Strong, flexible, healthy collagen is key to youthfulness.
Bone broth is a missing food group collagen tissues crave.
Inflammation damages collagen in ways that make us feel older than our age.
Food allergies are a warning sign of collagen-damaging inflammation.
Three key practices will keep your collagen healthy.
One morning, several years ago when I was still practicing in Hawaii, a woman ran into our office shouting, “My baby! My baby!” and disappeared back out into the parking lot. The nurse on duty raced out front to find a panicked mother struggling with a car seat where a baby lay listless, strawberry red and covered in blotchy hives, his lips purple and swollen. The infant was having a severe allergic reaction and was struggling just to breathe.
Baby Kyle, a mostly formula-fed toddler, was in the throes of an anaphylactic reaction, triggered by a few spoonfuls of low-fat, high-sugar blueberry yogurt. Anaphylaxis is an allergic reaction involving inflammation of the blood vessels throughout the body, and it can be fatal. In the last chapter, we saw how inflammation interferes with cell communication and leads to weight gain. Anaphylaxis is a classic case of inflammation gone completely out of control. Fortunately, the pediatrician on call administered powerful anti-inflammatory medications, which saved little Kyle’s life.
Anaphylactic reactions like this are the most extreme example of an allergic reaction, which is what happens when a person’s immune system, disoriented by the noise of low-grade inflammatory signals, makes a serious mistake. Allergies are a more common manifestation of such immune system malfunctions than is anaphylaxis. Whether allergic reactions are triggered by pets or molds or foods, the underlying issue is the same: the immune system confuses a harmless protein for an invading bacteria, and launches an attack.
Serious food allergies are on the rise.565 According to the CDC, the number of children hospitalized for food allergies rose 300 percent between 1996 and 2006.566 This and other disturbing medical trends are mysteries to researchers and sources of frustration for parents. But now that you know sugar and vegetable oil (the main ingredients in infant formulas, the mainstay of Kyle’s diet) combined with nutrient-deficient foods make up the perfect pro-inflammatory diet, you already know what was wrong with Kyle and what might have been done to make him healthy.
Kyle’s severe reaction was too dramatic to casually brush away as one of the normal, or at least common, experiences of childhood. But many parents do view less severe allergic reactions in that light. I would like to change that, because I see any allergy as an indication that someone is very likely to develop other inflammatory issues down the road, problems that can break down what I call the youth tissue, collagen, and make their bodies age far more rapidly than they should.
You hear all the time about supernutritious foods touted as anti-aging miracles. The combination of sugar and vegetable oil, and its effects on the tissue whose integrity is most related to your physiologic age—collagen—might rightly be called the miracle foods of age acceleration. Because when it comes to staying young and feeling young, collagen is a big deal. If your parents aged well or lived a long time, you can be sure they had good, strong collagen.
Unfortunately, however, you can’t count on inheriting collagen of the same quality. The quality of a person’s collagen is not written in genetic stone. (As you now know, there’s no such thing as “genetic stone,” since your genes are always changing.) Like other tissue types, collagen is made from raw materials you must eat. Unlike other tissues, however, collagen is uniquely sensitive to metabolic imbalances. When your body is making collagen, it’s performing a physiologic high-wire act, a feat of extraordinary timing and mechanical precision. This level of complexity makes collagen more dependent on good nutrition and more vulnerable to the effects of pro-inflammatory foods than other tissue types.
FEEDING YOUR SKIN WITH BEAUTY CREAM
The highest quality skin products contain the collagen-building nutrients your skin needs to restore itself. Even skeptical doctors admit that regular use of these expensive products can have impressive results. However, skin care expert Dennis Gross, M.D., warns that it’s not an overnight solution. “It takes time, molecule by molecule, to build collagen fibers.” Dermatologists advise patience and regular application to get anti-wrinkle creams in contact with skin as much as possible. Why not also feed your skin from the inside?
Left: Fine wrinkling on an eighty-four-year-old woman’s arm. Right: Her skin after just three months of applying a vitamin A cream.
FEED YOUR SKIN SOUP
If a cream containing two or three collagen-building nutrients can help your skin, imagine how effectively you could nourish and rebuild your dermal collagen if you ate a meal containing dozens of growth factors. The nutrients in bone stocks switch the genes for collagen manufacture to “on.” This effect is magnified by vitamins A, D, E, and C, and a few common minerals. Whether in a skin cream or your soup bowl, the same natural ingredients help you look young. But when you ingest them, you infuse all the layers of your skin, and all the other tissues of your body, with rejuvenating nutrients.
When we talk about people who have aged well, one of the first things we think about is healthy skin. But if you’ve read any beauty magazines in the past decade, you know that skin health depends on collagen health. Michelle Pfeiffer is one of the most beautiful actresses working today, but whether she retains that beauty as the years wear on depends not so much on the superficial layers of her skin but on what lies beneath.
Epidermis, dermis, and subcutaneous fat. The outer layer, called the epidermis, is a husk of dead cells that are filled with waterproofing material and pigment. The middle layer, called the dermis, is the support system of your skin, containing blood vessels, nerves, sweat and oil glands, and the muscles controlling hair follicles, all held in place by strong and elastic fibers made of collagen. The innermost layer is called the subcutaneous fat. It’s where the bulk of our body fat is stored.
