Nutritional Approach to Sun Protection by Niva Shapria This article titled "Nutritional approach to sun protection: A suggested complement to external strategies' by Niva Shapria, is an extensive review of recent research evidence on the efficacy of a simple, natural, dietary model in protecting against harmful UVR exposure and related skin cancers. Through this article, the author clearly points out that a dietary or internal method of sun protection is a very effective complementary approach to preventing skin cancer due to solar radiation for the more susceptible light skinned population living in very sunny regions.

At the outset the author highlights that there is a growing incidence of melanoma around the globe with a significant number of new cases diagnosed among U.S. women. Projections indicate that the rates of melanoma will literally double over the next 2 decades with the increase in UVR exposure due to global warming as well as the increased sun exposure due to vitamin D awareness. It is also now observed that the use of sunscreen encourages extended exposure to the harmful UVR, and this, paradoxically, contributes to the increasing rates of melanoma. With a growing body of recent research providing evidence for the positive sun protective effects of diet that includes carotenoids, flavanoids, vitamins, n-3 polyunsaturated fatty acids, n-9 monounsaturated fatty acids, 'low pro-inflammatory n-6 polyunsaturated fatty acids', etc., a diet based approach against solar oxidative damage is clearly indicated. Through this article the author emphasizes that such a dietary approach coupled with the external protective methods may offer the ideal defense against melanoma and other skin cancers.

Main Facts

The author provides a brief background of UV rays and how they are harmful to the human body. The author then discusses the natural defense mechanisms available against UVR exposure. In particular, she discusses the anitioxidative pathways. Enzymes such as superoxide dismutase, catalase, glutathione Peroxidase, other nutrients with anti-oxidant properties such as carotenoids that are readily derivable from vegetables such as carrots, potatoes, spinach, etc., and other vitamins and peptides such as ascorbic acid, vitamin E and glutathione are the main antioxidants that the body utilizes to counteract oxidative stress. Hence the increasing consumption of dietary antioxidants is a good way to reduce the damaging effects of UVR exposure. This is verified by studies that show that dietary antioxidants are evenly distributed across the outer skin layer offering an internal protective effect against sun damage. Studies have also shown that naturally occurring antioxidants such as selenium is important for the body to maintain its anti-oxidative enzyme system. So there is strong evidence to suggest that a diet containing high levels of antioxidants would greatly reduce the disruptive effects of UVR by boosting the natural protective defense of the body.

The author also discusses the protective effects of the various antioxidants such as carotenoids, flavanoids, vitamins, minerals and fatty acids by discussing empirical research evidence for each of these. For instance, the author cites research from Wertz et.al (2005) which concluded that carotenoids act by quickly consuming the destructive superoxide free radical (o2 -1). Other studies conducted by the author (Shapira & Kulklinski) also indicate the protective effects of beta carotene in combination with other antioxidants such as vitamin C and E. In controlling the increase in plasma malonyldialdehyde (MDA) (a reactive mutagen and known marker of preoxidative damage) formation after prolonged sun exposure in the dietary supplement group, while the control group who were not given the dietary antioxidant supplement showed a drastic (50%) increase in plasma MDA. Evidence from Astner et.al (2007) and Lee et.al (2004) for the beneficial effects of dietary Lutein in slowing down photocarcinogeneis adds more support to dietary model of photoprotection. The article also includes evidence from Draelos et.al (2008) and Stahl et.al (2001) that corroborate the positive protective effects of another dietary antioxidant, Lycopene.

The author then describes the efficacy of dietary flavanoids in the control of skin cancer due to UV radiation. Particularly, the author stresses the anticarcinogenic effects of consuming green tea, black tea, caffeine, citrus juice, etc. For instance, the author cites evidence from Rees et.al (2007) to demonstrate an inverse effect between tea consumption and skin cancer while Hakim et.al (2001) showed that regular consumption of black tea in combination with citrus peel led to a drastic reduction in squamous cell carcinoma (SCC) incidence. Similarly, the author also uses research evidence to discuss the protective effects of Vitamin C and Vitamin E When supplemented with Folate, Vitamin C is also shown to downplay the photosensitizing...

