Health for the over 50s: inflammation and oxidative stress

Ageing is a natural part of life and cannot be avoided. However, the chronic and systemic inflammation that is generated by poor diet and lifestyle choices can accelerate the ageing process and increase the risk of many age-related  conditions.

In this week’s blog, we look more closely at two of the fundamental processes that can drive ageing: inflammation and oxidative stress and explore the beneficial impact that omega 3 fatty acids and specific antioxidants can have on these processes and how they can help to delay biological ageing.

Ageing, inflammation and oxidative stress

The notion of ‘healthy ageing’ as defined by the WHO is ‘the process of developing and maintaining functional ability that enables wellbeing in older age’. Whether or not we experience accelerated ageing or go on to develop age-related disease in later life has two main underpinning factors:¹

• The presence of chronic low-grade inflammation
• High levels of oxidative stress

When left unchecked, both inflammation and oxidative stress can lead to damage at a cellular level and can increase our biological age, which is intrinsically linked to health.

Inflammation is a natural biological response of the body to tissue damage, infections and chemical or physical agents, in which the production of inflammatory mediators such as cytokines, prostaglandins and reactive oxygen species (ROS) are triggered. It is also a part of normal metabolic processes, although for this the response is only weakly inflammatory. When inflammation is regulated and under control, it is beneficial and an essential component of our immune system and tissue remodelling. .

Chronic low-grade inflammation

Conversely, if inflammation is not controlled, these inflammatory mediators are a significant risk factor in many chronic conditions as most share a common inflammatory basis. As we age, many of us can develop a pro-inflammatory status – a condition aptly named ‘inflammageing’.² The following are often related to the chronic inflammation seen in ageing:

• Dysregulation of immune functioning
• Increased gut permeability
• Central obesity
• Changes to cellular signalling
• Mitochondrial dysfunction
• Chronic infection
• Cellular senescence (cells that no longer divide, but don’t die off)
• Decreased autophagy (autophagy is the body’s way of cleaning out damaged cells, to regeneratenewer, healthier cells)

Oxidative Stress is caused by an imbalance between the production and accumulation of ROS in cells and tissues and the level of antioxidants that are able to defend against them. When present in low concentrations, ROS play a number of critical functions in the body. However, when ROS levels are in excess and are not quelled, they can lead to damage to cells and tissues and accelerate biological ageing.³

Nutritional interventions for inflammation and oxidative stress

Although the ageing process is an inevitable part of life, developing illness doesn’t need to be. The good news is that nutrition plays a huge role in determining how our ageing takes place and we have this modifiable factor at our fingertips. Through nutrition we can help to mitigate some of the inflammation and oxidative stress that occurs with ageing and there are many nutrients that serve as a natural anti-inflammatory and antioxidant agents.

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Omega 3

The omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are known to have many roles in supporting human health, with one of their primary actions being to reduce inflammation and promote its resolution.¹ The human body not only needs sufficient amounts of omega-3 but also a suitable ratio between omega-6 and omega-3. Evidence suggests that we evolved to consume omega-6 and omega-3 fatty acids in a ratio of around 1:1. However, in today’s Western diet, it is thought to be closer to 16:1 and is shifted towards a more pro-inflammatory response.

An increased consumption of omega-3 fatty acids results in their incorporation into cell phospholipids, partly at the expense of the omega-6 fatty acid, arachidonic acid.

• A decrease in arachidonic-acid content means a decreased amount of substrate available for synthesis of the classic pro-inflammatory eicosanoids.
• EPA and DHA also produce the novel mediators D and E series resolvins, which seem to exert potent anti-inflammatory and immunomodulatory actions on immune cells.

Omega-3 therefore exerts a multi-faceted anti-inflammatory action in the body.² It may also increase antioxidant activity, such as superoxide dismutase and glutathione, enhancing the resistance to free radical attack and reducing lipid peroxidation and oxidative stress.³ 

Antioxidants

Antioxidants are compounds that help to prevent and repair damage to cells caused by oxidative stress.

CoQ10 serves as a powerful lipid soluble antioxidant. In this role it acts as a free radical scavenger by affecting the initiation and propagation of ROS. In addition to its direct antioxidant activity, CoQ10 is involved in the regeneration of the antioxidants vitamin C and vitamin E. In a meta-analysis, researchers found that the activity of glutathione peroxidase, superoxide dismutase, and catalase increased following supplementation with CoQ10 and there was a significant increase in total antioxidant capacity.¹ CoQ10 can by synthesized by the body, but levels decrease with age and poor nutritional status.

