Health Guide

Rationale / Background

• Vitamin C is the general name for a group of compounds, chiefly ascorbic acid and dehydroascorbic acid (which is readily converted back into vitamin C in the body).
• In the 1970’s Dr Ewan Cameron and Dr Linus Pauling published Cancer and Vitamin C, which proposed that taking regular high doses of vitamin C can play a part in both prevention and in the treatment of cancer.
• Cancer patients are reportedly significantly depleted of ascorbic acid. Cameron and Pauling believe this indicates substantially increased requirements and utilisation of this substance in order to boost the person’s resistance to disease.

What does the therapy involve?

• In 1991 Dr Cameron published a protocol for the use of vitamin C in the treatment of cancer. The protocol recommends that all cancer patients receiving vitamin C be given an initial 10 day course of intravenous ascorbate, followed by an oral maintenance dose to be continued thereafter. The importance of continuous rather than intermittent administration is emphasised.
• Oral vitamin C is to be taken to what is called bowel tolerance. When the body’s maximum saturation tolerance is reached, diarrhoea results. The aim is to reach an oral dose which is just below this point.
• This is achieved by taking several divided doses of vitamin C throughout the day, usually in a powdered form mixed in a glass of water. The standard recommended dosage is 10 grams/day.
• In addition to vitamin C therapy, it is recommended other supplements be taken. A flyer distributed in 1991 by the Linus Pauling Institute recommended daily doses of 6,000 to 18,000mg (6 to 18g) of vitamin C; 400 to 1600IU of vitamin E; and 25,000 IU of vitamin A, in addition to other supplements.

Here are some cautions for a person with cancer regarding vitamin C

• As the dosage levels of vitamin C are increased, absorption falls markedly. At the level of dietary intakes (about 30-180mg), vitamin C is approximately 90% absorbed. Absorption falls to 50% with a dose of 1,500mg (1.5g), and to 16% with a dose of 12,000mg (12g).
• Several reviews have concluded that vitamin C has little toxicity. Protection from toxicity is due to two factors: the efficient excretion of excess ascorbic acid in the urine when doses exceed 130mg per day; and the limited absorption capacity of the gut. With large doses of vitamin C, most passes on to the colon (large intestine). Little is known about compounds produced from vitamin C by the bacteria in the colon.
• Intestinal symptoms can occur with high doses of vitamin C, including nausea, vomiting, bloating and gas. Depletion of certain minerals (such as calcium) can occur. More serious risks include haemorrhage and rebound scurvy (ie vitamin C deficiency, occurring upon sudden withdrawal of large doses of vitamin C which the body has become accustomed to receiving).
• Intravenous vitamin C can harden the vein, making other intravenous therapy difficult to administer.
• High intakes of ascorbic acid increases the excretion of oxalate in the urine, which may contribute to a greater risk of kidney stone formation. High intakes of vitamin C are not recommended for people with iron storage disease (iron toxicity can occur) or in patients with chronic renal failure.
• Megadoses of the other mentioned vitamins can be dangerous, especially in the case of vitamin A, as liver toxicity and other associated effects may occur.
• It has been suggested that antioxidants (such as vitamin C) interfere with the ability of radiation and chemotherapy to kill cancer cells, due to the mechanism of action by which these treatments work. Thus combining vitamin C with these treatments should be fully discussed with a doctor.

Evaluation

• The evidence cited by Pauling and Cameron to support their claims has not proved to be scientifically valid. The subjects used to compare vitamin C against placebo (“dummy” pills/treatment) were not comparable, hence accurate conclusions cannot be made.
• Three studies were reported in 1979, 1983, and 1985, which were conducted in a reputable clinic according to accepted scientific protocols. It was found that patients given 10,000mg (10g) of vitamin C daily did no better than those given a placebo.

Costs and Commitment

• Vitamin C is readily available at Health Food outlets.

In Summary . . .

