Dear Dr. Eva,

My objection to the keto diets my friends describes is that they are very meat-heavy. I’m a quasi-vegetarian, which means I try to eat as little animal protein as possible. So, no keto for me!


Dear Quasi-V,

You are right. I can’t think of any way to put together a vegetarian ketogenic diet, since most vegetable proteins like nuts and beans include carbohydrates (starch). There also are important health, economic, and environmental reasons to decrease meat intake.

Dr. Eva

Dear Dr. Eva,

When I tried a Keto diet, I got the worst heartburn I’ve ever had. Was that just me, or is this common? What can I do to prevent that?

Sour Stomach

Dear Sour,

It’s not just you. High-fat meals, which would include most meals on a keto diet, can cause or worsen gastroesophageal reflux (also called heartburn or GERD.) Other aggravating foods/drinks include citrus, especially citrus juices, caffeine including coffee, colas, and chocolate, fried/greasy foods, and carbonated drinks. This is specific to each person – for example, a particular person with reflux might be bothered by fried foods but not by carbonated drinks.

The single most effective thing you can do to control reflux symptoms is to avoid lying down for four hours after eating: that is, do not lie down after a meal and don’t eat or drink for four hours before bedtime.  In addition to greatly reducing nighttime GERD symptoms,  if you consume a lot of calories in after dinner snacks, this will also promote weight loss if needed.

Dr. Eva

Dear Dr. Eva,

What about tanning beds? I thought these were safer because they only give you a controlled amount of UV light, the minimum necessary to get a good tan.


Dear Good Tan,

I’m sorry to tell you that, from a medical point of you, there is no such thing as a good tan. There is also no good tanning bed: the amount of UV light it takes to tan in any tanning bed is the same amount of UV light it takes to get the same tan from the sun. Tanning beds cause skin cancer in the same way sun exposure on the beach (with or without an aluminum foil reflector) does. To reduce your risk of skin cancer, you will need to adjust your ideas about what’s attractive. A tan is not a healthy look.

Dr. Eva

Dear Dr. Eva,

I heard that sunblocks are just as carcinogenic as tanning. Is that true? Are some sunblocks safer than others? Also, aren’t sunblocks dangerous for the environment?

Burns Easy

Dear Burns,

Sunscreens are classified as either chemical or physical. Physical sunscreens, which include zinc or titanium, block the sun’s rays, while chemical sunscreens chemically change the energy from ultraviolet light to prevent sun damage. Some ingredients in chemical sunscreens can be absorbed in small amounts through the skin. However, there is no evidence that these trace amounts of sunblock chemicals can cause cancer or any other illness in humans or animals.

As far as environmental effects, it’s more complicated. Some chemical sunscreens may contribute to coral bleaching. While there are differences among chemical sunscreens and some are much more damaging than others, the simplest approach if you are concerned about environmental damage is to stick with titanium or zinc-based sunscreens. A list of  environmentally safe sunscreens is online at the Best Reef Safe Sunscreen List [ Ocean & Eco Friendly] 2020.

Dr. Eva

Dear Dr. Eva,

I’m not sure I agree with you about tans. My father’s parents were farmers and their skin was many times darker than their children’s because of their long years in the sun. Neither one ever had skin cancer.

Could this be genetically determined? Or could it be that steady sun exposure and staying tan all the time is safer then sudden bursts of intense tanning?


Dear Scientist,

Your grandparents were lucky. Perhaps they did have lower risk of skin cancer due to genetic differences.  Some people do, but unfortunately we don’t have any way of knowing which people have that good luck. It’s important to remember, though, that back when your grandparents were farming, the ozone layer that protects us all from ultraviolet sun rays was twice as thick as it is today. This means that people today have much less natural atmospheric protection from skin cancer. Although even one second-degree sunburn (second degree means a burn with blistering) increases the risk of skin cancer, there is no reason to believe that prolonged ongoing sun exposure is any safer. Many farmers and other long-term outdoor workers develop skin cancers including the most deadly, melanoma. Thanks for your thoughts.

Dr. Eva

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Dr. Eva Hersh, MD
Dr. Eva Hersh, MD
Eva Hersh is a family physician. Send your comments and questions to her by email at

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