Swiss-Alp Health Logo Blue
Swiss Alp Health Logo Blue

Deutsch

Français

English

Ageing and health maintenance

Factors affecting our health with age

Ageing is a normal complex phenomenon and is to be distinguished from ill health. Among the many definitions of ageing from a biological point of view, one can find “Changes in our body that, over time, reduce our capacity to repair and adapt to our environment, decrease our physiological capacity for self-regulation and our probability of survival.”

For example, intercellular communication decreases, stem cells are depleted and within our cells our DNA is less stable. Our mitochondria (producing energy, reducing oxidative stress and managing the survival of our cells) malfunction.1 This leads to a slowing down of the functions of our organs: it is common, for example, for vision or hearing to diminish a little, or for our immune system to be less responsive.2 Ageing is affected by internal factors (genetics, metabolism, hormones…) and external factors (environment, lifestyle, infection, stress…), which can sometimes be modified, the sooner the better.1  

Our lifestyle determines our level of exposure to factors leading to oxidative stress and inflammation. In the long term, this excess oxidative stress affects the functioning of our organs and can lead to disease. As we age, we accumulate small dysregulations in our bodies and when the body no longer has enough resources to counteract them, they can cause damage and harm to our health. But no disease is inevitable with age, so getting older is not enough to cause chronic disease.1

The role of oxidative stress

As mentioned in the previous paragraph, the accumulation of oxidative stress seems to be involved in many of the health problems that occur with age. It is due to a production of free radicals and oxygen and nitrogen ions (reactive oxygen and nitrogen species – RONS) that is too strong to be counterbalanced by antioxidant defences. These RONS come from our body’s normal cellular metabolism on the one hand, and from exogenous sources such as air and water pollution, tobacco, alcohol, heavy metals, certain drugs, smoked fats or foods, radiation… They cause major changes to our DNA, proteins, lipids, carbohydrates, cells and their mitochondria, which, accumulated over the long term, can cause problems in functioning. Fortunately, we have antioxidant defences: enzymes that can convert these RONS into harmless molecules, and molecules that interact with the RONS and stop the chains of reactions.3-5

Often, the presence of significant oxidative stress correlates with the presence of relatively low but constant inflammation, as their biochemical pathways of activation are interdependent.6 This chronic inflammation also damages our organs. Learn more about oxidative stress and inflammation.

We can support our antioxidant defences through our lifestyle: by minimising exposure to exogenous RONS, which are unfortunately very present; by regular and moderate physical activity, as studies have shown that both inactivity and high-intensity sport increase oxidative stress, while regular endurance increases antioxidant defences; by taking care of our diet and consuming antioxidants.3

Ingredients to limit oxidative stress

Green tea, for example, with its polyphenols (e.g. epigallocatechin gallate), increases the amount of antioxidants in the plasma and the activity of antioxidant enzymes. Fewer DNA mutations were observed in animals, an anti-inflammatory effect was present, and green tea may also have some anti-cancer effects.7,8 It may also be useful for metabolic syndrome, type II diabetes, obesity, and cardiovascular or liver disease, particularly by acting on carbohydrate and lipid metabolism. However, beware of over-consumption of tea, especially for people with iron absorption problems.9,10

Rosehip is also a powerful ally against oxidative stress, due to a high concentration of flavonoids, vitamin C and specific galactolipids. By increasing the activity of antioxidant enzymes (such as superoxide dismutases SOD, catalases…), rosehip helps to reduce the concentrations of free radicals and nitrogen oxides (RONS) that can damage tissues. It also ensures good communication and adhesion between cells, is a powerful anti-inflammatory and can reduce pain. It can be useful for osteoarthritis, rheumatoid arthritis, osteoporosis, diabetes, as well as protecting the skin and improving the digestive and immune systems.11

Pomegranate is also an antioxidant, thanks in part to its polyphenol ellagic acid, which helps eliminate toxins, protects against free radicals by activating antioxidant enzymes, and limits the production of pro-inflammatory cytokines. It is particularly useful for skin health (UV toxicity) and may have antitumour effects.12

Edelweiss and yellow gentian are two anti-inflammatory, antioxidant and analgesic alpine plants. They can be used for joint or cardiovascular problems, gastrointestinal health and skin integrity.13,14

The properties of melon should not be overlooked either. Melon is high in SOD, an essential antioxidant enzyme. Several studies have highlighted the antioxidant and anti-inflammatory properties of melon, which reduces the production of inflammatory cytokines and free radicals.15 It is also useful for limiting mental and muscular fatigue and stress.16

Coenzyme Q10 is a cofactor found in mitochondria (the part of the cell that produces energy, reduces oxidative stress and prevents cell death). It is therefore a powerful antioxidant and cell protector. Taking coenzyme Q10 orally increases the concentrations of Q10 throughout our body, for example in our brain and eyes. Cardiovascular diseases and chronic inflammation can also be relieved by the antioxidant power of Q10.17

The impact of the menopause

The menopause is the complete cessation (more than 12 months) of menstruation, due to the decrease with age in the number of ovarian follicles and therefore in the level of oestrogen, which interrupts the hormonal cycle causing the menstrual cycles. The woman can no longer have children. The median age of menopause is around 51 years.

It is a normal phenomenon and not a pathology, even if certain unpleasant symptoms are recurrent: hot flushes and night sweats, migraines, vaginal dryness and urinary problems, weight gain… as well as other longer-term effects such as osteoporosis or cardiovascular risks (oestrogens promote the flexibility of blood vessels). Almost half of the women also experience psychological symptoms such as irritability, anxiety, depression, loss of self-confidence, lack of concentration or sleep problems. But not everything is negative, as this phase of life can also be welcomed as a liberation. The end of menstruation can therefore be experienced positively and with serenity.

 Meditation and breathing exercises can help with this, as can attending information sessions to understand what is happening. Regular sport has a positive effect on the cardiovascular system, bones, muscles and weight, as well as on mental well-being. In contrast, alcohol and emotional stress can worsen symptoms.18-20 There are some treatments to limit symptoms, often oestrogen substitutes or oestrogen receptor modulators, but with some side risks. Many nutrients can be effective in preventing some of the health effects of menopause, such as phytoestrogens (from soy or flaxseed) or calcium and vitamin D for bones.20

Skin ageing

The skin is a barrier between our body and the outside world, protecting us from aggressors, retaining water and controlling our temperature. The skin has three layers: the epidermis, the dermis and the subcutaneous tissue.

As the skin ages, these three components undergo changes. Some changes are obvious: wrinkles appear and elasticity decreases. Indeed, our skin cells are no longer as efficient, the fibres (collagen and elastin) that give structure and elasticity to our skin are less numerous, melanomas fill up with melanin creating dark spots… The causes are numerous: Internal, such as genetics, cell metabolism and hormonal changes (e.g. at menopause), but also external, including sun exposure (UV), pollution, chemicals, oxidative stress, regular sugar consumption, smoking, skin care, sleep, stress… UV for example promotes the destruction of extracellular matrix fibres (collagen, hyaluronic acid) and damages mitochondria (part of the cell responsible for reducing oxidative stress, cell survival and energy production). 21,22,23

As the famous quote goes “You never get a second chance to make a first impression”, so every second is important in the quest for healthy aging in general and skin aging in particular.

  • Ingredients for the skin

Collagen is the most abundant protein in the human body and in mammals. It forms fibres in the extracellular matrix, giving shape and mechanical properties to tissues. There are 28 types of collagen in our body, of which the first 3 are the most abundant. Types I and III are the ones most commonly found in the skin as well as in bones and nails. Collagen improves the health of the skin and has anti-ageing properties, reducing wrinkles, thickening of the epidermis, redness and water evaporation. It increases skin hydration and elasticity and reduces the impact of UVB on skin dehydration.24-27 It has also been shown to be effective in wound healing, particularly post-surgical,28 and in the healing of pressure sores (pressure ulcers on the skin due to soft tissue compression between a hard surface and bone, mainly in bedridden people).29 Collagen peptides reduce the severity of rashes in atopic dermatitis, as well as transepidermal water loss and inflammatory biomarkers in skin keratinocytes.30 People with cellulite also benefit from the virtues of collagen hydrolysates. Taking them for 6 months has shown a reduction in cellulite, skin rippling, as well as an increase in dermal density and improved appearance.31

Lysine is one of the amino acids necessary for collagen synthesis and then for its optimal function. It plays a key role in collagen structure, as it allows the links within and between collagen chains.32 Lysine also inhibits MPPs, the enzymes responsible for collagen degradation.33 These properties make lysine an ideal ally in supporting wound healing. In the skin, it facilitates cell proliferation, modulates inflammation and angiogenesis (vascularisation) and may even have an antimicrobial action, especially against herpes, which accelerates healing.34,35
Valine is one of the branched side chain amino acids (BCAAs) along with leucine and isoleucine. They are important in the synthesis of collagen, especially types I and III in the skin.36 In combination with other amino acids, BCAAs may restore collagen synthesis in the dermis, which is compromised by UV radiation.37

Glucosamine is a monosaccharide naturally present in our body and is the precursor of several very important constituents of the extracellular matrix (hyaluronic acid, chondroitin, keratan…). Widely used for its benefits for the joints, glucosamine, through the molecules of which it is the precursor, also helps to improve skin hydration and reduce wrinkles. In addition, it can regulate melanin production, be useful in treating hyperpigmentation and be beneficial in accelerating healing, especially in the case of burns.38-40