• Many studies have demonstrated a strong link between high consumption of fruit and vegetables with a low incidence of certain cancers. Conversely, low fruit and vegetable intakes are associated with an increased risk of developing cancer.
• The relationship between overall diet and cancer tends to be strong. However, as you restrict the emphasis to individual nutrients found in foods, the relationship becomes less clear. This is probably because we have not discovered all of the important nutrients contained in foods, some of which may have cancer-fighting properties.
• It is therefore unjustified to single out a particular nutrient as protective against cancer, or indeed as a cure for cancer, until reputable scientific studies have demonstrated this to be the case.

Rationale / Background

• Ian Gawler is an Australian veterinarian who has developed an integrated approach to cancer which combines diet, detoxification, stress management, positive thinking and meditation techniques. His belief is that by utilising all these means “the body’s natural healing response can be helped to reassert itself”. Gawler himself recovered from advanced metastatic osteosarcoma (bone cancer).
• Gawler’s beliefs about the causes of cancer are very similar to those of Max Gerson. He essentially believes that cancer is a multifactorial, degenerative disease which results from our food and environment being too far removed from nature.

What does the therapy involve?
In order to optimise healing Gawler suggests the following is important:

• To make conscious and informed decisions about all the treatment options, be they conventional, complementary or alternative treatments.
• Embrace your decisions positively to release the positive potential of the mind, emotions and spirit.

Gawler devised the following basic concepts for his therapy:

• Avoid known problems.
• Any vitamin and mineral imbalance needs to be corrected.
• Digestion should be restored and flooded with fresh, vital, pure and suitably prepared food
• Eating should be a joy not a cause of stress.

Diet is a major component of his approach.

• The diet is based on vegetables, grains and fruits. Ideally 70% raw foods and the rest lightly cooked.
• Have no added salt, sugar, refined foods and caffeine and chemical additives.
• The diet should be low in fat especially animal fat and low in protein. There are many low protein sources recommended in the diet which add to the overall total eg grains. He suggests that 500gm total per week be taken from the high protein sources listed in descending order of preference.

Vegetable proteins such as soy beans, tofu bean curd, lentils, chick peas are the preferred sources.
Fish preferably deep sea fish.
Dairy products.
Meat ie lean white meat, lean red meat.

• Low alcohol consumption.
• High fibre.

Preparation of the food.

• Where possible use chemical free produce eg organic vegetables.
• Preferred utensils - stainless steel, cast iron, glass, tin, enamel, earthenware but not aluminium.
• Preferred cooking methods - steaming, dry baking, wok with water.
• Prepare food with love and joy.

Attitude.

• Important to pause for a moment’s stillness before a meal and affirm the value of good food to your health.

Gawler recommends that if you are making major changes to your diet that you first seek professional guidance.

Here are some cautions for a person with cancer regarding the Ian Gawler Approach

• Gawler’s book You Can Conquer Cancer contains nutritional analyses of the maintenance diet he suggests. Levels of vitamin E, vitamin B12, and zinc are low. To correct this he advises nutritional supplementation. The diet is also low in energy, and the analysis is based on the needs of a healthy person, not someone with increased energy requirements as is the case for individuals with cancer. People may lose weight on this diet which is not generally advisable for individuals with cancer.
• If a person does not get well using this therapy then it is seen as a defect in the person’s own will rather than a defect in the therapy itself. This is an enormous burden to place on someone with cancer.

Evaluation

• There is no scientific evidence available which demonstrates the diet can cure cancer.

Costs and Commitment

• The Gawler Foundation in Victoria offers a 10 day residential program for around $2,400

The contact details for the Gawler Foundation are: www.gawler.org

• There is a time commitment involved in undertaking this program with the shopping, food preparation and relaxation techniques.
• Stephen Taylor who was trained by Ian Gawler and has also recovered from cancer runs a similar course at Tayen Park in Clare South Australia. The charge for this course is by donation. Contact details for Stephen Taylor are:PO Box 614, Clare 5453, tel: 8842 3114, email: tayen@rbe.net.au

The Cancer Council South Australia recognises that people with cancer, their families and friends will seek out information about alternative and complementary therapies. These methods may also be referred to as “unproven”, “non-toxic”, “unorthodox” or “unconventional” therapies and represent methods which are not scientifically proven by random clinical trials. The following information is intended to help with making decisions about the use of such treatments.