Astaxanthin is a natural pigment found in microalgae, plankton, krill and other seafood such as salmon, trout and crustaceans. This powerful pigment is responsible for giving a red-orange tone. Astaxanthin is a fat-soluble carotenoid and is often dubbed the “king of carotenoids,” as research shows that it is one of the most powerful antioxidants in nature.² Unlike most antioxidants, astaxanthin stretches through the bilayer membrane, providing protection against oxidative stress by scavenging ROS in both the inner and outer layers of the cellular membrane.³ The interest in this compound has increased dramatically over the last few years and many studies are now applying this molecule across many disease models.⁴

Oregano is a herb prominent in the Mediterranean diet. Flavonoids and phenolic acids (primarily carvacrol and thymol) are the main types of compounds present in oregano and have been studied due to their therapeutic potential, which has been partly attributed to their antioxidant and anti-inflammatory properties. ⁵

Grapeseed – Grape seeds contain high concentrations of antioxidant compounds including phenolic acids, anthocyanins, flavonoids, and oligomeric proanthocyanidin complexes (OPCs) –  all of which have been reported to exhibit a broad spectrum of pharmacological and protective effects.

Rosemary – is native to the Mediterranean region and has been used in herbal and folklore medicine for thousands of years. Rosemary is a rich source of antioxidants and bioactive chemicals (including phenolic diterpenes, such as carnosol), which may help to counteract oxidative stress and support the immune system.

Research into antioxidants, inflammation and oxidative stress

There have been many studies that support the use of omega 3 and specific antioxidants in a number of age-associated conditions. Below we discuss a few although this list is not exhaustive.

Cardiovascular disease (CVD)

CVD refers to a collection of conditions affecting the heart and blood vessels and is one of the leading causes of disability and death in the UK.¹ Strong evidence indicates that inflammageing is a risk factor for CVD.²

Omega 3

Evidence suggests that inflammation can lead to the development of hypertension, and that oxidative stress and endothelial dysfunction are both key steps in the development.

• Studies show that omega-3 can protect vascular cells and attenuate the proinflammatory reactions in hypertension.³

CoQ10

CoQ10 is a substance found naturally throughout the body, with some of the highest levels found in the heart.

• As a potent antioxidant, COQ10 can have a direct effect on the endothelium through increasing the bioavailability of nitric oxide, provoking vasodilation and lowering blood pressure.⁴
• RCTs also show CoQ10 can mediate chronic inflammation, often seen in CVD via effects on pro-inflammatory markers such as CRP, interleukins 1 and 8 and tumour necrosis factor-alpha.⁵
• In a 2022 systematic review of predominantly older adult males with CVD and hypertension, CoQ10 supplementation added to conventional therapy was shown to be safe and offered benefits clinically and at the cellular level.⁶

Astaxanthin

• Results from multiple studies support the antioxidant properties of astaxanthin, establishing it as a potential therapeutic agent for cardiovascular health.⁷
• Studies have also shown various protective roles of astaxanthin against CVD through its ability to improve inflammation by inhibiting the production of pro-inflammatory cytokines and modulating lipid metabolism, demonstrating reduced triglyceride and increased HDL levels in human trials.⁸

Oregano

• Specific to CVD, flavonoids, such as those found in Oregano have been shown to exhibit anti-platelet activity, which can reduce the risk of the formation of a blood clot that can obstruct blood vessels and cause stroke or heart attack.⁹

Grape seed extract

• The oxidation of LDL cholesterol considerably increases this risk of atherosclerosis, which is a well-known risk factor for CVD. In human studies, grape seed extract has been found to exert reducing effects on oxidized LDL.¹⁰
• Furthermore, a meta-analysis showed that grape seed extract appeared to significantly lower systolic blood pressure and heart rate.¹¹

Rosemary

• Rosemary has been shown to promote healthy circulation and to defend against inflammation.¹² 

Osteoarthritis (OA)

Over 8 million people in the UK are reported to have this degenerative joint condition¹ which is characterized by a state of low-grade inflammation contributing to both joint pain and degradation of the joint. ROS play key roles in the development of OA as they can accumulate in the synovial joint, causing extensive structural damage, inflammation, and cell death.

Omega 3

• Omega-3 fatty acids are thought to help those with OA by reducing the amount of pro-inflammatory substances and cartilage-damaging enzymes in the body.

