Friday, 8 February 2019

Is there a link between alcohol and skin cancer?

The winter holidays are almost universally experienced as a time of joy, and of familial togetherness. For many they are the highlight of the year, a time of relaxation, gift-giving, spiritual renewal, and reflection on a year of skirmishes fought on behalf of one’s family.

But for people in recovery from substance use disorders, such as from opiates or alcohol, the holidays can be a time of unique and profound stress. Part of this stress is related to the freely flowing alcohol that can be found at many holiday events, and another aspect is often related to complex interactions with family members who can be “triggers” for dark and uncomfortable feelings that can even threaten one’s hard-won sobriety.

If you are in recovery from a substance use disorder, be it drugs or alcohol, and the holidays do cause you emotional distress, it is critical to have plans and strategies in place for dealing with the realities of the holiday season, to minimize any risks to your sobriety. As it is commonly said in recovery parlance, “The first thing you put ahead of your sobriety will be the second thing you lose.” Even if you have to be, for lack of a better word, ruthless, and step on a few toes, it is essential that you guard your recovery as the most precious gift you have, because it is.

It is critical to have a plan in place, in advance of the holidays, to minimize stress and dangerous exposures. While one certainly can’t foresee or predict all contingencies, many can be anticipated and planned for. What are your triggers and flash points? What are the scenarios that have proven dangerous in the past? What kinds of interactions knock you off center? Who can you call if/when you start feeling like you are losing your grip? How are you planning to re-center yourself? Can you envision yourself just walking away from stressful situations?

The first obstacle that often comes up is the holiday office party. I’ve worked with many people in recovery who tell me that coworkers can look at them as if they have a third eye, or as if they have just sprouted wings, if they decline an alcoholic beverage. Many have trouble just being around alcohol, not to mention the unchecked inebriation that can occur at these parties. Some skip these events altogether, if the office politics allow this; others show up briefly, and those who are more comfortable with their sobriety simply say, “I don’t drink.” That usually ends the conversation, unless the person they are conversing with is clueless enough to ask why.

An even more complex scenario can be a holiday family gathering. In addition to the issue of freely available alcohol, many find resentments, conflicts, hostility, guilt, and triggers lurking just below the superficial holiday cheer. I’ve heard it said that your family can push your buttons better than anyone else because they are the ones that put them there.

Some families are considerate enough to hide the alcohol or, better, to go alcohol-free, but often, sadly, there are many people who just can’t enjoy themselves without some type of intoxicant. As addictions can run in families, many in recovery complain about their addicted or alcoholic family members who refuse to get diagnosed or admit their problems, but who drink like fish at all family gatherings.

To deal with stress, some try to limit time at family events. Some bring sober friends. Some skip them altogether. Some plan extra therapy sessions before the holidays to try to smooth things over in advance. Others spend time with their “recovery families” instead, and go to sober events. For example, most cities have holiday recovery-a-thons (24-hour recovery meeting events) for the exact reason that this is such a difficult time for people in recovery. I’ve heard that they can be really fun.

Recovery, if about anything, is about connecting with other people. It is about far more than just the absence of drugs or alcohol. Addiction slowly robs you of your relationships, as you become emotionally obsessed with your drug of choice. With recovery comes a blossoming of human connection, interaction, meaning, and hope. In order to recover, we learn tools to keep ourselves centered, such as humility, compassion, listening skills, and mindfulness. We learn to ask for help, and not try to internalize and fix all of our problems on our own. The holidays present a perfect opportunity to reach into your recovery toolbox and use any and all of these tools. In line with this, don’t forget to check in on your brothers and sisters in recovery during the holiday season. It’s easy enough to pick up the phone, and you will find yourself feeling better as well.

And if you are not in recovery, but you are at an office party and someone declines an offer of an alcoholic beverage, please accept that as the most reasonable choice in the world and move on. If it makes you uncomfortable that they aren’t drinking, you may wish to reflect upon your own relationship to alcohol. Picking a health insurance plan can be maddeningly complicated. It may seem that no matter what you do, you’re picking the wrong plan. Should you go with the one with high monthly premiums that covers just about everything and even pays for medications? Or maybe it’d be best to go with one with lower premiums but that covers fewer expenses. Picking the one that’s best depends on your medical conditions, the medications you take, and, to some degree, your ability to predict future medical expenses. And it only gets more difficult as costs rise and medical care gets more complex.

Enter the “high deductible health plan” (HDHP). While these health insurance plans have relatively low monthly premiums and cover catastrophic illness, they have high deductibles — the out-of-pocket payments charged before the insurance plan kicks in. For example, a typical HDHP might require you to pay out of pocket for health care expenses up to $1,300/year (or $2,600/year for families), in addition to your monthly premiums, before insurance covers most medical expenses.

