Dr Frances Pitsilis - Is Natural Best?

Consumers are becoming more aware of the positive issues around natural and organic products.  With more and more natural and organic skin products set to come into an already busy skin care market, we need to be aware of the pros and cons of these products and contrast them to the conventional products that are already here. We need to be able to critically assess the value of a potentially new product in our skin care arsenal and decide what our criteria will be and whether that product fits our needs.


What is “natural”?  
I searched for a firm criterion for the definition of what is natural and had some difficulty.  However, it is generally thought that a natural product will contain ingredients that are extracted directly from plants or animal products as opposed to being produced synthetically.  It would be reasonable for the natural product to undergo basic processing and still be called natural.  The basic processing could include physical processing, simple chemical reactions and the like. As a result, a natural ingredient would be considered to include plant, animal, mineral or microbial ingredients.  

The natural ingredients would be grown, harvested, raised and processed in an ecological manner, not produced synthetically and be free of chemicals.  The natural ingredient would not be extracted or processed using anything other than natural ingredients as solvents.  In addition the natural product would not be exposed to irradiation and neither would it contain any genetically modified organisms.  Natural products should not contain synthetic ingredients, artificial ingredients including colours, nor synthetic chemical preservatives.


What is “organic”?
With all of that in mind, we are now interested in what constitutes “organic”.  Organic refers to the way that the natural product was grown and farmed.  When it comes to agriculture, organic farming refers to the way the crop is grown, the way it is farmed and delivered to the consumer, and all the paperwork required.   This would mean that instead of pesticides and chemicals, the farmer would use manure, compost and forms of biological pest control so that he can avoid chemicals.  The farmer would also avoid modified organisms.

 In addition, organic agriculture is a production system that pays attention to sustaining the health of the soil, ecosystems and people.  So the philosophy of organic farming goes one step further as compared with production of natural ingredients by paying attention to the environment and the sustainability of the soil.  What I have read suggests that generally, but not necessarily, organic pesticides are safer and more environmentally friendly than synthetic pesticides.  The main five pesticides used in organic farming are a type of bacterial toxin called Bt®, pyrethrum, rotenone®, copper and sulphur.  It is important to note that few organic farms manage to eliminate the use of pesticides entirely.  

One source of information states that organic products stand out as having higher levels of secondary plant compounds and vitamin C.  In addition it states that organically grown produce has double the flavenoids, an important antioxidant. The interesting thing about organic farming is that avoiding herbicides and pesticides allow more bio-diversity of weeds, plant and insect species, which improves the quality of the soil and therefore gives a better product.  This in turn helps organic farmers to have a much bigger yield of crops.

You might wonder about the process of organic certification and what that means to the consumer.  In fact, requirements for this certification vary from country to country and generally involve a set of production standards for the growing, storage, processing, packaging and shipping of the organic product.  The requirements for certification include avoiding synthetic chemicals like fertiliser, pesticides, antibiotics, additives, genetically modified organisms, irradiation, and the use of sewage sludge.  They also require the use of farmland that has been free from chemicals for at least three or more years.  On top of this, there are production and sales records that must be kept.

The reason organic certification exists is to ensure the quality of the product, to prevent fraud and to promote commerce of these products – the label “certified organic” gives the consumer an assurance that the product is what it states it is, similar to labels in the supermarket like “low fat”, and “no artificial preservatives”.  

In some countries, organic certification and standards are overseen by the Government but not so in others.  In Australia, where a good percentage of our organic ingredients come from, there are no domestic standards for organic produce and there is no system for monitoring the labelling of organic produce sold within Australia.  The largest certifier of organic products in Australia is Australian Certified Organic, which is a subsidiary of Biological Farmers Australia, the largest organic farmers collective in the county.

In the USA, there is federal organic legislation which defines three levels of organics.  The label “100% organic” means that the product is made entirely with certified organic ingredients and methods.  The label “organic” means that the product contains at least 95% organic ingredients, and the label “made with organic ingredients” means that the product contains a minimum of 70% organic ingredients.  So, you see, you will have to look at where the product came from to know what the label “organic” means.

So, someone else’s idea of “natural” might mean something different to your idea of “natural”, and similarly someone else’s idea of organic may mean something different to your idea of organic.  In addition to that, we have to look at the toxicity of cosmetics and also look at cosmetics that may well be designed for vegans and vegetarians who don’t want any animal products in the cosmetic.


