Understanding The Effects Of Antioxidants, Hormonal Imbalances And Stress On Aging

Antioxidants

1. Define the term ‘oxidation’.

2. What is a ‘free radical’ and how do they cause damage?

3. What is an anti-oxidant and what role does it play in oxidative stress?

4. Fill in the missing terms.

_____ damages the phospholipid bi-layer of the cell membrane. This causes the membrane to _____ and _____ . Once this happens the cell wall inhibits ______and disrupts the transport of ______.

This also disrupts   and   movement into the cell and metabolic by-products or wastes are not able to leave the cell resulting in increased _____and potentially in cell death. 

5. In your own words summarise the ‘antioxidant defence strategy’

6. Anti-ageing medicine treatment protocols for oxidative stress are to assess the biomarkers or levels of damage to DNA, muscles, proteins etc. and from here identify appropriate interventions. These can be used to reduce chronic inflammation as well as oxidative stress.

What supplementation or treatments are indicated for the following?

Malondialdehyde
Reactive Carbonyls formed from AGEs

The Endocrine System

7. How does the endocrine system play a role in the ageing process?

8. List 3 conditions that possibly result from hormonal imbalances and identify the main hormone responsible. 

9.a. Hormones can be divided into two types: water-soluble and fat-soluble. Explain the action of each and provide examples.

Water-Soluble	Fat-soluble

 
b. What role do Eicosanoids play?

10. All steroids originate from cholesterol, which then converts to pregnenolone and into other hormones. What are the 5 categories of steroid hormones?

11. Identify what affect the following hormones have on the skin?

Androgens
DHEA
MSH

12. Explain how anti-ageing treatment guidelines/protocols might correct stress-related hormonal imbalances 

13. Identify the conditions of adrenal gland that maybe associated with nutritional deficiency

14. Identify the key nutrients used in anti-ageing treatment regimes to correct adrenal fatigue

15. For the following nutrients, state the therapeutic daily amounts and contraindications for each of the key nutrients

(Nutrient Reference Values refers to The Australian Government Department of Health Nutrient Reference Value Guidelines and can be found at https://www.nrv.gov.au/nutrients/) 

Key Nutrients	Nutrient Reference Values	How do these nutrients affect body systems
Vitamin C
Niacin
Pantothenic Acid
Magnesium

16. a. Discuss the affects thyroid hormone deficiency and thyroid hormone excess has on the body

Deficiency	Excess

b. In relation to your answer above, what are the suggested treatments to correct these?

Deficiency	Excess

17. How have changes in our life styles and diet played a role in affecting our hormone activity?

18. How can assessment and alteration of our nutrient deficiencies improve our hormone imbalances?

19. What are the symptoms and potential disease implications of continual elevated cortisol levels?

Hormonal Imbalances

20. What are the suggested dietary guidelines (to include and to avoid) in relation specifically to diet that may help to lower cortisol levels?

21
a. Explain the differences between saliva, urine and serum hormone analysis

b. What are the advantages and disadvantages of testing hormone levels in the blood? 

22. What are the five main pathology tests or assessments aiming to identify? 

23. How frequently should testing be carried out?

24. Why are hormone ratios important? What is the correct ratio for the three types of oestrogen?

25. How does analyse and interpretation of hormone testing results help provide treatment protocols in anti-ageing medicine?

26. What is aromatisation and why is this significant?

27. Identify the hormones involved in the stress response.

28. Describe the role of a medical practitioner in anti-ageing medicine

29. The role of other multi-disciplinary members (including you) varies. What role might the nurse/therapist play in anti-ageing medicine?

Section 2

Case Studies

Scenario 1

Tina is 52 years old. She feels that she has ’aged overnight’ following a very difficult year. Tina and her husband are separated and this has not been amicable. He has a new relationship with a woman 25 years younger than Tina. This has left her feeling ‘old, ugly and unloved’.  She has two children ages 19 and 23. They live at home but work shifts, have busy social lives and partners of their own.

Tina explains that she has a stressful job that involves sitting in front of the computer for hours on end and deadlines to meet. She does try hard to go to the gym but maybe only manages 2 visits a week. She states she usually misses breakfast and just has a few coffees at work. Lunch is usually a sandwich. As she often finds herself at home alone during the evening, she often just picks up a takeaway and bottle of wine on the way home. She states she is having problems sleeping as she gets too hot and feels this may be contributing to her irritability and mood swings.

