Does drinking water really make your skin glow?

The Question

I’ve always been told to drink lots of water and that would help with wrinkles, dryness and even acne, is this true?

The Answer

Unfortunately the short answer is, we don’t know.

While popular beauty advice says, “Yes”, newer articles have cited a British paper which indicated that drinking more water provided no skin benefits. However when we look at the study itself the authors indicate that there isn’t enough research on the topic.

Approximately 40-75% of your body is water, 1/3 of this being extracellular and the rest intracellular. A 1% reduction in your body’s water content can cause thirst, and a 10-20% reduction can lead to death.

Water is gained from drinking and eating and is lost through the skin, the lungs and excrement. It’s important in temperature regulation, cardiovascular function, transportation of nutrients, waste removal and other important functions.

The stratum corneum, or outer layer of skin, is about 20-30% water, and a 10-20% loss can result in skin dryness causing reduced elasticity and increased skin roughness. If one becomes dehydrated, water is pulled from the blood and tissues (including the skin) for more important functions.

A survey of studies trying to determine a recommended water intake showed results between 1.8 to 5 litres daily. The common adage of 8 glasses daily would provide 64 ounces or just under 1.9 litres. More water is recommended for those living in warmer climates as those living in hotter climates can sweat as much as 4-7 litres a day. The National Research Council of the National Academy of Sciences recommends a water intake based on your calorie intake, they recommend 1-1.5 ml per calorie of food. So someone consuming a diet of 2000 calories daily would (according to their recommendation) require between 2 to 3 litres of water.

Unfortunately there aren’t many studies that examine the effect of water consumption and the skin, however I will review the two that I was able to find.

The first study performed in Germany, took a group of 93 subjects and had them drink either 2.25 litres of mineral or tap water daily. They were first monitored for 2 weeks to determine their average water intake previous to the study. As a group they found no cosmetic changes in the skin, though some individuals did have improvement in the smoothness of their skin. Those who drank mineral water experienced a decrease in skin density, a slight increase in skin thickness, no change in skin surface pH and a decrease in the circumference of their ring finger (a marker for water retention). Those that previously drank very little water experienced a greater increase in skin thickness. Oddly enough the people that drank tap water experienced the opposite, their skin became denser, less thick, and the acidity of their skin increased. There was no noticeable change in the circumference of their fingers, however.

The second study comes from Japan and is very small with only 18 subjects. The study specifically looked at the effect that 500 ml of deep sea water had on the skin of those suffering from excema/dermatitis compared to 500 ml of tap water. Both groups of patients with excema or dermatitis showed elevated levels of magnesium to potassium and calcium to magnesium ratios. With the group drinking deep sea water, the ratios returned to normal levels. As well those drinking deep sea water produced less anti-podies and inflammatory cytokines. No visual assessment of improvement was performed.

From the studies it seems like the important factor isn’t so much the amount of water consumed, but the minerals that the water contains – mainly magnesium and calcium. A study has shown that topical application of magnesium ions increased skin barrier recovery, and that this effect was accelerated when the magnesium to calcium ratio was lower. As well studies have used magnesium deficient diets in rats to induce an eczema like skin condition.

The difference in effects between mineral water and tap water is a bit confusing, and it’s hard to determine which result is actually better. For example with the use of an ingredient like alpha hydroxy acids, the skin’s density of collagen increases as does thickness. It’s doubtful that mineral water is inducing production of collagen and tap water is destroying it. Like the researchers mentioned it might have to do with mineral water increasing the extracellular water in the skin.

So drink away, if you’re dehydrated you probably will notice some visual improvement in your skin, but it’s unlikely that it will lead to a large improvement in the quality of your skin – though it won’t hurt.

How do I deal with acne on my body?

Body acneThe Question

My face is relatively clear, however I have acne on my body that hasn’t gone away. I wear a clean shirt to bed, yet I still have acne all over my back, chest and on my arms. How should I go about treating the acne on my body?

The Answer

Treating acne on the face and treating acne on the body requires the same ingredients and methods, however because the skin on the body is thicker, has less pores and is less sensitive you can use products with a higher percentage of active ingredients.

Two basic ingredients to look for are salicylic acid and benzoyl peroxide. This combination is usually too irritating for the face, but effective for the body.

Salicylic acid

Salicylic acid is commonly found in body washes and cleansers formulated for acne, it’s a liphophilic acid, meaning that it can dissolve in to sebum and help remove oily plugs and dead skin cells from the inner lining of pores. It also has a mild anti-inflammatory effect as well as a mild anti-bacterial effect. Salicylic acid is also found in pre-soaked alcohol based pads. It’s important that the pH of the product be lower than the pH of your skin to have an exfoliating effect, the greater the pH difference the more intense the exfoliation will be.

Common side-effects include redness, dryness and irritation – which usually resolves on its own.

Some may argue that because salicylic acid based washes are only on the skin for a brief period of time they can’t be effective in treating the skin, however a study showed that a 2% salicylic acid wash was better in reducing acne compared to an unmedicated wash, and was also superior to a 10% benzoyl peroxide wash.