Collagens are a family of extra-cellular proteins that give skin its ability to move, stretch, and rebound into shape. Thin wisps of tough, elastic collagen molecules run between adjacent cells in the outermost layer of skin, called the epidermis. And larger bundles of collagen form strips that weave together in a continuous layer beneath the epidermis, in a part of the skin called the dermis.
Collagens aren’t just in skin; they’re everywhere, imparting strength to all your tissues. Just as strands of collagen running between skin cells hold our outermost layer of skin together, collagens unite adjacent cells in all your glands and organs, from collagen-rich robust tissues like bone and heart valves to squishy soft lower collagen-content organs like brain, liver, and lungs. Bundles of collagen form extended strips and sheets in the sturdier tissues like ligaments and tendons that surround your joints and hold your skeleton together. Collagen is the most prevalent kind of protein in your body; about 15 percent of your dry weight is pure collagen (dry weight is your body weight without water, which composes about 60 percent of a normal adult male’s total mass). Without it, we wouldn’t just fall apart at the joints; we would literally disintegrate into small piles of individual cells. While it may seem like an obvious connection, doctors are only now beginning to appreciate the relationship between collagen strength and sports and, for those with jobs that involve lifting or physical labor, work performance. Research now reveals that people with weak collagen experience more injuries throughout their lives.568, 569, 570
A CLASSIC SIGN OF WEAK COLLAGEN
This child has a mild case of intoeing, which is associated with abnormal collagen growth and lax ligaments. Were he to play soccer or ski, this child would be at higher than normal risk for joint injuries (like ligament tears). Today, more children than ever need joint reconstruction after sports injuries. Unlike my medical colleagues, who believe the problem is increased physical activity, I believe the root of the problem is decreased collagen strength. To protect their joints, children must expose their tissues to the stimulus of exercise and give their bodies the collagen-building foods needed for growth and repair. (See Chapter 10.)567
The reason collagen health is so dependent on a healthy diet has to do with the complexity of the individual collagen molecules. You can get some idea of how hard collagen is to manufacture from the wound-healing process. If you’ve ever cut yourself so deep that you needed stitches, you may have noticed how long the scar takes to heal—sometimes a full year. When new collagen is formed in a wound, it’s composed of shorter, less organized strands than the original. By six weeks, the collagen fibers have become far more organized and they’ve grown longer, but they’re still only back to about 70 percent of their original strength.571 As the supporting collagen becomes gradually more organized, the scar on the surface fades. In about a year, the skin strength is just about what it was before the injury, though a small scar may remain if the collagen fibers below could never quite iron out smooth.
All collagens are made from chains of amino acids coiled around each other in sets of three to form a triple helix. The longer they are, the more strength they give to the tissue they’re in. But the longest, strongest collagens are also the hardest to make. All collagens carry special molecules called glycosaminoglycans (which you might recall from the bone stock section in Chapter 10) attached like bangles on a necklace to the triple helix backbone. Each class of collagen varies in length and amount of attached glycosaminoglycan bangles, allowing for all sorts of variation in strength, flexibility, water retention, and lubrication. Once manufactured, collagen molecules get anchored to the exterior of the cell and unfurl throughout the extra-cellular matrix where molecules from adjacent cells can intertwine. The structural biology of collagen is incredibly complex; it is unquestionably a masterpiece of extra-cellular engineering. If you are one of the lucky people to be endowed with good quality collagen, not only will your skin resist wrinkling, you will have a better chance of avoiding joint and circulatory problems down the road.
If any one of the thousands of steps involved in making collagen goes haywire—which is likely to happen if your diet was poor during critical growth periods (meaning your diet was low in nutrient-rich foods and high in sugar and vegetable oils)—the integrity of the finished product is compromised and may break down prematurely. You might imagine that with lesser quality collagen holding us together, our tissues would start pulling apart and separating after a certain number of years. That’s exactly what causes wrinkling,572 arthritis,573 and even circulatory problems.574
No matter the strength of your collagen today, how good you feel tomorrow depends a lot on your diet. People who eat pro-inflammatory foods experience more joint damage on a daily basis because sugar acts like an abrasive in the joints.575, 576 At night, the small frays and tiny breaks in the collagen that formed during the day must be repaired. But inflammation interferes with healing. Instead of waking up feeling recovered, people on bad diets wake up with stiff joints.577 Their scars and stretch marks will be more obvious, too, because inflammation disorganizes the collagen fibers so that, as tissue heals, it forms irregular lumpy mounds or deep pits, with more disfiguring results.578
One of the best ways to help collagen heal is, not surprisingly, to eat some. Eating collagen-rich organs (like tripe and tendon) or using bone broths in soups, stews, and sauces floods your bloodstream with glycosaminoglycans, which head directly to the parts of the body that need collagen most.579 These extraordinary molecules attract enormous amounts of water, up to 1,000 times their own weight, which coats your joint tissues in tiny, electrically charged clouds, transforming ordinary water molecules into a protective layer of super-lubricating fluid.580 Glycosaminoglycans will naturally adhere to collagen anywhere in your body, moistening dry skin, helping your tendons and ligaments stay supple, and generally making you look and feel younger.581, 582
Eating homemade bone stock in childhood has fantastic joint-strengthening and collagen-fortifying effects that can last a lifetime. The benefits are so dramatic that it’s astounding to me that more people haven’t noticed the connection. My patients who eat traditional cuisine with meaty stocks and rich bone broths on a regular basis tend to enjoy all the hallmarks of well-built bones and connective tissue—no matter their age. They have broad hands with wide knuckles and relatively large feet that are proportionately wide from toe to heel. Their skin is smoother, with tighter pores and smaller hair follicle openings, reflecting greater tensile strength. Because their bodies are so well built, these are the people who can enjoy their golden years to the fullest, or work past retirement if they so choose.
