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Greetings!
With summer just beginning, I want to share some of my research on Vitamin D and sunscreen. Vitamin D has been getting a lot of media lately, most of which is superficial and often contradictory. I hope to clarify the situation and equip you with the knowledge you need to best weigh the risks and benefits of sun exposure, sunscreen use, and Vitamin D supplementation. |
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The Duality of UV Light | |
Skin Cancer Vs. Vitamin D Deficiency
 There are two types of UV light that penetrate our atmosphere: UVA and UVB rays. UVA rays penetrate deep into the skin and increase the risk of melanoma, which is by far the most serious form of skin cancer. Melanoma is responsible for 75% of the deaths caused by skin cancer. UVB rays have two important effects in the skin: they cause Vitamin D production, and, in excess, they cause sunburn. Cumulative UVB exposure is correlated with an increased risk of the largely-treatable basal and squamous cell carcinomas. Skin cancer kills 12,000 Americans every year. I know that sounds scary, and that number has been used to produce the sunphobia endemic these days, but at this moment, there are 311,636,011 Americans. Some quick math reveals that skin cancer only kills one out of every 26,000 Americans per year. So even if we accept that UV light exposure causes skin cancer, we must weigh the risks of the UV light with its beneficial ability to produce Vitamin D. There has been an explosion in Vitamin D research within the past decade as the profound effects of Vitamin D deficiency have been unmasked and the massive scope of the deficiency has been discovered. Unfortunately, much of this research is still only known within scientific circles. New research and new ideas spread far more slowly than they should. |
| Vitamin D: Way More Important Than Most Are Aware | | Stop Thinking In Terms of Rickets
It is now known that Vitamin D does so much more than promote healthy bones by increasing calcium absorption. Many, many studies have found Vitamin D deficiency to be associated with an increased risk of most types of cancer, heart disease, diabetes, autoimmune diseases, depression, and more. Interestingly, most tissues in the body have a Vitamin D receptor. Not only is there data linking Vitamin D deficiency to these diseases, but there is emerging data showing a benefit to Vitamin D supplementation to treat and prevent these conditions.
Finland, which receives only 2 hours of sunlight in the winter, has the highest rates of Type 1 diabetes in the world. Finland now recommends their infants supplement with 2000 IU of Vitamin D per day, and a large birth-cohort study there found that infants who received the recommended 2000 IU had a 78% lower risk of developing Type 1 diabetes. A large meta-analysis (a study that pools together data from other studies) found that Vitamin D supplementation with 300-2000 IU per day reduced overall mortality a statistically-significant 7% in adults. Many studies done here in the U.S. by the National Institute of Health have used subtherapeutic doses of 400 IU which have then unsurprisingly found little benefit to Vitamin D supplementation seeing as how 400 IU is inadequate even for a baby. If even that small a dose of Vitamin D can decrease overall mortality 7%, why isn't there a public health campaign recommending supplemention with 2000 IU of oral Vitamin D per day in an oil-based gelcap? (Note: Vitamin D is a fat-soluble vitamin so it is best absorbed when in oil; don't waste your money on dry tablets of Vitamin D).
Given that research by Dr. Michael Holick, the discoverer of the active form of Vitamin D in the body, known as 25-hydroxy Vitamin D, has shown that 20 minutes of sun exposure in a bathing suit on Cape Cod in July produces between 10,000 and 20,000 IU of Vitamin D in caucasian skin, and studies have found absolutely no harm from supplementation with doses up to 10,000 IU per day in healthy men, it starts to become clear that not only are concerns about Vitamin D toxicity nonsensical, but that concerns about skin cancer have brewed a systemic myopia. Avoiding UV light may decrease your risk of skin cancer, but it also may increase your risk of death by causing profound Vitamin D deficiency. |
| Does Sunscreen Even Work? |  Despite an exhaustive review of the existing literature, I can find absolutely no solid data to even show that sunscreen reduces the risk of skin cancer, and there is certainly no data to support that sunscreen use offers an overall health benefit. And it's not just me, the Food and Drug Administration (FDA) reported in 2007, "FDA is not aware of data demonstrating that sunscreen use alone helps prevent skin cancer." In fact, epidemiologic data suggests that skin cancer rates have increased along with increasing sunscreen use.
