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Better Health Update #64 - Monte Kline, Clinical Nutritionist

HA (Hyaluronic Acid)

THE VILLAGE OF LONG LIFE

Two hours outside Tokyo lies the village of Yuzuri Hara. Over 10% of the residents are 85 or older - 10 times the norm for America. These people don't just live longer - they live healthier. They have little cancer, diabetes, Alzheimer's or any of the other usual degenerative diseases. And then there's the skin of the residents - elderly people with skin showing little age. For example, there's 93 year-old Tadanao Takahashi, who has worked in the sun for over 50 years without ever using sun block or skin cream-yet he shows unusually smooth and soft skin.
Contrary to the usual pattern in Japan, Yuzuri Hara does not grow rice. Instead its terrain is better suited to growing different "sticky vegetable" carbohydrates. These include satsumaimo, a type of sweet potato; satoimo, a sticky white potato; konyaku, a gelatinous root vegetable combination; and imoji, another potato. Dr. Toyosuke Komori, the village doctor, believes these locally grown starchy vegetables stimulate the body's natural production of a substance called hyaluronic acid, otherwise known as Hyaluronan or HA, something our bodies lose as they age.

Dr. Komori, himself 80 years old, has studied and written books on the anti-aging effects of the village's diet. He notes that heart disease has doubled since Western-style foods came in a few years ago. With the young embracing Western diets, they now have parents often outliving their children. A 91 year-old woman stated, "Although my children ate what I had been eating while they were young and lived here, when they moved away they chose to eat differently." She has outlived two of her six children! [As an aside I might ad that this echoes the research of Weston Price, D.D.S. in the 1930's. As recorded in his book, Nutrition and Physical Degeneration, Dr. Price studied people eating primitive diets around the world. He found that when they changed to modern processed food diets, their health rapidly deteriorated.]

IMPORTANCE OF HYALURONIC ACID

HA is a primary component of our connective tissue. It has been likened to the mortar in a brick wall, the bricks being comparable to our cells. Just as the first thing to break down in a brick wall is the mortar, the first thing to break down in our bodies is the connective tissue. Collagen takes up much of the space in between cells, providing a supporting structure to particularly the eyes, joints, and skin. Its function is to cushion and lubricate. HA also retains water and therefore helps keep tissues hydrated. The skin contains 56% of the body's HA, while 35% of it is found in the muskulo-skeletal system, and 9% in the blood, lymph and synovial joint fluid.

HA was discovered in 1934. The name is derived from the Greek word for glass-hyalos-due to its transparent, glass-like appearance. It has been used over a million times in injectible form and has recently been made available in an oral supplement in enteric coated capsules to prevent neutralization by the stomach acid.

ENVIRONMENTAL FACTORS AFFECTING "HA"

Various studies have revealed a number of factors that affect the body's levels of HA. Abnormal HA may be created by zinc deficiency, magnesium deficiency, cigarette smoke, thyroid deficiency, protein deficiency, and low caloric intake. It may be that a lot of the common dietary and nutritional deficiencies cause the health problems they do because they interfere with HA!

The enzyme hyaluronidase breaks down hyaluronic acid, so anything that increases hyaluronidase will adversely affect your HA levels. It's interesting then to note that both strep and staph bacteria produce hyaluronidase. Weakening the connective tissue by lowering the HA levels gives an entryway for the bacteria into the body. Therefore, your basic immunity against common infections may be a function of your HA levels!

So what normally keeps the hyaluronidase enzyme suppressed and your HA up? It's bioflavonoids - the antioxidants found in citrus fruit peelings, grape seed extract, bilberry, rutin, milk thistle, quercetin, etc. (Biochemical Pharmacology, 40:397-401, 1990; Biology Reproduction, 56:1383-89, 1997). Bioflavonoids also appear to be anti-viral. We have long used various bioflavonoids for their anti-inflammatory effect, but this connection with HA explains why bioflavonoids work - suppress the action of hyaluronidase and you have more HA, with its positive effect on the connective tissue and joints.

HEALTH PROBLEMS BENEFITED

Currently HA is being used or studied in connection with the following conditions:

Let's examine some of the more common conditions that HA appears to help.

OSTEOARTHRITIS

HA functions in the joints as a shock absorber, lubricant and antioxidant (Inflammation Research 46:114-17, 1997). HA injections are considered one of the latest "breakthrough" treatments for arthritis. Synvisc is an FDA approved injectible form of HA to aid in lubrication and shock absorbing. Up to 80% of those receiving HA injections for osteoarthritis note improvement. HA also exerts a protective influence on the synovial joint fluid and augments joint collagen (Proceedings of the Society of Experimental Biological Medicine, 149:594-98, 1975). Since HA is the primary component of the synovial fluid in the joints, it only stands to reason that it would be helpful.

