and other teas, is a water booster These formulations, packaged in dropper-style bottles, can be added to any beverage The author recommends Dr Brandt AntiOxidant Water Booster/Pure Green Tea Liquid supplements to be placed on the tongue such as Dr Andrew Weil for Origins Plantidote Mega-Mushroom Supplement are also popular, but unproven These products should be combined, more importantly, with a wellrounded diet, exercise, and a good multivitamin Finally, pomegranate juice does note require any vitamin fortification As long as no sugar is added, pomegranate juice packs a potent antioxidant punch
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