May 25, 2016

Harness the Power of the Sun for Health

Sunshine is good for you!
It is important to manage your sun exposure with an understanding of
Sunshine is important for your health, but before you get sun rays you need to assess your current situation. We want to get sunshine and all its beneficial aspects, but we don't want to burn. Serious sun burns, particularly before the age of 20, increase the risk of all types of skin cancer.
What's the Proper Time to be in the Sun?


What is a minimum erythema dose?
An "erythema dose" is used by doctors to define the amount of ultraviolet radiation, from the sun or ultraviolet lamp, which results in a reddening of the skin. A minimal erythema dose is defined by a pinkness of the skin about 1-6 hours after sun exposure, going away within 24 hours. Sunny Hippocrates, our cartoon mascot this month, has been telling you to get a *smidge* pink. There is no single number, due in part to differences in skin type and other individual differences in vitamin D production, but one minimal erythema dose is equivalent to roughly 10,000 - 25,000 IU of supplemental vitamin D. 
How long does that take? 
The time to reach a minimal erythema dose depends on  
1) Skin type 
2) UV strength 
It could be as short as 5 minutes (very fair skin with high UV strength) and as long as hours/never (very dark skin with very low UV strength).  
What are the risks of skin cancer? 
The American Cancer Society (ACS) has very good information on skin cancers and melanoma. ACS reports about 3.3 million Americans are diagnosed with basal or squamous cell skin cancer each year, with approximately 80% of diagnoses being for basal cell cancer. Only about 1% of all skin cancers are melanoma.  
"Basal cell and squamous cell skin cancer: These cancers are most often found in areas exposed to the sun, such as the head, neck, and arms, but they also can occur elsewhere. They are very common but are also usually very treatable." - ACS web site  
Basal and squamous cell skin cancers are not usually deadly, whereas over 10,000 Americans are expected to die of melanoma in 2016 (ACS).  
"Death from these [basal and squamous cell] cancers is uncommon. It's thought that about 2,000 people in the US die each year from these cancers, and that this rate has been dropping in recent years. Most people who die from these cancers are elderly and may not have seen a doctor until the cancer had already grown quite large. Other people more likely to die of these cancers are those whose immune system is suppressed, such as those who have had organ transplants." - ACS web site 
No cancer! 
We do not advocate sun exposure that leads to burning and increased risk of skin cancer. What we do want is to help you understand the causes and risk factors for skin cancers, the different types of skin cancers, and their associated treatments and seriousness. We encourage you to consider the benefits of sun exposure and weigh that against the risks to help you make your decision about how to use the sun - what makes sense for you. Should you go out and get a minimal erythema dose daily in order to raise your natural vitamin D level, produce nitric oxide and prevent disease? Is a suberythemal dose (no reddening of the skin), combined with some supplements more comfortable for you? Or would you rather avoid the sun and get all of your vitamin D through supplementation?  
How long? 
Back to the question of how long.... We recommend you download the app dminder - on your phone. Study and input your Fitzpatrick skin type, and use it to gauge your minimal erythema dose. dminder is very conservative because it uses estimates from the environmental protection agency (EPA). So, if after a week of using dminder you notice you have never gotten pink then increase the time little by little.  
The lighter your skin and the more you have stayed indoors- the more important it is to be cautious and slow, allowing your skin to adjust to sun exposure gradually.  


If you are a D*action participant, we invite you to download dminder, a free iPhone or Android app. Go to the App Store, search for 'dminder' and download today.

Connected to D*action?

Sun4Health*action is a new feature that integrates dminder with D*action. Here are some of the benefits of Sun4Health*action:

Daily vitamin D tracking - Use dminder on your smart phone to help determine when to get sun, to approximate your vitamin D production, estimate your current vitamin D level and to record this data. With dminder you can set reminders for solar noon, when to get out of the sun, other solar events, and when to take your supplements.

Help Prevent burning - Enter your personal data (age, weight, skin type, location, initial vitamin D level) and dminder will approximate how much time you can stay in the sun before burning. An alarm will sound when you have reached your goal of D for the day, or when you might start burning. Serious sun burns, particularly before the age of 20, increase the risk of all types of skin cancer. 