In the last 6 months Tina has been diagnosed with high blood pressure and advised that she needs to loose weight. She is 5 foot 4” (1.64m) and weighs 85Kgs. Her ideal weight should be around 55 to 60kgs. 

1. Explain the principles of the ageing process to Tina. 

2 a. Analyse how Tina’s diet and lifestyle may be contributing to her ‘ageing concerns’.

Stress

b. Examine how recommended lifestyle changes may contribute to improving Tina’s well being  

3. Does Tina have any acute stress in her life? If so, what? How may chronic stress, also be contributing to Tina’s aging.

4. Consider Tina’s whole endocrine system. How might her hormones levels contribute to her concerns and presenting symptoms?

5. What anti-ageing treatment protocols could be implemented to correct these hormonal imbalances (Q4)

6. Using your knowledge gained from this unit, (and the answer above) create a plan for Tina that introduces key nutrients and nutriceuticals, to help address her long-term health and ageing concerns?

Scenario 2

David is 57 years old. In the last 5 years he has really changed his life around. He was diagnosed with diabetes in his childhood and has been insulin dependant since age 11. He was always a bit overweight and was never well enough to participate in sports at school. At age 51, he was rushed to hospital with chest pain and it was suggested that he was developing angina. David decided this was the wake-up call he needed. He joined a rehab group and then the gym and has since become obsessed with exercise. He trains everyday and runs long distances. He has completed 4 full marathons and several half marathons. 

He has attended the clinic because he feels he is looking really old. He has lost a great deal of weight especially from his face.  His facial skeletal structure is well defined and his skin appears to be sagging with no underlying fat to support the skin. He also states he is sweating more and needs to use more deodorant than usual. He feels his skin is oiler and his hair needs washing more often. He is not sure if this is because of his age?

1 a. Analyse how David’s diet and lifestyle may be contributing to his ‘ageing concerns’.

b. Examine how recommended lifestyle changes may contribute to improving David’s well being  

2. Does David have anything causing acute stress in his life? If so, what? 

What chronic stress/stressors may also be contributing to David’s aging?

3. Review how David’s endocrine system and hormones levels may also be contributing to his concerns and what anti-ageing treatment protocols may help correct these imbalances

4. Using your knowledge gained from this unit, discuss a plan for David to introduce key nutrients and nutriceuticals to help with his long-term health?

Antioxidants

Answer 1

The interaction between the oxygen molecule and other substances that they may contact, these substances may be metal or tissues. In other words, it is the process of loss of electrons from an atom.

Answer 2

Free radicals are defined as any element or molecule capable of free existence that has one unpaired electron in its atomic orbital. Hydroxyl radicals and nitric oxide radicals attack the important macromolecules such as lipids, nucleic acid and proteins and leads to hemostatic disruption and cell damage.

Answer 3

Antioxidants are substances that can be created by humans or found naturally. These substances may prevent or reduce that cell damage. They are naturally found in fruits and vegetable and can be taken as dietary supplements. Examples of antioxidants are: lutein, lycopene, selenium, Vitamin A, C, and E.

The antioxidant representatives play a crucial role in preventing or inhibiting specific factors associated with oxidative injury. But the unbalance between antioxidant defence mechanism and oxidant species may trigger a specific factor that triggers oxidative stress (Pisoschi & Pop, 2015).

Answer 4 Fill in the blanks

• Necrosis
• Abnormal ion flux
• Organelles dysfunction
• Channel protein
• Molecules
• Membrane receptors
• Nutrients
• Osmoregulation

Answer 5

Antioxidants are the molecules that prevent the effects of the free radicals by donating an electron. This sharing of electron results in reducing the activity of free radicals. When a free radical released or steals an electron, another radical is formed (Patekar, Kheur, Bagul, Kulkarni, Mahalle, Ingle, & Dhas, 2013). This molecule continues to make more unstable products. This process did not stop until the terminations occur where the radical is stabilized by the chain breaking antioxidant like beta-carotene and vitamin C and E (Villines, 2017).

Answer 6

• Advanced Glycation End products (AGEs) are found in most tissues in the body and their concentration increases from the age of twenty onward.
• Malondialdehyde treatment:  L-Carnitine may protect the damage of cells by reducing the levels of MDA and increasing GSH (Ates, Alp, Mumcu, Azizi, Cinici, Kiziltunc, & Baykal, 2008).

Reactive Carbonyls produced from AGEs

Carbonyls are responsible for oxidative stress in the human body which leads to aging. Antioxidants such as Vitamin E can isolate or sequester carbonyl can provide an action against the oxidative stress (Hwang, Lee, Aldini, & Yeum, 2016).