Hyaluronic acid protects against oxidative stress, by reducing free radicals and increasing antioxidant synthesis. It also mitigates inflammation by reducing the production of pro-inflammatory mediators, such as cytokines, bradykinin and prostaglandin, thereby limiting over-inflammation.41 As wound healing involves a complex sequence of remodelling of the extracellular matrix, hyaluronic acid regulates the coordination of the various steps involved. By influencing the tissue microenvironment and binding to cell receptors, it can influence cell behaviour and function, as well as gene expression, for example in skin and mucous membranes.41-44 Due to its viscoelastic and water-retaining properties, hyaluronic acid is a very good moisturiser for all tissues. Taking hyaluronic acid has a clear benefit for the health of the skin. Indeed, taking it for 6 weeks allows an 8% increase in skin hydration, still visible 2 weeks after the end of the treatment.45

Ellagic acid is a polyphenol found in certain fruits and vegetables, mainly berries, pomegranates and certain oilseeds. It is known for its antioxidant properties: it helps eliminate toxins and protects against free radicals. Ellagic acid is a good photoprotector for the skin: it helps limit the production of pro-inflammatory cytokines and free radicals (oxidative stress), as well as the degradation of collagen due to UV-B, which reduces wrinkling, thickening of the epidermis and pigmentation, making the skin brighter.12,46-48 Some studies on mice even suggest that it could be a good treatment for inflammatory skin diseases (dermatitis, oedema), or for wound healing.49,50

Coenzyme Q10 is a cofactor found in the mitochondria (the part of the cell that produces ATP energy) and a strong antioxidant. It is very useful in protecting the skin from UV rays which can cause oxidative stress damaging DNA, lipids and proteins in cells, and it protects mitochondria from degeneration and allows ATP regeneration.51 It also increases collagen and elastin production and inhibits the PPMs that destroy them.52 A clinical study highlighted the reduction in wrinkles and improvement in skin smoothness after 12 weeks of taking Q10.53   

Zinc is used for a multitude of processes in our body, and is involved in the formation, repair and maintenance of the skin. The skin contains about 6% of our body’s zinc, and as we cannot store it, a regular supply is important. The skin is constantly renewing itself and many enzymes need zinc to function. For example, it is useful for stabilising cell membranes, managing oxidative stress and blocking UV light. It helps to improve wound healing because many of the enzymes involved in this process need zinc to function.52,54 Zinc can also be used in the treatment of inflammation, acne, dermatoses and pigmentation problems.55,56 Zinc is approved by EFSA* to help maintain normal skin and protect cells from oxidative stress.

Copper is involved in the synthesis and stabilisation of extracellular matrix fibres. It therefore helps to improve skin elasticity and healing and reduce wrinkles. It is also useful for its good vascularisation. It also has antiseptic properties against certain viruses, bacteria and fungi. These benefits explain why it has been used for thousands of years for the treatment and maintenance of the skin.57 Copper contributes to the maintenance of connective tissues, of which the skin is a part, to the protection of cells against oxidative stress and to the normal pigmentation of the skin, according to EFSA*.

Manganese is an essential metal for certain antioxidant enzymes, particularly in the skin. Thus, manganese intake helps to protect skin cells against the effects of oxidative stress and UV light.58 As oxidative stress increases the signs of ageing, manganese also limits the formation of wrinkles, maintains skin firmness and improves healing.59 EFSA* points out that manganese contributes to the maintenance of connective tissues, of which the skin is a part, and to protecting cells against oxidative stress.  

A combination of zinc, manganese and copper appears to be particularly effective for skin healing, as they act on different cells and phases.60,61 

Selenium is involved in several processes involved in reducing oxidative stress and its damage. It can prevent the damaging effect of UVB which can kill skin cells. It is present in selenoproteins, which are involved in the proper functioning of skin cells, among other things, and is useful in wound repair.52 Selenium protects cells from oxidative stress*.

Hair and nails

Our hair and nails also age. Their growth, structure and colour change. In the hair, the fibres in the roots are weaker, the melanocytes responsible for the colour function less well, and the cells in the follicle decrease in hair production. The nails are more fragile, thin and discoloured, the morphology of the nail plate (which grows the nail) changes and their lipid content varies with age. This is normal because the cells degenerate progressively, but oxidative stress and the environment (care, pollution, sun …) have also had time to impact. It is important to take care of them, from an aesthetic point of view, but also to avoid some of their problems which can impact on the quality of life.62-66

  • Ingredients for hair and nails

Millet is a grain that contains many amino acids, B vitamins, silicic acid and minerals, including manganese. Millet extract combined with amino acids and calcium is believed to improve hair growth (anagen phase).67

Biotin is one of the B vitamins, useful for many functions of our body. For the nails, taking biotin makes them firmer and harder, and is effective in limiting brittle nails.68,69 Moreover, according to EFSA*, biotin contributes to the maintenance of normal skin and hair.

Collagen helps to promote nail growth, reduce nail breakage and generally improve the appearance of nails.70,71 Hair also benefits, as collagen intake increases cell proliferation and hair thickness.72

Selenium contributes to the maintenance of normal hair and nails, according to EFSA* For example, selenium deficiency appears to be involved in hair loss and non-colouring,73 with the recommended daily amount being 55µg.

Immune system

Our immune system is essential for our survival and is extremely complex. Many micro-organisms live in harmony with us and are very useful, but some can damage our tissues, these are the pathogens. Our first barrier is physical (skin, mucus, healthy bacterial flora…) and prevents some pathogens from infecting us. Then, if a pathogen gets in, our innate immunity cells act immediately, but in a way that is not specific to that pathogen. Some of these cells will also secrete molecules (cytokines) to attract more innate immune cells. This leads to the symptoms of inflammation (redness, pain, swelling, heat – e.g. fever -), caused by the increased blood flow and infiltration of immune cells into the attacked tissue. Inflammation is a good thing here because it helps to fight the pathogen and activate the innate immune system (it is chronic inflammation, often due to our lifestyle or chronic diseases, that is a problem, as our body is constantly fighting). Some of these innate cells will also go to the nearest lymph node and inform the rest of the immune system of the type of pathogen infecting us, and select cells that will be more effective in fighting it. This is adaptive immunity, which is very effective and precise, but takes around a week to become active. Finally, when the infection has been overcome, everything returns to normal, but the body keeps a memory of this infection thanks to memory lymphocytes. So, if the same pathogen re-infects us, our body can react more effectively and quickly.

Thanks to the memory lymphocytes, we are protected from more and more diseases as we age because we recognise and fight them immediately. But the functioning of our immune system cells slows down with age and we are more vulnerable to unknown diseases or pathogens that mutate very quickly (e.g. the flu virus, which is different every year). It is therefore important to take good care of your immune system, including a healthy lifestyle.

It is well known that vitamin C helps to maintain the normal functioning of the immune system, to protect cells against oxidative stress and to reduce fatigue, claims authorised by the EFSA*. Indeed, numerous studies have highlighted that vitamin C promotes T-cell maturation (adaptive immunity) and improves immune system function.74 It is also a key antioxidant for detoxifying free radicals (ROS).75

Vitamin D is an essential element that contributes to the normal functioning of the immune system, according to EFSA*. It can bind to receptors on immune cells and thus modulate innate and adaptive responses.76,77 Vitamin D also enables cells to better resist stress.78 One study found that children taking vitamin D3 had a reduced incidence of influenza.79 In contrast, vitamin D deficiency has been associated with an increase in autoimmune disease and susceptibility to infection.

The 8 B vitamins influence many cellular processes and their deficiency has been linked to a number of dysfunctions, including immune, inflammatory and nervous systems.80,81 Taking vitamin B6, for example, improves immune function82 and B5 can limit bacterial growth by stimulating the immune system.83 Biotin is essential for the proper functioning of our cells. It is a cofactor for many enzymes central to the metabolism of cells, including lymphocytes (immune cells). When it is lacking, the immune system does not function properly and inappropriate inflammation develops.84-86

Vitamin E supplementation has clear benefits for the stimulation of the immune system, for example on the proper maturation of T cells (adaptive immunity). These effects are particularly important in older people with weakened immune defences. It also reduces susceptibility to infections, limits the effects of oxidative and immune stress on cells and facilitates the elimination of certain pathogens.87-91

A β-glucan is a polysaccharide found in oats, among other things. It increases the immune system by activating parts of the immune system (complement system) and stimulating the production of cytokines.92,93 Studies have shown that taking β-glucans reduces the risk and duration of respiratory infections in adults, the elderly and children under 4 years of age, while improving vigour, mood and reducing tension and fatigue.94-96

Choline is essential for the synthesis of phospholipids (components of cell membranes) and for the maintenance of homeostasis of inflammation molecules. It also regulates the activation of the immune system. Thus, it can help fight pathogens and also plays a role in reducing oxidative stress. 97-99

Zinc is a molecule recognised by EFSA* for its effects in contributing to the normal functioning of the immune system and protecting cells against oxidative stress, among many other functions. For example, zinc is necessary for neutrophils (immune cells) to form their ‘net’ and eliminate pathogens. It plays an important role in modulating the pro-inflammatory response, regulating inflammatory cytokines and controlling oxidative stress. Thus it is useful against viral (colds, diarrhoea, HIV…), bacterial and parasitic infections.100-103

Calcium appears to play a central role in the activation of immune cells. It acts as a messenger between cells, particularly lymphocytes, regulating the different stages of their development and maturation.104,105

Magnesium also has a strong relationship with the immune response, both innate and adaptive. It is required for the synthesis of adhesion molecules, receptors and antibodies.  It is also required for lymphocyte proliferation, proper functioning and certain immune responses. Magnesium deficiency can lead to inflammation, cell death and impaired immune cell function.106-108