Accurate data reporting - By using your smart phone daily to record your sun exposure and supplement intake, GrassrootsHealth will have the most accurate account of your vitamin D intake. In turn, this allows GrassrootsHealth to link daily vitamin D inputs with serum levels and be better able to investigate vitamin D production at a population level.

Largest international cohort of vitamin D aware individuals with data on sun exposure - The GrassrootsHealth cohort of over 10,000 participants is continually growing. With data on daily sun exposure and/or approved sun lamps, we can research and report on the health benefits of sun, the safety of sun, and how much sun is necessary for optimal health.

Test now - sale on D*action participation

For those of you who are ready for a new vitamin D test, or your first one - we are offering a special of $50 for the at-home test. This will make sure you have up to date information as you start the summer and regular tracking of your sun exposure.


Video of the Week

Edward Gorham, MPH, PhD
UCSD School of Medicine
February 2009

Edward Gorham, PhD, takes the dermatologists head on - should we get sun or stay out of the sun? The dermatologists tell us to stay out, but several researchers have explained the benefit of sunshine and vitamin D. This presentation talks in depth about the difference between UVA and UVB exposure, the body's physiological response to each type of irradiance, and how sun exposure and sunscreens affect the risk of melanoma and vitamin D production.

What about Melanoma?

Gorham presents data on the rising rates of melanoma and explains how to screen for it. He states that the best secondary screening is a scanning/analysis of the skin - looking for moles and skin lesions - a screening method that is neither costly nor painful. Primary prevention for melanoma includes vitamin D and careful sun exposure.

Can vitamin D help melanoma?

Gorham highlights studies which show that vitamin D inhibits melanoma's growth and keeps melanoma cells in a more stable state. Studies show a dose-response relationship of higher vitamin D levels and increased survival.

What about sunscreen?

Gorham presents 16 studies on sunscreen and melanoma risk - four studies found protective value to sunscreen; five studies had no conclusion; and seven studies showed increased risk with use of sunscreen. But organized by latitude, these same studies show increased risk of melanoma with sunscreen use for people with lighter pigmentation (northern latitudes); and no relationship with people of darker pigmentation (lower latitudes).

"The people who are using sunscreen are precisely the people who shouldn't." - Edward Gorham

How do sunscreens louse up the photo protection qualities of our skin?

Gorham explains the layers of the skin, what changes happen to the skin upon sun exposure - the natural photo protective response to sunshine. 

Gorham also shows the incidence of melanoma over time, and also plots usage and sales of chemical sunscreens. This graph rises so rapidly with the introduction of sunscreen that Gorham did not even need to make a statement about correlation.

Gorham explains that UVA is the culprit for skin damage, which the popular chemical sunscreens don't always repel - meaning they do not protect against UVA damage, and thus melanoma. [Note: "broad spectrum" sunscreens that protect against both UVA and UVB have become popular since this presentation was recorded.]
Summary of recommendations for primary prevention of melanoma
  • Minimize UVA exposure and maximize UVB exposure
  • Depending on your skin type - get some sun (without sunscreen) between 10am - 2pm
  • Supplementation in Australia, NZ because of the ozone layer blocking UVB
  • Use sunscreens that attenuate the entire UVA spectrum - recommend using titanium dioxide or zinc oxide (opaque compounds)
  • Don't rely on clear chemical sunscreens to reduce the risk of melanoma - instead cover up with hats or clothes after your erythemal dose
Editor's Letter
Susan Siljander
Marketing Director, GrassrootsHealth

Enjoy and share this week's Sunny Hippocrates cartoon! Download and share them all.

Susan Siljander
Marketing Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research Into Practice NOW!
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Your participation in this project provides information for your answers to D questions and helps fund the GrassrootsHealth projects.

Skin Cancer / Sunscreen - The Dilemma
Edward Gorham, MPH, PhD

UCSD School of Medicine
February 2009

May is...
National Sunshine Month
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Warning Signs of Melanoma
Skin Cancer Foundation
Article - Do you Know your ABCDEs?

Development and validation of a melanoma risk score based on pooled data from 16 case-control studies
John R. Davies, et al.
May 2015

Harvard School of Public Health Quiz
(based on above paper)

Cutaneous Vitamin D Synthesis versus skin cancer development   
J�rg Reichrath and Bernd N�rnberg
Sept 2009

Sunlight and Vitamin D Both Good for Cardiovascular Health
Michael F Holick
Sept 2002 


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