Nutraceuticals and the Elderly

(1/12/10)- Improvement of Naturally Aged Skin-Vitamin A-Dermatologists refer to wrinkles as a symptom of intrinsic skin aging. Intrinsic aging, also known as the natural aging process, is a continuous process that normally begins in our mid-20s. Within the skin, collagen production slows, and elastin, the substance that enables skin to snap back into place, has a bit less spring. Dead skin cells do not shed as quickly and turnover of new skin cells may decrease slightly. While these changes usually begin in our 20s, the signs of intrinsic aging are typically not visible for decades

Researchers are constantly looking to improve the clinical signs of naturally aged skin. The journal Archives of Dermatology (2007;143: 606-612) included a study by Rezi Kafi, Heh Shin R. Kwak, Wendy E. Schumacher et alinvestigating the role of vitamin A (Retinol) in improving naturally ages skin

The study used 36 elderly subjects, with a mean age of 87 years, residing in 2 senior citizens facilities. A 0.4% topical retinol lotion was applied 3 times a week for 24 weeks to either the left or right arm of the subject. Both clinical and biochemical measures were used to evaluate the skin.

The authors concluded that "Topical retinol improves fine wrinkles associated with natural aging...retinol-treated aged skin is more likely to with stand skin injury and ulcer formation along with improved appearance"

This study is another step in supporting the use of Vitamin A (retinol) in improving naturally aged skin. It is probably most valid in minimal aged skin with fine wrinkles. This study did not show the effects of application for greater than 24 weeks. It needs to be replicated and extended over at least one year. It also limited retinol application to the arm. Most people are concerned with facial wrinkles, sometimes called spider lines that appear around the eyes

Research shows that there are, in fact, two distinct types of aging. Aging caused by the genes we inherit is called intrinsic (internal) aging.. The other type of aging is known as extrinsic (external) aging and is caused by environmental factors, such as exposure to the suntan rays. We would suggest that you consult a Dermatologist before you undertake any of the options related to skin anti-aging. We suggest special caution when applying the variety of over-the-counter anti-aging products.

(11/20/08)- Supplementation with Fish Oil- A review of the literature suggests that in the last ten year no new life-prolonging drugs have appeared on the scene in heart failure. Now the results of the GISSI-HF study, chaired by Fr. Luigi Tavazzi, professor of cardiology at the University of Pavia (Italy), indicated that a single daily low dose of fish oil in patients with chronic heart failure results in moderate but clinically significant reduction in mortality and cardiovascular hospitalization.

As opposed to many studies of the role of fish oil supplement as a treatment with short evaluation time, this study had a median follow-up of 3.9 years. The study began with 6,975 patients of whom nearly 5000 stayed compliant to the protocol and the duration of the study. This is a high retention rate considering the length of the study.

It was a randomized, double blind, placebo/control research protocol. The daily dose of fish oil was 1 g/day of omega-3 polyunsaturated fatty acids (n-3 PUFA) in the form of eicosapentaenoic acid and docosahexaenoic acid.

In the Lancet article, the findings were "In absolute terms, 56 patients needed to be treated for a median duration of 3·9 years to avoid one death or 44 to avoid one event like death or admission to hospital for cardiovascular reasons. In both groups, gastrointestinal disorders were the most frequent adverse reaction (96 [3%] n-3 PUFA group vs 92 [3%] placebo group).

Dr Tavazzi is quoted as saying "If you prescribe a new drug forever, you need to have a well-tolerated dose, and this was exceptionally well tolerated. He also noted that the fish oil was essentially devoid of side effects. The results were modest, but showed a 14% relative risk reduction in mortality rates when compared to the placebo group for those who completed the study..

A study like this lends credence to the epidemiological studies that linked fish intake to reduced cardiovascular death.

For more detailed information of this study, see Lancet,Volume 372, Issue 9645. pages 1223 - 1230, 4 October 2008.

It should be noted that a group of pharmaceutical companies including Societa Prodotti Antibiotici S.p.A., Pfizer Inc., Sigma-Tau Pharmaceuticals Inc., and AstraZeneca funded this study.

(10/29/00)- Many of the biggest companies in the chemical industry have begun to plan for entry into a market that affects the elderly. They are building up sizable businesses in an untraditional market called nutraceuticals. Nutraceuticals involve health-enhancing or disease-preventing products that are not as strictly regulated as the bulk pharmaceutical industry. Have you noticed the amount of products that are now "vitamin enriched" and/or other health related items that are now on the market?