Selenium plays a crucial role in the development of many physiological processes, including the immune response. However, approximately 50% of the Swiss population is deficient in selenium (less than 100 µg/day), which can cause numerous problems (metabolic, nervous, immune, allergic, etc.). However, be careful, more than 850 µg/day can lead to intoxication. Selenium intake stimulates the immune system (activation of cell proliferation and functions) and can modulate inflammation of the respiratory tract thanks to its antioxidant capacities. Numerous studies on rodents have shown that an optimal amount of selenium can eliminate many pathogens more easily, giving it an “antiviral” effect.109-111

Rosehip’s comprehensive composition makes it a very good ally against winter ailments, such as colds and flu, by boosting the immune system, especially due to its high vitamin C content.112 Its phenolic compounds also correlate with antimicrobial properties. Although the mechanisms are not fully defined, it appears that it can decrease the energy of pathogens and suppress some of their enzymes that act as virulence or resistance factors. It also modulates inflammation: enough for the immune system to be effective, but not so much that it destroys tissue.11

In addition, glucosamine supplementation has been associated with a significant reduction in all-cause mortality (cancer, cardiovascular, respiratory, digestive, etc.),113-115 in particular due to its anti-inflammatory properties, which are useful for many ailments.116 It has been used, for example, to alleviate inflammatory bowel disease (IBD), migraines or viral infections.38   

Bones and joints

Our musculoskeletal system allows us to be stable and mobile, which is useful in every moment of our daily lives. Chronic joint pain is unfortunately very common with age, to the point where it seems almost normal to have it. The causes can be varied, but osteoarthritis is one of the major joint disorders. Injury, sedentary lifestyle, overweight, repetitive movements, oxidative stress, as well as inflammatory, genetic and metabolic factors, can all contribute to the degeneration of joint cartilage.18 Physical rehabilitation is particularly recommended to maintain the mobility of the affected joint, as is an assessment of one’s lifestyle (good sleep, sugar-free and plant-rich diet, weight loss, etc.).

Osteoporosis is another widespread skeletal disease (1 in 3 women and 1 in 5 men over the age of 50): the bone becomes demineralized because calcium and phosphorus can no longer be fixed and bone resorption becomes faster than its renewal, making the bone fragile and predisposing to fractures and reducing quality of life. Alcohol, smoking, use of corticosteroids, lack of vitamin D, previous injuries, low BMI, certain genetic factors, metabolic disease and the menopause can increase the risk of osteoporotic bones. There are medications available, including bisphosphonates, but they can have serious side effects. Regular moderate physical activity to strengthen muscles, as well as calcium and vitamin D3 (necessary for calcium absorption and transport), are recommended. Similarly, a good protein intake, combined with an adequate calcium intake, would limit the risk of fractures.117 Finally, the role of a high intake of fruits (fresh and dried) and vegetables is essential for adequate bone remodelling and reduction of inflammation and oxidative stress. They are rich in minerals (potassium, phosphorus, manganese, boron, copper…) and vitamins (B, C and K): potassium, for example, would help balance the acidity of our body and the conservation of calcium in our bones.118

  • Ingredients to support bones and joints

Calcium is the best known mineral for bone health and maintaining good bone mineralization.119 However, experts stress the importance of combining it with vitamin D to increase bone mineral density, limit osteoporosis and some fractures, although the results are more mixed in the latter case.120,121 Vitamin D regulates intestinal calcium absorption.122 Good calcium intake also appears to be correlated with a reduced risk of osteoarthritis of the knee,123 which may be explained by inhibition of cartilage cell (chondrocyte) death by blocking inflammatory cell pathways.124

Supplementation with vitamin D (which is poorly synthesised naturally by our bodies in winter and when we spend a lot of time indoors) has been shown to be associated with a significant slowing down of abnormalities in the knee (joint structure and cartilage composition).125 Inflammation and oxidative damage can also be reduced, improving protein and DNA function.126,127 In addition, vitamin D supplementation may limit musculoskeletal pain and prevent osteoporosis in these patients.128 Finally, vitamin D is an important mediator and is involved in the regulation of immune responses and inflammation, a key role in autoimmune diseases such as arthritis.129

Zinc is a potent antioxidant and is involved in the proliferation of chondrocytes (cartilage cells). Thus, zinc supplementation may prevent the progression of osteoarthritis.130 Zinc also appears to play an important role in preventing or even curing osteoporosis, as it stimulates bone mineralisation and bone formation by osteoblasts and inhibits bone resorption by osteoclasts.119,131 The recommended daily dose of zinc is 10mg/d, as too much consumption may lead to nausea or headaches.  

Vitamin K is involved in the mineralisation of bone and cartilage, as well as in the regulation of articular cartilage matrix genes and certain enzymatic reactions.132 People who are deficient in vitamin K are at increased risk of damage to cartilage and subchondral bone, and thus of developing osteoarthritis and other joint diseases,132-135 whereas an adequate daily intake would appear to be protective.136 Vitamin K is also essential for bone health, affecting bone strength and metabolism, particularly by promoting the activation of bone-forming cells (osteoblasts) and extracellular bone matrix mineralising proteins.137 In addition to its role in mineralisation, vitamin K appears to have an anti-inflammatory action, which is useful for many chronic diseases (cardiovascular, osteoarthritis, osteoporosis…).138,139

The benefits of collagens I and III are important for bone health, and are particularly useful in cases of osteoporosis, especially postmenopausal, by decreasing the presence of markers of bone breakdown and increasing mineral density and markers of bone regeneration.140-142

Glucosamine is a monosaccharide naturally present in our body and is the precursor of several very important constituents of the extracellular matrix (hyaluronic acid, chondroitin, keratan…). Its benefits for the joints are well established. In cases of osteoarthritis, often combined with chondroitin, it can reduce pain and increase mobility, by reducing cartilage degradation, restoring the extracellular matrix, and limiting inflammation and oxidative stress.143-145

Musculature

Muscles allow us to perform precise movements, maintain our balance and posture, and generate heat. Our muscle mass decreases with age and our strength decreases in parallel (by 10-15% per decade up to the age of 70, 25-40% after), which can lead to sarcopenia. The consequences of reduced muscle mass include a marked increase in the risk of falls and fractures, as well as poor balance and reduced ability to move.146

To care for our muscles, which are plastic and can adapt throughout our lives, regular and moderate physical training is essential. Endurance exercises coupled with muscular resistance exercises can improve the cardiovascular system and muscle strength and mass, both in young and old.147 Good nutrition is also essential, with enough protein (more than 1g/kg/d), vegetables (alkalizing power and presence of potassium), vitamins, minerals, antioxidants, unsaturated fatty acids…

  • Ingredients to support the musculature

In addition to its essential role in bone mineralisation, calcium is required for proper muscle function, as it regulates muscle contraction.148 Calcium is also a regulator of muscle growth, maintenance and regeneration (e.g. after injury), particularly through its action on muscle stem cells. We therefore need calcium to promote muscle regeneration and to prevent muscle loss with age.149

Magnesium also plays a vital role, as it is used by over 300 enzymes in many of our body’s functions.150 It is involved in maintaining muscle function and contraction and in energy production. Magnesium intake can increase strength and physical and muscular performance in athletes and especially in non-athletes or older people, particularly by increasing glucose availability and reducing lactate accumulation.151,152 Magnesium intake also appears to prevent muscle damage in competitive cyclists.153

Energy, vision and the nervous system

Our nervous system consists of our nerves, our brain and our spinal cord linking the two. We process information from our 5 senses and send messages, conscious and unconscious, to our body. Coordination of movements, mobility, spatial orientation, problem solving and planning, emotions, decoding of sensory information, attention, language, memory, control of appetite or sleep, reflexes and reward mechanisms, unconscious control of blood glucose levels, hormone production, breathing and heart rhythms… are part of our daily functions. Vision is one of the senses we use the most. Our eyes and brain work together to transform light into an image, from the pupil to the retina and then to the visual cortex via the optic nerve. As we age, inflammation and oxidative stress may have had time to take hold, which can cause certain diseases and lower our visual acuity.

Over the course of our lives, our neural plasticity and information processing speed decreases, as our cells’ ability to repair and create new networks is reduced. Nevertheless, while some functions may decline with age, others remain intact and may even benefit from accumulated experience. In any case, the nervous system remains plastic and some functions can be improved with time and training. Factors such as regular exercise, good sleep, limited stress, intellectual stimulation, healthy nutrition and limited alcohol intake appear to be beneficial in maintaining a functional nervous system. In addition, certain nutrients play a protective role.

We all need energy in our daily lives. This energy is produced by each of our cells, thanks to their numerous mitochondria. The mitochondria continuously convert the air we breathe and the nutrients from our food into large amounts of energy called ATP. ATP is needed for almost every action in each of our cells and therefore for the functioning of all our organs. Moving a muscle, talking, blinking, thinking, digesting… everything uses ATP. And our brain is one of the biggest consumers: although it weighs only 2% of our body weight, it consumes about 20% of the energy we spend at rest (~ 300 kcal / day).