Skin care priorities
Clearly, when we are looking at choosing products for our clinics, we normally think about the goals that we have for that product.  Some of the goals may include the following:

1. Safety – we want to know that what we are advising our clients to use is not going to harm or irritate them in any way.
2. Results - following on closely from safety, our clients rely on our advice giving them great results or they may not return.
3. Shelf life – there is no point in having a natural or organic product if you must throw it away in a month.
4. Saleability – does the product look, feel and smell good, because we all know that these attributes improve the acceptability of a product.

Cosmeceuticals
Over the last few decades, the emergence of a type of skin care called “cosmeceutical” has emerged from the USA, the term having been coined by Professor Kingman there.  The definition of a cosmeceutical is that it is a marriage between cosmetics and so-called pharmaceuticals.  The concept is that a cosmeceutical will be superior to a cosmetic in that it will give a definitely superior skin care result.  It is important to note that the skin care marketplace is relatively unregulated.  In the USA the term cosmeceutical is not recognised by the Federal Food Drug & Cosmetic Act and they are not subject to review by the FDA (Food & Drug Administration).  Although cosmetics and cosmeceuticals are tested for safety, testing to determine whether beneficial ingredients actually live up to the manufacturers claim is not mandatory.


Skin care goals
When it comes to getting therapeutic results from the products, I would suggest that our skin care goals would be divided into several categories.  The first category might well be to protect the skin.  For that, we use sunscreen, moisturisers and even antioxidants within skin care.  The sunscreen is to protect UV radiation from hitting the skin and causing ageing changes and the potential for skin cancer.  The moisturiser is one of the things that helps to restore the integrity of the skin and its barrier function, which in turn reduces ageing and protects the skin from cancer.  Antioxidant ingredients are present in much of the skin care available in order to reduce the impact of UV radiation on the skin and protect the skin.

The second category of treatment that will help our skin care goals for our clients are to treat and restore the skin.  The par excellence product has been with us for decades is the Retinoids which are known to protect the skin from skin cancer, normalise and regulate cell differentiation, as well as normalising pores and pigmentation.  Retinoids are derived from vitamin A, an intermediate being retinoic acid and the strongest of all being tretinoin. The Retinoids are the number one on our list of therapeutic ingredients.

Another treat and restore ingredient, which is number two on the list are the alpha hydroxyl acids which exfoliate the skin, hydrate and therefore restore skin barrier function.  Alphahydroxy acids or glycolic acid, are commonly part of the skin care arsenal.  From time to time, betahydroxy acid or salicylic acid can be used on its own or in combination with alphahydroxy acids.  Other acids that can be of some use include lactic acid.

Salicylic acid is a multifunctional ingredient  that reduces inflammation, is keratolytic, and reduces blemishes because of these traits. It can also improve skin thickness, barrier functions and collagen production.

Zinc Oxide is a safe physical sun blocker wish is thought to be an antioxidant, and safe to use.
De-pigmenting agents are used to treat and restore and they can include hydroquinone, vitamin C, kojic acid, and sometime botanical ingredients.

Antioxidant additives to skin care generally tend to be natural.  They are the usual ones which include vitamin C, vitamin E and co-enzyme Q10 ( or ubiquinone).  Another natural substance is alpha lipoic acid which, in addition to having anti inflammatory and antioxidant properties, acts as an exfoliant.  

When you look at the list so far, its largely natural………


Botannicals
And then you have botanical antioxidants which are generally made up of flavinoids, carotenoids and polyphenols – it is enough to know that these names are just descriptions of plant ingredients that have active actions.  The carotenoids are related to vitamin A and include astaxanthin which can be found in tomatoes, as well as lutein and lycopene which are found in tomatoes.

The polyphenols include rosemary, St Johns Wort, pomegranate, blueberry leaf and olive leaf.

The flavones include rutin which is found in apples and blueberries, quercetin (apples and blueberries), hesperitin (lemons and oranges), and dooming (found in lemons and oranges).  However, as you will see later, putting some of these plant ingredients into skin care may cause more problems than it solves.

With some of these botanicals, we don’t have any data on whether they help the skin, even though they help when swallowed – this can be the case with many botanicals. In addition, some of them actually irritate the skin – like St Johns Wort ,which causes light sensitivity.

A very important polyphenol is that of epigallocatechin-3-gallate (EGCG) which his found in green tea.  This is one of the major and most chemo preventive constituents responsible for the pharmacological effect in green tea.

Copper peptides improve superoxide dysmutase in the skin.  The latter is an enzyme that destroys superoxide, which is a highly reactive free radical.  

Additional botanical antioxidants include Soy.  Soya beans are a rich source of flavenoids called isoflavones, e.g. genistein and daidezein.  When swallowed and eaten, these work like phytooestrogens and reduce heart disease and breast cancer.  When placed on the skin, they have been found to increase skin thickness and product collagen synthesis.  It stimulates hyaluronic acid  production in the skin. Genistein functions as a potent antioxidant scavenging peroxide radicals and protecting against lipid peroxidation (fat going rancid).