We also recommend you read “Making an informed choice”.

Rationale / Background / Claims
Dr Max Gerson developed this treatment in the 1920’s. He believed cancer was a result of faulty metabolism, brought about by poor nutrition and long-term exposure to chemical and environmental pollutants. His theory was that cancer cannot occur unless the functions of the liver, pancreas, immune system and other body components have degenerated.

The aims of the Gerson therapy are to:

• Boost the body’s natural immune system to heal the cancer.
• Rid the body of poisons.
• Stimulate enzyme production to improve digestion.
• Correct the balance of vitamins and minerals in the body.
• Promote a positive attitude towards the body and towards life.

The therapy claims to be a whole body approach to healing which can reactivate the body’s ability to heal itself and then reverse the conditions that support the growth of malignant cells.

What does the therapy involve?
Two main principles are applied:

• A low-fat, low-protein, salt-free diet with additional supplements.
• A detoxification program to help eliminate toxins and waste materials.

The diet is a core component of the therapy. Its main features are described in the following points:

• The daily regime requires 13 eight-ounce glasses of fresh organic juice be consumed at hourly intervals. The 13 juices include one orange, four of green leaf and five apple/carrot all selected and prepared in a specific way.
• Meals are restricted to salad, baked potatoes, oatmeal and raw and cooked fruit and vegetables. Two tablespoons of linseed/flaxseed oil are also included on a daily basis.
• Meat is not allowed and other sources of animal protein are not permitted for the first six to twelve weeks, after which it is kept to a minimum.
• Among the items forbidden indefinitely are salt, coffee, nuts, berries, drinking water, alcohol and all canned, preserved, refined, bottled or frozen foods. No aluminium utensils are to be used and a special grinder and press are required to make the juices.
• Patients receive daily medications, including thyroid extract, pancreatic enzyme, potassium iodine, niacin and an intra-muscular injection of vitamin B12. Potassium iodine solution is added to each of the ten fruit and vegetable juices.

The key detoxification method is the coffee enema which patients are taught to self-administer five times throughout the day, four hours apart. This is said to stimulate the liver in the removal of toxins, and increase the production of bile. As a further aid in detoxification, some patients may receive an oral dose of castor oil on the first day. This is then alternated after the initial day.

Here are some cautions for a person with cancer regarding the Gerson Method
Within three to ten days, the patient can expect to experience what Gerson termed “an allergic inflammation reaction” or “healing reaction”. The timing of these reactions is hard to predict.

Nausea, vomiting, intestinal spasms, fever and headaches are among the symptoms reported.

Risks from enemas include perforation or rupture of the colon (large intestine), infections transmitted through use of the enema devices and serious fluid, electrolyte, and vitamin imbalances.

The level of supplementation can lead to toxicity or disrupt the metabolic balance.

Evaluation
There is no evidence in the peer-reviewed literature that enemas are useful in detoxifying the body.

The Gerson regime requires extensive commitment in order to undertake the therapy and a support person is absolutely mandatory.

The treatment methods have documented risks and there is no reliable scientific evidence to support the validity, safety and usefulness of the program.

Costs and Commitment
This therapy is available at the Gerson Institute in San Diego, California, USA at a cost of approximately US$4,900 per week, with an additional US$200 or more per week for laboratory testing. It is recommended a companion accompany the patient to the clinic, at an additional cost of US$330 per week. Supporters recommend a three to eight week stay. A three month supply of Gerson medications costs US$550, and a juicer costs a minimum of US$240.

Cancer cures are said to be achieved only by strict adherence to every aspect of the diet and techniques. It has been estimated 12 - 16 hours a day are required for shopping, preparing the food and cleaning the equipment as instructed. Juices cannot be prepared ahead of time.

In Summary . . .
The Gerson regimen requires an extensive commitment in order to undertake the therapy, and a support person is mandatory.

