More than 1 million cases of skin cancer occur each year in the United States, which makes skin cancer the most common type of cancer that Americans develop. Eighty percent are basal-cell carcinoma, 16 percent are squamous-cell carcinoma and 4 percent are melanomas.1 Based on advertising and information from a variety of sources, including health care professionals, many think that sunscreen use is protective against melanoma, which is stated to be directly linked to sun exposure. What do you and your patients think about this subject?
We should appreciate that this is an emotional topic, especially for dermatologists. First, it is important to embrace the fact that melanomas commonly develop in places where the sun doesn't shine, such as the vulva,2 penis3 and rectum.4 Second, the epigenetics of all chronic diseases are complicated, including melanoma,5 which is why it is inappropriate to equate sun exposure with melanoma or elevated cholesterol with heart disease. Third, while painful sunburns are associated with malignant melanoma, lifetime sun exposure is associated with a decreased risk of malignant melanoma.6
Seems like we have been misled a bit. It turns out that painful sunburns before the age of 20 and lifetime sun exposure are predominantly correlated to squamous-cell carcinoma and to a lesser degree with the most common type of skin cancer, basal-cell carcinoma.6 In other words, the most common type of skin cancer, basal-cell carcinoma, is least associated with sun exposure.6
Sun Exposure and Skin Health
There is evidence that painful sunburns are clearly unhealthy; in fact, painful sunburns are associated with all forms of skin cancer.6 However, sun exposure is associated with reduced expression of most cancers,8 including melanoma.6-7 Regarding the skin, it seems that sun-derived vitamin D protects the skin against the photo-oxidizing effects caused by the sun.1 In other words, moderate sun exposure is good for our skin and does not appear to cause skin cancer.
Simply stated, we need to avoid the extremist perspective that "sun is bad." The problem is the development of sunburns due to prolonged exposure, which means that we should be encouraged to pursue healthy sun exposure. In other words, it is OK to get a tan, but burning should be avoided. Instead, Americans have been scared out of the sun and are urged to venture out only if we are slathered in sunscreen, both of which are known to promote vitamin D deficiency.9
Does Diet Combat Sun Exposure?
Research continues to support the view that a healthy, anti-inflammatory diet is preventive against chronic diseases such as diabetes, heart disease and cancer. A commonly appreciated anti-inflammatory diet is the traditional Mediterranean diet rich in fish, vegetables and fruit. But what does this have to do with skin health? When it comes to skin, we have been somewhat conditioned to believe that the skin is nourished from the outside by creams and lotions. Rarely is nutrition for skin health a consideration, despite multiple papers published on this topic.11-14
In short, the anti-inflammatory diet that is recommended for primary and secondary prevention of diabetes and heart disease15 is also known to reduce the expression of skin cancer.11-14 Compared with the United States, Australia and New Zealand, Mediterranean countries with high levels of sunlight exposure, including Greece, Spain and Italy, have a substantially lower incidence of skin cancer.11 This may be due to the anti-inflammatory nature of the Mediterranean diet. It turns out that the consumption of large amounts of vegetables and fruit and reduced consumption of pro-inflammatory omega-6 fatty acids, which is characteristic of the Mediterranean diet, is associated with reductions in the negative effects of sun damage, including oxidative, mutagenic, immunosuppressive, and inflammatory responses.11
The Mediterranean diet also appears to modify the risk for developing cutaneous melanoma. According to the authors of a 2008 study, "After careful control for several sun exposure and pigmentary characteristics, we found a protective effect for weekly consumption of fish, shellfish, fish rich in n-3 fatty acids, daily tea drinking, a high consumption of vegetables, in particular carrots, cruciferous and leafy vegetables, and fruits, in particular citrus fruits."12
A Rational Plan for Skin Health
It is extremely important to avoid excessive exposure that leads to sunburns, particularly when we are young. Otherwise, we should take a graded approach to sun exposure based on our skin pigmentation. For especially fair-skinned people, this may mean only 10 minutes without sunscreen. Because it is not normal for humans to spend multiple hours at the beach lying in the sun, after brief sun exposure, the use of sunscreen is required and a beach umbrella is recommended.
For the average Caucasian individual, it takes only 30 minutes of summer sunbathing to produce 20,000 IU of vitamin D.16 Viewed another way, 1 minimal erythemal dose causes a slight pinkness to the skin and is equivalent to ingesting approximately 20,000 IU of vitamin D.17 Substantially longer time is required for darker-skinned individuals to generate such levels, especially very dark-skinned African Americans.18 In a Minnesota-based study, 100 percent of African Americans, East Africans, Hispanics, and American Indians had deficient levels of serum 25(OH)D.19 Supplementation with vitamin D is recommended for individuals who cannot get adequate sun exposure.
While diet may not typically be considered to influence skin health, the evidence suggests the exact opposite. In addition to healthy sun exposure, we must eat a skin-protecting anti-inflammatory diet. For the average person, this means the avoidance of sugar, flour and refined oils, and substantially increased consumption of vegetables and fruit, which provide vital antioxidants and phytonutrients.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
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Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
