Note: Vitamin D by itself is a fraction of the nutritional equation. Top of your list should be magnesium and Vitamin K2 along with Vitamin D—a synergistic trio. And you CANNOT get enough magnesium and Vitamin K2 via diet unless your diet is highly unusual. Don’t forget other nutrients, minimal sugar and low carbohydrates, and of course, Vitamin C.
Every dermatologist so far has told me that my skin is in excellent condition for my age. In spite of a great deal of sun exposure, much of it at very high altitude (8000 feet to 14000+ feet). I have never had any skin cancer even though I have quite a few moles starting at young age. My natural skin color is quite light, tanning to a pleasing brown with sun exposure.
How many people are BEING KILLED because of BAD MEDICAL ADVICE regarding sunlight?
Many more details below, but here are key take-aways:
“Vitamin D supplements are not an effective substitute for adequate sun exposure”...
The only identified risk associated with the amount of non-burning sun exposure needed to achieve serum 25(OH)D levels of 30 ng/mL is some possible increased risk of nonmelanoma skin cancer.
... risks of inadequate non-burning sun exposure include increased risks of all-cause mortality, colorectal cancer, breast cancer, non-Hodgkins lymphoma, prostate cancer, pancreatic cancer, hypertension, cardiovascular disease, metabolic syndrome, type 2 diabetes, obesity, Alzheimer disease, multiple sclerosis, type 1 diabetes, rheumatoid arthritis, psoriasis, non-alcoholic fatty liver disease, statin intolerance, macular degeneration and myopia.
— NIH “The risks and benefits of sun exposure 2016”.
As a youth, I loved to fish and be outdoors. I was burned and tanned very satisfactorily as a youth, including blistering on my face at age 16 after skiing in March. In summer, I had a very dark tanned back and bleached blonde hair—dang it feels good to be in the sun as a kid! That kind of excessive sun exposure is surely Not Good—no argument.
....Being a past scientist, having done research in Molecular and Cellular Biology at UC Davis and Los Alamos National Lab, and being a trained hazard and risk analysis professional at LANL, and trained in contamination control and response to bio- and rad-attacks.... [WIND:see comment in yesterday’s blog post].
I also think the Vitamin D slant has merit and think that the folks at Oak Ridge National Lab have come up with an interesting bradykinin hypothesis. That said, I think you state the Vitamin D case and getting 20 minutes of sun in the middle of the day a bit strongly.
I agree that we need Vitamin D and that some people are deficient. I agree that sunscreen has the potential to be shown to be harmful in the long run. But I don’t agree with having to get out in the mid day sun to get your Vitamin D.
[WIND: my full advice incorporates geography and much more, and Miami is not San Fran, see below]
About 2.5 months ago, during the peak of COVID in Miami, I had the pleasure of going to the Miami Cancer Center for melanoma surgery on my arm plus a one node lymph node extraction. I was lucky and they got it in time and it had not yet spread (but it was way too damned close.) Anyway, I looked up an article on Yale Medicine and I’m thinking we can get enough vitamin D in the morning sun, even in shade and minimize risk to skin cancer and avoid sunscreen. It’s a win win.
WIND: I am so glad that Donna got her skin cancer caught in time. May we all be so fortunate! But my family has seen a curious absence of skin cancer, in spite of being very outdoorsy—I’d bet on a strong genetic component, and perhaps nutrition too. But Miami is not Wisconsin or Northern California and the sun intensity varies a lot over the year in northern areas.
My sun-exposure advice
My sun-exposure advice is much more nuanced than “20 minutes of sun in the middle of the day” — it involves skin color, geographic location, time of year, time of day and avoiding any reddening of the skin. It might mean 3 hours a day in winter (very hard to find the time), or 10 minutes at high altitude in July.
I do *not* advocate excessive sun exposure, only moderate regular mild sun exposure, e.g. for a Caucasian male like me in my mid-50's: 15 minutes daily (roughly 10 to 2 PM) in the summer, and up to an hour in our weak winter sun, at my latitude. Reduce the figures for more intense sun (time of year, geography) and increase the time for dark skin substantially. And use the less exposed areas for shorter duration while avoiding sun on high-exposure area. In other words, sun your belly and sunscreen your face!
So let’s get to a quality paper which actually does risk assessment across fields. Emphasis added in places.
Public health authorities in the United States are recommending that men, women and children reduce their exposure to sunlight, based on concerns that this exposure will promote skin cancer. On the other hand, data show that increasing numbers of Americans suffer from vitamin D deficiencies and serious health problems caused by insufficient sun exposure.
The body of science concerning the benefits of moderate sun exposure is growing rapidly, and is causing a different perception of sun/UV as it relates to human health. Melanoma and its relationship to sun exposure and sunburn is not adequately addressed in most of the scientific literature. Reports of favorable health outcomes related to adequate serum 25(OH)D concentration or vitamin D supplementation have been inappropriately merged, so that benefits of sun exposure other than production of vitamin D are not adequately described.