The treatment methods have documented risks, and there is no reliable scientific evidence to support the validity, safety, and usefulness of the program.


For further information contact the:

The Gerson website
www.gerson.org

Rationale / Background / Claims

• In 1971, Dr Judah Folkman published a hypothesis regarding tumour growth which stated:

• As cartilage does not contain blood vessels, it was reasoned that it may have an inherent mechanism for preventing angiogenesis. Supporters believe that a protein present in the cartilage is responsible for this action.
• The cartilage theoretically should be most effective against fast-growing, highly vascularised tumours, such as those of the breast, cervix, central nervous system and liver.
• The number of cancers found in sharks is quoted as being insignificant.

What does the therapy involve?

• Shark cartilage is available as either pills or loose powder. Powdered cartilage can be taken either orally or rectally.
• Depending on a person’s weight, the dosage could range from 40g to 90g per day.
• When taken orally in the form of the powder, it is mixed with either water, milk, vegetable juice (eg carrot, tomato) or with a fruit nectar (eg pineapple, apricot). The powder is mixed with the juice in a blender to produce a frothy shake. These shakes are consumed three to four times daily, usually 30 minutes prior to meals. Theoretically, when taken on an empty stomach, the drink passes rapidly through the stomach acids, thus avoiding breakdown of the active proteins.

Here are some cautions for a person with cancer regarding shark cartilage

• Children and pregnant women should not take shark cartilage because if the cartilage does work as an inhibiter of blood vessels it could adversely affect growing children and the growing foetus.
• Those who have had recent surgery should not take shark cartilage because it can theoretically impair healing.
• Avoid shark cartilage enemas if you are neutropenia (have low white blood cell count). You can induce a life threatening infection.
• Some shark cartilage may contain additives, fillers and contaminants.
• Shark cartilage can cause diarrhoea which can affect the patient’s ability to tolerate conventional cancer treatments.

Evaluation

Human trials on the effectiveness of shark cartilage in the treatment of cancer were conducted in Cuba. The study initially reported that patients “felt better” several weeks after starting on shark cartilage. This study was however later reviewed by the National Cancer Institute (NCI) which felt the data was incomplete. A subsequent study was reported at the American Society for Clinical Oncology in 1997. Patients with advanced cancer were given shark cartilage for twelve weeks. Of the fifty eight patients treated there was not one complete response or partial response to shark cartilage. Only two patients had a significant improvement in quality of life. There are currently some ongoing studies of shark cartilage at a number of institutions but no positive trials have been published in scientific literature.

Costs and Commitment

The cost is approximately $90 for 400 capsules, or $100 for 200g of powder.

In Summary . . .

Studies performed on shark cartilage at the National Cancer Institute in America have not demonstrated that shark cartilage is effective as a treatment for cancer.

The Cancer Council South Australia recognises that people with cancer, their families and friends will seek out information about alternative and complementary therapies. These methods may also be referred to as “unproven”, “non-toxic”, “unorthodox” or “unconventional” therapies and represent methods which are not scientifically proven by random clinical trials. The following information is intended to help with making decisions about the use of such treatments.
We also recommend you read “Making an informed choice”.

Rationale / Background / Claims

• The terms Laetrile and amygdalin are often used interchangeably, although they are not chemically identical. Both belong to a family of compounds called the cyanogenic glycosides. What is actually used in Laetrile therapy is amygdalin.
• According to the supporters of Laetrile, amygdalin is split by the enzyme beta-glucosidase, releasing glucose (sugar), benzaldehyde (a mild anaesthetic) and cyanide (a poison), which is lethal to cells. Cancer cells supposedly contain more of this enzyme than normal cells and therefore receive more cyanide. “Normal” cells are said to contain another enzyme, rhodanese, which detoxifies cyanide, thus preventing unwanted destruction of healthy cells.
• Another theory as to how Laetrile works relies on the belief that cancer is a vitamin deficiency disease, and Laetrile is the “missing vitamin” (vitamin B17).
• Laetrile is found naturally in the kernels and pits of apricots, peaches, cherries, apples, plums and nectarines. In the time of the pharoahs, peach kernel extract was used for performing executions.

