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Sugar Sag

Over the years, I've had a lot of patients ask me about their wrinkles. Specifically, are there any creams that can help with deep wrinkles?

That's a tough one. There are many options when it comes to treating fine lines and wrinkles. Unfortunately, your options narrow when it comes to deep wrinkles and a sagging jawline.

A diet heavy in refined carbohydrates and added sugars can lead to collagen damage, ultimately causing sagging and deep wrinkles.

The problem is that by the time you see sagging skin, you've already experienced significant damage to the collagen and elastic fibers in the skin. Some of that is due to age and genetic factors. Much of it is due to damage from external sources, such as UV radiation and pollution (and smoking!).

But some of that collagen damage is due to your dietary choices. 


Many people don't realize just how much diet can impact our collagen. In fact, one of the cornerstones of an anti-wrinkle diet is eating foods that help maintain steady blood sugar levels.

Prevent Sugar Sag By Stopping Sugar Spikes

What is the link between blood sugar and collagen?

Physicians have known for many years that patients with diabetes experience poor wound healing. One of the reasons for this is that the elevated blood sugar levels in diabetics cause changes in collagen.

Those same effects on collagen can be seen on our face.

Specifically, higher levels of blood sugar can result in the cross-linking of collagen fibers through a process called glycation.


When your blood sugar rises, a chemical process called glycation takes place. This results in the production of compounds called advanced glycation end products, fittingly known as AGEs.  These "sticky" compounds act to cross-link collagen fibers.


If you think of your collagen fibers as a strong net that bounces back easily, then you can imagine what happens when that net starts to get tangled up: it starts to sag, and it doesn't bounce back as well. In the skin, that translates to a loss of skin elasticity, with wrinkling and sagging skin.

We call this sugar sag, and one of the keys to avoidance is maintaining steady levels of blood sugar.

June 10 Sugar Sag.png

The following information is excerpted from

Glow: The Dermatologist’s Guide to a

Whole Foods Younger Skin Diet

©Rajani Katta MD





Fine lines and wrinkles. A deepening of smile lines. A softening of the jawline.  These are common signs of aging skin, and they reflect collagen damage. And one of the major threats to your collagen is sugar. Specifically, excess sugar in your bloodstream.


Excess sugar can combine with proteins in your body and create collagen-damaging molecules. That’s why one of the keys to eating for younger skin is “stop sugar spikes.”


Collagen Is Strong, Flexible, And Extremely Resilient


Collagen is one of the major skin proteins, and it’s what makes our skin so strong and at the same time so flexible and resilient. Your skin is an amazing organ, especially when you think about all of the functions that it has to perform. It maintains a protective skin barrier, and it helps our skin move with us and then bounce right back. The collagen fibers in your skin are able to accomplish that, partly because of the fact that they're arrayed in the skin so well. I think of collagen fibers as similar to a net: closely and carefully arrayed, so that they can be strong yet flexible. 


That strong flexible foundation, though, can be damaged. Ultraviolet radiation is one of the biggest threats to your collagen. Sun exposure, over time, causes cumulative damage to collagen on a microscopic level. But UV radiation isn't the only threat to your collagen. Sugar is another. 


Higher Blood Glucose Levels Threaten Collagen


When you experience higher levels of sugar in your bloodstream (known as blood glucose), some of that sugar attaches to proteins. In a process known as glycation, excess sugar attaches to proteins and creates new molecules known as AGEs (advanced glycation end products).


AGEs Are Sugar-Protein Molecules That Act Like Caramel Tangling Up A Collagen Net


I think of AGEs as similar to caramel. If you combine sugar and butter, you end up with gooey, sticky, golden caramel. As that caramel hardens, it becomes hard and brittle. AGEs, just like caramel, are sticky: they act to cross-link your collagen fibers. That ultimately leads to wrinkling and sagging of your skin.


Think of what would happen if you added caramel to a net: you'd end up with a tangled mess that wouldn't function very well. It’s the same with your collagen fibers, with the effect being a loss of resiliency. To make things worse, your collagen, once it’s been cross-linked by AGEs, becomes more brittle and harder to repair. That "harder to repair" part is important, because it accelerates the aging process. As your skin loses its resiliency, you'll start to see more wrinkling and sagging. 


Sugar Sag Is Irreversible, But It Is Preventable


This process is known as sugar sag, and it's irreversible. Once your collagen becomes cross-linked, there's no way to undo that process.


That's why it's so important to focus on prevention. And it’s the reason "stop sugar spikes" is one of my key tenets of eating for healthy skin: it's important to keep your blood sugar levels stable so that they can't contribute to making more AGEs. 


AGEs Impact Many Organ Systems


Eating for skin health means eating for health. AGEs don't just impact the collagen in your skin. They impact many other organs, such as your blood vessels. That’s important, because once your blood vessels lose their flexibility, they put you at higher risk for diseases such as hypertension and heart disease. 


To Protect Your Collagen, Protect Against Sugar Spikes


This is one of the reasons why that bedtime bowl of ice cream isn’t the best choice. Foods with added sugars, or foods that contain refined carbohydrates, or even too large a serving of whole grains, can all lead to rapid increases in your blood sugar levels. These are known as “sugar spikes”, and they’re problematic. If you want to protect your collagen, it’s important to limit those sugar spikes.


In one study, strictly controlling blood sugar levels over a 4-month period resulted in a 25% reduction of glycated collagen formation.

For more book excerpts from Glow, see this link

For a link to the medical journal article on Sugar Sag, see this link

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