Answer 7

1. Production of cortisol and aldosterone decreases
2. Production of aldosterone hormone reduces which takes part in low blood pressure
3. The decrease in estrogen and progesterone
4. The parathyroid production has been increased with age, which contributes to osteoporosis (Medline Plus, 2018).

Answer 8

1. Cushing syndrome is caused by the abnormally high levels of cortisol hormone.
2. Congenital Adrenal hyperplasia is the hereditary disease which occurred due to low production of cortisol and aldosterone.
3. Diabetes is associated with high blood sugar levels which are caused by the defect in Insulin production (Brito, 2017).

Answer 9 (A)

Water soluble hormones

WSH attaches to receptor molecule and causes a chemical reaction inside a cell and activates enzymes. These enzymes further either increase or decrease the speed of chemical reactions of the cell.

Example: Adrenalin, noradrenalin, TSH, and HGH.

Fat-soluble hormones (FSH)

It is also known as lipid soluble. They pass through the plasma membrane and attaches to a receptor and make hormone receptor complex which further moves to the nucleus and attached at the binding site of DNA. This results in gene activation (on) and inactivation (off).

Hormonal Imbalances

Example: testosterone, progesterone, and estrogen (Ivyroses, 2018)

Answer 9 (B)

The changes occurred in endothelial eicosanoids contributes to reducing the function of the endothelium, pathological dysfunction, and age-related heart disease. The main functions of eicosanoids are reducing inflammation, blood clot inhibition, dilate blood vessels. Eicocenpide also associated with diabetic nerve damage, high blood pressure, allergies, skin inflammations and cancer. 

Answer 10 

1. Glucocorticoids
2. Androgens
3. Progesterone
4. Mineralocorticoids
5. estrogen (Nature, 2018)

Answer 11

• Androgen:  Affects thickness of skin, wrinkle formation, skin moisture, hair growth and sebaceous gland growth.
• DHEA: Allergic reactions of DHEA on the skin include skin redness, swelling, itching, and rashes. It also associated with hair loss, acne and facial hair growth in women’s (Nnama, 2017).
• MSH: Increased production of melanin results in skin darkness, Hyperpigmentation of skin. Deficiency of MSH leads to loss of protection from ultraviolet rays of the sun and inflammation (you and your hormones, 2018).

Answer 12

How Anti-ageing treatment protocols correct the stress-related hormonal imbalance

• Reduce calorie intake: calorie restriction leads to increase growth hormone production.
• Hormone replacement therapy: It slows down the aging process. However, it has some side effects such as carpal tunnel and edema.
• Eflornithine (Vaniqa): it helps to slow the abnormal facial hair growth in women’s by regulating the excessive production of growth hormone
• Antiandrogen Medications: these prescription blocks androgen and helps to reduce severe acne and abnormal hair growth (Huizen, 2018).

Answer 13

Adrenal gland conditions

• Adrenal gland fatigue: Deficiency of vitamins D, E and k leads to adrenal gland fatigue   
• Adrenal burnout: caused by low levels of macromolecules such as calcium, magnesium potassium and sodium. Low protein intake, vitamins A, C and E and manganese also associated with adrenal burnout (Wilson, 2018).

Answer 14

Nutrients used in antigen treatment to treat adrenal glands

• Vitamin D
• Vitamin E
• Vitamin K
• Protein

Answer 15

Nutrients	Reference value	How affects body systems
Vitamins C	45 mg/day	Deficiency of Vit c causes scurvy
Niacin (B3)	16 mg/day	Severe deficiency may cause Pellagra
Pantothenic Acid (B5)	6 mg/day	Deficiency affects the nervous system, energy production, and metabolism
Magnesium	330 mg/day	Deficiency causes diabetes, poor absorption, celiac and disease

Answer 16

1. Effects of hypothyroidism

• Dry hair
• Goiter
• Reduced heart rate
• Fatigue
• Dry skin
• Memory loss

Hyperthyroidism

• Hair loss
• Rapid heart rate
• Muscle weakness
• Irritability
• Nervousness

1. Treatments for hyperthyroidism

• Medicine such as methimazole stops the productions of thyroid
• Radioactive iodine: it is given orally either in the form of pill or liquid to ablate a hyperactive thyroid gland
• Radioactive iodine: removal of thyroid tissue that is producing the excess hormone (Medicine net, 2018).