Why is there a disconnect between the reality that sunscreen has proven ineffective at preventing skin cancer and the seemingly commonsensical notion that blocking UV rays from reaching the skin should offer a protective effect? Well, for starters, sunscreen is completely unregulated. There are no standards and no regulatory agency to ensure that sunscreen does what it advertises. The FDA set out to establish safety standards for sunscreen in 1978 and only this month did they finally announce safety standards to be implemented by next summer. Secondly, the Sun Proof Factor (SPF) on sunscreen refers to its ability to block UVB rays, not UVA. So, despite the unsubstantiated claims on its label, many chemical sunscreens block UVB, which prevents sunburn, but they don't do a good job blocking UVA. As a result, people stay out in the sun longer, believing they are protected from the sun since their skin isn't burning, and that whole time their DNA is being battered by UVA light. Additionally, most people only use 1/4 the recommended amount of sunscreen, making the SPF on the bottle completely inaccurate. |
| Finding the Right Balance | |
After applying very advanced science and hundreds of hours of research towards Vitamin D, sun exposure, and sunscreen, the best advice I can give is simple: Most people should try to get a little bit of sun (about 20 minutes or so) on a large surface area of skin every day, get out of the sun before they start to burn or turn red, know their 25-hydroxy Vitamin D level, and use a quality sunscreen when out in the sun for an extended period of time. The best sunscreens use Zinc Oxide, which effectively prevents both UVA and UVB from reaching your skin. As far as I'm concerned, all the other sunscreens presently available are junk.
As for how to interpret 25-hydroxy Vitamin D levels, my read of the data is that levels of at least 32 ng/ml are needed just to maintain strong bones, and levels higher than that are likely needed for optimal health. Based on the data presently available to me, I believe it is best to aim for a 25-hydroxy Vitamin D right around 50 ng/ml. Most everyone in America today requires oral supplementation with Vitamin D to achieve optimal levels because we simply get so much less sun exposure than nature expected.
There really is no one ideal dose of Vitamin D to take per day; the ideal dose is simply the one that raises your blood level into the ideal range, which I can only crudely categorize as somewhere between 40 and 65 ng/ml at this time. I recognize that is a wide range, but I left it that way to reflect the uncertainty of the boundary between optimal and sufficient. Most Americans are so deficient that there isn't yet good data to highlight the border between good and great. There is still debate over the border between being obviously sick from Vitamin D's absence and having just enough to keep you from being obviously sick. It is reassuring that significant data has shown that oral Vitamin D supplementation with up to 5,000 IU of Vitamin D doesn't push 25-hydroxy Vitamin D levels higher than 60 ng/ml, which is nearing the upper limit of a physiologically attainable dose still sometimes seen in lifeguards. It is possible that there are benefits to running even higher than that, but I've yet to see any solid data to justify recommending a level greater than 65 ng/ml at this time.
I believe the data is convincing enough to support that most adults would benefit from taking 2000 IU of Vitamin D3 (cholecaliferol) per day until such a time as their 25-hydroxy Vitamin D can level can be obtained and that data can then be used to adjust the dose as needed. Vitamin D metabolism varies widely amongst individuals, which is reflective of the complexity and diversity of the many roles Vitamin D plays in the body. Even the conservative Institute of Medicine has set the Tolerable Upper Intake Level, which is the level they believe has been proven safe, at 4000 IU per day for everyone age 9 and over. For a moment, let us think about the crudity of a value, like the Tolerable Upper Intake Level, that seems so solid, and yet it is one number meant to apply to everyone in the United States age 9 or older with no regards to season, diet, sun exposure, skin color, or weight. Imprecise, oversimplified numbers like that often do far more harm than good.
To learn more about the best sunscreens, check out the link to the Environmental Working Group's 2011 Sunscreen report. For more information on Vitamin D, visit the Vitamin D Council's website which has lots of useful information. And most importantly, have fun this summer, get some sun (not too much), know your 25-hydroxy Vitamin D, and tell everyone you know all about Vitamin D and how you read this awesome article written by this great guy who taught you CPR . . .
Best Wishes,
Dan
Daniel A. Clinton, RN, BSN
CPR and First Aid Instructor & Professional Nursing Tutor
www.clintoncpr.com
www.awesomenursingtutor.com
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| About The Author | |
Dan Clinton is a Registered Nurse, CPR and First Aid Instructor, Professional Anatomy, Physiology, Nursing, and NCLEX-RN tutor, Researcher, Writer, Entrepreneur, and overall swell guy. Dan channels his passion for helping others through his businesses, striving to fulfill the American dream of succeeding through hard work, persistence, and ingenuity. As a CPR and First Aid Instructor, he offers comprehensive and cutting-edge American Heart Association CPR and First Aid instruction throughout Massachusetts and the New England area. As a professional tutor, Dan holistically aids his clients reach (and often exceed) their goals, and he has quickly developed a reputation as one of Boston's premier tutors for the nursing board exam (the NCLEX-RN).
Dan lives in Waltham, Massachusetts, works way too hard, and hopes to soon finish his first book which will show how to fix the fractured American healthcare system and teach its readers everything they need to know to dramatically improve their health. |
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