HDHPs are often chosen by young, healthy people who don’t anticipate the need for a lot of healthcare or medications. Of course, anyone’s healthcare needs can change; a new illness or injury can make what seemed like a good choice at the time even more expensive than traditional healthcare insurance.
Do high deductible health plans lead to more cost-conscious use of healthcare?

It’s long been assumed that having to shoulder more of the financial burden for doctors’ visits or treatments would encourage people with HDHPs to become more cost-conscious and careful about their use of healthcare services. Not so, according to a new study.

Researchers surveyed more than 1,600 people enrolled in an HDHP about their use of healthcare services (such as seeing doctors or filling prescriptions) over the prior year, including efforts to plan ahead and limit their own out-of-pocket expenses.

Here’s what they found:

    Only 40% saved in advance for healthcare expenses.
    Just 25% talked to a healthcare provider about the cost of services.
    Only 14% compared prices of healthcare providers or services in advance of receiving care; a similar proportion compared quality.
    Only 6% tried to negotiate the price of healthcare services with the provider.
    While a minority of people took these measures to lower their healthcare costs, those who did were often successful — about half of the time, they were able to get help receiving a needed service, or paid less for it.

These results suggest that people with HDHPs are not doing all they can to lower their own healthcare expenses.
Not the last word

The results of this study may not apply to everyone. The researchers “over-sampled” people with chronic conditions who have the most to gain by trying to lower their healthcare expenses; about half of the study sample had at least one chronic condition. In addition, more than 80% of the study sample was employed and had an employer-sponsored healthcare plan. Finally, this study relied on self-reported information from an internet-based survey. For people who are healthier, don’t have healthcare benefits at work, or do not have access to the internet, results could have been different.
So what?

If you have an HDHP, you may be able to cut the costs of your healthcare by taking the results of this study to heart. Not so long ago, many considered talking about the cost of healthcare with their healthcare provider taboo. Those days are long gone. And saving in advance only makes sense, since unforeseen healthcare expenses can be hefty.

While the landscape of American healthcare and payment programs continues to evolve, as long as healthcare costs are high and rising, HDHPs are likely to be a common option. And that means more financial risk than with traditional plans. So it’s important to speak up, ask questions, and recognize that when it comes to healthcare, it’s often possible to save money without sacrificing quality. You know the saying “Don’t go to the grocery store hungry”? The reason is pretty obvious. If you’re famished, you may not make the best food choices. Well, the same applies to holiday parties. If you are truly hungry, have something healthy and filling beforehand, like a beautiful salad. Pressed for time? Eat an apple.

Already there? Look at the appetizers. Is there anything reasonably healthy? Pick up a small plate and choose from the healthier options, like crudités (vegetable slices), shrimp cocktail, even fruit and cheese (no crackers). Avoid fried snacks and processed carbohydrates. Enjoy! Take the edge off your hunger, then walk away from the table.

Are you the host? Serve delicious hors d’oeuvres that also happen to be healthy. Some ideas: make or purchase fresh guacamole, sprinkle with red pepper flakes, and serve as a dip with crisp sweet red pepper slices. Or try red pepper hummus sprinkled with crushed toasted pistachios, served with bright green cucumber rounds. Easy, and easy on the eyes as well!
Stay hydrated

Drink water, and a lot of it, to feel full as well as minimize alcohol intake and its effects. Are you the host? Serve a fancy festive mocktail: sparkling water with cranberries, orange slices, and a sprig of rosemary. Another idea: try lime-infused seltzer with mint (basically a virgin, sugar-free mojito). At a party with an open bar? Ask for a seltzer with a twist of lemon. Feeling bold? Ask for it in a martini glass with extra olives, drink with flourish, and be the envy of everyone, as you stay blissfully (and soberly) hydrated.
Prepare yourself, pace yourself

Know you’ve got a big function coming up? Live the days leading up to it as healthfully as possible. Get your steps in, work out, eat your veggies, shun the fried foods and carbs, and sleep like a baby. The event may be a late night laden with junk food and drinks, but if you walk in feeling fit and proud, you will be less likely to lose control. If you’re feeling good about yourself, you’re more likely to keep to your limits.

Is Aunt Ida bringing her world-famous pecan pie that’s only served once a year and you’re dying for a slice? Then have a slice! If you allow yourself a special indulgence, you’ll be less likely to waste your time (and calorie allotment) on cheap, mass-produced boxed baked goods.
Did you overdo it anyway?

Did you already pig out on pigs in a blanket? Feeling sick on chips and dip? Too many champagne toasts? All is not lost. Take a step back, get a glass of cold water, and go for a walk. Sometimes just removing yourself from the temptation is enough. Never underestimate the power of water. And fresh air is remarkably, well, refreshing.