Treatments for hypothyroidism

• Use of synthetic hormone levothyroxine. It restorers adequate level of hormone.

Answer 17

Effects of lifestyle and diet on hormone activity

• Excessive consumption of alcohol and sugar, contraceptive pills leads to the hormone problem
• Emotional upset, lack of sleep, stress, aging, smoking, exposure to heavy metal such as lead and mercury, sedimentary lifestyle lead to hormonal imbalance (Butler, 2016).

Answer 18

• Fibre rich diet can reduce the excessive level of estrogen. Lower levels of estrogen lower the risk of breast cancer in women’s. Salmon which is rich in omega 3 fatty acid boost testosterone level.
• Niacin intake has an effect on adrenal hormone and promotes the production of growth hormone
• Diet rich in Pantothenic acid promotes estrogen and progesterone production.

Answer 19

• Cushion disease is associated with elevated level of cortisol
• Fatigue
• Weight gain
• Back pain
• Thin skin
• Blood sugar dysregulation
• High blood pressure
• Muscle wasting
• Acne
• Impaired memory (Mayoclinic, 2018)

Answer 20

• Avoid high sugar diet, caffeine, and alcohol, high amount of trans fat
• Increase intake of micronutrients, antioxidant-rich diet, consumes enough fiber and healthy fats or protein.

Answer 21

Saliva	Urine	serum
Real life function of hormone evaluated	Test results reported as: high, low or normal	Test results show high, low or normal levels
Multiple salivary specimens	Single urine specimen	Routine serum testing is required
The collection at multiple times allow analysis of hormonal stress response	24-hour urine does not reflect the stress response	serum collection requires hospital or clinic visits

B) Blood Advantages

• A wide range of tests available
• Accepted as a high standard testing method
• Ideal for peptide hormones

Disadvantages

• Invasive method
• Processing of specimen required (centrifugation)
• The limitation of testing sex hormones

Answer 22

1. Liver function test
2. Full blood examination
3. Iron studies
4. TSH quantification
5. Urinalysis

Answer 23

Taking blood specimen is an invasive and testing is time, so cannot be done frequently.

Answer 24

Hormone ratios are important because they provide a straightforward way to analyze the effects of the twin interdependent hormones.

Estriol estradiol estrone

80:10:10

Answer 25

Measuring hormone level is important for the accurate diagnosis of hormone-related disease states which all exhibit same overlapping symptoms. It also enables one to ensure the adequate balance of hormones. Inaccurate identifications of hormone level result in inappropriate treatments (Horone Testing, 2018).

Answer 26

Aromatisation is a chemical process where the aromatic system is formed. Steroid aromatization is a natural process where testosterone is converted into estrogen carried out by the aromatase enzyme.

Answer 27

• Epinephrine
• Corticotrophin-releasing hormone
• Adrenocorticotropic hormone
• cortisol

Answer 28

• Dermatologist deals with skin related problem such as wrinkles, dryness and hair loss
• physiotherapist: to guide about the exercises beneficial in anti-aging
• general physician: to provide basic medicines related to blood pressure regulations
• Endocrinologist: specialist in hormones.

Answer 29

Nurses regularly perform dermal filler and injections of neurotoxin and laser treatment.

• To provide care patient had surgery
• To help the patient with medicine instructions
• To describe the precautions related to anti-aging medicines.

Answer 1

Aging is the natural process but it increases if diet and lifestyle of a person are unfavorable to the body. Tina suffers stressful events because her husband left her and married to younger women than Tina. The aging process of Tina associated with unhealthy diet, lack of exercise and sleeplessness. She also consumes alcohol on daily basis.

Answer 2

1. Aging is associated with lack of nutrients intake, alcohol intake and lack of exercise. Tina reported that she was taking high-calorie food and having stress during work hours which may be the reason for accelerating aging in Tina’s case.
2. Lifestyle-related changes

Consuming foods rich in B3, B6, and B12, reducing alcohol consumption 3 drinks a week, minimize fat intake. Yoga, dancing, and swimming might be a help to slow down aging, improve mood, and maintain healthy BMI and keeps brain sharp.

Answer 3

Tina has acute stress which was related to her work where she sits for hours in front of the computer and to meet the deadlines. The chronic stress she suffers was related to her husband who left her and married to other younger women.

Stress

Answer 4

The symptoms such as mood swings, stress levels, body temperature, weight gain, difficulty sleeping, high blood pressure, irritability, and anxiety are associated with hormonal imbalance. This is due to the increased or decreases productions of hormone such as insulin, steroids, growth hormone and adrenaline in the body.