What does the therapy involve?

• Laetrile is most commonly given intravenously for two to three weeks, followed by oral doses for maintenance therapy.
• Dietary therapy may accompany Laetrile treatment, and usually has the following characteristics:

Here are some cautions for a person with cancer using Laetrile/amygdalin

• Low doses of cyanide, the “active” breakdown product of amygdalin, causes headache, dizziness, nausea, vomiting, diarrhoea, fever, lethargy, abdominal tenderness and cramps, rash, neuro-muscular weakness of the arms and legs, gradual progressive loss of hearing and vision and other deteriorative nerve damage. Cyanide poisoning can lead to death.
• Cyanide toxicity is a risk when Laetrile is taken orally. Beta-glucosidase made by bacteria in the intestine breaks down amygdalin to cyanide; with intravenous Laetrile - the usual method - most is excreted in the urine without releasing cyanide. Thus intravenous Laetrile can have no therapeutic effect. Laetrile is 40-times more toxic when taken orally rather than by injection.
• Combining doses of Laetrile with foods containing beta-glucosidase, such as vegetables or apricot kernels, will generally poison the patient, and may lead to death. Megadoses of vitamin C in conjunction with Laetrile administration also increases the possibility of poisoning, as there is laboratory evidence vitamin C helps release cyanide from amygdalin.

Evaluation

• The theories underlying the mechanism of action of Laetrile are unfounded. The claim that beta-glucosidase, the enzyme responsible for breaking down amygdalin, is abundant in cancerous cells is misleading. Analysis shows that only traces of this enzyme are present in animal tissues. In addition, the enzyme responsible for protecting normal cells from cyanide toxicity, rhodanese, is present in equal amounts in both normal and cancerous tissues.
• A vitamin is classified as an organic substance which is required to promote one or more specific and essential biochemical reactions within the living cell. Disease will occur if deficiency is present, and reversal of the disease is achievable through administration of the missing vitamin. Laetrile does not meet these criteria, and therefore is not a vitamin.
• Laetrile has been proposed as a cancer remedy since 1845, but never has been found to be of value against cancer. Scientific studies commencing in the mid-1950’s were conducted for over 20 years, and no evidence for any benefit against tumours in animals was found. Despite this, a human trial was conducted in 1981. It did not show any anti-cancer effect of Laetrile.

Costs and Commitment

• Laetrile is usually given as part of a larger treatment program which can cost between US$2,000 and $5,000 per week.
• The Richardson Centre in Reno, Nevada, charges US$2,500 to $3,000 for the first four months. This does not include travel or room costs.

In Summary . . .

The available research does not support the claim that Laetrile is an effective anti-cancer agent. The risks of cyanide poisoning which accompany this therapy are clearly a cause for concern.

The Cancer Council South Australia recognises that people with cancer, their families and friends will seek out information about alternative and complementary therapies. These methods may also be referred to as “unproven”, “non-toxic”, “unorthodox” or “unconventional” therapies and represent methods which are not scientifically proven by random clinical trials. The following information is intended to help with making decisions about the use of such treatments.
We also recommend you read “Making an informed choice”.

Rationale / Background / Claims

• Macrobiotics is a nutritional system, a philosophy, and a way of life. It draws on Eastern principles of complementary forces (yin and yang) embodying a universal principle.
• Macrobiotics believes that a change in diet can not only prevent cancer, but may also reverse the cancerous process and eliminate disease.
• Zen Macrobiotics was designed by George Oshawa (1893-1966). Michio Kushi, a former student of Oshawa, is the leading promoter today. According to Kushi, cancer is the result of a person’s behaviour, primarily due to an improper diet, but also to his or her thinking and lifestyle.
• Improper diet causes a “chronically toxic blood condition”. Cancer is seen as an unbalanced but “natural mechanism”, whereby the body attempts to localise toxins and thereby produce balance. Cancers are broadly classified as yin or yang, depending on the cause. The standard macrobiotic diet is varied according to the type of cancer.
• Kushi claims the types of cancers which respond best to macrobiotics are cancers of the breast, cervix, colon, pancreas, liver, bone and skin. He states that cancers of the lung, ovaries and testes have responded poorly to the diet.