Is it the next day? Feeling the aftereffects of too much rich food or alcohol, such as headache and nausea? Again, hydrate, hydrate, hydrate. Try to get up and out for a walk, or even a jog. Fresh air and increased blood flow brings oxygen to all the angry cells, and helps flush toxins out.

Stick to very light foods, like fresh fruit slices and yogurt. Try to avoid over-the-counter pain relievers such as acetaminophen and ibuprofen. These medications when combined with alcohol can cause irritation of the lining of the stomach, as well as liver or kidney damage. The real problem underlying your headache is dehydration, so focus on no-sugar-added beverages like water, coffee, or tea. Ginger tea especially works wonders. Use store-bought ginger tea bags, or make your own from slices of fresh ginger steeped in boiling water. Other soothing (and safe) herb teas include chamomile and mint. Need to be fully functional right away? If you absolutely have to, NSAIDs like ibuprofen will be more effective than acetaminophen. Just use with caution, and make sure you’ve had plenty of nonalcoholic beverages to drink as well as something to eat.
When to seek help

Severe stomach pain or persistent nausea and vomiting after too much alcohol can signal a medical emergency, such as a stomach ulcer or inflammation of the pancreas. If you’re worried, call your doctor.

Are you regularly overeating or drinking too much alcohol? If you have trouble staying in control, and especially if the overindulgence is having a negative impact on your relationships, work, finances, or health, then please talk to a doctor. These can be signs of a possible substance use disorder or eating disorder, which are medical problems that need to be specifically addressed.
And remember

No healthy diet and lifestyle plan is ever “ruined.” You can never overdo it enough to justify giving up on your body. It’s always a good time to start over. You do not need to wait for January first. You’ve only got one body, one life, and you always come first. Take care of yourself this holiday season. Patients are always elated when you can recommend an enjoyable, health-improving, recreational activity. As a runner, my favorite “prescription” while pregnant was exercise! However, more often than not, pleasurable activities are not what’s best for one’s health. But as a dermatologist who specializes in skin cancer, I am generally the bearer of bad news when I tell patients to never get another tan.

This November, alcohol came into the spotlight. The Cancer Prevention Committee of the American Society of Clinical Oncology recommended minimizing drinking alcohol, as it is thought to be a “modifiable risk factor for cancer.” Alcohol is estimated to be responsible for 3.5% of all cancer deaths in the United States.
Does alcohol influence skin cancer risk?

The short answer is that alcohol may be associated with skin cancer.

Several studies have tried to answer this very question with varying results. However, two meta-analyses, which combine results from a number of other studies, found that alcohol intake was associated with the development of basal cell carcinoma and squamous cell carcinoma (the two most common types of skin cancer) and melanoma. One of the studies found that the risk of basal cell carcinoma increased by 7% and squamous cell carcinoma increased by 11% for every 10-gram increase in intake of alcohol in distilled spirit form (or one standard beer or small glass of wine) each day. Another study found a 20% increase in melanoma in drinkers (compared to those who don’t drink alcohol or only drink occasionally) and an increased risk based the amount of alcohol intake, with a 55% increase in risk for those who drink 50-grams of alcohol (or five beers!) per day.
How could alcohol cause skin cancer?

Ultraviolet light causes mutations in DNA and typically our body repairs these alterations. However, one of the byproducts produced when the body metabolizes alcohol can interfere with DNA repair, which can eventually lead to cancer. Alcohol also causes formation of something called reactive oxygen species, which also has the ability to damage DNA. There are other proposed mechanisms, including increasing one’s susceptibility to damage from ultraviolet light and suppressing one’s immune system. Some studies have shown that white wine consumption had a stronger association with skin cancer formation, which may be due to lower levels of antioxidants in white wine.

But before you completely alter your social practices, it is important to recognize a few limitations to these studies. The first is that ultraviolet light is the main factor that increases basal cell carcinoma and squamous cell carcinoma, and alcohol consumption has been associated with behaviors that increase one’s risk of getting a sunburn. So, it is not clear whether alcohol is the cause of the skin cancer or a bystander. In addition, there are other unmeasurable factors that were not accounted for in these studies.
What should you do?

The American Cancer Society recommends limiting alcohol consumption to one drink per day for women and two drinks per day for men. But it is important to consider your underlying risk for developing skin cancer, and to understand how your lifestyle modifications are impacting your health through factors such as sun exposure habits and even ethnicity (a Caucasian’s lifetime risk for melanoma is 1 in 44, whereas an African American’s lifetime risk is only 1 in 1,100).

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