This review of recent studies and their analyses consider the risks and benefits of sun exposure which indicate that insufficient sun exposure is an emerging public health problem. This review considers the studies that have shown a wide range health benefits from sun/UV exposure. These benefits include among others various types of cancer, cardiovascular disease, Alzheimer disease/dementia, myopia and macular degeneration, diabetes and multiple sclerosis.
The message of sun avoidance must be changed to acceptance of non-burning sun exposure sufficient to achieve serum 25(OH)D concentration of 30 ng/mL or higher in the sunny season and the general benefits of UV exposure beyond those of vitamin D.
Public health authorities in the United States are currently advising that human sun exposure be reduced.1 At the same time, NHANES data show that 32% of Americans suffer from vitamin D insufficiency.
In this paper we review the current state of the science of the risks and benefits of sun exposure and suggest that public health advice be changed to recommend that all men, women and children accumulate sufficient non-burning sun exposure to maintain their serum 25hydroxyvitaminD [25(OH)D] levels at 30 ng/mL or more year-round.
...A letter signed by many respected vitamin D scientists and physicians recommends 40–60 ng/mL70 which is in line with what the Endocrine Society recommended as the preferred range for health... [WIND: that is 3X HIGHER than the 20 ng/ml figure cited by the Yale article]
.... Using the Endocrine Society's definition of vitamin D sufficiency of 30 ng/mL, the level of vitamin D insufficiency increased from 55% of the US population in NHANES III to 77% in NHANES 2001–2004,38 which indicates that the vast majority of Americans have an insufficient vitamin D status.
...study found an inverse association of circulating 25(OH)D with risks of death due to cardiovascular diseases, cancer and other causes (RR 1.35, 95% CI 1.22–1.49 for all cause mortality... authors further estimate that 9.4% of all deaths in Europe and 12.8% in the United States could be attributable to vitamin D insufficiency... found that the overall age-adjusted hazard ratio for all-cause mortality comparing the lowest (0–9 ng/mL) group to the highest (greater than 50 ng/mL) was 1.9 (95% CI 1.6–2.2), indicating that individuals in the lowest [Vitamin D] group had nearly twice the age-adjusted death rate as those in the highest quantile..
...As compared to the highest sun exposure group, the all-cause mortality rate was doubled (RR 2.0, 95% CI 1.6–2.5) among avoiders of sun exposure and increased by 40% (RR 1.4, 95% CI 1.1–1.7) in those with moderate exposure...
...measured low 25(OH)D levels in the general population associated with increased mortality...
...patients in the highest quintile of prediagnostic circulating 25(OH)D concentration (more than 40 ng/mL) had a 42% reduced risk of colon cancer as compared to patients with the lowest quintile (less than 10 ng/mL)....
Breast cancer incidence and mortality
...breast cancer mortality which found that patients in the highest quintile of 25(OH)D (more than 32 ng/mL) had approximately half the death rate from breast cancer as those in the lowest quintile...
Non-hodgkins lymphoma, colorectal, prostate and breast cancer, and multiple sclerosis
[WIND: sunlight has MORE benefits than just Vitamin D production]
1) there is an inverse association between sun exposure and both colorectal cancer risk and colorectal cancer mortality; 2) there is an inverse association between vitamin D status and both colorectal cancer risk and colorectal cancer mortality; 3) there is a negative association between sun exposure and prostate cancer risk and prostate cancer mortality but not between vitamin D status and prostate cancer risk or mortality; 4) there is an inverse correlation between sun exposure and breast cancer risk and breast cancer mortality, and possibly between 25(OH)D and breast cancer mortality, but studies on the association between 25(OH)D and breast cancer risk are inconclusive; 5) there is a negative association between sun exposure and NHL risk and NHL mortality but not between vitamin D status and NHL risk or mortality; 6) there is a negative association between sun exposure and lymphoma risk, but no association between lymphoma risk and vitamin D intake or 25(OH)D levels; and, 7) for multiple sclerosis, both experimental and epidemiological studies show that the preventative role of sun exposure is independent of vitamin D production.
...reduced risk of bladder cancer associated with 25(OH)D concentrations above 30 ng/mL compared to less than 15 ng/mL...
Cardiovascular disease (CVD)
[WIND: sunlight has MORE benefits than just Vitamin D production]
...stores of nitrogen oxides in the human skin are mobilized to the systemic circulation by exposure of the body to UVA radiation, causing arterial vasodilation and a resultant decrease in blood pressure independent of vitamin D...
Metabolic syndrome (MetS) and type 2 diabetes
...higher 25(OH)D levels were associated with lower prevalence of metabolic syndrome... low 25(OH)D levels are associated with type 2 diabetes independently of BMI...
