Do any supplements or foods help prevent sunburn or skin damage from sun exposure? Can any increase your risk of sun-related skin damage?

Answer:

Certain supplements may provide modest protection from sun, while others may actually increase photosensitivity and should be avoided if going in the sun.

Protection from Sunburn

There is some evidence that oral beta-carotene or a combination of beta-carotene and other carotenoids, such as lutein and lycopene, provide some protection from sunburn. One study found that 24 mg of beta-carotene (from an algal source) or 24 mg of a combination of carotenoids (8 mg each of beta-carotene, lutein and lycopene) taken daily for 12 weeks significantly reduced redness from UV exposure (Heinrich J Nutr 2003). An analysis of seven studies also concluded that beta-carotene protected against sunburn, and noted that the benefit increased with each month of supplementation; however, a minimum of 10 weeks supplementation was necessary to see a statistically significant benefit (Kopcke Photochem Photobiol 2008).

Astaxanthin, a carotenoid derived from Haematococcus pluvialis algae which is also found in other animals up the food chain, such as krill and salmon - giving them their red color, has been shown in preliminary studies to protect skin from UV and UVA exposure (Lyons J Dermatol Sci 2002; Suqanuma J Dermatol Sci 2010). An oral daily dose of 4 mg (2 mg twice a day, with meals) has been reported to reduce sunburn (Lorenz 2002). This amount can be found in astaxanthin supplements, which typically contain between 2 and 4 mg per capsule, or as a natural or added ingredient in some krill and fish oil supplements. It is best to begin supplementation several days to a week prior to sun exposure. (See the Astaxanthin Supplements Review for additional information.)

A high-flavanol cocoa beverage (providing 329 mg of total cocoa flavanols daily, for 12 weeks) was found in one clinical study to reduce redness from UV exposure in women (Heinrich J Nutr 2006). (You can find products containing cocoa in the Review of Cocoa Powders, Extracts and Chocolate.)

When taken orally in high doses, a combination of vitamin C and vitamin E may provide some protection from redness and damage caused by exposure to sunlight. One small study found that 2,000 mg of vitamin C and 1,000 IU of vitamin E (as d-alpha-tocopherol - the natural form) taken daily for 8 days modestly reduced redness caused by UV light (Eberlein-Konig J Am Acad Dermatol 1998). Another study found that 3,000 mg of vitamin C and 2,985 IU of vitamin E (as d-alpha-tocopherol) taken for about 2 months provided a sun-protection factor of 2 (Fuchs Free Radic Biol Med 1998). (Sunscreen lotions typically provide a sun-protection factor between 15 and 50).

However, these doses reach or exceed the Tolerable Upper Intake Levels (ULs) for vitamin C (2,000 mg per day for adults) and vitamin E (1,500 IU of d-alpha-tocopherol per day for adults) and may cause side effects or medication interactions that make this an impractical supplement regimen for some people. High daily doses of vitamin C, for example, can cause diarrhea and may increase the risk of cataracts, while vitamin E can increase the risk of bleeding and should not be taken by people taking anti-coagulant medications, such as Coumadin. High daily doses of vitamin C and vitamin E may also hamper beneficial cellular changes that occur during endurance training, and so may not be advisable for athletes. (See the Cautions and Concerns sections of the Vitamin C Supplements Review and the Vitamin E Supplements Review --also see How Much is Too Much? in the Vitamin E Review) for more information about dosage and potential side effects.

Several small, company-funded clinical studies suggest an extract of the fern Polypodium leucotomos (Fernblock/Heliocare, Ferndale Healthcare), may help reduce skin damage from the sun. For example, in a double-blind study among 40 men and women who received either 240 mg of the extract, or a placebo, twice daily for two months, those who took the placebo were significantly more likely to report having at least one episode of sunburn during the study than those who took the extract (although the amount of time spent in the sun was reported to be similar in both groups, the actual number of hours were not provided). Ten people in each group were also exposed to artificial UV light, and those taking the extract required more exposure before skin damage occurred (Nestor, J Clin Aesthet Dermatol 2015). Three other very small clinical studies suggest a benefit (Middelkamp-Hup, J Am Acad Dermatol 2004; Middelkamp-Hup, J Am Acad Dermatol 2004; Gonzalez, Photodermatol Photoimmunol Photomed 1997). However, given the small size of these studies, and other potential design flaws (e.g., subjects were aware that they were given the actual treatment in two of the studies) these results can only be considered preliminary.