 Astaxanthin

• Astaxanthin may protect against OA via the Nrf2 signaling, suggesting it might be a potential therapeutic supplement for OA treatment.²

 CoQ10

• Oral supplementation with CoQ10-micelles attenuated OA symptoms, including pain, tissue destruction, and inflammation. The expression levels of inflammatory cytokines and inflammatory cell death markers in synovial tissues were significantly reduced by CoQ10-micelle supplementation.³

 Brain/cognitive health

Cognitive health can be defined as the ability to think clearly, learn, and remember and is an important component of performing everyday activities. Cognitive health is just one aspect of overall brain health and is important for healthy ageing. Accumulating evidence has linked persistent inflammation to cognitive decline and risk of dementia.¹

Omega 3

• Increasing evidence indicates that poor status of essential nutrients such as omega 3 is associated with increased risk of cognitive decline.²

CoQ10

• Several nutrients including CoQ10 may target neurobiological pathways perturbed in diseases affecting the brain such as inflammation, oxidative stress, and mitochondrial dysfunction.³ Mitochondrial dysfunction, for example, has been associated with the onset and/or development of neurodegenerative diseases such as Parkinson’s disease, Alzheimer’s disease and Huntington’s disease.⁴ 

 Grapeseed

• Older adults who took grapeseed extract daily showed improved attention, language and memory after 12 weeks.⁵
• One study identified a critical role for grape seed proanthocyanidin extract as a neuroprotectant in the hippocampus and in preventing cognitive loss with ageing.⁶

Skin health

The skin can often display the most obvious signs of ageing and is subjected to oxidative stress caused by a variety of exogenous and endogenous sources. Excessive ROS can exacerbate skin pigmentation and ageing, which can lead to uneven skin tone, pigmentary disorder, skin roughness and wrinkles.¹ Antioxidants such as carotenoids, polyphenols, flavonoids as well as essential fats, have been widely referred to as agents capable of promoting skin health.

Omega 3

• Excessive sun exposure over time can lead to skin laxity, thickening and wrinkling, and contribute to accelerated ageing in the skin. Increasing antioxidant defences in our skin cells can limit this photodamage.
• Through the same potential to suppress the inflammatory response, omega-3 fatty acids can also confer a degree of photoprotection.²

Astaxanthin

Dietary carotenoids remarkably accumulate in the skin where they are needed most.

• Randomised, double-blind, placebo-controlled trials have shown that supplementation with astaxanthin daily can reduce signs of ageing such as fine lines and wrinkles.³

CoQ10

The skin is the body’s largest organ and a reduction in CoQ10 leaves it more susceptible to damage from free radicals which can impact us aesthetically in the form of wrinkles, loss of radiance and skin tone.

• CoQ10 provides skin cells with the energy needed for repair and regeneration.

It also offers antioxidant protection against the oxidative effects of UVA.⁴

Rosemary

• Rosemary’s antioxidants may help prevent wrinkles by stopping free radicals from breaking down the skin’s elasticity.

Eye health

Vision problems can lead to a higher risk of falls and accidents and can make day-to-day life harder as we age. Globally, at least 2.2 billion people suffer from varying degrees of visual impairment, and it is thought that in around half of these cases, it could have been prevented.¹ Although there are several risk factors for eye issues (smoking, genetics etc), good nutrition is key to promoting optimal eye health in ageing.

 Omega 3

• A meta-analysis looking at the efficacy of omega 3 supplementation for dry eye syndrome found that it offered an effective therapy.²
• A study in middle-aged and older adults with diabetes found that taking omega-3 daily may reduce the risk of diabetic retinopathy.³

Astaxanthin

A growing body of evidence suggests that astaxanthin is efficacious in the prevention and treatment of several ocular diseases, ranging from the anterior to the posterior pole of the eye.⁴

• A study showed that astaxanthin helped protect retinal cells against oxidative damage.⁵
• Several clinical trials showed significant improvement in the outcomes of various ocular diseases including diabetic retinopathy, age-related macular degeneration, glaucoma and cataract.⁴
• The antioxidant efficacy of astaxanthin has been confirmed by studies, which report a significant reduction in the levels of oxidative markers, such as malondialdehyde and isoprostane, and increased levels of antioxidant agents such as superoxide dismutase.⁴ 

CoQ10

• CoQ10 levels in the retina can decline by approximately 40% with age. This decline may have two consequences: a decrease in antioxidant ability and a decrease in the rate of ATP synthesis in the retina. This decline may be linked to the progression of macular degeneration.⁶