Even if you didn’t get traditional soups as a child, regular infusions of stock convey bone-strengthening benefits throughout your life. An unusually holistic-minded bone surgeon at a prestigious university in Iraq recognized that “the use of bone broth dietary supplementation by the common folk for promoting the fracture-healing process is an old practice in our community” and designed a study to investigate whether the practice actually produced tangible benefits for healing fractures. He fed rabbits with fractures either normal chow (control group) or normal chow fortified with bone stock (study group) prepared in the traditional manner. He compared the density of newly built bone. At five weeks the density of the healing bone callous in the soup fortified study group was nearly twice that of the control group.583
If there is one beef I have with Nature’s design for our bodies it’s with our joint cartilage, specifically, its reaction to injury. While most cell types in the body react to injury by multiplying in order to fill in gaps left by their fallen comrades, the cells that build cartilage, called chondrocytes, have a tendency to undergo the process of self annihilation, called apoptosis, leaving fewer chondrocytes around to cultivate and support whatever collagen remains. Over time, with repeated injuries, the collagen layer thins and weakens even to the point that the underlying bone is exposed—which is generally about the time joints becomes symptomatic with arthritis. Fortunately, there is something you can eat that will help curb your chondrocytes’ out-of-control suicidal tendencies—and I’ll bet you’ve already guessed it: bone broth. Research has shown that components in broth, including hyaluronans and collagen hydrolysate, are particularly efficient at preventing chondrocytes from undergoing apoptosis after injury.584, 585
CELLULITE FAT LACKS ADEQUATE COLLAGEN SUPPORT
Left, normal. Right, cellulite. The fat under our skin is composed of individual adipose cells (light-colored blobs) surrounded and supported by three types of collagenous fibers, illustrated by I) black horizontally oriented lines (the topmost is skin); 2) X-shaped gray struts; and 3) lighter gray reticular matrix surrounding each fat cell. In those prone to cellulite, the skin has only two horizontal layers instead of the normal three, and all collagenous supports are substantially less robust. The less robust the supporting collagen, the more readily cellulitic dimpling develops. This is why some people develop cellulite from only a few excess pounds while others can be quite overweight and still maintain smooth curves. Genes, age, and diet during childhood and adolesence all play major roles in determining the amount of connective tissue support you have. (Images based on MRI and ultrasound analyses.)
Though I couldn’t find a study showing a direct association between dietary bone stock and the reduction of cellulite, there are reasons to suggest that, in addition to healing bone and protecting cartilage, grandma’s homemade soup might help smooth the appearance of lumpy collagen as well. A lot of people think cellulite comes simply from being too fat. But extra fat where you don’t want it is only part of the problem. Lumpy, irregular cellulite forms in fat deposits that lack adequate connective tissue struts to support a smooth shape.586 The connective tissue-creating cells I introduced earlier, called fibroblasts, are distributed throughout adipose (fat) tissues—including cellulite. Cellulite’s lumpy appearance comes in part from the fact that cellulite contains less of the supportive collagen structure that helps to keep the layer of fat organized and smooth. When I see photos of celebrities with terrible cellulite on their thighs, I imagine how their nutritionists are probably telling them to avoid all animal products, which would include bone stock, and how frustrated they’ll be as their cellulite hangs on. To get rid of cellulite, combine exercise with a diet full of healthy, natural fats (including animal fat) and collagen-rich stocks. This will send the message that you want your body to replace the saggy fat pockets with smooth, toned curves.
Now that you know why collagen health is important not just to skin, but to every organ in your body, let’s learn how inflammation affects your collagen day to day, and over the years.
Inflammation, as the name suggests, creates a burning sensation—but only when it reaches our nerves. Skin is full of nerves, so inflammation in the skin causes irritating sensations, including burning, stinging, and itching. Inflammation in the joints may cause an aching feeling. In the head, a headache; in the gut, nausea or cramping; in the heart, a crushing chest pain; and in the lungs, it can make us wheeze and cough.
Like pain, which alerts us to the fact that something is wrong with us, inflammation does have a good side. It’s supposed to signal the body’s repair systems that a section of tissue needs special care. A bee sting is a classic example of an inflammatory event caused by toxins injected under the skin, which swells up as surrounding blood vessels leak in an attempt to dilute and neutralize the toxin. An ankle swells a little immediately after a sprain. But the real swelling begins hours later, when inflammation signals capillaries to begin leaking serum, stem cells, growth factors, and all the other materials needed to lay the groundwork for the creation of replacement tissue. One of the most dramatic examples of beneficial inflammation occurs during bacterial infection and abscess formation. Inflammation triggered by bacteria invading our tissues releases powerful enzymes that chew through collagen to help the body drain the abscess and expel the invaders. The resulting scar is the small price we pay for avoiding deadly sepsis.