  • Ingredients for vision, the nervous system and energy

There are 8 B vitamins (thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), vitamin B6, biotin, folate (B9) and vitamin B12). These vitamins contribute to energy production, nervous system function, maintenance of vision, psychological and cognitive functions and protection of cells against oxidative stress, according to EFSA*. They are involved in DNA repair and neurotransmitter synthesis and are thought to limit cognitive decline and visual acuity loss. In addition, multivitamin B supplementation may reduce inflammation and oxidative stress in the brain and improve energy storage and cellular metabolism.154-157

Magnesium is required for more than 300 reactions in our body, including neural transmission and muscle contraction. Deficiency (affecting more than half of the Western population – recommended ADI 300-400 mg/d) has been associated with many conditions, such as migraines, metabolic problems such as diabetes, some cardiovascular problems, cataracts, osteoporosis, asthma etc.158,159 Magnesium is important for eye health, and a deficiency has been linked to many eye problems, which can be limited by supplementation.160,161 It can also be very helpful in limiting pain,162 and in increasing cognitive performance.163 Furthermore, interacting with biochemical stress pathways, stress and hypomagnesemia amplify the negative effects of each other. Both have been associated with migraines, chronic fatigue, fibromyalgia, physical manifestations of stress, chronic pain, anxiety, depression, among others. The brain is particularly sensitive to stress, and magnesium intake could prevent some neuronal damage caused by glucocorticoids released during acute stress situations, and limit certain self-destructive behaviours during a stressful situation (smoking, overeating, alcohol, risk-taking…).164,165

Metals, such as zinc and copper, are essential for retinal health, including the proper functioning of phototransduction and neurotransmission involved in visual information processing. Zinc is, for example, required for photoreceptor membranes, light response and synaptic transmission. Zinc and copper, which often decline with age, are also crucial for the proper functioning of antioxidant enzymes, which are very present in the retina and allow the reduction of oxidative stress that can damage it.166,167 A homeostatic level is essential because both a deficiency and an excess can lead to retinal dysfunction. Zinc deficiency, for example, can be implicated in poor night vision, even age-related macular degeneration or diabetic retinopathy, and copper deficiency can be linked with optic neuropathy.168,169 On the contrary, zinc supplementation may slow the progression of age-related macular degeneration, the main cause of blindness.170 Zinc’s function in the immune system and regulation of inflammation is also important for maintaining eye health.171 According to EFSA*, zinc contributes to the maintenance of normal vision.

Copper influences energy metabolism and body composition.172 Zinc is also involved in cellular energy metabolism, mitochondria and DNA maintenance and can protect our cells.173 Copper is present at high levels in the nervous system, plays a role in cellular energy production (ATP), is present in many enzymes and modulates synaptic transmission of neurotransmitters.174 Zinc and copper deficiency has been associated with neuropathies leading to motor difficulties and pain.175 Copper’s antioxidant action is also essential for proper communication of neurons and astrocytes,176 and for proper neurological function.177 Zinc plays an essential role in brain development and maintenance of brain function throughout our lives, being key to 300 enzymes and modulating synaptic activity, neuronal plasticity and cell survival. Altered zinc levels have been implicated in brain problems (e.g. stroke, brain injury), neurodegenerative problems (e.g. Alzheimer’s) and psychological problems (e.g. depression).178-180 According to EFSA*, copper contributes to normal nervous system function and reduced fatigue, zinc contributes to normal cognitive and psychological function.

The Acceptable Daily Intake of copper is 9mg/day, and if a deficiency is harmful to our health, an excess is also problematic for our cells.181 The ADI for zinc is around 10mg/d, more than 50mg/d could have a toxic effect on our cells.182

Coenzyme Q10 is a cofactor found in the mitochondria (the energy-producing part of the cell) and a strong antioxidant. As a component involved in the chain of reactions to convert carbohydrates and fatty acids into usable ATP energy, Q10 is an essential nutrient for every cell and organ function. 183,184 For example, taking Q10 can restore proper muscle and brain function,185 whereas a deficiency can lead to a variety of problems.186 As well as increasing our energy, it also boosts our immune system.183,187 It is also a powerful neuroprotectant, for example by preventing apoptosis (cell death) and scavenging free radicals.17 It can also reduce eye damage, for example from UV or radiation and oxidative stress.188

L-serine is an amino acid that is useful for nucleotide (DNA) synthesis, cell division and cellular energy production.189,190 It is a conditional amino acid, i.e. it can be synthesised, but not always in sufficient quantities to meet our needs. Dysregulation of serine levels in the eyes can lead to various retinal pathologies.191 Serine is also crucial for our nervous system and brain function190 : it is neuroprotective and may be beneficial for some neuropathies.192 

Metabolism

Metabolism is the set of chemical reactions that take place in our body. Many reactions need enzymes (proteins that allow the reaction to take place) and/or energy (ATP) to occur. For example, there is digestion, the transport of molecules, and many reactions within our cells: for the synthesis of cellular components (proteins, DNA, lipids, glycogen…) and for the degradation of constituents – especially food – to produce energy. It is therefore a kind of cycle: the lipids, proteins and carbohydrates in our diet are reduced to small components by our digestion and in our cells, and these small components allow the construction of new large cellular components and the production of energy in the form of ATP necessary for many reactions.

The digestion of carbohydrates is an important source of energy. Complex sugars are broken down into smaller molecules and then into glucose. This glucose passes through the bloodstream to all our cells. Insulin, produced by the pancreas, is secreted when glucose is detected in the blood (blood sugar) and helps to activate receptors on our cells so that the glucose can enter. Once the glucose has entered, our cells use it to produce ATP. If there is too much, it is stored as glycogen.
Under certain conditions (consumption of too many sugars, sedentary lifestyle, overweight, etc.) and over time, the secretion of insulin by the pancreas can be disrupted (insulin resistance) and the blood sugar level (glycaemia) will be less well regulated and will increase. This chronic dysregulation can lead to metabolic syndrome and type II diabetes, and their common cardiovascular complications.

Fats are an even more concentrated source of energy for our body. They are converted by our digestion into simple fatty acids, and then become ATP energy in our cells. However, lipids are only used once all the energy from carbohydrates (glucose) has been used. In the presence of a lot of carbohydrates, fatty acids are stored as triglycerides in the adipose tissue and the liver, and when supplies run low, fatty acids are used as a source of energy, especially by the muscles and the heart. 

Cholesterol is a fat particle circulating in the blood, carried by one of three types of lipoproteins. The VLDL and LDL (-very- low density lipoprotein) types can deposit cholesterol on the walls of the blood vessels, and hypercholesterolaemia can eventually clog the vessels, causing cardiovascular problems. The HDL (high density lipoprotein) type, on the other hand, captures the cholesterol circulating in the blood and brings it back to the liver to be eliminated.

  • Ingredients for metabolism

Numerous studies on β-glucans, a fibre derived from oats, have highlighted their ability to lower cholesterol, particularly LDL, but not ‘good’ HDL.193 This is because β-glucans can interact with lipids and bile acids (cholesterol derivatives that help digest dietary fats) in the intestines, thereby lowering cholesterol levels.194 EFSA* endorses their use to maintain normal cholesterol levels.

Chromium may be beneficial for the regulation of insulin, blood sugar and cholesterol, and thus reduces the risk of cardiovascular disease. Chromium is often deficient in people with type II diabetes, and chromium intake is useful in limiting glucose intolerance.195-197 The EFSA* validates its use to help maintain normal blood sugar levels.  

Choline is an important nutrient and plays an essential role in lipid metabolism. It helps to reduce the amount of triglycerides and fatty acids in the blood by acting on the expression of certain genes, the activation of certain molecules, inflammation and oxidative stress. A diet too rich in saturated fatty acids can lead to liver problems (such as non-alcoholic steatohepatitis – NASH), and choline intake could help protect the liver. Choline also supports healthy muscle function.198-201 According to EFSA*, choline contributes to fat metabolism and normal liver function.

 

 

 

Disclaimer of liability:

The information published on www.swiss-alp-nutrition.ch does not claim to be complete and is not a substitute for individual medical advice or treatment. It cannot be used as an independent diagnosis, nor can it be used to select, apply, modify or discontinue treatment of any disease. In case of health problems, it is recommended to consult a doctor. Access to www.swiss-alp-nutrition.ch and its contents is at the user’s own risk.

Indications :

Food supplements should not be used as a substitute for a varied diet. The recommended daily allowance should not be exceeded. In general, food supplements are not suitable for pregnant and nursing women, children and adolescents. Keep out of reach of children.

 

 

 

* EFSA: official health claims of the European Food Safety Authority. An EFSA health claim is a statement about a relationship between a food and health. The European Commission allows different health claims provided they are based on sound scientific evidence.