 Rosemary

• The compound carsonic acid, has been found to protect the retina from degeneration and toxicity. Findings suggest it may potentially have clinical application to diseases affecting the outer retina, including age-related macular degeneration and retinitis pigmentosa, in which oxidative stress is thought to contribute to disease progression.⁷

Inflammation and oxidative stress and lifestyle

We can further mitigate some of the inflammation and oxidative stress that occurs with ageing by adopting various practices such as:

• Moderate exercise
• Ensuring blood glucose levels are balanced
• Eating an anti-inflammatory diet
• Minimising stress
• Maintaining a healthy weight
• Being mindful of toxic exposures 

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References

Ageing, inflammation and oxidative stress

1. Peterson, K.S & Smith, C (2016) Ageing-Associated Oxidative Stress and Inflammation Are All Alleviated by Products from Grapes, Oxidative Medicine and Cellular Longevity
2. Ferrucci, L., (2018). Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nature reviews. Cardiology, 15(9), 505–522.
3. Pizzino, G et al. (2017) Oxidative Stress: Harms and Benefits for Human Health, Oxidative Medicine and Cellular Biology 

Omega3

1. Troesch, B., (2020). Expert Opinion on Benefits of Long-Chain Omega-3 Fatty Acids (DHA and EPA) in Aging and Clinical Nutrition. Nutrients, 12(9), 2555.
2. Saravanan, P (2010). Cardiovascular effects of marine omega-3 fatty acids. Lancet (London, England), 376(9740), 540–550.
3. Liao, J., (2022). The Effects of Fish Oil on Cardiovascular Diseases: Systematical Evaluation and Recent Advance. Frontiers in cardiovascular medicine, 8, 802306. 

Antioxidants

1. Sangsefidi, Z. S. (2020). The effect of coenzyme Q10 supplementation on oxidative stress: A systematic review and meta-analysis of randomized controlled clinical trials. Food science & nutrition, 8(4), 1766–1776.
2. Ambati, 2014. “Astaxanthin: Sources, Extraction, Stability, Biological Activities and Its Commercial Applications—A Review” Marine Drugs 12, no. 1: 128-152.
3. Giannaccare, G., (2020). Clinical Applications of Astaxanthin in the Treatment of Ocular Diseases: Emerging Insights. Marine drugs, 18(5), 239.
4. Grimmig, B., (2017). Neuroprotective mechanisms of astaxanthin: a potential therapeutic role in preserving cognitive function in age and neurodegeneration. GeroScience, 39(1), 19–32.
5. Gutiérrez-Grijalva, E. P., (2017). Flavonoids and Phenolic Acids from Oregano: Occurrence, Biological Activity and Health Benefits. Plants (Basel, Switzerland), 7(1), 2.

Cardiovascular disease

1. NHS [online] Available at NHS England » Cardiovascular disease (CVD)[accessed on 31.3. 2022]
2. Pizzino, G et al. (2017) Oxidative Stress: Harms and Benefits for Human Health, Oxidative Medicine and Cellular Biology
3. Yang, B. (2020). Lowering effects of fish oil supplementation on proinflammatory markers in hypertension: results from a randomized controlled trial. Food & function, 11(2), 1779–1789.
4. Zozina, V. I. (2018). Coenzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem. Current cardiology reviews, 14(3), 164–174.
5. Mantle, D., (2021). Coenzyme Q10 and Immune Function: An Overview. Antioxidants (Basel, Switzerland), 10(5), 759.
6. Sue-Ling. (2022). Coenzyme Q10 as Adjunctive Therapy for Cardiovascular Disease and Hypertension: A Systematic Review. The Journal of nutrition, 152(7), 1666–1674.
7. Pashkow, F.J., (2008) ‘Astaxanthin: A Novel Potential Treatment for Oxidative Stress and Inflammation in Cardiovascular Disease’, American Journal of Cardiology, 101(10 SUPPL.), pp. S58–S68.
8. Kishimoto, Y., (2016). Potential Anti-Atherosclerotic Properties of Astaxanthin. Marine drugs, 14(2), 35.
9. Ozdemir, B., (2008). Effects of Origanum onites on endothelial function and serum biochemical markers in hyperlipidaemic patients. The Journal of international medical research, 36(6), 1326–1334.
10. Sano, A. et al. (2007) “Beneficial effects of grape seed extract on malondialdehyde-modified LDL,” Journal of Nutritional Science and Vitaminology. J Nutr Sci Vitaminol (Tokyo), 53(2), pp. 174–182.
11. Feringa, H. H. H., (2011). The Effect of Grape Seed Extract on Cardiovascular Risk Markers: A Meta-Analysis of Randomized Controlled Trials. Journal of the American Dietetic Association, 111(8), 1173–1181.
12. de Oliveira, J. R., (2019). Rosmarinus officinalis L. (rosemary) as therapeutic and prophylactic agent. Journal of biomedical science, 26(1), 5. 