In the setting of dietary imbalance, however, inflammation can go from the physiologic equivalent of a mild-mannered Dr. Bruce Banner into a destructive and uncontrollable Hulk. You may have just such a dietary imbalance and not have any symptoms, or only vague aches and a feeling of tiredness, but on a pro-inflammatory diet you are a true ticking time bomb. When inflammatory responses are triggered with little or no provocation, or are overly vigorous, swelling tissues and destructive enzymes may become life threatening. That’s exactly what happened to Kyle when he turned strawberry-red.
If you slap someone’s cheek, it turns red. Ever wonder why? The injury triggers a healthy inflammatory response, which dilates the blood vessels of the skin. This allows more oxygen, white blood cells, and nutrients to give the injured tissue a little boost to regain normal function.
But what about red rashes that just appear for no apparent reason? I see patients with rashes every day in my clinic. And I take every one of them seriously because they’re a sign that the body—and diet—are out of balance, maybe severely. In the most severe cases of imbalance, anaphylactic reactions like baby Kyle’s are a real possibility. Even slight immune system imbalance leaves you vulnerable to all manner of recurring problems, feeling fine one minute and horrible the next.
All kinds of allergic reactions can occur whenever someone’s immune system has been so overwhelmed by conflicting signals from excessive, ongoing inflammation that its chemical programming gets confused. The confused immune system interprets normal body proteins as foreign and launches an attack. The affected tissues then ooze chemicals that increase blood flow and cause serum to leak into their surroundings. On the skin, you may see a number of red, raised so-called wheal and flare reactions that look a little like mosquito bites. The affected blood vessels can be anywhere: sinuses, lungs, kidneys, joints, etc. Depending on the location and the severity of the immune response, a person’s symptoms may be mildly annoying—a runny nose or watery eyes—or they may be life threatening. Immune system confusion will vary day by day depending on stress, degree of infection, sleep, and diet, making allergic reactions hard to predict. To get off the roller coaster, be confident that a good diet can straighten out even the most confused immune systems.
One of the most common rashes I see is eczema. People with eczema can develop itchy, blotchy red rashes all over their bodies. As with all allergic disorders, the symptoms of eczema can resolve but then flare up again and again throughout a person’s entire life. People with eczema—just like people with food allergies—may also experience immune system imbalance elsewhere in the body, causing allergic rhinitis, sinusitis, and asthma. Food allergies, chronic runny noses, asthma—the underlying cause is the same: immune system imbalance caused by pro-inflammatory foods. And you already know what the cure is: eating the Human Diet and incorporating the Four Pillars into your daily routine.
When Kyle’s pediatrician referred him for allergy testing, his mother learned that her ten-month-old had already developed allergies to proteins in milk, shellfish, green beans, and eggs—some of which he’d never even eaten. As Kyle grows and his airway enlarges and better tolerates small degrees of swelling, he may overcome the breathing crises. But if his mother keeps feeding him the standard food-pyramid-compliant diet, he will develop more inflammatory problems. One of the most common and most disfiguring is acne.
Earlier in the book, I explained how oxidation damages fats, and how those damaged fats lead to inflammation, making it nearly impossible to lose weight. Oxidized fats in our skin lead to the pustular inflammation that teenagers, and many adults, dread.587, 588
Right now, you’re covered in bacteria—billions of them. Don’t bother running off to the shower; you’ll never get rid of them all. These beneficial skin bacteria protect us from infection. They make their living off the shed husks of dead skin cells, which are so loaded with protein and fat that they offer a reliable food source for all kinds of microbes.
If bacteria were to penetrate the dead outermost layer of skin, patrolling white blood cells would go berserk. To them, the foreign proteins and oxidized fats adorning cell membranes of invasive bacteria are signs of trouble, and like beat cops spotting a couple of hoodlums carrying weapons into a playground, they sound the alarm.589 Like a well-trained SWAT team, swarming white blood cells bust down doors and break through walls to get to their target, shooting free radicals and releasing collagen-chewing enzymes (called collagenases).590
If it was all a false alarm caused by diet-induced accidental inflammation and in reality no real infection—well, too bad. White blood cells aren’t disposed to quibbling over such nuances, so you’ll just have to deal with the scars. If you’ve ever had an abscess, you know that the first thing the doctor wants to do is drain it. That’s all the body is trying to do by unleashing its collagenases.
Free radicals help kill bacteria but also damage collagen. Here we see an enzyme that generates free radicals to destroy bacteria. Without these enzymes, invasive bacteria would take over our bodies and kill us. Unfortunately, an enzyme’s aim is not so accurate and many innocent body bystanders also get hurt—the cost of doing business.
Acne is a problem of oil oxidation. When we eat easily oxidizable, unnatural oils, they wind up everywhere—our arteries, our nervous system, and the skin on our face. White blood cells mistake oxidized oil for the fatty acids that coat the surface of invasive bacteria, and squads of white blood cells rush to the scene. And as you know, they show up swinging and strike at everything within reach. The acne lesion swells and reddens. Once the battle is over, the site is commemorated with a permanent pit. This is called cystic-nodular acne, an example of an inflammatory false alarm generated not by infection but by oxidized oils.591, 592 So if you or your teen is fighting acne, step one is getting off of vegetable oil. And while you’re at it, get off sugar, too. Sugar suppresses the immune system and feeds the bacteria living in acne pustules.593, 594
,When I see a patient with acne, it suggests they’ve been eating pro-inflammatory foods full of sugar and vegetable oil. Pro-inflammatory foods send powerfully disruptive signals that will override signals for less urgent metabolic needs (like muscle development, as we saw in the last chapter). So I’ve found that people with bad acne are also prone to hormone imbalances, reproductive challenges, and a variety of other problems.