  1. Fulop, T., Larbi, A., Khalil, A., Cohen, A. A. & Witkowski, J. M. Are We Ill Because We Age? Frontiers in Physiology vol. 10 (2019).
  2. Jaul, E. & Barron, J. Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Frontiers in Public Health 5, (2017).
  3. Liguori, I. et al. Oxidative stress, aging, and diseases. Clinical Interventions in Aging vol. 13 757–772 (2018).
  4. Gemma, C., Vila, J., Bachstetter, A. & Bickford, P. C. Oxidative Stress and the Aging Brain: From Theory to Prevention. in Brain Aging 353–374 (CRC Press, 2019). doi:10.1201/9781420005523-15.
  5. Cui, H., Kong, Y. & Zhang, H. Oxidative Stress, Mitochondrial Dysfunction, and Aging. Journal of Signal Transduction 2012, 1–13 (2012).
  6. Biswas, S. K. Does the Interdependence between Oxidative Stress and Inflammation Explain the Antioxidant Paradox? Oxidative Medicine and Cellular Longevity vol. 2016 (2016).
  7. Forester, S. C. & Lambert, J. D. The role of antioxidant versus pro-oxidant effects of green tea polyphenols in cancer prevention. Molecular Nutrition and Food Research vol. 55 844–854 (2011).
  8. Yan, Z., Zhong, Y., Duan, Y., Chen, Q. & Li, F. Antioxidant mechanism of tea polyphenols and its impact on health benefits. Animal Nutrition vol. 6 115–123 (2020).
  9. Chacko, S. M., Thambi, P. T., Kuttan, R. & Nishigaki, I. Beneficial effects of green tea: A literature review. Chinese Medicine vol. 5 13 (2010).
  10. Peluso, I. & Serafini, M. Antioxidants from black and green tea: from dietary modulation of oxidative stress to pharmacological mechanisms. British Journal of Pharmacology vol. 174 1195–1208 (2017).
  11. The Royal Australian College of General Practionners. Rosehip – an evidence based herbal medicine for inflammation and arthritis.
  12. Baek, B., Lee, S. H., Kim, K., Lim, H. W. & Lim, C. J. Ellagic acid plays a protective role against UV-B-induced oxidative stress by up-regulating antioxidant components in human dermal fibroblasts. Korean Journal of Physiology and Pharmacology 20, 269–277 (2016).
  13. Speroni, E. et al. In vivo efficacy of different extracts of Edelweiss (Leontopodium alpinum Cass.) in animal models. Journal of Ethnopharmacology 105, 421–426 (2006).
  14. Öztürk, N., Başer, K. H. C., Aydin, S., Öztürk, Y. & Çaliş, I. Effects of Gentiana lutea ssp. symphyandra on the central nervous system in mice. Phytotherapy Research 16, 627–631 (2002).
  15. Vouldoukis, I. et al. Antioxidant and anti-inflammatory properties of a Cucumis melo LC. extract rich in superoxide dismutase activity. Journal of Ethnopharmacology 94, 67–75 (2004).
  16. Carillon, J., Notin, C., Schmitt, K., Simoneau, G. & Lacan, D. Dietary supplementation with a Superoxide dismutase-melon concentrate reduces stress, physical and mental fatigue in healthy people: A randomised, double-blind, placebo-controlled trial. Nutrients 6, 2348–2359 (2014).
  17. Hernández-Camacho, J. D., Bernier, M., López-Lluch, G. & Navas, P. Coenzyme Q10 supplementation in aging and disease. Frontiers in Physiology vol. 9 (2018).
  18. Institute for Quality and Efficiency in Health Care. Menopause: Overview. (InformedHealth.org, 2020).
  19. Taebi, M., Abdolahian, S., Ozgoli, G., Ebadi, A. & Kariman, N. Strategies to improve menopausal quality of life: A systematic review. Journal of Education and Health Promotion 7, 93 (2018).
  20. Peacock, K. & Ketvertis, K. M. Menopause. StatPearls (StatPearls Publishing, 2020).
  21. Cao, C., Xiao, Z., Wu, Y. & Ge, C. Diet and skin aging—from the perspective of food nutrition. Nutrients vol. 12 (2020).
  22. Clatici, V. G. et al. Perceived Age and Life Style. The Specific Contributions of Seven Factors Involved in Health and Beauty. Maedica 12, 191–201 (2017).
  23. Schagen, S. K., Zampeli, V. A., Makrantonaki, E. & Zouboulis, C. C. Discovering the link between nutrition and skin aging. Dermato-Endocrinology vol. 4 298 (2012).
  24. Pyun, H. B. et al. Effects of collagen tripeptide supplement on photoaging and epidermal skin barrier in UVB-exposed hairless mice. Preventive Nutrition and Food Science 17, 245–253 (2012).
  25. Kang, M. C., Yumnam, S. & Kim, S. Y. Oral Intake of Collagen Peptide Attenuates Ultraviolet B Irradiation-Induced Skin Dehydration In Vivo by Regulating Hyaluronic Acid Synthesis. International journal of molecular sciences 19, (2018).
  26. Proksch, E. et al. Oral intake of specific bioactive collagen peptides reduces skin wrinkles and increases dermal matrix synthesis. Skin Pharmacology and Physiology 27, 113–119 (2014).
  27. Lupu, M., Gradisteanu Pircalabioru, G., Chifiriuc, M., Albulescu, R. & Tanase, C. Beneficial effects of food supplements based on hydrolyzed collagen for skin care (Review). Experimental and Therapeutic Medicine 20, 12 (2019).
  28. Knefeli, H.-C. & Durani, B. Improved wound healing after oral application of specific bioactive collagen peptides. doi:10.17470/NF-017-1031-1.
  29. Lee, S. K., Posthauer, M. E., Dorner, B., Redovian, V. & Maloney, M. J. Pressure ulcer healing with a concentrated, fortified, collagen protein hydrolysate supplement: a randomized controlled trial. Advances in skin & wound care 19, 92–6 (2006).
  30. Hakuta, A. et al. Anti-inflammatory effect of collagen tripeptide in atopic dermatitis. Journal of dermatological science 88, 357–364 (2017).
  31. Schunck, M., Zague, V., Oesser, S. & Proksch, E. Dietary Supplementation with Specific Collagen Peptides Has a Body Mass Index-Dependent Beneficial Effect on Cellulite Morphology. Journal of medicinal food 18, 1340–8 (2015).
  32. Yamauchi, M. & Sricholpech, M. Lysine post-translational modifications of collagen. Essays in Biochemistry 52, 113–133 (2012).
  33. Roomi, M. W., Ivanov, V., Kalinovsky, T., Niedzwiecki, A. & Rath, M. Inhibition of cell invasion and MMP production by a nutrient mixture in malignant liposarcoma cell line SW-872. Medical Oncology 24, 394–401 (2007).
  34. Datta, D., Bhinge, A. & Chandran, V. Lysine: Is it worth more? Cytotechnology 36, 3–32 (2001).
  35. Spallotta, F. et al. Enhancement of lysine acetylation accelerates wound repair. Communicative and Integrative Biology 6, (2013).
  36. Yamane, T. et al. Branched-chain amino acids regulate type I tropocollagen and type III tropocollagen syntheses via modulation of mTOR in the skin. Bioscience, Biotechnology and Biochemistry 82, 611–615 (2018).
  37. Murakami, H., Shimbo, K., Inoue, Y., Takino, Y. & Kobayashi, H. Importance of amino acid composition to improve skin collagen protein synthesis rates in UV-irradiated mice. Amino Acids 42, 2481–2489 (2012).
  38. Bissett, D. L. Glucosamine: An ingredient with skin and other benefits. Journal of Cosmetic Dermatology 5, 309–315 (2006).
  39. Wang, T. W. et al. The effect of gelatin-chondroitin sulfate-hyaluronic acid skin substitute on wound healing in SCID mice. Biomaterials 27, 5689–5697 (2006).
  40. Jerosch, J. Effects of glucosamine and chondroitin sulfate on cartilage metabolism in OA: Outlook on other nutrient partners especially omega-3 fatty acids. International Journal of Rheumatology vol. 2011 (2011).
  41. Gupta, R. C., Lall, R., Srivastava, A. & Sinha, A. Hyaluronic acid: Molecular mechanisms and therapeutic trajectory. Frontiers in Veterinary Science 6, (2019).
  42. Oksala, O. et al. Expression of proteoglycans and hyaluronan during wound healing. Journal of Histochemistry & Cytochemistry 43, 125–135 (1995).
  43. CHEN, W. Y. J. & ABATANGELO, G. Functions of hyaluronan in wound repair. Wound Repair and Regeneration 7, 79–89 (1999).
  44. Olczyk, P., Komosińska-Vassev, K., Winsz-Szczotka, K., Kuźnik-Trocha, K. & Olczyk, K. [Hyaluronan: structure, metabolism, functions, and role in wound healing]. Postepy higieny i medycyny doswiadczalnej (Online) 62, 651–9 (2008).
  45. Kawada, C. et al. Ingested hyaluronan moisturizes dry skin. Nutrition Journal 13, 1–9 (2014).
  46. Bae, J. Y. et al. Dietary compound ellagic acid alleviates skin wrinkle and inflammation induced by UV-B irradiation. Experimental Dermatology 19, (2010).
  47. Kasai, K., Yoshimura, M., Koga, T., Arii, M. & Kawasaki, S. Effects of oral administration of ellagic acid-rich pomegranate extract on ultraviolet-induced pigmentation in the human skin. Journal of Nutritional Science and Vitaminology 52, 383–388 (2006).
  48. Yoshimura, M., Watanabe, Y., Kasai, K., Yamakoshi, J. & Koga, T. Inhibitory effect of an ellagic acid-rich pomegranate extract on tyrosinase activity and ultraviolet-induced pigmentation. Bioscience, Biotechnology and Biochemistry 69, 2368–2373 (2005).
  49. Mo, J., Panichayupakaranant, P., Kaewnopparat, N., Songkro, S. & Reanmongkol, W. Topical anti-inflammatory potential of standardized pomegranate rind extract and ellagic acid in contact dermatitis. Phytotherapy Research 28, 629–632 (2014).