When you go to your neighborhood health food store and buy vitamins, supplements and other nutritional products, you are probably buying products composed of long-chain polyunsaturated fatty acids (PUFAs), or a product that takes advantage of some combination of chemical knowledge and biotechnology expertise. The companies that make the active raw ingredients for these nutraceuticals are also involved in chemical, margarine, grain and plant-derived products. They have always been aware of the potential of the health-product market, but only now are starting to go into it in a big way. Sales indicate that the elderly are the largest users of health care products. Witness all the advertisements targeted to this group. Secondly, the largest growing age category of the population is the elderly. Combining profits with health is very attractive to these chemical companies, especially when they are under attack from environmental groups and could righteously proclaim they are engaged in health- enhancing activity.

Omega -3 and omega –6 fatty acids, less commonly known as docosalhexaenoicacid (DHA) and arachidonic acid (AA), are marketed, long-chain polyunsaturated fatty acids (PUFAs), one of the most common nutraceuticals. DHA can be produced in one of two ways: microbal fermentation and extraction from the oil of fatty fish such as tuna. It is also found in breast milk and is the predominant structural fatty acid in brain gray matter. This opens its use in the infant formula supplementation market as well as in individuals experiencing cognitive decline. One company, Martek, is reported to have signed a nonexclusive PUFA technology licensing agreement with all the major infant formula manufacturers except Nestle. They await approval from the FDA to include this product into the US term infant formula. This would bring the infant formula closer to natural breast milk, a requirement for federal approval.

Two small companies market DHA-rich oils produced by advanced fermentation techniques, while the large firms use fish-oil-based products combined with their knowledge of microencapsulation of the fatty oil along with encapsulated powders. The small companies usually have agreements to get the unrefined product, which they then refine, for consumer distribution. One of these companies makes DHA by fermenting algae, similar to what the fish does naturally. This company linked itself to a division of a very large chemical company, Montsano (since acquired by Pharmacia), that had a large facility to ferment the algae. Part of the agreement allowed the chemical company to market a DHA containing dietary supplement through General Nutrition Company (GNC) stores.

You can expect to see omega fatty oils, not only in infant formula and dietary supplements but also in "functional foods" and beverages stressing that these products provide a health benefit beyond basic nutrition, just like the claims for vitamins. There is a claim before the FDA that these omega fatty oils can provide cardiovascular health. The FDA has yet to rule on this subject.

Another nutritional supplement is lecithin-derived phospholipids, suggested as a way to improve memory. The worldwide leader in lecithin products, Lucas Meyer Group, was bought out by the international chemical industry firm SKW and folded into its bioactives unit. Other nutritional products in this unit include gamma linolenic acid, creatine, pyruvates and phytosterols and some new amino acids. It has been predicted that this product will do $200 million in sales by the year 2003.

Another company, BASF, came out with a nutraceutical blockbuster in 1999 called SAMe (adenosylmethionine), and is one of the country’s best-selling nutritional supplement. It is made via fermentation in Switzerland and then tablets in Italy and then sold directly to the consumer under the label of stores such as GNC and Nature Made.

BASF is searching for a new blockbuster and it thinks it may have it in the product 5-MTHF (5 methyltetrahydrofolate), an ingredient considered to be the biologically active form of the B vitamin folic acid. It is also pursuing new antioxidants and a complement to vitamins C and E and beta-carotene called lycopene. This compound has been shown to reduce the risk of prostate cancer. Roche, the number one vitamin producer, launched its own lycopene in the US in the third quarter of 1999.

Raisio, a Finnish company involved in chemicals, margarine and grain combined with McNeil Consumer Healthcare, to market plant derived stanol esters, extracted from vegetable oils and tall oils, a product of paper pulping. A recent study showed that stanols have a cholesterol-lowering effect and there is a way to combine the otherwise insoluble stanols with vegetable fat to produce an edible product. They are using the Benecol labeling for their products. The FDA has allowed them to state that the product has been proven to lower cholesterol and may lower the risk of heart disease. This is only the 12th ever approval by the FDA to a product to make this claim. The public will have 75 days to make comments and then the claim will start appearing on product labels.

All these products could prove healthier for the individual, but we would hope that there would be effective monitoring of these products so that the consumer gets what is on the label. We have reported in another article on this web site of the varying amounts of the active ingredients found in St John’s Wort. We were recently informed that, an independent testing firm in White Plains, NY, found only six out of 13 retail SAMe products contained the level of the active ingredient indicated on the label.

We would also be concerned about the potential for the "functional food" enhancers to interact with the medications being taken by the elderly and result in synergistic effects not previously seen or reported in the literature. It is imperative for all manufacturers to maintain the highest product quality, and also to be aware of allpotential side effects with medications. The elderly are particularly vulnerable to adverse effects from medications. Nutraceuticals are a new frontier needing continuing excellent science and high standards if they are to take their place in the health armentarium. They will need to monitor the intermediate users of their products in order to protect the consumer.


Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated January 12, 2010

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