...individuals with 25(OH)D levels above 25 ng/mL had a 43% lower risk of developing type 2 diabetes (95% CI, 2457%–) compared with individuals with 25(OH)D levels below 14 ng/mL, and that vitamin D supplementation had no effect...
Alzheimer disease and cognitive decline
...participants with serum 25(OH)D levels below 10 ng/mL were more than twice as likely to develop Alzheimer disease than participants with serum 25(OH)D levels greater than 20 ng/mL... the probability is about 140% that an individual without Alzheimer would have a higher 25(OH)D level than an individual with Alzheimer if both individuals were chosen at random from a population...
Multiple sclerosis (MS), type 1 diabetes, rheumatoid arthritis
...findings support the long-held view that the incidence of MS is inversely related to UVR exposure... more sun exposure in the third gestational trimester was associated with lower risk of type 1 diabetes in male children...
...Vitamin D deficiency was associated with psoriasis independently of other factors (OR 2.50, 95% CI 1.18–4.89).
[WIND: sunlight has MORE benefits than just Vitamin D production]
...circulating vitamin D levels may represent a proxy for bodily exposure to sunlight122 explaining the observation that mediators induced by sun exposure other than vitamin D may play important roles in curtailing NAFLD...
Statin intolerance and muscle pain, weakness
...statin intolerance because of myalgia, myositis, myopathy, or myonecrosis associated with serum 25(OH)D less than 23 ng/mL can be resolved with vitamin D supplementation raising serum 25(OH)D to 53 ng/mL. Aleksic et al. 2015123 found that low vitamin D levels are a potentially significant and correctible risk factor for statin-related myopathy, especially in African-Americans.
....6.7-fold increased risk of age-related macular degeneration (AMD) among women with serum 25(OH)D levels less than 12 ng/mL who also had genetic risk for AMD, and noted that previous studies had found that decreased odds of AMD are associated with high compared to low concentrations of 25(OH)D...
Dental caries in infants
...low prenatal 25(OH)D concentrations were associated with increased risk of dental caries among offspring in the first year of life...
UVR exposure may be an effective means of suppressing the development of obesity and metabolic syndrome through mechanisms that are independent of vitamin D but dependent on other UVR-induced mediators such as nitric oxide...
... children who spend more time outdoors are less likely to be or to become myopic, irrespective of how much near work they do or whether their parents are myopic. The likely mechanism for this protective effect is visible light stimulating release of dopamine from the retina, which inhibits increased axial elongation, the structural basis of myopia. The authors describe the effect of time outdoors on the risk of myopia as robust.
Other benefits of sun exposure
Prevailing amount of sunlight affects brain serotonergic activity. Deficiencies in serotonin and brain serotonergic activity have been linked to sudden infant death syndrome,134 seasonal affective disorder,133 depression,135 schizophrenia,136 Alzheimer disease,137 and migraine headaches.138 Beta-endorphin, a neuorohormone that acts as an analgesic, has been known for many years to be released in the human body by exercise,139 producing a feeling of wellbeing similar to the feeling of wellbeing induced by sun exposure.
Vitamin D supplements vs. sun exposure
...vitamin D supplements are not an effective substitute for adequate sun exposure.
Balancing the risks of moderate non-burning sun exposure against the risks of inadequate sun exposure
The only identified risk associated with the amount of non-burning sun exposure needed to achieve serum 25(OH)D levels of 30 ng/mL is some possible increased risk of nonmelanoma skin cancer. The amount of sun exposure required to produce this level of Vitamin D varies among individuals and according to time of year, time of day and latitude.
White people with Type II skins at 40 degrees latitude can obtain their annual requirements of vitamin D by spending about 15 minutes in the sun with face, arms and legs exposed (half that time if in a bathing suit) 2 to 3 times a week between 11 a.m. and 3 p.m. during the months of May through October.141 In comparison, nonmelanoma skin cancer is associated with many thousands or tens of thousands of cumulated hours of lifetime sun exposure.16,52,53 Moreover, inadequate acclimatization to UVR in daily life carries the risk of sunburn and corresponding increased risk of both nonmelanoma skin cancer and melanoma.
The risks of inadequate non-burning sun exposure include increased risks of all-cause mortality, colorectal cancer, breast cancer, non-Hodgkins lymphoma, prostate cancer, pancreatic cancer, hypertension, cardiovascular disease, metabolic syndrome, type 2 diabetes, obesity, Alzheimer disease, multiple sclerosis, type 1 diabetes, rheumatoid arthritis, psoriasis, non-alcoholic fatty liver disease, statin intolerance, macular degeneration and myopia.