  50. Yuniarti, W. M., Primarizky, H. & Lukiswanto, B. S. The activity of pomegranate extract standardized 40% ellagic acid during the healing process of incision wounds in albino rats (Rattus norvegicus). Veterinary World 11, 321–326 (2018).
  51. Schniertshauer, D. et al. Accelerated Regeneration of ATP Level after Irradiation in Human Skin Fibroblasts by Coenzyme Q10. Photochemistry and Photobiology 92, 488–494 (2016).
  52. Vollmer, D. L., West, V. A. & Lephart, E. D. Enhancing skin health: By oral administration of natural compounds and minerals with implications to the dermal microbiome. International Journal of Molecular Sciences vol. 19 (2018).
  53. Žmitek, K., Pogačnik, T., Mervic, L., Žmitek, J. & Pravst, I. The effect of dietary intake of coenzyme Q10 on skin parameters and condition: Results of a randomised, placebo-controlled, double-blind study. BioFactors 43, 132–140 (2017).
  54. Schwartz, J. R., Marsh, R. G. & Draelos, Z. D. Zinc and skin health: overview of physiology and pharmacology. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] vol. 31 (2005).
  55. Dhaliwal, S. et al. Effects of Zinc Supplementation on Inflammatory Skin Diseases: A Systematic Review of the Clinical Evidence. American Journal of Clinical Dermatology vol. 21 21–39 (2020).
  56. Gupta, M., Mahajan, V. K., Mehta, K. S. & Chauhan, P. S. Zinc therapy in dermatology: A review. Dermatology Research and Practice vol. 2014 (2014).
  57. Borkow, G. Using Copper to Improve the Well-Being of the Skin. Current Chemical Biology 8, 89–102 (2015).
  58. Parat, M. O. et al. Does manganese protect cultured human skin fibroblasts against oxidative injury by uva, dithranol and hydrogen peroxide? Free Radical Research 23, 339–351 (1995).
  59. Treiber, N. et al. The role of manganese superoxide dismutase in skin aging. Dermato-Endocrinology vol. 4 232 (2012).
  60. Tenaud, I., Sainte-Marie, I., Jumbou, O., Litoux, P. & Dréno, B. In vitro modulation of keratinocyte wound healing integrins by zinc, copper and manganese. British Journal of Dermatology 140, 26–34 (1999).
  61. Tenaud, I., Saiagh, I. & Dreno, B. Addition of zinc and manganese to a biological dressing. Journal of Dermatological Treatment 20, 91–94 (2009).
  62. Mandt, N. & Blume-Peytavi, U. Alterung von haaren und nägeln. Mögliche präventive und supportive ansatzpunkte. Hautarzt vol. 56 340–346 (2005).
  63. Maddy, A. J. & Tosti, A. Hair and nail diseases in the mature patient. Clinics in Dermatology 36, 159–166 (2018).
  64. Abdullah, L. & Abbas, O. Common nail changes and disorders in older people: Diagnosis and management. Canadian Family Physician vol. 57 173–181 (2011).
  65. Goodier, M. & Hordinsky, M. Normal and aging hair biology and structure “Aging and Hair.” Current Problems in Dermatology (Switzerland) 47, 1–9 (2015).
  66. Trüeb, R. M. Oxidative stress in ageing of hair. International Journal of Trichology vol. 1 6–14 (2009).
  67. Hosking, A. M., Juhasz, M. & Atanaskova Mesinkovska, N. Complementary and Alternative Treatments for Alopecia: A Comprehensive Review. Skin Appendage Disorders vol. 5 72–89 (2019).
  68. Floersheim G L. Treatment of brittle fingernails with biotin. Z Hautkr (1989).
  69. Colombo, V. E., Gerber, F., Bronhofer, M. & Floersheim, G. L. Treatment of brittle fingernails and onychoschizia with biotin: Scanning electron microscopy. Journal of the American Academy of Dermatology 23, 1127–1132 (1990).
  70. Hexsel, D. et al. Oral supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails. Journal of Cosmetic Dermatology 16, 520–526 (2017).
  71. TYSON, T. L. The effect of gelatin on fragile finger nails. The Journal of investigative dermatology 14, 323–325 (1950).
  72. Oesser, S. The oral intake of specific Bioactive Collagen Peptides has a positive effect on hair thickness. doi:10.17470/NF-020-0019.
  73. Almohanna, H. M., Ahmed, A. A., Tsatalis, J. P. & Tosti, A. The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatology and Therapy vol. 9 51–70 (2019).
  74. Manning, J. et al. Vitamin C promotes maturation of T-cells. Antioxidants and Redox Signaling 19, 2054–2067 (2013).
  75. Pawlowska, E., Szczepanska, J. & Blasiak, J. Pro- And antioxidant effects of Vitamin C in cancer in correspondence to its dietary and pharmacological concentrations. Oxidative Medicine and Cellular Longevity vol. 2019 (2019).
  76. Prietl, B., Treiber, G., Pieber, T. R. & Amrein, K. Vitamin D and immune function. Nutrients vol. 5 2502–2521 (2013).
  77. Aranow, C. Vitamin D and the Immune System. J Investig Med 59, 881–886 (2011).
  78. Chirumbolo, S., Bjørklund, G., Sboarina, A. & Vella, A. The Role of Vitamin D in the Immune System as a Pro-survival Molecule. Clinical Therapeutics vol. 39 894–916 (2017).
  79. Urashima, M. et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. American Journal of Clinical Nutrition 91, 1255–1260 (2010).
  80. Spinas, E. et al. CROSSTALK BETWEEN VITAMIN B AND IMMUNITY. Journal of biological regulators and homeostatic agents vol. 29 283–288 (2015).
  81. Mikkelsen, K., Stojanovska, L., Prakash, M. & Apostolopoulos, V. The effects of vitamin B on the immune/cytokine network and their involvement in depression. Maturitas vol. 96 58–71 (2017).
  82. Ueland, P. M., McCann, A., Midttun, Ø. & Ulvik, A. Inflammation, vitamin B6 and related pathways. Molecular Aspects of Medicine vol. 53 10–27 (2017).
  83. He, W. et al. Vitamin B5 reduces bacterial growth via regulating innate immunity and adaptive immunity in mice infected with Mycobacterium tuberculosis. Frontiers in Immunology 9, 365 (2018).
  84. Agrawal, S., Agrawal, A. & Said, H. M. Biotin deficiency enhances the inflammatory response of human dendritic cells. American Journal of Physiology – Cell Physiology 311, C386–C391 (2016).
  85. Báez-Saldaña, A. & Ortega, E. Biotin Deficiency Blocks Thymocyte Maturation, Accelerates Thymus Involution, and Decreases Nose-Rump Length in Mice. The Journal of Nutrition 134, 1970–1977 (2004).
  86. Zempleni, J. & Mock, D. M. Utilization of biotin in proliferating human lymphocytes. The Journal of nutrition 130, 335S-337S (2000).
  87. Pekmezci, D. Vitamin E and Immunity. Vitamins and Hormones vol. 86 (2011).
  88. Moriguchi, S. The role of vitamin E in T-cell differentiation and the decrease of cellular immunity with aging. BioFactors 7, 77–86 (1998).
  89. TENGERDY, R. P. Vitamin E, Immune Response, and Disease Resistance. Annals of the New York Academy of Sciences 570, 335–344 (1989).
  90. Liu, Y. J. et al. Protective Effect of Vitamin E on laying performance, antioxidant capacity, and immunity in laying hens challenged with Salmonella Enteritidis. Poultry science 98, 5847–5854 (2019).
  91. Hussain, M. I. et al. Immune boosting role of vitamin E against pulmonary tuberculosis. Pakistan journal of pharmaceutical sciences 32, 269–276 (2019).
  92. Akramiene, D., Kondrotas, A., Didziapetriene, J. & Kevelaitis, E. Effects of beta-glucans on the immune system. Medicina (Kaunas, Lithuania) vol. 43 597–606 (2007).
  93. Carpenter, K. C., Breslin, W. L., Davidson, T., Adams, A. & McFarlin, B. K. Baker’s yeast β-glucan SUPPL.ementation increases monocytes and cytokines post-exercise: Implications for infection risk? British Journal of Nutrition 109, 478–486 (2013).
  94. Fuller, R. et al. Yeast-derived β-1,3/1,6 glucan, upper respiratory tract infection and innate immunity in older adults. Nutrition 39–40, 30–35 (2017).
  95. Meng, F. Baker’s Yeast Beta-Glucan Decreases Episodes of Common Childhood Illness in 1 to 4 Year Old Children during Cold Season in China. (2016) doi:10.4172/2155-9600.1000519.
  96. Talbott, S. & Talbott, J. Effect of BETA 1, 3/1, 6 GLUCAN on upper respiratory tract infection symptoms and mood state in marathon athletes. Journal of Sports Science and Medicine 8, 509–515 (2009).
  97. Snider, S. A. et al. Choline transport links macrophage phospholipid metabolism and inflammation. Journal of Biological Chemistry 293, 11600–11611 (2018).
  98. Garcia, M., Mamedova, L. K., Barton, B. & Bradford, B. J. Choline regulates the function of bovine immune cells and alters the mRNA abundance of enzymes and receptors involved in its metabolism in vitro. Frontiers in Immunology 9, 2448 (2018).
  99. Zhao, H. F. et al. Dietary choline regulates antibacterial activity, inflammatory response and barrier function in the gills of grass carp (Ctenopharyngodon idella). Fish and Shellfish Immunology 52, 139–150 (2016).
  100. Prasad, A. S. Zinc in human health: Effect of zinc on immune cells. Molecular Medicine vol. 14 353–357 (2008).