Pine bark extract (Pycnogenol®, Flavangenol®) has been found in clinical studies to significantly increase the amount of simulated UV-radiation required to cause redness and skin damage, as well as reduce measures of skin damage caused by UV exposure. It has also been found to decrease the color of age spots in healthy young women.

Additionally, be aware that some herbal supplements, like St. John's wort and dong quai (found in some menopause supplements) can increase photosensitivity, and so should be avoided if you are going out in the sun.

Skin Cancer Protection

Vitamin A intake has been associated with a reduced risk of melanoma, especially in women.  A large study found that men and women taking 4,000 IU or more of vitamin A (as retinol) daily had a 40% lower risk of developing melanoma over an average of 6 six years compared to those not taking a vitamin A supplement. The protective effect was strongest and most statistically significant among women.

Taken daily, high-dose niacin may reduce the risk of non-melanoma skin cancer (squamous and basal cell cancer) in adults with a history of these lesions.

Daily consumption of d-limonene (found in the peels of citrus fruits and also sold as a supplement) has been associated with a reduced risk of skin cancer in older adults. However, be aware that higher intake of certain citrus fruits has been associated with an increased risk of melanoma (see below for details).

Maintaining optimal  levels of vitamin D and omega-3 and omega-6 fatty acids may also be beneficial, as some preliminary studies suggest they may play a role in maintaining skin health and protecting the skin from sun damage (Dixon Cancer Prev Res 2011; Field Dermatoendocrinol 2013; Nicolaou Prostaglandins Leukot Essent Fatty Acids 2013; van der Pols Cancer Epidemol Biomarkers Prev 2011; Noel Int J Cancer 2014) — although the benefits of supplementation for this use has not been proven.

Increased Risk of Skin Cancer

Several observational studies have generally shown higher intake of citrus to be associated with increased risk of skin cancers, with some differences in the types of citrus and types of cancers. An analysis of data from the U.K. Biobank that included 1,592 cases of melanoma and 197,372 controls found that those who consumed more than two servings of citrus (orange, grapefruit or satsuma; intake of lemon, lime, tangerine and other citrus were not assessed) per day had a 63% greater risk of melanoma than those who did not consume citrus. This association was greatest among those with fair or very fair skin. When sub-grouped based on type of citrus, those who consumed more than one serving daily of orange or orange juice had a 79% or 54% greater risk of melanoma, respectively, than those who did not consume those foods. Higher intake of grapefruit, grapefruit juice or satsuma was not associated with melanoma risk (Marley, Br J Dermatol 2021).

An analysis of data from women in the Nurses' Health Study and men in the Health Professionals Follow-Up Study, which were both conducted in the U.S., also found a 36% increased risk of melanoma among those who consumed at least 1.6 servings of citrus per day compared to those who consumed citrus less than twice weekly (Wu, J Clin Oncol 2015). A study conducted across 10 European countries found citrus fruit intake to be associated with all forms of skin cancer, although citrus juice intake was associated with only basal cell and squamous cell carcinomas but not melanoma (Mahamat-Saleh, Eur J Epidemiol 2020). Conversely, a study that focused only on melanoma risk among women in the U.S. did not find an association with citrus fruit intake but detected a possible association for citrus juice intake just among women spending at least 30 minutes outdoors daily during the summer as adults (Melough, Nutr Cancer 2020).

What to make of all of this? If you're in the sun a lot, it may be best to go easy on citrus, particularly if you are fair skinned.

Also see our article about contamination of sunscreens.