Hanging jowls, bulldog cheeks – there are many names for a phenomenon most of us experience with age. Sagging skin – when everything that was ones perky decides it is time to follow gravity and move downwards.
As always in skincare the reasons for that happening are complex, but today I want to solely focus on one of them – the infamous “Sugar Sag” caused by a process called Glycation.
But why “Sugar Sag”? What exactly is Glycation? And is there something we can do against it, both internally and with topical treatments?
Just to make one thing crystal clear before we dive into Glycation, A.G.E.s and what they do to the skin: Out of the different factors that accelerate skin aging, the biggest is still external damage done by UV exposure, which depending on your lifestyle and where you live makes up for around 70% of premature skin aging, so if you have yet to master the art of regular sunscreen application and sun avoidance strategies, you probably don´t really need to worry about Glycation just yet. (More about sunscreen? Read here)
What exactly is Glycation?
It is a nonenzymatic (meaning it happens without the help of a special enzyme) process in which proteins, amino acids and lipids bind to sugar molecules like glucose and fructose, so for example your collagen, which is a protein, binds to glucose, creating a so called Advanced Glycation Endproduct (fittingly abbreviated to A.G.E.).
This glycation hinders the function of the protein or lipid and is not to be confused with Glycosylation, which is the same process catalyzed by an enzyme in order to transfer a molecule to its active or functional state.
Basically Glycation is without an enzyme, happens at random parts of the molecular structure and leads to impaired function, whereas Glycosylation happens with an enzyme, at a specific area of the molecule and increases the function.
What happens if A.G.E.s are formed?
Now that we have learned that Glycation and the creation of A.G.E.s lead to an impaired function of the molecule, what does that exactly mean for our skin and the rest of our bodies? Well, A.G.E.s can be formed basically anywhere, but proteins with a slow turnover rate like collagen are very susceptible to it, simply because they are around for longer. The collagen in your skin has a half-life of around 15 years, so once it has become an A.G.E., it stays that way for a long time.
A.G.E.-Collagen is more stiff, more brittle, it has difficulties cross-linking to other molecules in an orderly manner and its charge changes, so it can´t interact as well with the surrounding cells as it used to.
All that combined leads to impaired wound healing, an increased risk of scarring, loss in firmness and elasticity and, over time, sagging of the skin.
And that is just what we see on our face, A.G.E.s have been found to be behind many of the diabetic complications we see as well as a tendency for vascular problems like micro- and macro aneurysms with bleeding or stroke, as collagen is an integral part of our vascular walls.
On top of that A.G.E.s can bind to a specialized receptor called Receptor for A.G.E.s or RAGE that can trigger several cellular signaling pathways that increase inflammatory reactions in the skin, which, as we all know, is never a good thing.
Which mechanisms exactly lead to the development of A.G.E.s?
We don´t want A.G.E.s, I think that is well established now. But where do they actually come from and what makes them happen?
Well, there are two forms, endogenous and exogenous A.G.Es.
Endogenous A.G.E.s develop inside the body, when there is an abundance of sugar present around the protein or lipid. In short: High blood glucose levels will increase the chance of glycation. (More adverse effects of sugar on acne? Read here)
Exogenous A.G.E.s are formed in food preparation, especially when there is either a high temperature or a prolonged cooking time involved. Means of preparation that lead to high levels of A.G.E.s are frying, grilling and roasting, while water-based means like boiling and steaming produce lower amounts.
With the increase of food processing, we also see an increasing amount of A.G. E.s added to foods as they act as flavor enhancers and colorants. Of these exogenous A.G.E.s around 30% are absorbed in the gut and distributed with the blood stream.
And to come full circle to what I said earlier about sun protection: Formation of A.G.E.s seems to happen more frequently in areas that are exposed to UV rays as opposed to body parts that are usually covered up, even though I can not offer you an explanation as to why that is.
What is the best diet to prevent the effects of Glycation on the skin?
With A.G.E.s being so closely related to blood sugar levels and means of food preparation, it is only natural that we look at our dietary choices in order to prevent Glycation. And while that is surely a good idea, let me preface that part of the post by saying that most of the data we have here is from in vitro and animal studies and that the data in humans we have is limited to studies done on already diabetic patients or patients undergoing hemodialysis, all of which cannot just be transferred to healthy individuals.
With that said, we know that a diet low in A.G.E.s correlates to a reduction of inflammatory biomarkers in the skin and that caloric restriction and the prevention of blood sugar spikes are probably a good idea if you are concerned about the sugar sag.
The critical role glucose and fructose play in the Glycation process has led many to the conclusion that a carnivore diet is preferable over a plant based one, since fruits and vegetables contain much more glucose and fructose than meat does. But while again there is good reasoning behind that approach, it is important to keep in mind that it is not only the blood sugar levels that are important, but also the exogenous A.G.E.s. High fat cheeses and meat high in protein and fat that is grilled or roasted naturally contains much higher levels of these than fruits, vegetables and whole grains, especially if they are boiled or steamed.
Are there supplements that prevent or reverse Glycation?
Again, let me remind you that data is sparse and not usually found in studies done on healthy humans due to the many limitations nutritional studies have, but with that in mind, there are a variety of herbs and spices that seem to aid the body in getting rid of A.G.E.s:
Ginger, garlic, Flavonoids from tea, Niacinamide (more on the effect of that in skincare here), Zinc and of course more exotic ones like taurin, carnosine, pyridoxal and alpha-lipoic acid, just to name a few.
Another thing that might help due to the fact that A.G.E. formation is accelerated in the presence of Reactive Oxygen Species (ROS) are antioxidants like resveratrol.
Out of all of them, Carnosine is the one with the best human data from a study done on hemodialysis patients – it is available as a nutritional supplement, but also abundant in meat, poultry and dairy products.
With all the talk about prevention and supplements, I feel it is necessary to point out that our body is very well equipped to handle Glycation and A.G.Es if they occur at a normal rate – it just becomes a problem if there is an excess of glycation happening.
The role of topical skincare against Glycation
Of course there are topicals that promise to help against glycation. Best known for that is probably Dr Susanne von Schmiedeberg, who basically built her whole skincare line around L-Carnosine and skin glycation. As we do however have limited data on the effects these substances have when used internally, we have even less data that suggests topical application will do anything. And as the products are on the more expensive side, I personally have so far not felt the need to buy them.
The conclusion I drew in basically all of my post about skin and nutrition is the same I will come to here: If you eat a balanced diet rich in fibre, vegetables and lean meat and stay away from processed, deep fried or overly sugary things, you are probably good. If you, like me, have a huge sweet tooth and a weakness for Coke, you are probably speeding up the inevitable sagging of the skin.
Supplements are probably not necessary either and topicals are also not what I would spend my hard earned money on.