  101. Maywald, M., Wessels, I. & Rink, L. Zinc signals and immunity. International Journal of Molecular Sciences vol. 18 (2017).
  102. Wessels, I., Maywald, M. & Rink, L. Zinc as a gatekeeper of immune function. Nutrients vol. 9 (2017).
  103. Gammoh, N. Z. & Rink, L. Zinc in infection and inflammation. Nutrients vol. 9 (2017).
  104. Grinstein, S. & Klip, A. Calcium homeostasis and the activation of calcium channels in cells of the immune system. Bulletin of the New York Academy of Medicine: Journal of Urban Health vol. 65 69–79 (1989).
  105. Vig, M. & Kinet, J. P. Calcium signaling in immune cells. Nature Immunology vol. 10 21–27 (2009).
  106. Tam, M., Gómez, S., González-Gross, M. & Marcos, A. Possible roles of magnesium on the immune system. European Journal of Clinical Nutrition vol. 57 1193–1197 (2003).
  107. Galland, L. Magnesium and immune function: an overview. Magnesium 7, 290–9 (1988).
  108. Kubena, K. S. The role of magnesium in immunity. Journal of Nutritional Immunology 2, 107–126 (1994).
  109. Avery, J. C. & Hoffmann, P. R. Selenium, selenoproteins, and immunity. Nutrients vol. 10 (2018).
  110. Rayman, M. P. Selenium and human health. The Lancet vol. 379 1256–1268 (2012).
  111. Huang, Z., Rose, A. H. & Hoffmann, P. R. The role of selenium in inflammation and immunity: From molecular mechanisms to therapeutic opportunities. Antioxidants and Redox Signaling vol. 16 705–743 (2012).
  112. Crawford, C., Boyd, C., Berry, K. & Deuster, P. Dietary Ingredients Requiring Further Research Before Evidence-Based Recommendations Can Be Made for Their Use as an Approach to Mitigating Pain. Pain Medicine 20, 1619–1632 (2019).
  113. Li, Z. H. et al. Associations of regular glucosamine use with all-cause and cause-specific mortality: A large prospective cohort study. Annals of the Rheumatic Diseases 79, 829–836 (2020).
  114. Pocobelli, G. et al. Total mortality risk in relation to use of less-common dietary supplements. The American Journal of Clinical Nutrition 91, 1791–1800 (2010).
  115. King, D. E. & Xiang, J. Glucosamine/Chondroitin and Mortality in a US NHANES Cohort. Journal of the American Board of Family Medicine 33, 842–847 (2020).
  116. Bell, G. A., Kantor, E. D., Lampe, J. W., Shen, D. D. & White, E. Use of Glucosamine and Chondroitin in Relation to Mortality. doi:10.1007/s10654-012-9714-6.
  117. Sahni, S. et al. Protective effect of high protein and calcium intake on the risk of hip fracture in the framingham offspring cohort. Journal of Bone and Mineral Research 25, 2770–2776 (2010).
  118. Higgs, J., Derbyshire, E. & Styles, K. Nutrition and osteoporosis prevention for the orthopaedic surgeon: A wholefoods approach. EFORT Open Reviews 2, 300–308 (2017).
  119. della Pepa, G. & Brandi, M. L. Microelements for bone boost: The last but not the least. Clinical Cases in Mineral and Bone Metabolism vol. 13 181–185 (2016).
  120. Harvey, N. C. et al. The role of calcium supplementation in healthy musculoskeletal ageing: An expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF). Osteoporosis International vol. 28 447–462 (2017).
  121. Sunyecz, J. A. The use of calcium and vitamin D in the management of osteoporosis. Therapeutics and Clinical Risk Management vol. 4 827–836 (2008).
  122. National Research Council (US) Committee on Diet and Health. Osteoporosis. (1989).
  123. Li, H. et al. Serum Calcium Concentration Is Inversely Associated with Radiographic Knee Osteoarthritis. Medicine (United States) 95, (2016).
  124. Kang, S. J., Kim, J. W., Kim, K. Y., Ku, S. K. & Lee, Y. J. Protective effects of calcium gluconate on osteoarthritis induced by anterior cruciate ligament transection and partial medial meniscectomy in Sprague-Dawley rats. Journal of orthopaedic surgery and research 9, 14 (2014).
  125. Joseph, G. B. et al. Associations between Vitamin C and D Intake and Cartilage Composition and Knee Joint Morphology over 4 years: Data from the Osteoarthritis Initiative. Arthritis Care & Research (2019) doi:10.1002/acr.24021.
  126. Ravalli, S., Szychlinska, M. A., Leonardi, R. M. & Musumeci, G. Recently highlighted nutraceuticals for preventive management of osteoarthritis. World Journal of Orthopaedics vol. 9 255–261 (2018).
  127. Manoy, P. et al. Vitamin D supplementation improves quality of life and physical performance in osteoarthritis patients. Nutrients 9, (2017).
  128. Kostoglou-Athanassiou, I., Athanassiou, P., Lyraki, A., Raftakis, I. & Antoniadis, C. Vitamin D and rheumatoid arthritis. Therapeutic Advances in Endocrinology and Metabolism 3, 181–187 (2012).
  129. Aslam, M. M., John, P., Bhatti, A., Jahangir, S. & Kamboh, M. I. Vitamin D as a Principal Factor in Mediating Rheumatoid Arthritis-Derived Immune Response. BioMed Research International vol. 2019 (2019).
  130. Huang, T. C. et al. Zinc protects articular chondrocytes through changes in Nrf2-mediated antioxidants, cytokines and matrix metalloproteinases. Nutrients 10, (2018).
  131. Yamaguchi, M. Role of nutritional zinc in the prevention of osteoporosis. Molecular and Cellular Biochemistry vol. 338 241–254 (2010).
  132. Shea, M. K. et al. The association between vitamin K status and knee osteoarthritis features in older adults: The Health, Aging and Body Composition Study. Osteoarthritis and Cartilage 23, 370–378 (2015).
  133. Thomas, S., Browne, H., Mobasheri, A. & Rayman, M. P. What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology (Oxford) (2018) doi:10.1093/rheumatology/key011.
  134. Misra, D. et al. Vitamin K deficiency is associated with incident knee osteoarthritis. American Journal of Medicine 126, 243–248 (2013).
  135. Ishii, Y. et al. Distribution of vitamin K2 in subchondral bone in osteoarthritic knee joints. Knee Surgery, Sports Traumatology, Arthroscopy 21, 1813–1818 (2013).
  136. Chin, K. Y. The relationship between vitamin k and osteoarthritis: A review of current evidence. Nutrients 12, (2020).
  137. Akbari, S. & Rasouli-Ghahroudi, A. A. Vitamin K and Bone Metabolism: A Review of the Latest Evidence in Preclinical Studies. BioMed Research International 2018, (2018).
  138. Harshman, S. G. & Shea, M. K. The Role of Vitamin K in Chronic Aging Diseases: Inflammation, Cardiovascular Disease, and Osteoarthritis. Current Nutrition Reports vol. 5 90–98 (2016).
  139. Simes, D. C., Viegas, C. S. B., Araújo, N. & Marreiros, C. Vitamin K as a powerful micronutrient in aging and age-related diseases: Pros and cons from clinical studies. International Journal of Molecular Sciences vol. 20 (2019).
  140. Zhang, H. et al. Preventive effects of collagen Peptide from deer sinew on bone loss in ovariectomized rats. Evidence-based complementary and alternative medicine : eCAM 2014, 627285 (2014).
  141. Adam, M., Spacek, P., Hulejová, H., Galiánová, A. & Blahos, J. [Postmenopausal osteoporosis. Treatment with calcitonin and a diet rich in collagen proteins]. Casopis lekaru ceskych 135, 74–8 (1996).
  142. König, D., Oesser, S., Scharla, S., Zdzieblik, D. & Gollhofer, A. Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women-A Randomized Controlled Study. Nutrients 10, (2018).
  143. Herrero-Beaumont, G. et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: A randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis and Rheumatism 56, 555–567 (2007).
  144. Bruyere, O. et al. Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlled trials. Osteoarthritis and Cartilage 16, 254–260 (2008).
  145. Laverty, S. et al. Synovial fluid levels and serum pharmacokinetics in a large animal model following treatment with oral glucosamine at clinically relevant doses. Arthritis and Rheumatism 52, 181–191 (2005).
  146. Siparsky, P. N., Kirkendall, D. T. & Garrett, W. E. Muscle Changes in Aging: Understanding Sarcopenia. Sports Health vol. 6 36–40 (2014).
  147. Seals, D. R., Hagberg, J. M., Hurley, B. F., Ehsani, A. A. & Holloszy, J. O. Endurance training in older men and women. I. Cardiovascular responses to exercise. Journal of Applied Physiology Respiratory Environmental and Exercise Physiology 57, 1024–1029 (1984).
  148. Wakabayashi, T. Mechanism of the calcium-regulation of muscle contraction: In pursuit of its structural basis. Proceedings of the Japan Academy Series B: Physical and Biological Sciences vol. 91 321–350 (2015).
  149. Tu, M. K., Levin, J. B., Hamilton, A. M. & Borodinsky, L. N. Calcium signaling in skeletal muscle development, maintenance and regeneration. Cell Calcium vol. 59 91–97 (2016).
  150. Gröber, U., Schmidt, J. & Kisters, K. Magnesium in prevention and therapy. Nutrients vol. 7 8199–8226 (2015).