"HA" vs. GLUCOSAMINE SULFATE

Many people use Glucosamine Sulfate for arthritic concerns. What's the difference between HA and Glucosamine? Actually, glucosamine sulfate is a precursor to the synthesis of HA. High doses of glucosamine may increase the HA levels. Glucosamine is part of the protein make-up of the joint collagen, while HA is part of the polysaccharide (type of sugar molecule) part. Since both HA and glucosamine sulfate are involved in the joint health, supplementation of both for those dealing with arthritis makes sense. Having used glucosamine sulfate with arthritic clients for years, I've noted consistently good results. I expect the addition of HA to show very good benefits as well.

SKIN PROBLEMS

As noted earlier, HA has properties of rehydrating the skin and building collagen. Skin wrinkling is a function of the breakdown of collagen with aging. Therefore, anything we do to increase or maintain collagen levels is going to keep the skin softer and more wrinkle-free. HA has been an ingredient in many moisturizing creams where it is reported to soften facial lines and improve skin elasticity and firmness.

Skin ulcers have also been helped by HA. Dermatologist, Ronald Reece, M.D., Assistant Professor of Family Practice at the University of California-Davis, says that increasing HA may produce more rapid healing of this condition. Scaring is likewise reduced with HA. Fetal skin almost never scars due to its high content of HA.

EYE PROBLEMS

One of the most interesting and promising applications for the usage of HA is with various eye problems. Again, the breakdown of connective tissue from low HA levels is a prime cause of aging, including aging of the eyes. HA has been used in injectible form in perhaps millions of eye surgery procedures, where it provides protection to exposed tissues, but the benefits of oral supplementation are just beginning to be understood. In addition to their longevity, the residents of Yuzuri Hara, Japan note fewer eye problems than is usually seen in the elderly.

The vitreous gel inside the eye contains a high percentage of HA. Studies done on the HA content of the eyes with aging are most interesting. Fetal tissue has a high level of HA, while no HA could be detected in the eye tissues of those over age 50 (Archives of Ophthalmology, 111:963-67, 1993). Deterioration of the vitreous gel results in "clumping" of this material and has been associated with "floaters".

HA eye drops have been successfully used to relieve eye strain associated with computer screens (Experimental Eye Research 68:663-69, 1999). Corneal damage from contact lens abrasion has also been helped with HA eye drops (CLAO Journal, 21:261-64, 1995).
A leading pharmaceutical firm in Japan has tested an HA oral supplement on 1000 people with approximately half of them reporting smoother skin, less fatigue and better eyesight.

INTERSTITIAL CYSTITIS

Interstitial cystitis is an inflammation of the bladder epithelium that is not caused by a bladder infection. HA is an important component of the glycosaminoglycan (GAG) layer of the bladder mucosa, and HA has a restorative effect on this layer. Urologists are instilling HA directly into the bladder to treat this painful condition. The drug form of HA for this purpose, Cystistat, has been used 1.5 million times. In one study of 25 patients a positive response was noted with 56% of the group at week four and 71% by week twelve.

While oral HA has not been studied specifically as to its effects on interstitial cystitis, HA supplementation would certainly merit trial.

DIABETES

A lot of medical research has gone on regarding the connections between HA and diabetes. One study suggests that the connective tissue weakness from HA deficiency, allows invasiveness of autoimmune disease processes into the Islets of Langerhans in the pancreas (Proceedings of the National Academy of Sciences, 2000 Jan 4; 97(1) 285-90). Other studies have been done relative to diabetic neuropathy, skin problems, kidney problems and more.

Studies on diabetic rats indicate lowered levels of glycosaminoglycan (GAG)-a component of HA-which in turn would delay wound healing (Exp Toxicol Path 1999 May; 51:(3) 239-43). A lack of HA adversely affects the fibroblast cells, which are necessary to healing. HA supplementation could have a significant effect on diabetic symptoms. It should certainly be considered by anyone with a diabetic condition.

"HA" ORAL SUPPLEMENTATION

While the injectible form of HA has been in significant usage for years with over a million people, oral supplementation is relatively new. Medical journals suggests that oral supplementation may be helpful for problems of the eyes, joints, liver, skin, and varicose veins. Actual experience of people taking oral HA certainly confirms its benefit.
A key factor with oral supplementation is preventing destruction of HA by the stomach acid. Thus, enteric coated capsule supplements are available to solve this problem.

HA is derived from chicken cartilage. Therefore, anyone with an allergy to chicken or eggs probably should not take HA. Since that is a relatively uncommon allergy, there are few people who cannot safely take HA.
Time-wise, I feel that HA needs to be taken for a couple of months to determine if it will be helpful, though improvements are often noted in a month. Some authorities recommend taking a double dosage the first month to stimulate the greatest effect.

DISCLAIMER: The information contained in this publication is for educational purposes only. It is not intended to diagnose illness nor prescribe treatment. Rather, this material is designed to be used in cooperation with your nutritionally-oriented health professional to deal with your personal health problems. Should you use this information on your own, you are prescribing for yourself, which is your constitutional right, but neither the author nor publisher assume responsibility.