Today acne is the most common skin disease, with nearly 90 percent of adolescents affected.595 But there’s little evidence that acne occurred at anything near these rates in the distant past, and many dermatologists believe it is a modern disease.596 Not only were the fats ancient people consumed healthier than what we eat today, they may have enjoyed protection from acne and other skin infections because of a secret ingredient in their makeup.
Archaeologists have found the earliest evidence of cosmetics being used in Egypt dating back to 4,000 years B.C. The Egyptians made their makeup using fat blended with special saps and either red ochre or ashes. Around the world today, indigenous people still go to great lengths to find the right ingredients to make their own makeup. For instance, the Himba, a nomadic tribe of goat herders in Northern Africa, mix goat butter with ochre and finely crushed herbs, and the paste gives their skin a beautifully smooth red-brown hue. In Hawaii, people used coconut butter that had been left in the sun for a few weeks to give themselves a shiny glow for (frequent) festival occasions. This common practice of applying carefully blended fats to our skin has several purposes.
For one, fat holds moisture in our skin, which helps it stay smooth and soft. Today, high-quality skin care products still contain cocoa butter, avocado, olive oil, and even egg yolk. As good as modern cosmetics may be, they lack the secret ingredient of their aboriginal counterparts: probiotics. The blends of goat butter, cocoa butter, and probably even the ash and fat the Egyptians used, were all loaded with beneficial bacteria, thanks to the fact that their raw materials and containers were colonized with microbes. Applying creams with beneficial bacteria has the same benefits to your skin that eating probiotic-rich foods like yogurt has to your intestinal tract: healthy numbers of beneficial critters outnumber any potentially invasive bacteria. This would have helped people in the past—who generally had little or no clean water to wash with—from getting infected after cutting their skin.597
Next time you’re having lunch with one of your friends and she’s pouring on the low-fat dressing, ask her if she’d use the same ingredients to condition her hair or moisturize her skin. Probably not. Quality beauty products are made with natural saturated fats. Vegetable oil is less suitable because it oxidizes too easily, gets sticky, and irritates our skin. The cosmetic manufacturers would probably love to use these cheap oils instead of more expensive natural fats, but they would never get away with it. Putting this stuff in makeup would lead to obvious allergic skin rashes and acne. Of course, food manufacturers can get away with putting vegetable oil in everything—while telling us that it’s good for our hearts! Lucky for them, we can’t see the inflammatory damage it does to our arteries. And because we don’t have nerve endings in our arterial lumens, we can’t even feel it. But we can think in the more naturalistic common-sense terms of our ancestors and say, If I can’t put it on my skin, I won’t put it in my mouth.
So far, we’ve seen that vegetable oils and sugar can create imbalances in the immune system and cause acne, and both diseases can damage our collagen. But one of the most well-known collagen-destroying factors is the sun.
Given the near-obsessive use of sunscreen in all but the dimmest of light, you’d think that UV radiation passed right through our bodies, like X-rays. In reality, UV has little penetrating power, and most UV (95 percent or more) is blocked by the rapidly regenerating epidermis. The collagen beneath the epidermis absorbs much of the rest.598 Depending on your diet, that 5 percent may lead to inflamed, sunburned skin—or it may not. (Of course, if you get way too much sun, you’ll get redness and inflammation even on the best diet.) Inflammation leads to the release of those collagen-chewing enzymes and can greatly exacerbate the damage done by UV light, leading to wrinkling down the road.599 A diet full of nutrients will keep those enzymes on a short leash and keep your skin looking young.
So should we avoid the sun as much as possible? The more your diet is full of pro-inflammatory fats and sugar, the more my answer is yes. But if your diet is healthy, then your collagen won’t be seriously injured unless your skin actually burns—which I would never recommend. The more vegetable oil in your diet, and the more PUFAs end up in your skin, the more readily you will get burned and the more extensive the invisible damage to the deeper layers of your skin. I recommend that my patients who follow a healthy diet enjoy sensible sunlight exposure. But what that means in terms of minutes in the sun will vary widely depending on your latitude, altitude, climate, the time of year, color of your skin, and your body’s ability to tan.
Like plants, we use sunlight to grow. Plants use sunlight for photosynthesis. We use sunlight when our skin uses sunlight to make vitamin D, without which a child’s growth will be severely stunted. We used to get much of our vitamin D—the sunshine vitamin—directly from sunlight.600 When UV smashes into the epidermis, it strikes cholesterol molecules, transforming ordinary cholesterol into a precursor of vitamin D, which gets fully activated in the liver and the kidney. We need D to metabolize calcium, so if a child doesn’t get enough, the deficiency can weaken their bones and stunt their growth. As you know from previous chapters, few of us get enough D these days. We used to eat a lot more liver than we do today, which happens to be the best dietary source of vitamin D. Even fortified milk rarely contains the amount of vitamin D it’s supposed to, and only cholecalciferol supplements work like the real thing (ergocalciferol can even be toxic).601, 602 No matter where we humans live around the globe, we’ve got to get our sunshine vitamin one way or another, whether directly from the sun or indirectly—as they do in Norway and Alaska—by consuming liver oils from fish and other animals that did get sunlight.