People with darker skins require more time in the sun to produce their requirements of vitamin D but also have lower risks of nonmelanoma skin cancer, and people with Type I skins, who are unable to tan, require less time in the sun but have higher risks of nonmelanoma skin cancer. All persons should avoid sunburns, which are associated with substantial increased risk of melanoma and nonmelanoma skin cancer.
Correlation is not causation, but the idea that the human body evolved for millennia to make lots of Vitamin D from sunlight as some kind of genetic accident replaceable by a single crude supplement, and that all these powerful correlations are accidental... that just defies all logic.
Don’t get me started on impairing the body’s key building block for Vitamin D production via statin drugs—the morally and financially degenerate use of statin drugs by the medical establishment is grotesque in its dishonesty and anti-scientific basis.
Critiquing a typical “expert” halfpinion article — Yale Medicine
Halfpinion = the intellectual malpractice of having a viewpoint based on swiss-cheesed understanding of the myriad factors involved in any complex issue, typically far less than half the perspective needed to understand a
The referenced Yale Medicine article “Vitamin D Myths 'D'-bunked” is halfpinion dogmatic medical malpractice misinformation, full of flaws and major omissions including some really obvious ones. These so-called “experts” are ignoring risk management and thereby promulgating “fake medical news”. Just for starters:
- Following the cited advice to avoid sun exposure is a recipe for numerous health problems, including other cancers. See the NIH article that follow.
- The authors are seemingly ignorant of the key role that magnesium plays in calcium regulation (“you may absorb too much calcium”), not once mentioning that high calcium levels might be a sign of magnesium deficiency and that you CANNOT absorb it properly without Vitamin K2 and magnesium. Indeed, the doctor had to use “medications” instead of recognizing a more basic nutritional possibility, possibly putting the baby (patient) at much higher risk than instead assessing dietary inputs.
- Intellectual incompetence of conflating individuals health and genetics with populations as in “Testing is important only for certain populations...”. What twaddle—reminds me of the BMI bullshit with categorized me as “borderline obese” at 8% body fat.
- Citing dubious RDA guidelines e.g., 20 ng/ml for Vitamin D.
- The “body is a test tube with one ingredient” idiocy of taking supplements in isolation: “majority of people can get their vitamin D from nutritional supplements”. And what about the non-majority? Nutrition is a highly synergistic and extremely complex system, and some supplements have problems, like lead contamination.
- Being outdoors with the body almost entirely covered as I see most people doing is the norm around my neighborhood is probably KILLING people from COVID-19 due to low Vitamin D levels needed to combat all sorts of immune system challenges (not just CV19). I see older people covered head to toe—and they are the crowd most at risk from COVID. Ironically, there is a CV19 warning on the page, yet no mention of the role sunlight and Vitamin D might have in fending off CV19.
- Following the cited advice in winter and in northern latitudes and/or with dark skin is dangerously bad advice. Articles that don’t even mention these critical considerations are the worst of the worst halfpinions, misleading tens of millions of people in the USA alone.
- The scientific evidence for skin cancer has NOT shown direct causation—only correlation and correlation is not causation. Researchers isolate a single factor, then choose to NOT STUDY the 100 other factors that might be involved, either because they lack imagination or have a financial agenda, or because they have no training in nutrition or lifestyle factors. The human body is not a god-damned test tube; it is a complex organism with thousands of inputs, including nutrition and microbiome and genetics and environmental toxins.
- Sunblock may make skin cancer WORSE by blocking the critical production of Vitamin D (blocking UV-B rays), needed for the body to destroy cancers of many kinds! Focusing on a single cancer while ignoring dozens of upsides is anti-health and anti-science.
- The author’s claim that the bulk of the population is not Vitamin D deficient is bunk, based on bad science and arbitrary cutoffs, and it ignores dark-skinned individuals, who may need hours in the sun for adequate Vitamin D. Citing bogus statistics and generalizing so casually is the hallmark of bad medicine and bad science and just plain Bad Thinking.
- The author fails to mention that breast milk might not have enough D because the mother is deficient.
- Direct causation of melanoma has NOT been proven, nor has it ever been proven that moderate daily sun exposure raises the risk of skin cancer (see quotes from NIH that follow).
- That the author of the Yale article recommends expensive food (salmon, which might be farmed and contain toxins), mercury-high food (tuna), unpalatable food (beef liver), and high-sugar foods (orange juice, cereal) shows he is an ignoramus about nutrition and total health, that at best his competence is reading a food label. Does that author understand anything about health or nutrition, or that the body is a complex system with thousands of health threats and hundreds of important nutritional inputs?
Dermatologists who fail to do total health risk assessment are just demonstrating intellectual blind spots, expressing their single-variable halfpinions and thus putting millions of people at increased risk of many ailments. Those same doctors have a near complete ignorance of nutrition, having received nearly nil training in it, let alone any scientifically defensible training—the food pyramid is what most doctors still point you at—unbelievable.