For maximum effectiveness (but also increased risk of irritation, which is counter-productive) you can use medicated pads, or salicylic acid containing gels and liquids.

Benzoyl peroxide

Benzoyl peroxide is primarily an antibacterial, it works against acne by producing free radicals which kills anaerobic acne causing bacteria. However studies have shown that benzoyl peroxide also has a keratolytic or skin peeling effect, similar to that of salicylic acid. The downside to benzoyl peroxide is that it will bleach colored fabrics, which limits its daytime use (unless you always wear white t-shirts).

Benzoyl peroxide is most commonly available as a cream, gel or wash formulation – however cream and gels are most effective. Products generally contain between 2.5% to 10% benzoyl peroxide. Studies have shown that lower percentage benzoyl peroxide creams are just effective as the higher dosage ones, but people experience less side-effects like redness, peeling and irritation. Lower dosage benzoyl peroxides do take longer to have effect though.

Benzoyl peroxide treatment reduces levels of the antioxidant Vitamin E in the skin, consider supplementing with Vitamin E or using a product that contains the ingredient topically. However a study showed that with alcohol based benzoyl peroxide formulations, Vitamin E may actually increase free radical damage. This increase in free radical damage, however, may actually increase the effectiveness of benzoyl peroxide – so it’s a bit of a trade off.

A sample regime

I would recommend washing in the morning with a salicylic acid based cleanser, and then applying a benzoyl peroxide based cream in the evening (or mornings and evenings – if you’re conscious of the possibility of fabric bleaching).

Here are some recommendations for salicylic acid and benzoyl peroxide based products. It’s actually much easier to just go to a pharmacy or drug store and make a purchase there. I recommend a minimum of 2% salicylic acid, and 5% benzoyl peroxide. Look for products that do not contain fragrance or alcohol.

Because benzoyl peroxide is the same across brands, choose a product that provides the most bang for your buck. Good brands include Panoxyl, Benzagel and Solugel. Products from larger brands that are 1 oz. sized are generally overpriced.

I would recommend not buying salicylic acid products that are in a spray format, inhaling salicylic acid is a potent irritant, and as well the chemicals commonly used to dissolve salicylic acid – propylene glycol can be irritating.

Neutrogena Body Clear Body Wash, 2% Salicylic Acid

ProActive Solutions Clear Zone Body Lotion, 2% Salicylic Acid

Selsun Blue Naturals Dandruff Shampoo, 3% Salicylic Acid

Oxy Face Wash Maximum, 10% Benzoyl Peroxide

Topical, over the counter products are a good starting point, especially when used consistently. However some acne does require more aggressive treatment such as antibiotics (topical and oral), or in some cases isotretinoin. However those treatment methods require consultation with a dermatologist.

When to see a doctor

Most studies that have examined salicylic acid and benzoyl peroxide report improvements at the 8 to 12 week mark, so try to commit to that time period before re-evaluating your situation. Hopefully there is marked improvement, but if not, it may be time to consider booking an appointment and looking at prescription products.

What about diet and supplements?

Some studies have shown that a diet low in high glycemic foods, IGF containing foods like dairy can help resolve acne. Most of these studies were performed by one researcher Dr. Melkin. There are definitely links between diet and acne, and some studies have shown that chemicals found in dark chocolate can exacerbate acne.

Supplements can also help in treating acne. They also have the benefit of affecting your skin systematically. Consider supplements like zinc or pantothenic acid. Fish oil has also been shown to be anti-inflammatory which can benefit those dealing with acne.

Things to keep in mind…

Stop or reduce your frequency of application if you notice your skin starting to look raw, red or begin to crack and peel. Compromised skin is not only uncomfortable, but also has a reduced ability to fight off new infections which can lead to worsened acne. Let your skin return to it’s normal texture before continuing treatment.

Anything that speeds up the removal of dead skin will also increase your risk of sun damage. When dealing with body acne, clothing usually covers the areas treated which generally provides an SPF of 15 depending on the type of fabric and closeness of the weave. However do consider being extra cautious with exposed skin and use a higher SPF with broad spectrum UVA/UVB protection.

My skin is clear now…how do I keep it that way?

Keep on using the salicylic acid based cleanser, or switch to one if you’re using a pad. Salicylic acid not only will help keep your pores clear from oil and debris, it also exhibits a mild photo-protective effect (nowhere near sunscreen though, so don’t be overconfident with your sun exposure!). Because of it’s exfoliative effect, salicylic acid will also help fade hyperpigmentation left from acne break outs.

Reduce the use of benzoyl peroxide, as the free radical damage may have negative long-term effects (This hasn’t been thoroughly studied, but benzoyl peroxide has been shown to increase risk of skin tumor markers in mice.)

Consider using benzoyl peroxide once every other day, reducing to once every two days, eventually to once a week. You can also consider switching to using a benzoyl peroxide containing wash.

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Zinc supplements could help with your fight with acne

Zinc supplementsWhat is Zinc?

Zinc is a metallic mineral and an essential micronutrient . Your body requires zinc daily, but can’t produce or store a supply of it’s own.

