MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
Issue link: https://medesthetics.epubxp.com/i/238490
SUGAR ATTACK! Glycation occurs when sugar molecules, such as glucose, attach to a protein, resulting in a cross-linking of the protein. In the case of collagen—the most abundant protein in the skin—the sugar becomes enmeshed in the collagen, creating cross links that cause the skin's protein to become stiff and brittle, says Nannan Chen, PhD, Scientific Affairs, Research & Innovation for La Roche-Posay (laroche-posay.us). Unlike the enzymatic process of glycosylation—an essential step in protein modification—glycation is a nonenzymatic, abnormal joining of sugars with proteins, notes Jeannette Graf, MD, board certified dermatologist, assistant clinical professor of dermatology at Mt. Sinai Hospital in New York, and author of Stop Aging, Start Living (Crown). Without the regulation of enzymes, the process becomes random and irregular, resulting in a loss of elasticity and weaker, thinner skin. " Internally, glycation plays a role in neurodegenerative disorders and atherosclerosis. In the skin it shows up under fluorescence testing specifically in the form of pentosidine, a biomarker for AGEs, says Dr. Graf. Often referred to as the Maillard Reaction—named for the French chemist Louis-Camille Maillard, who first observed the effects of glucose and protein interaction—glycation affects the properties of the skin's collagen and alters the skin's extracellular matrix, thereby affecting cell migration, growth, proliferation and gene expression. Who Is at Risk? The more sugar there is in the body, the higher the incidence rate of glycation. For that reason, diabetics who do not manage their blood sugar through diet and exercise are at a greater risk than the average individual. Those who eat a lot of white rice, flour, sugar and refined carbohydrates also are prone to developing the condition. "Foods that are high on the Glycemic Index scale quickly turn into sugar in the body," says Michael York, president and CEO of Senté (sentelabs.com), a company that develops skincare products aimed at mitigating glycation-related damage in the skin. According to Dr. Graf, glycation usually begins to set in at about age 35, and it accelerates with age. "As we age, we become insulin resistant," agrees Charlene DeHaven, MD, FACEP clinical director of Innovative Skincare (innova, tiveskincare.com) and an antiaging expert trained in internal medicine. "If you're overweight, you're more resistant," she 36 JANUARY/FEBRUARY 2014 | MedEsthetics says. "Interestingly, except for severe obesity, age becomes more of a factor than weight after the age of 40." While the systemic effects of glycation are well-documented, the use of topicals to reverse or prevent glycation in the skin remains controversial. "Some of the ingredients that are being touted as anti-glycation are good, and we've been using them for 10 to 20 years," says Rhonda Allison, founder and CEO of Rhonda Allison Clinical Skin Care (rhondaallison.com). "They can help with inflammation, and there is some talk of ingredients that act as MMP inhibitors, but we have to be careful to not make in-depth claims." Dr. Graf echoes this reluctance to link ingredients with hard-hitting anti-glycation claims. "Glycation is not just limited to the skin," she says. "It's a systemic problem. It's not so much an outside-in problem as it is an insideout problem." Can Topicals Help? While diet can put the brakes on glycation by limiting the amount of free sugar in the bloodstream, skincare formulators are seeking topical ingredients that can help alleviate the damaging effects of glycation by fortifying the skin's natural defense system and helping it to synthesize new collagen to replace what is lost to crosslinking. The science can be hard to track, as many processes, Preventing the damaging effects of glycation including normal free radical starts by reducing one's intake of sugary oxidation, all result in damfoods and refined carbohydrates. age to the skin's collagen. "It's hard to tell clinically whether something is aged because of glycation or something else that may be going on," says Dr. Graf. One group of ingredients that has gained the most legitimacy in anti-glycation topical formulations is antioxidants, based on research, including "A Perspective on the Maillard Reaction and the Analysis of Protein Glycation by Mass Spectometry: Probing the Pathogenesis of Chronic Disease" (Quibin, Z, et al, J. Proteome Res. 2009, 8(2): 754-769), that linked glycation to oxidation. DeHaven points out that antioxidants help fortify the body's intrinsic antioxidant system. She recommends a good mix of oil and water-soluble choices. In particular, polyphenols such as catechins from green tea; resveratrol from red grape skin; and flavonoids, including pomegranates and blueberries. © ISTOCKPHOTO.COM What Is Glycation?