HOW SUN CAUSES WRINKLNG
On a pro-inflammatory diet, sun exposure (A) causes excess inflammation (B), which induces fibroblast cells to release enzymes that chew apart your collagen (C), leading to the imperfect repair (D) that distorts the smoothness of your collagen fibers and enables a wrinkle to form. The more cycles of collagen destruction your skin goes through, the more you wrinkle. Both inflammation and UV radiation damage your DNA, potentially leading to skin cancer.
Warning: To prevent aging, you have to block UVB and UVA, and no known sunscreen can yet block UVA. Fortunately melanin, which makes our skin dark, can. Sunblocks (opaque creams like zinc oxide) also block both UVA and UVB.
By the way, SPF reflects UVB blocking ability only. The FDA doesn’t have any standards for UVA blocking creams, so labels claiming to block UVA are meaningless.
Compare how these two sixty-year-olds have aged. The man on the right has spent most of his life out in the sun eating a traditional Himba diet composed of 50–80 percent animal fat. His smooth, tight skin represents what everyone’s skin could look like at this age had we all been raised on balanced diets. The kind-looking man on the left is Dr. Dean Ornish, a non-smoking American physician, and a well-intentioned proponent of a low-fat, industrialized interpretation of a Mediterranean diet. Unfortunately, his collagen is sagging and deteriorated due to lack of fat-soluble vitamins and unintentional consumption of pro-inflammatory fats (trans and MegaTrans; see Chapter 7).
Dr. Ornish is not overweight, yet we see fat deposits under his chin because of his pro-inflammatory diet. Inflammation also elevates insulin levels. Insulin is a powerful signal for storing both sugar and fat, and doing so in a hurry. The kind of fat receptors under our necks (and on our bellies) are called alpha receptors, which are the body’s first responders to excess energy. So even on a low-fat diet, with alpha receptors turned on, your body is greedy for energy, and any sugar you eat is converted to fat and stored under your chin, on your belly, and around your internal organs.
Low-fat (left) versus high-fat diets (right). Who looks tougher? Because sagging skin and bloated neck wattles belie a weakness within the connective tissues supporting our bones and joints as well as our skin, we can judge a person’s potential strength by how well their skin holds up. Trans fat plus high carbs are largely responsible for the decline and fall of the American physique.
In the summer, a Caucasian sunbathing for twenty minutes at 35 degrees latitude on the outer banks of North Carolina or a beach in San Luis Obispo, California, at midday can make enough vitamin D to last at least a week.603 After that amount of radiation, ideally, we’d shut off the supply of UV because too much destroys collagen and vital nutrients, including vitamin D. Fortunately, your skin has a way of regulating the dose of UV you get. A skin pigment called melanin accomplishes this for us. Our genetics so perfectly modulate the baseline amount of pigment in our skin that the skin tone of indigenous people can be used to predict their latitude of origin to within a few degrees.604
How does your skin manage its day-to-day regulation of melanin, say, when you go to the beach? By responding to an increase in the amount of radiation it gets. When UV light penetrates the thin outermost layer of dead cells, it enters special cells called melanocytes. Melanocytes, which live in the outermost layer of living skin (the epidermis), where they can best protect the layer of collagen beneath, contain a signaling chemical that acts like a tiny mechanical switch. When UV hits the chemical, it flips the switch to its “on” position. The chemical undergoes a shape change (because an electron is stripped away by the UV rays), which allows it to fit into an enzyme that turns on the melanocyte’s melanin-production proteins, jump-starting your tanning systems. Within a matter of minutes to hours, depending on your genetics, your skin begins to darken. The faster your melanin appears, the more effectively your body protects you from the damaging UV rays.
Melanocytes, clothing, and opaque sunblocks effectively block both UVA and UVB. But while sunscreens block UVB, which can damage epidermal cell DNA and increase your risk for skin cancer, they do nothing to stop the lower energy, more deeply penetrating UVA radiation.605 UVA can penetrate to the deeper layers of the skin, where it can damage the collagen that keeps your skin looking smooth and healthy. While UVA does not have enough energy to directly damage DNA, it can—in much the same way as heat in a frying pan—interact with PUFAs to incite free radical cascades that will damage both DNA and collagen.606 So while sunscreens do reduce burning and, importantly, the direct UVB-induced DNA damage, in a way they can also lull you into a false sense of security, letting you soak up far more UVA than you otherwise would. This may be one reason why sunscreens have never been shown to prevent skin cancer.607 In my view, a complete strategy for preventing cancer-causing UV-induced DNA and wrinkle-promoting collagen damage includes more than just slopping on sunscreen and presuming you’ve done all you can. I also advise optimizing your diet to reduce PUFA oxidation and, if time permits, gradually coaxing your body into manufacturing more of the skin pigment melanin.