Zinc is found in abundance in oysters, beef, nuts and beans. The National Institute of Health has put together a list of foods and their zinc content [Table 2]. You can also search for any food’s nutrient content through the Nutrient Data Laboratory provided by the National Agricultural Library.

Zinc is associated with sexual function (possibly why oysters are considered an aphrodiasic), development, enzyme function, immune function and for the skin – control of inflammation.

Zinc and People with Acne

Acne vulgaris may be correlated with a zinc deficiency

There is some evidence that shows that people who have inflammatory skin diseases have lower levels of zinc in their body. Whether this deficiency arises from zinc being used to combat inflammation or that low zinc from the diet is one of the causes of inflammatory skin diseases is not yet known.

One study from India found that a study population with acne vulgaris showed a significantly lower level of zinc compared to a population of people who did not have acne.

The study also found that people who had psoriasis exhibited lower levels as well – those with larger areas of the body affected had lower levels of zinc.

This study isn’t definitive though, but there is some evidence showing that those with acne, who don’t have low levels of serum zinc, may have lower levels of zinc in their skin.

Studies have shown zinc supplementation improves acne

The majority of studies examining the effect of zinc on acne have focused on zinc sulphate. Results are mixed, some experiments showed statistically significant improvement in lesions [2]- specifically pustules with a smaller effect on infiltrates, papules and cysts. Other studies showed that zinc sulphate treatments were no better than a placebo [2], however there is the confound of seasonal changes in the severity of acne, which the researchers mentioned.

A newer form of zinc, zinc gluconate, has less research behind it, but is better assimilated by the body. It also causes less side-effects, such as nausea and stomach upset, than zinc sulphate. Zinc gluconate has been shown to reduce or reverse chemical changes in the skin caused by acne. Specifically, studies have shown that zinc gluconate was able to increase immune cell functioning in the skin, reduce inflammatory markers in the skin and also reduce the increase in growth hormones which occurs in acne lesions.

One study recommends a dose of 200 mg zinc gluconate per day, this study also showed that there was no benefit in “front-loading” zinc. Patients who were on a constant dose had the same benefits as those that started on a higher dose tapering to a smaller dose.

Zinc gluconate was shown to be 17% less effective as a common antibiotic, minocycline. However a double-blind study showed it was as effective as oxytetracycline.  Another study showed that zinc gluconate supplementation was able to reduce bacterial adaptation to erythromycin, making the antibiotic more effective. The researchers recommended a daily 30 mg elemental zinc (in the form of zinc gluconate) supplement be combined with a topical erythromycin cream for best results.

And unlike some antibiotics commonly used to treat acne, such as doxycycline and tetracycline , zinc gluconate was shown to not increase photosensitivity, so it’s safe to use during the summer and times of sun exposure.

Should I Supplement?

If you’ve tried things like antibiotics or don’t want to – zinc supplementation may  help improve your skin.

The extra “boost” of anti-inflammatory benefits and other skin chemistry changes could just be the push that allows your topical products to start working. If you’re not using anything on your skin, I would recommend you begin using a benzoyl peroxide or salicylic acid product.

A convenient benefit of zinc supplementation is that it affects all of your skin, this is especially beneficial for those who suffer from acne on harder to reach areas of the body, such as the back.

Zinc salts have been shown to be safe for pregnant women at doses below 75 mg a day, as well they found no issues with women who were breastfeeding while taking zinc.

Again it’s important to keep in mind that there is no 100% guaranteed cure for acne. Zinc may clear your skin completely, or it may just become a part of your acne regime. It may do nothing at all for you.

Am I deficient?

It’s likely that you aren’t. The average American man consumes about 14 mg of zinc a day, and the average American woman 9 mg. The US RDA recommends a daily intake of 11 mg for men and 8 for women, and sets the upper limit of safety at 40 mg of zinc a day (20 mg daily is the recommended maximum though).

A blood test can be performed which will assess the levels of zinc in your blood.

How much zinc?

Start off with a 200 mg  zinc gluconate supplement (providing 30 mg zinc mineral) and assess your skin at the 1, 2 and 3 month mark.

Take a photo in the morning, before you’ve showered (the heat from the shower can make your lesions look worse than they are) to document your progress.

If there’s no improvement after 90 days perhaps – unfortunately – zinc supplements aren’t an effective method to treat your acne.

Zinc glycinate, zinc oxide, zinc picolate? Which one should I take?

Zinc comes in a multitude of forms and studies have shown that some of these are better absorbed than other. One study (with possible ties to the manufacturer) found that of the commonly available zincs; zinc sulfate, zinc glycinate, zinc lactate, zinc gluconate –  zinc glycinate and zinc gluconate were best absorbed.

I would recommend using zinc gluconate as it has more research on its use for acne treatment.

Side-effects? Copper?

Zinc on an empty stomach can cause queasiness or dizziness, if you find this happening just take it with a meal.

Zinc can block the absorption of copper, so if you find yourself having success with treating your acne with zinc and are considering it longterm, it’d be wise to use a copper supplement at the opposite time of day you take your zinc. A recommended ratio of zinc to copper is 15 to 1.

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