Answer 5

• Metformin: to help manage to decrease blood sugar level.
• Hormone replacement therapy and be provided to alter the imbalanced hormone levels
• Avoid alcohol consumption which may trigger the excess hormone production
• Regular exercises and healthy diet  improves the insulin receptor sensitivity

Answer 6

As mentioned above Tina was suffering from acute and chronic stress. She was having an unhealthy diet and irregular exercise habits. Aging is the natural process that cannot be stopped but by adding some healthy nutrients and nutraceuticals in diet healthy aging can be maintained. Food sources can be used as nutraceuticals to maintain the healthy aging in Tina's case are dietary fibers, probiotics, prebiotics fatty acids polysaturated, amino acids minerals, and peptides, vitamins, carotenoids, phytochemicals (Pérez-Sánchez, Barrajón-Catalán, Herranz-López, & Micol, 2018).

Answer 1 A)

Mr. David never exercised before he diagnosed with diabetes but at the age of 57, he started to do excessive exercise. At this age, the body is unable to handle such pressure which may result in excessive sweating and skin problems. He even reduced the healthy fat from his face. Long-term insulin may be the reason for chest pain in David's case.

B) Recommendation

David needs to maintain the healthy fat in his body. Exercise should be limited which his body can handle. He should drink enough water to maintain the recover the loss of water, enough sleep, adding fruits in diet. 

Answer 2

The most stress event in Mr. David's scenario was the development of angina. He was always overweight since his childhood and it may be the stress he has all the time.

Answer 3

ACTH is the hormone that associated with aging. It stimulates the production of cortisol from the adrenal gland. It may results in poor skin condition, weight, pain, and insomnia. Stress may associate with stimulation of sympathetic nerves leads to excessive sweating.
          By using antiperspirant, excessive sweating can be controlled. Relaxing techniques and meditation may help to reduce the stress.

Answer 4

Nutrients that can be added to David’s diet are proteins, water, iron, calcium, Zinc Vitamins: A, D, E and K, Vitamin B complex and C (Clifford & Bellows, 2018).

Nutraceuticals

Bioactive peptides, bioactive polysaccharides, carotenoids, vitamin supplements and polyunsaturated fatty acids

Analyse the principle of anti-aging medicine

Clinical case study 1

1. Glycation is the process by which a molecule of sugar binds to protein and lipid. The Maillard reaction associated with AGEs where non-stable Schiff bases are formed due to the attachment of a glucose molecule to the amino acid. Further, it leads to the formation of ketoamine. Both Amadari product (ketoamine) and Schiff can react with amino acid or protein to produce adducts of protein. This will undergoes oxidation, dehydration, oxidative breakdown, polymerization and from a number of other AGEs.
2. According to the article, the glycosylation process is an enzymatic reaction and glycation is the non-enzymatic reaction. Glycation is the pathological reaction where AGE is the end product of the reaction and glycosylation is found to be a physiological reaction.
3. Effects of glycation on the skin are reduced epidermal homeostasis, cell renewal, and decrease skin contractile function, less tissue permeability, decreased elasticity and increase in stiffness. It also associated with induction and propagation of inflammation.
4. Extracellular proteins are the target of glycation. Collagen glycation affects its functioning. It also causes increased stiffness and decreased flexibility. In the intracellular protein, AGE modifies vimentin and CK10 in keratinocytes. Enzymes and growth factors are the targets.
5. Topical and edible ingredients such as aminoguanidine, Pyridoxamine, age breaker chemicals like dimethyl-3-phenyl-thiazolium chloride and FAOX enzyme.

Nutraceuticals such as ascorbic acid, niacinamide, trolex, riboflavin, zinc, manganese, selenium yeast and trolox can help to inhibit in vitro glycation of albumin.

6. Anti-aging Strategies

1. Substances like Aminoguanidine and pyridoxamine helps top prevent or inhibit the formation of AGE.
2. Age breakers such as ALT-711, N-Phenacylthiazolium, and N- phenacyl—4, 5-dimethyl thiazolium break the Maillard reaction.
3. Nutraceuticals such as Trolox, niacinamide, pyridoxal, sodium selenite, selenium yeast inhibits glycation.
4. By restricting calorie intake prevent accumulation of AGE
5. Antagonism of RACE is also helpful to reduce accumulation of AGE. Gene knockdown of RACE by using siRNAs (Gkogkolou & Böhm, 2012).