This is my forearm at age forty. My collagen was not formed properly, due to epigenetic damage on my father’s side (he also aged prematurely), lack of cartilage/bone broth in childhood, and dietary toxins (my sugar habit, plus margarine). You can perform this test by starting with fingers two inches apart and pinching gently to bring your fingers one inch apart. Continuous wrinkling indicates inadequate elastin. If I don’t watch my diet now, I’ll age rapidly.
Many of us Irish folk have sluggish melanocytes that can’t pump out the color fast enough, and so we tend to burn. Then, after a day or so, the redness starts to tan. How do we get tan after sun? Too much sun inflames the skin. The inflammation releases free radicals. And the free radicals trigger the melanocyte-signaling chemical, which gets the tanning engine running. This delay feature may be by design; in higher latitudes, a hyper-reactive tendency to tan wouldn’t allow people to make enough vitamin D. Even on a good diet, that whopping dose of UVA on your first day of hanging out in the sun can damage your collagen down to the deep dermal layers and age your skin prematurely, but on a bad diet, the damage will be worse.
What happens inside our brains that makes us think young skin is more attractive? Like children, our brains can be easily frustrated. They can’t stand confusion, even if it only exists at the subconscious level. When you look at someone, your eyes travel from feature to feature in jerky bursts of motion called saccades, darting between features as if magnetized by contrast. Young skin is smooth, with no distracting wrinkles. This enables us to focus on the person’s expressions, facilitating safe and pleasant communication.
The picture on the right shows the trace of a person’s gaze while examining the portrait on the left. These two pictures are taken from the work done by Russian psycho-physicist Dr. Alfred Yarbus in the 1950s. Yarbus demonstrated that human beings do not scan a scene randomly. Our eyes move deliberately between points of interest, which tend to be areas of contrast, particularly around the eyes and mouth. The quick darting from feature to feature strongly suggests that, rather than assessing features individually, we measure their relationships to one another and to the face as a whole. When those relationships conform closely to the Marquardt Mask (see Chapter 4) we want to keep looking!
So get some summer sun, but pace yourself—especially if you’re light-skinned. Ideally, before your Hawaiian vacation, get a base tan first. That melanin can protect your deeper tissues from UVA and UVB. I know you’ll be tempted, but please, whenever and wherever you’re getting sun, try to stay away from pro-inflammatory vegetable oils and sugar even if you’re on vacation. Not only will you be protecting your skin, but that move will help steer you toward your vacation destination’s best traditional cuisine.
When we see a seventy-five-year-old who looks half her age, we might presume she’s spent her whole life ducking into the shadows to avoid the sun. That, and maybe Botox. But when you hear that she loves the outdoors, hikes regularly, and spends three days a week out on the golf course, you think, What gives? Why does her skin look so smooth? The secret isn’t avoiding the sun. It’s avoiding inflammation.
If this woman, let’s call her Mary, is so adept at avoiding inflammation, chances are good that the rest of her body is holding up just as well. She avoids inflammation by staying away from artificial fats and sugar—giving into none of those buffet-table temptations and steering clear of vegetable oil dressings and the sugary juices that could damage her nerves—so she’s as sharp and feisty as ever. She remembers what happened sixty years ago and what happened sixty days ago. Mary and her husband have recently taken up ballroom dancing. Sometimes, when they get home after class, they waltz themselves straight into the bedroom to keep the music going. And they can, thanks to healthy arteries and the robust blood flow that comes with it.
Mary loves making stock, sauerkraut, her own fresh bread, and all the foods from the Four Pillars that her mother taught her to make and that keep inflammation away. When her friends come over for brunch, they compliment Mary on her amazingly smooth skin—especially lately, as they’ve been noticing more blotches on theirs. On imbalanced diets, something as minor as a pimple, a rap on the shin, or even friction around the neck from clothing and jewelry can produce enough inflammation to trigger the body’s tanning machine by mistake, causing a dark spot. Their skin seems to have aged faster than Mary’s. And it has: inflammation accelerates cell division, setting the aging process to fast forward, making skin thinner, weaker, and vulnerable to bruising. Mary’s adherence to the Human Diet has slowed it all down.
Practically every nutrient studied plays a role in protecting collagen by acting as an antioxidant and/or growth factor. Vitamin A, vitamin C, glutathione, glucosamine, and omega-3 fatty acids have each been shown to cut collagen damage from UV radiation by up to 80 percent.608, 609, 610, 611 Imagine the effects of getting enough of all of them combined, as Mary does. Cortisone has been studied too, and found to have similar anti-wrinkle effects. Cortisone is a hormone made from cholesterol by the adrenal glands, which, as with all organs, function best when fortified by a good diet, exercise, sleep, and avoidance of chronic stress. By eating poorly and suppressing adrenal function, we reduce our body’s natural cortisone production and prematurely age all our collagenous tissues—most conspicuously, our skin. By eating real food, full of genuine vitamins (not synthetic counterfeits), Mary has kept her collagen in superb condition.
Mary does strength training, but toned muscles alone can’t prevent “the sag” that we all dread, which develops as gravity relentlessly tugs our tissues downward. Mary has a built-in anti-gravity device, a latticework of sturdy collagen woven throughout her body fat. Having enough healthy collagen in the subcutaneous fat (just under your skin, where most body fat is stored) doesn’t just prevent cellulite and keep your curves looking taut, as we saw earlier. It also prevents the development of the chin wattle, the droopy butt, the floppy underarm, and even those creases on the sides of the nose and mouth. Mary’s mother didn’t have these things, and neither does Mary. The reason is healthy subcutaneous fat.