What does the therapy involve?

• Oshawa proposed ten diets of progressive restrictiveness and value in achieving a sense of well-being. The most restrictive diet, number “7”, is regarded as the ideal diet and consists entirely of cereals.
• The “standard” macrobiotic diet promoted by Kushi is largely a vegetarian diet consisting of:

• The diet is adapted to an individual’s age, sex, level of activity, personal needs and type of cancer. For a cancer which is primarily yang (eg colon, prostate, pancreas), a standard diet is recommended, but with more emphasis on yin foods. Conversely, cancers that are primarily yin (eg lymphoma, leukaemia, breast) would require a standard diet which emphasises yang foods.
• Healthy individuals are advised to chew each mouthful 50 or more times; cancer patients are to chew each mouthful 150 or more times to make foods “more yang” and to prevent overeating.
• Individuals are advised to be grateful, live happily and follow particular recommendations for lifestyle aspects regarding sleep, housekeeping, bathing, and exercise. Such advice includes the need for regular exercise, and the avoidance of radiation, synthetic fabrics and chemical fumes.

Here are some cautions for a person with cancer regarding the macrobiotic diet

• The diet has been very restrictive and would often result in a range of nutritional problems including: scurvy; anaemia and folic acid deficiency; low protein levels; low calcium levels and muscle wasting due to starvation. The diet has however been modified now to reduce some of these risks.
• Participants may lose significant weight which can make standard cancer treatments harder to tolerate.
• Restrictive macrobiotic diet is dangerous for children who have high energy and nutrient need for growth and development.
• Pregnant women are also at risk of severe nutritional deficiencies.
• If you are considering the macrobiotic diet, wait until completion of all conventional cancer treatments. This will allow you to have the full benefit of proven cancer therapy. Using macrobiotic diet after conventional therapy is completed may help you gain control of your life.

Evaluation

• The macrobiotic diet has not been demonstrated by properly controlled trials to be helpful in maintaining nutritional status among cancer patients, nor can the clinical progress of cancer patients following the regimen be accurately assessed.

Costs and Commitment

• The Kushi Institute in Becket, Massachusetts offers classes on macrobiotic diet and lifestyle in weekend, week-long and month-long seminars. The cost for these programs are US$350, $1495 and $2900 respectively.
• Switching to macrobiotic diet requires a significant amount of time, energy and effort in order to change dietary habits.

In Summary . . .

The increased caloric needs of cancer patients are unlikely to be met by a macrobiotic diet and serious nutritional deficiencies tend to accompany strict macrobiotic regimes. This is of particular concern for those with existing weight loss problems, general ill health and malnutrition..

What are sunscreens?

Sunscreens are products which protect the skin against the damaging effects of the sun's ultraviolet radiation (UVR).

They contain chemicals which either absorb or reflect the UV rays which would otherwise burn and damage the skin.

Ultraviolet radiation and skin damage

There are three types of UV radiation - UVA, UVB and UVC.

Naturally occurring UVC does not reach the earth's surface as it is absorbed or scattered in the atmosphere.

UVB is primarily responsible for sunburn, suntan and, after many years, premature ageing and skin cancer. UVB also depresses the immune response which is the body’s system for fighting infection.

UVA causes skin damage contributing to premature ageing and skin cancer.

What protection do sunscreens give?

SPF 30+ sunscreens filter out 97% of the UVB rays. Sunscreens that are labelled BROAD SPECTRUM also filter out at least 90% of UVA.

Sunscreens are tested on human volunteers. Using a grid pattern, some patches of their skin are covered with sunscreen and some are left uncovered. They are then exposed to an artificial source of UVB in a laboratory. The Sun Protection Factor (SPF) is determined by comparing the time it takes for the patches of skin with sunscreen to show minimal redness with the time it takes to produce the same amount of skin redness without sunscreen.