Clinical case study 2

1. In the stress event hypothalamus secrets CRH, this will further stimulate the pituitary gland to produce POMC peptides which includes ACTH, Adrenal gland then secretes GC and Catecholamines. In the response of these events, sebaceous gland produces CRH and prolactin, in nerve endings, secrete SP and catecholamine’s, dermal fibroblast secrets cortisol, epidermal keratinocytes, and melanocytes secretes CRH and Nts.
2. Atopic dermatitis is a skin disease associated with eczema and itching. The key features of an AD are skin barrier and function defect. Stress negatively impairs the permeability barriers function of the skin and also impacts homeostatic. Stress can is also suspected to trigger acne flares. Psoriasis exacerbation also associated with stress, the psoriasis stress affects skin peripheral HPA and SAM axis.
3. Pro-inflammatory signals such as cytokinesis cause oxidative damage to the cells and tissues, debris release. Psoriasis is associated with chronic skin inflammation leads to hyperplasia. Chronic inflammation also leads to dysfunction of protein, cell and organ and these changes contribute to aging.
4. Epinephrine binds to adrenergic receptors leads to decrease inflammation functions of the skin. NGF also contributes to allergic and neurogenic inflammation. Substances P or SP induces the release of cytokinesis leading to the proliferation of T cell and inflammation. 
5. Anti-inflammatory medicine may help to reduce chronic inflammation. Taking low doses of anti-inflammatory medicine such as Aspirin may decrease inflammation. Glutathione is an antioxidant that has the efficacy to control severe forms of inflammation. Vitamin A, C, D, K, and E have treated all inflammatory condition.
6. The author suggests sleep deprivation can affect the skin because lack of sleep may cause fine lines, pigmentations, and decreased the elasticity of the skin. Sleeplessness also associated with slow recovery from skin disruption. These symptoms are directly related to aging (Chen, & Lyga, 2014).

Clinical case study 3

1. Some of the sites like promoter-associated CpG islands that shows low DNA methylation tend to induce Methylation with age, while the person with increased DNA methylation like intergenic island tends to decrees methylation with the age.
2. Biochemical pathways associated with methylation are folate cycle where THF (tetrahydrofolate) changes to 10 formyls THF in the presence of DHFR. At this stage, purine is synthesized. The 10 formyl THF is then transformed in 5, 10 methylene THF in the presence of MTHFR and Riboflavin and further results in 5 MTHF. Another pathway is transsulfuration pathway where homocysteine changes to cysteine. 
3. Epigenetic drift is described as the collection of epigenetic changes occurs with age, which could be related to a person's unique environment.

Epigenetic clock reflects the aging process. It occurs due to the increasing variability which is caused by epigenetic drift.

1. Epigenetic drift and the epigenetic clock used as a marker to understand to the aging process in a particular person so that the treatments can the applied accordingly. DNA methylation can be sued as age predictor. Epigenetic age could be helpful to assess intervention or treatments. 
2. Findings of this studies related to the link between DNA methylation, epigenetic drift, and epigenetic drift can be helpful to discover new treatment for age-related problems. The results about the biochemical pathways related to methylations show that the aging process can be reduced by altering some pathways that accelerate aging.
3. According to Wilson, it was found that ALU and Line-1 elements exhibit decreased reduced methylation levels and increase in variability with age.
4. Most important nutrient in DNA methylation pathways is folate and B12. Some other nutrients such as cysteine, DHA, zinc, magnesium, riboflavin, niacin and choline also play a role in therapeutic treatment (Jones, Goodman, & Kobor, 2015).

References

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Chen, Y., & Lyga, J. (2014). Brain-skin connection: stress, inflammation and skin aging. Inflammation & Allergy-Drug Targets (Formerly Current Drug Targets-Inflammation & Allergy), 13(3), 177-190.

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Pérez-Sánchez, A., Barrajón-Catalán, E., Herranz-López, M., & Micol, V. (2018). Nutraceuticals for skin care: A comprehensive review of human clinical studies. Nutrients, 10(4), 403.

Villines, Z. (2017). How do free radicals affect the body?. Medicine News Today. Retrieved from: https://www.medicalnewstoday.com/articles/318652.php

Wilson, L. (2018). Adrenal Burnout Syndrome. Retrieved from: https://www.drlwilson.com/articles/adrenal_burnout.htm

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Pisoschi, A. M., & Pop, A. (2015). The role of antioxidants in the chemistry of oxidative stress: A review. European journal of medicinal chemistry, 97, 55-74.