  151. Zhang, Y., Xun, P., Wang, R., Mao, L. & He, K. Can magnesium enhance exercise performance? Nutrients vol. 9 (2017).
  152. Dominguez, L. J. et al. Magnesium and muscle performance in older persons: the InCHIANTI study. (2009).
  153. Córdova, A., Mielgo-Ayuso, J., Fernandez-Lázaro, D., Roche, E. & Caballero-García, A. Impact of magnesium supplementation in muscle damage of professional cyclists competing in a stage race. Nutrients 11, (2019).
  154. Gestuvo, M. K. & Hung, W. W. Common dietary supplements for cognitive health. Aging Health vol. 8 89–97 (2012).
  155. Kennedy, D. O. B vitamins and the brain: Mechanisms, dose and efficacy—A review. Nutrients vol. 8 (2016).
  156. Ford, T. C. et al. The effect of a high-dose vitamin b multivitamin supplement on the relationship between brain metabolism and blood biomarkers of oxidative stress: A randomized control trial. Nutrients 10, (2018).
  157. Damodaran, M., Rameshwar Sarma, K. v., Tiar, A. & Nadamuni Naidu, A. Vitamin B-complex deficiency and visual acuity. British Journal of Nutrition 41, 27–30 (1979).
  158. Schwalfenberg, G. K. & Genuis, S. J. The Importance of Magnesium in Clinical Healthcare. Scientifica 2017, (2017).
  159. al Alawi, A. M., Majoni, S. W. & Falhammar, H. Magnesium and Human Health: Perspectives and Research Directions. International Journal of Endocrinology vol. 2018 (2018).
  160. Agarwal, R., Iezhitsa, L. & Agarwal, P. Pathogenetic role of magnesium deficiency in ophthalmic diseases. BioMetals vol. 27 5–18 (2014).
  161. Ajith, T. A. Possible therapeutic effect of magnesium in ocular diseases. Journal of Basic and Clinical Physiology and Pharmacology vol. 31 (2020).
  162. Na, H. S., Ryu, J. H. & Do, S. H. The role of magnesium in pain. in Magnesium in the Central Nervous System 157–166 (University of Adelaide Press, 2011). doi:10.1017/UPO9780987073051.012.
  163. Hoane, M. R. The role of magnesium therapy in learning and memory. in Magnesium in the Central Nervous System 115–124 (University of Adelaide Press, 2011). doi:10.1017/UPO9780987073051.008.
  164. Cuciureanu, M. D. & Vink, R. Magnesium and stress. in Magnesium in the Central Nervous System 251–268 (University of Adelaide Press, 2011). doi:10.1017/UPO9780987073051.020.
  165. Kirkland, A. E., Sarlo, G. L. & Holton, K. F. The role of magnesium in neurological disorders. Nutrients vol. 10 (2018).
  166. Wills, N. K., Sadagopa Ramanujam, V. M., Kalariya, N., Lewis, J. R. & van Kuijk, F. J. G. M. Copper and zinc distribution in the human retina: Relationship to cadmium accumulation, age, and gender. Experimental Eye Research 87, 80–88 (2008).
  167. Grahn, B. H., Paterson, P. G., Gottschall-Pass, K. T. & Zhang, Z. Zinc and the eye. Journal of the American College of Nutrition vol. 20 106–118 (2001).
  168. Ugarte, M., Osborne, N. N., Brown, L. A. & Bishop, P. N. Iron, zinc, and copper in retinal physiology and disease. Survey of Ophthalmology vol. 58 585–609 (2013).
  169. Miao, X. et al. Zinc and diabetic retinopathy. Journal of Diabetes Research vol. 2013 (2013).
  170. Smailhodzic, D. et al. Zinc supplementation inhibits complement activation in age-related macular degeneration. PLoS ONE 9, (2014).
  171. Gilbert, R., Peto, T., Lengyel, I. & Emri, E. Zinc Nutrition and Inflammation in the Aging Retina. Molecular Nutrition and Food Research vol. 63 (2019).
  172. Hoogeveen, R. C. A. J. M., Reaves, S. K., Reid, P. M., Reid, B. L. & Lei, K. Y. Copper deficiency shifts energy substrate utilization from carbohydrate to fat and reduces fat mass in rats. Journal of Nutrition 124, 1660–1666 (1994).
  173. Yang, X. et al. Zinc enhances the cellular energy supply to improve cell motility and restore impaired energetic metabolism in a toxic environment induced by OTA. Scientific Reports 7, (2017).
  174. Gaier, E. D., Eipper, B. A. & Mains, R. E. Copper signaling in the mammalian nervous system: Synaptic effects. Journal of Neuroscience Research vol. 91 2–19 (2013).
  175. O’Dell, B. L. Roles of zinc and copper in the nervous system. Prog Clin Biol Res (1993).
  176. Kardos, J. et al. Copper signalling: Causes and consequences. Cell Communication and Signaling vol. 16 (2018).
  177. Poujois, A., Djebrani-Oussedik, N., Ory-Magne, F. & Woimant, F. Neurological presentations revealing acquired copper deficiency: diagnosis features, aetiologies and evolution in seven patients. Internal Medicine Journal 48, 535–540 (2018).
  178. Gower-Winter, S. D. & Levenson, C. W. Zinc in the central nervous system: From molecules to behavior. BioFactors vol. 38 186–193 (2012).
  179. Sensi, S. L., Paoletti, P., Bush, A. I. & Sekler, I. Zinc in the physiology and pathology of the CNS. Nature Reviews Neuroscience vol. 10 780–791 (2009).
  180. Portbury, S. D. & Adlard, P. A. Zinc signal in brain diseases. International Journal of Molecular Sciences vol. 18 (2017).
  181. Desai, V. & Kaler, S. G. Role of copper in human neurological disorders. in American Journal of Clinical Nutrition vol. 88 (American Society for Nutrition, 2008).
  182. Dineley, K. E., Votyakova, T. v. & Reynolds, I. J. Zinc inhibition of cellular energy production: Implications for mitochondria and neurodegeneration. Journal of Neurochemistry vol. 85 563–570 (2003).
  183. Saini, R. Coenzyme Q10: The essential nutrient. Journal of Pharmacy and Bioallied Sciences vol. 3 466–467 (2011).
  184. Crane, F. L. Biochemical Functions of Coenzyme Q10. Journal of the American College of Nutrition 20, 591–598 (2001).
  185. Barbiroli, B. et al. Coenzyme Q10 improves mitochondrial respiration in patients with mitochondrial cytopathies. An in vivo study on brain and skeletal muscle by phosphorous magnetic resonance spectroscopy – PubMed. Cell Mol Biol (1997).
  186. Quinzii, C. M. & Hirano, M. Coenzyme Q and mitochondrial disease. Developmental Disabilities Research Reviews vol. 16 183–188 (2010).
  187. Farough, S. et al. Coenzyme Q10 and immunity: A case report and new implications for treatment of recurrent infections in metabolic diseases. Clinical Immunology 155, 209–212 (2014).
  188. Lulli, M. et al. Coenzyme Q10 protects retinal cells from apoptosis induced by radiation in vitro and in vivo. J Radiat Res. (2012) doi:10.1093/jrr/rrs025.
  189. Lucas, S., Chen, G., Aras, S. & Wang, J. Serine catabolism is essential to maintain mitochondrial respiration in mammalian cells. Life Science Alliance 1, (2018).
  190. de Koning, T. J. et al. L-serine in disease and development. Biochemical Journal vol. 371 653–661 (2003).
  191. Sinha, T., Ikelle, L., Naash, M. I. & Al-Ubaidi, M. R. The Intersection of Serine Metabolism and Cellular Dysfunction in Retinal Degeneration. Cells 9, 674 (2020).
  192. Metcalf, J. S., Dunlop, R. A., Powell, J. T., Banack, S. A. & Cox, P. A. L-Serine: a Naturally-Occurring Amino Acid with Therapeutic Potential. Neurotoxicity Research vol. 33 213–221 (2018).
  193. Whitehead, A., Beck, E. J., Tosh, S. & Wolever, T. M. S. Cholesterol-lowering effects of oat β-glucan: A meta-analysis of randomized controlled trials1. American Journal of Clinical Nutrition 100, 1413–1421 (2014).
  194. Sima, P., Vannucci, L. & Vetvicka, V. β-glucans and cholesterol (Review). International Journal of Molecular Medicine vol. 41 1799–1808 (2018).
  195. Hummel, M., Standl, E. & Schnell, O. Chromium in metabolic and cardiovascular disease. in Hormone and Metabolic Research vol. 39 743–751 (2007).
  196. Rabinovitz, H. et al. Effect of chromium supplementation on blood glucose and lipid levels in type 2 diabetes mellitus elderly patients. International Journal for Vitamin and Nutrition Research 74, 178–182 (2004).
  197. Talab, A. T. et al. Effects of Chromium Picolinate Supplementation on Cardiometabolic Biomarkers in Patients with Type 2 Diabetes Mellitus: a Randomized Clinical Trial. Clinical Nutrition Research 9, 97 (2020).
  198. Zhu, J., Wu, Y., Tang, Q., Leng, Y. & Cai, W. The effects of choline on hepatic lipid metabolism, mitochondrial function and antioxidative status in human hepatic C3A cells exposed to excessive energy substrates. Nutrients 6, 2552–2571 (2014).
  199. Li, W. et al. Choline supplementation improves the lipid metabolism of intrauterine-growth-restricted pigs. Asian-Australasian Journal of Animal Sciences 31, 686–695 (2018).
  200. Jin, M. et al. Dietary choline supplementation attenuated high-fat diet-induced inflammation through regulation of lipid metabolism and suppression of NFκB activation in juvenile black seabream (Acanthopagrus schlegelii). Journal of nutritional science 8, e38 (2019).
  201. Michel, V., Singh, R. K. & Bakovic, M. The impact of choline availability on muscle lipid metabolism. Food and Function 2, 53–62 (2011).