The SPF on a sunscreen label should only be seen as a guide to the strength of the product. It should not be used to calculate the period of protection offered by the sunscreen.

As many things affect the time it takes for an individual to burn, it is impossible to calculate accurately a "burn time". Therefore the SPF rating on a sunscreen label should not be used to determine a "safe time" before burning will occur.

Damage to the skin begins as soon as the skin is exposed to the sun. Sunburn is the extreme level of this damage. It is a mistake to believe that damage only occurs if there is sunburn. The effects of the sun on the skin are cumulative so the damage is building up even without burning.

No sunscreen offers complete protection against UV radiation. Even if a sunscreen is reapplied regularly, a small amount of UV still reaches the skin. It is still possible for the skin to be sun damaged even with sunscreen protection if exposed to the sun repeatedly for prolonged periods.

What are the regulations regarding sunscreens?

Australia has had a standard for the testing and labelling of sunscreens since 1983 which has been revised regularly since then. Prior to March 1997, the maximum SPF allowed on a sunscreen label in Australia was 15+. Since then the maximum SPF that can be claimed for a sunscreen is 30+.

The current regulations for sunscreens are documented in the Australian/New Zealand Standard, AS/NZS 2604:1998 and apply to sunscreens produced and available in Australia. It specifies how sunscreens should be tested, the standard they must reach and how they should be labelled. The testing is done under strict laboratory conditions. The Australian Standard also refers to the water resistance of a sunscreen which relates to the product's ability to remain on the skin after immersion in water and still test at its SPF number.

"Protection times" shown on labels relate only to this water resistance. They do not relate to the degree of protection against sunburn offered by using the product, ie the SPF number.

In Australia, sunscreens have to be listed on the Therapeutic Goods Administration’s (TGA) Australian Register of Therapeutic Goods (ARTG). They can only be listed on this register if they comply with the Australian/New Zealand Standard.

What is the correct way to use sunscreens?

Sunscreens should be applied to clean, dry skin 20 minutes before being exposed to the sun. It is not necessary to rub sunscreen creams into the skin until they vanish. The cream will be absorbed into the skin over the 20 minutes prior to exposure to sunlight.

The amount of sunscreen applied should be enough to easily cover the exposed skin, eg one teaspoonful of cream for one arm. If it is difficult to spread the sunscreen over the area, it is likely that not enough has been applied.

Sunscreen should be reapplied about every two hours. The reason for this is not because sunscreens lose their effectiveness after two hours, but because they may have been inadvertently removed during normal activity such as nose-blowing, sweating or brushing up against something. It is not uncommon for areas of skin to be missed or inadequately covered during the first application of sunscreens. Reapplication will reduce the risk of inadequate protection.

How effective are roll-ons?

The testing of sunscreens as set out in the Australian Standard does not include testing the method of application. As it is difficult to judge how much sunscreen has been applied when using a roll-on, it is recommended that the ordinary sunscreen or lotion can be used for the first application and roll-ons used for top-up reapplications.

What are the costs and benefits of using sunscreens?

It has been clearly shown that sunscreens reduce the risk of sunburn. As sunburn is a risk factor for all types of skin cancer, the recommendation to use sunscreens has been based on the assumption that preventing sunburn should reduce the risk of skin cancer.

Sunscreens should not be the only approach to preventing skin damage. They should be used in conjunction with clothing, hats and where possible, avoiding the direct sun in the middle of the day. Sunscreens are not a substitute for these other forms of protection.

Short term side effects from sunscreens may include skin irritation, and less commonly, skin allergy, blackheads and acne formation and dryness or oiliness of the skin depending on the type of sunscreen used. The likelihood of these reactions occurring depends on the sensitivity of the skin and the number and concentration of the chemicals in the sunscreen.

Although most people focus their concerns on the active sunscreening chemicals in a product, there are other chemicals in the sunscreen base which can cause problems.

In general, the incidence of true allergy to the chemicals in sunscreens is low. The more common side effect is skin irritation.