More than anything else, the ability of your collagen to stand up to gravity depends on a very special member of the collagen family called elastin. Think of elastin as a latticework of interconnected proteins that function like molecular springs. When we develop wrinkles, it’s primarily because our elastin has sprung.612 Skin, arteries, lungs, and ligaments have the most elastin, which gives these tissues their elastic consistency and the ability to rebound after stretching. Women like Mary have a healthy amount of elastin throughout their bodies, as does anyone who ages well or looks younger than they are. If any single molecule could be said to represent the fountain of youth, this would be it.
Mary’s supple and resilient elastin molecules were built to last. With a half-life of seventy-five years, they’re meant to last a lifetime. UC Davis anatomy professor Charles G. Plopper tells us that “the half-life of elastin matches the life-span of the species,”613 suggesting that elastin plays a central role in determining life expectancy. (Half-life means that half of something will be gone in the given time interval.)
Elastin’s strength is also its drawback. Since it’s supposed to be made to last, your body doesn’t make much more after puberty. As far as we know, it’s only possible to make elastin during periods of rapid growth. Elastin depends on a unique chemical bond, called the desmosine cross-link, that’s extremely difficult to manufacture. It can be made only while your body is swimming in the hormones and growth factors that orchestrate its manufacture—during embryologic life, early childhood growth spurts, and adolescence. Although Mary’s mother didn’t know any of these physiologic details, she knew that the intricate and delicate growth processes going on inside Mary’s little body were dependent upon the best nutritional environment she could provide. This applies especially to elastin, since elastin’s complexity makes the process of manufacturing this vital tissue particularly easy to disrupt. Says Dr. Plopper, “It is now apparent that a range of intra-uterine and early postnatal factors, such as hypoxia, nutritional restriction, and FGR [not having enough room in the uterus] can affect elastin deposition.”
Mary’s upbringing was a lot different than Kyle’s, the sickly baby we met at the opening of this chapter. Thanks to the fact that Mary’s mother, and her mother’s mother, did everything right—from planning conception to fortifying their bodies to breastfeeding and cooking from scratch—Mary’s life has been blessed with superior health, good looks, and happy fortune. The same mixture of hormones and nutrients that ensured Mary’s strong elastin also ensured balanced skeletal growth. Her wide jaw and strong cheekbones allowed for straight teeth and a beautiful smile. And because optimal facial development leaves enough room for the eyes to develop normally, Mary never needed glasses. Even now, much to her eye doctor’s amazement, good quality collagen in the lenses of her eyes has delayed the onset of presbyopia (the age-related lens stiffness that necessitates reading glasses). Though she’s always enjoyed the sun, Mary’s anti-inflammatory diet has kept her free of cataracts, macular degeneration, and other degenerative diseases that make us feel old.
Even if your upbringing didn’t provide you with an optimized complement of youth-promoting elastin, there’s still a lot your diet can do to help you delay the aging process. In addition to avoiding harmful vegetable oils to reduce the tendency for inflammation to activate the elastin-destruction process, you can take another positive action. In 2014, Korean researchers studying the anti-aging effects of traditional bone stock discovered that a component of the stock, called bone hydrolysate, can help protect elastin from UV damage like that induced by overexposure to the sun.614 Their work was done on a tissue culture Petri dish. Another group studying living mice exposed to UV light found that consuming the hydrolysate protected not just elastin but all forms of collagen as well as the fibroblasts cells that produce and sustain the collagen network supporting our skin.615
Mary is the hero of this book. As is her mother, and her mother, and hers—all the way back to her most distant ancestors who followed dietary practices that ensured the benefits of beauty and health. Mary is the manifestation of that dream. And because she appreciates her ancestors’ gifts, she has fulfilled her duty to protect them and has passed the genetic vessel unbroken to her son and daughter.
The vessel is her family’s epigenetic code. And Mary’s granddaughter now benefits from it. If she’s careful, and willing to take seriously her charge as curator of her family’s genetic heritage, then her ancestors’ dream will live on in the healthy, beautiful body of Mary’s great-granddaughter.
The sacred vessel of epigenetic integrity does not belong to us. We receive it, benefit from it, and then pass it on. During our lives on Earth we must also protect it. And by eating food from the Four Pillars and celebrating the living art of ancient, traditional cuisine, we can do exactly that, engineering our bodies, and those of our children, into the forms that best represent balanced, uninterrupted, natural growth.
The requisites of perfect health are not hidden. We know what keeps us well, and we know what makes us sick. When we allow real food to connect our bodies to nature, nature speaks through that sustenance directly to our DNA, to the living, intelligent engines that drive our physiologies. Health is beautiful. Food informs physiology. Source matters. Your family’s physiologic destiny is largely under your control. These are the central tenets of Deep Nutrition. If you adhere to the principles outlined in this book, you’ll soon feel healthier than you do today. You will support vital symmetry within your children’s growing bodies and rig the genetic lottery to the benefit of those yet to be born. With every meal, you do the groundwork that will allow your legacy to sprout from the earth hundreds of years from now, in the form of a beautiful child. That child’s beauty and health is your beauty and health, an unending renewal that promises to keep you forever young.