Curcumin is a polyphenol antioxidant that comes from turmeric.  The hydrogenated form of curcumin is tetrahydrocurcumin which is an off white colour and can be added to skin care products to function as an antioxidant and to protect the lipids in the moisturiser from going rancid.  Cosmetic chemists report this antioxidant effect of tetrahydrocurcumin to be greater than vitamin E.

Resveratrol, a chemical related to curcumin and found in red wine, also has antioxidant properties. But does it safely do anything for the skin?

Silymarin is an extract of the milk thistle plant and is generally known as being an internal detoxifier.  However, it is a strong antioxidant and protects lipid peroxidation by scavenging free radicals.

Pycnogenol is an extract of French marine pine bark (pinus piaster) which when sold for oral consumption, is used as a cardiovascular disease preventer.  It also is a topical skin antioxidant because it is a potent free radical scavenger that can reduce the vitamin C radical returning vitamin C to its active form.  The active vitamin C in turn regenerates vitamin E in its active form.  I have noticed pycnogenol has been added to one of the vitamin C serum products that I use.  Pycnogenol is the ideal anti-ageing additive because it demonstrates no long term toxicity, no cellular changes and no allergenicity.

Pomegranate contains a lot of vitamin C, as well as vitamin B5, potassium and antioxidant polyphenols.  These substances have been demonstrated to protect against UVA and UVB induced cell damage in experiments using human skin fibroblasts.

Specific vitamins in addition to vitamin C&E that may have benefit, include panthenol, the alcohol analogue of vitamin B5.  It is converted in the skin to pantethenic acid, which is an important component of co-enzyme A, which is important for normal cellular metabolism – without good cellular metabolism, the skin cells do not work efficiently.

Some natural products may be antioxidants but may also cause irritation or cancer, as is the case with bergamot oil – it causes photosensitivity, and can also cause malignant cell changes.

Chamomile might be relaxing when taken orally, but if you are allergic to the daisy family, you can be allergic to this also.

Bitter Orange is an antioxidant, but causes skin irritation. Clove oil on the skin causes cell death.


Hormones
Hormones have been touted as being useful for skin rejuvenation, one of which could be melatonin, which is known to have cancer reducing actions.  It has been shown to suppress UV radiation induced erythema.

Other hormones that find their way into some skin care products includes oestradiol and stroll. Do we really want hormones on our skin? What if it rubs off on our male partners?

Although, wherever possible, consumers generally do like to have products that are as natural or organic as possible, sometimes these botanicals can cause unwanted side effects.  Below I will list a few that have good and bad actions:


Other skincare ingredients
Niacinamide, which is similar to vitamin B3 and a member of the vitamin B group, has been shown to have anti tumour effect on carotenocytes and to suppress UVB photocarcinogenesis in the test tube.

Dimethylaminoethanol (DMAE) has been touted for its ability to improve skin firmness and to lift the skin.  It is able to diminish the cross linking of proteins that occurs during ageing, probably acting as a free radical scavenger.

Emu oil – there may be a push from Australia for this. It is a good emollient, but does it do anything else?


As a doctor, I have been brought up through my training, to “first do not harm”.  As a result, I am always scrutinising any new treatment with care so that my client does not end up with an unwanted side effect.  One of the issues that has been circulating for at least a decade now has been the effect of preservatives and chemicals in skin care that is used on the body, face and even in the armpits, and their relationship with breast cancer and perhaps other problems with health.  Researchers around the world are working to see whether some of these chemicals may stimulate abnormal oestrogens in the skin and fat of the breast, which may adversely contribute to the production of breast cancer.  Nothing is proven that I know of as yet, however, it is worth being aware of the impact of chemicals, pesticides, preservatives, plastics and other chemicals that maybe found in skin care.  So, this is why go more natural, and even organic is generally a good thing.

How do natural substances compare with our old favourites? Is natural always best? After all , some of the naturals can irritate.  In addition, there is no solid definition of natural and organic across the world.

There are going to be some products that are largely natural and organic that cannot be categorised as such because they don’t quite meet the criteria.  If they work very well then you might want to keep them

The only thing is to be well informed and vigilant in relation to skin care ingredients and their actions.  You need to continue to be critical of new products and remember your priorities. On the one hand, natural and organic is best.  We want to avoid chemicals, preservatives and pesticides.  On the other hand, how well do some of our current ingredients work and do we need to replace them?

I believe my priorities will always be - safety, results, shelf life and saleability.