The long-term side effects of regular sunscreen use are unknown. Sunscreens have not been available for long enough and used by a sufficient number of people for an extended length of time for there to be any guarantees against long-term side effects. However, to date there is no evidence to suggest that long term side effects are likely.

Para amino benzoic acid (PABA), a chemical rarely used in currently available sunscreens, was linked to a higher risk of skin allergy. There was also some concern, in the past, about its carcinogenic effect but this has never been supported in laboratory testing.

Oxybenzone, which is also called Benzephenone - 3, is a chemical which absorbs UVA rays. It is sometimes included in sunscreens. It has been used for about thirty years and has never been shown to be toxic to humans or animals.

Current information indicates that there is much more to be gained from using a sunscreen in conjunction with other forms of protection, than avoiding its use and risking sunburn, premature ageing and skin cancer.

How do I choose a good sunscreen?

There are many different brands of Broad Spectrum sunscreens available. They can be bought as creams, milks, gels and clear lotions.

Different brands use various combinations and proportions of chemicals. For this reason, one brand may suit your skin better than others.

Creams are thicker and tend to be more expensive per gram than lotions. Lotions can be milky or clear. Clear lotions and gels have an alcohol base and are less sticky but more drying than creams and milks which usually contain moisturisers.

Some manufacturers incorporate substances like Titanium Dioxide and/or Zinc Oxide in their sunscreen. These provide a thin film of micro-fine particles which reflect the UV rays. These products may leave a white film or sheen on the skin.

Chain stores and supermarkets often sell their own brands which are usually cheaper than others. Sunscreens produced by cosmetic companies are generally the most expensive.

Look for a sunscreen labelled:

• SPF 30+
• Broad Spectrum

A water-resistant sunscreen is recommended when activity is likely to result in heavy sweating or for water-sports.

What about sunscreens labelled for babies and toddlers?

These sunscreens contain the same sunscreening chemicals as 'adult' products. Generally the only difference is that they use a gentler base and do not contain perfumes.

There is no evidence to suggest that the use of sunscreen on small areas of a baby’s skin is associated with any long term side effects. For a small proportion of babies, like adults, some sunscreens can cause minor skin irritation. In such cases it is recommended to try a product which is specially formulated for sensitive skin.

Babies must be protected against sunburn; the damage that begins in childhood can lead to skin cancer later in life.

The best protection for your baby is to avoid direct sunlight especially in the middle of the day during summer. When outdoors, babies and toddlers should be protected with hats, clothing and shade as much as possible. Sunscreen should be applied to those areas that cannot be protected with clothing.

Do sunscreens deteriorate after time?

Sunscreens have a shelf life of between 2 and 3 years. Sunscreen products have been required to carry an expiry (use-by) date since 1 September 1994.

Sunscreens can deteriorate if they are exposed to heat and/or air for long periods. Store sunscreens in a cool dry place and ensure the cap is replaced tightly after use.

Key points about sunscreens

• No sunscreen offers complete protection against the sun. Hats, clothing and shade should also be used.
• A thick coating of zinc cream does block out the UV totally. It works by reflecting the rays. However, as it is thick and completely coats the skin it is only appropriate for small areas such as noses, ears and lips.
• All brands of Broad Spectrum sunscreen with a SPF 30+ which comply with the Australian/New Zealand Standard AS/NZS 2604 provide effective protection when applied correctly.
• Using a SPF 30+ rather than a SPF 15 sunscreen halves your risk of sunburn for the same length of time in the sun. SPF 30+, however, should not be used to increase the amount of time you spend in the sun.
• Sunscreens should be applied to clean, dry skin 20 minutes before exposure the sun. They should be applied liberally - eg about one teaspoonful of cream for one arm.
• Sunscreens can be applied as a moisturiser under make-up. Sunscreens can be applied as a moisturiser under make-up.
• Babies under one year old should not be exposed to the direct sun. When taking babies outdoors avoid doing so between 11.00 am and 3.00 pm (daylight saving time) if possible. Natural protection, that is hats, clothing and shade, is best. However, small amounts of sunscreen can be applied to areas that cannot be protected with clothing.