Osteoarthritis

1. Versus Arthritis [online] Available at: https://www.versusarthritis.org/about-arthritis/data-and-statistics/the-state-of-musculoskeletal-health/[accessed on 1st April 23]
2. Sun, K., (2019). Astaxanthin protects against osteoarthritis via Nrf2: a guardian of cartilage homeostasis. Aging, 11(22), 10513–10531.
3. Na, H. S., (2022). Coenzyme Q10 encapsulated in micelles ameliorates osteoarthritis by inhibiting inflammatory cell death. PloS one, 17(6), e0270351. 

Cognitive health

1. Sartori, A. C., (2012). The impact of inflammation on cognitive function in older adults: implications for healthcare practice and research. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 44(4), 206–217.
2. Mohajeri, M. H., (2015). Inadequate supply of vitamins and DHA in the elderly: implications for brain aging and Alzheimer-type dementia. Nutrition (Burbank, Los Angeles County, Calif.), 31(2), 261–275.
3. Ashton, M. (2021). A Systematic Review of Nutraceuticals for the Treatment of Bipolar Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 66(3), 262–273.
4. Arun S, et al (2016) ‘Mitochondrial Biology and Neurological Diseases.’ Curr Neuropharmacol, 14(2), pp. 143-154.
5. Calapai G, A Randomized, Double-Blinded, Clinical Trial on Effects of a Vitis vinifera Extract on Cognitive Function in Healthy Older Adults. Front Pharmacol. 2017 Oct 31;8:776.
6. Asha Devi, S.,(2011). Grape seed proanthocyanidin lowers brain oxidative stress in adult and middle-aged rats. Experimental gerontology, 46(11), 958–964.

Skin health

1. Chen, J., (2021). Oxidative stress in the skin: Impact and related protection. International journal of cosmetic science, 43(5), 495–509.Pilkington, S. M., Watson, R. E., Nicolaou, A., & Rhodes, L. E. (2011).
2. Omega-3 polyunsaturated fatty acids: photoprotective macronutrients. Experimental dermatology, 20(7), 537–543.
3. Tominaga, K., (2012). Cosmetic benefits of astaxanthin on humans subjects. Acta biochimica Polonica, 59(1), 43–47.
4. Hoppe, U., (1999). Coenzyme Q10, a cutaneous antioxidant and energizer. BioFactors (Oxford, England), 9(2-4), 371–378.

Eye health

1. World Health Organisation (2019) ‘World report on vision’, World health Organisation,214(14), pp. 180–235. Available at: https://www.who.int/publications-detail/world-reporton-vision (Accessed: 1 November 2022).
2. Liu, A., & Ji, J. (2014). Omega-3 Essential Fatty Acids Therapy for Dry Eye Syndrome: A Meta-Analysis of Randomized Controlled Studies. Medical science monitor: international medical journal of experimental and clinical research, 20, 1583.
3. Sala-Vila, A., Prevención con Dieta Mediterránea (PREDIMED) Investigators (2016). Dietary Marine ω-3 Fatty Acids and Incident Sight-Threatening Retinopathy in Middle-Aged and Older Individuals With Type 2 Diabetes: Prospective Investigation From the PREDIMED Trial. JAMA ophthalmology, 134(10), 1142–1149.
4. Giannaccare, G., (2020). Clinical Applications of Astaxanthin in the Treatment of Ocular Diseases: Emerging Insights. Marine drugs, 18(5), 239.
5. Nakajima Y, Astaxanthin, a dietary carotenoid, protects retinal cells against oxidative stress in-vitro and in mice in-vivo. J Pharm Pharmacol. 2008 Oct;60(10):1365-74.
6. Qu, J., (2009). Coenzyme Q10 in the human retina. Investigative ophthalmology & visual science, 50(4), 1814–1818.
7. Rezaie, T., (2012). Protective effect of carnosic acid, a pro-electrophilic compound, in models of oxidative stress and light-induced retinal degeneration. Investigative ophthalmology & visual science, 53(12), 7847–7854. 

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If you have questions regarding the topics that have been raised, or any other health matters, please do contact our team of Nutritional Therapists.

nutrition@cytoplan.co.uk
01684 310099

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Last updated on 3rd January 2024 by cytoffice