The article highlights how both these vitamins in combination with beta carotene provide a synergistic effect that helps prevent lipid peroxidation and photosensitization of DNA. [Niva Shapria, (2010)]
Conclusion

After providing quite a detailed insight in to the protective roles of these various antioxidants and their synergistic effects, the author then concludes that the inclusion of these protective substances in dietary form would act to greatly reduce the risk of skin cancer among people in countries that are suffering with a high rate such as Australia, New Zealand, North America, Sweden, Denmark, etc. Particularly, the author stresses the efficacy of the Mediterranean diet which is naturally rich with the above mentioned protective compounds. For instance, the traditional Mediterranean diet comprising of red wine, (high in flavanoids and other phenolic compounds), green leaves, tomatoes, (carotenoids) onions, garlic, tea, coffee and herbs such as rose mary and thyme, and the extensive use of citrus peel and citrus juices offers a combination of most of the vitamins, carotenoids, flavanoids and healthy fatty acids, that are well documented for their anti-oxidant and anticancerous properties. The author also highlights the high folate content in the Mediterranean diet and particularly the low n-6:n-9 and n-6:n-3 FA ratios observed in Greek diet compared to other western European countries 15:1 -- 17:1 and the United States 17:1. In conclusion, the author highlights the low levels of red meat, pro-oxidants and low carcinogens in the Mediterranean diet. The author also includes research evidence that link Mediterranean diet to the longevity (Simopoulos, 2005), Trichopoulou A, Vasilopoulou E. (2000) & Lorgeril Et.al (1998). [Niva Shapria, (2010)]

Implications

This important insight about Mediterranean diet and its efficacy is particularly significant for people living in very sunny climates and with lighter skin color as they happen to be the population most affected by UVR related skin cancer. As the author indicates, the most dry and sunny countries like Australia and Israel happen to have the highest incidence rates for melanoma. Therefore, the target population would be the people living in these extremely sunny regions and with a lighter skin tone. From the nursing perspective, this article is highly educative and has practical implications. Community nurses caring for people affected by melanoma or other skin related symptoms can help create more awareness about the protective effects of Mediterranean diet to the patients and their family members who may also be at risk for sun induced skin cancer. This article offers conclusive evidence for the positive impact of a diet rich in antioxidants.

Also, it is to be noted that the risk for melanoma is greater particularly during the early years of life and hence children who are exposed to UVR for prolonged periods are at an increased risk for developing skin cancers. Early exposure (before 20 years) and the onset of melanocytic nevi also creates an increased risk for melanoma much later in life due to cumulative effect. Therefore people who are born and raised in these hot regions and with early history of melanocytic nevi, have a heightened risk for melanoma during their later adult stage. This has been confirmed by the prevailing high incidence and mortality rates for melanoma observed among the native populations in Australia and Israel (which have extremely hot climate). The incidence rates are much less for populations of people who immigrated to these regions after 20 years of age. So the results of this extensive review by the author are particularly significant for young children from these extremely hot places. This article would provide professional dermatology nurses the awareness to identify such high risk population and advise them suitably regarding the efficacy of Mediterranean dietary choice

From a community nursing perspective the information derived from this article is ideal for educating young children. In this case, the target audience, 6th grade elementary school children, would be vastly benefited from the nursing initiative. Nurses can emphasize the age associated high risk for skin cancers among this population. While stressing on the need for effective protective measures such as avoiding peak sun hours, using sunscreens, appropriate clothing, etc., nurses can use the latest research information provided in this article to encourage healthy eating habits among the kids as a natural protective method against UV damage. Sixth graders are in the phase of rapid physical growth and it is a very apt time to condition their eating behaviors.

In the classrooms nurses can recommend Mediterranean diet for kids and encourage the consumption of flavanoids, carotenoids and vitamins that could be entirely derived from natural food sources. To press home these points…