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Is Sunscreen and Reducing Sun Exposure a Crackpot Medical Goof? And is Sunlight Racist?

re: follow the money
re: ethics in medicine
re: photobiomodulation
re: risk assessment
re: Vitamin D

In the “everything you thought you knew turned out to be wrong” category... which here in 2022 is turning out to be a lot of stuff in a lot of areas.

My bias upfront: the idea that we evolved with sunlight and that it’s some sort of input we must avoid like salmonella—that’s a crackpot hypothesis driven by follow the money, and no credible science can say otherwise.

Outside: Is Sunscreen the New Margarine?

2019-01-10, by Rowan Jacobsen. Emphasis added.

These are dark days for supplements. Although they are a $30-plus billion market in the United States alone, vitamin A, vitamin C, vitamin E, selenium, beta-carotene, glucosamine, chondroitin, and fish oil have now flopped in study after study.

If there was one supplement that seemed sure to survive the rigorous tests, it was vitamin D. People with low levels of vitamin D in their blood have significantly higher rates of virtually every disease and disorder you can think of: cancer, diabetes, obesity, osteoporosis, heart attack, stroke, depression, cognitive impairment, autoimmune conditions, and more. The vitamin is required for calcium absorption and is thus essential for bone health, but as evidence mounted that lower levels of vitamin D were associated with so many diseases, health experts began suspecting that it was involved in many other biological processes as well.

But today most of us have indoor jobs, and when we do go outside, we’ve been taught to protect ourselves from dangerous UV rays, which can cause skin cancer. Sunscreen also blocks our skin from making vitamin D, but that’s OK, says the American Academy of Dermatology, which takes a zero-tolerance stance on sun exposure: “You need to protect your skin from the sun every day, even when it’s cloudy,” it advises on its website. Better to slather on sunblock, we’ve all been told, and compensate with vitamin D pills.

Yet vitamin D supplementation has failed spectacularly in clinical trials. Five years ago, researchers were already warning that it showed zero benefit, and the evidence has only grown stronger. In November, one of the largest and most rigorous trials of the vitamin ever conducted—in which 25,871 participants received high doses for five years—found no impact on cancer, heart disease, or stroke.

How did we get it so wrong? How could people with low vitamin D levels clearly suffer higher rates of so many diseases and yet not be helped by supplementation?

As it turns out, a rogue band of researchers has had an explanation all along. And if they’re right, it means that once again we have been epically misled.

These rebels argue that what made the people with high vitamin D levels so healthy was not the vitamin itself. That was just a marker. Their vitamin D levels were high because they were getting plenty of exposure to the thing that was really responsible for their good health—that big orange ball shining down from above.

One of the leaders of this rebellion is a mild-mannered dermatologist at the University of Edinburgh named Richard Weller... Weller’s doubts began around 2010, when he was researching nitric oxide, a molecule produced in the body that dilates blood vessels and lowers blood pressure. He discovered a previously unknown biological pathway by which the skin uses sunlight to make nitric oxide... Sure enough, when he exposed volunteers to the equivalent of 30 minutes of summer sunlight without sunscreen, their nitric oxide levels went up and their blood pressure went down. Because of its connection to heart disease and strokes, blood pressure is the leading cause of premature death and disease in the world, and the reduction was of a magnitude large enough to prevent millions of deaths on a global level.

Wouldn’t all those rays also raise rates of skin cancer? Yes, but skin cancer kills surprisingly few people: less than 3 per 100,000 in the U.S. each year. For every person who dies of skin cancer, more than 100 die from cardiovascular diseases.

... People don’t realize this because several different diseases are lumped together under the term “skin cancer.” The most common by far are basal-cell carcinomas and squamous-cell carcinomas, which are almost never fatal. In fact, says Weller, “When I diagnose a basal-cell skin cancer in a patient, the first thing I say is congratulations, because you’re walking out of my office with a longer life expectancy than when you walked in.” That’s probably because people who get carcinomas, which are strongly linked to sun exposure, tend to be healthy types that are outside getting plenty of exercise and sunlight.

Melanoma, the deadly type of skin cancer, is much rarer, accounting for only 1 to 3 percent of new skin cancers. And perplexingly, outdoor workers have half the melanoma rate of indoor workers. Tanned people have lower rates in general. “The risk factor for melanoma appears to be intermittent sunshine and sunburn, especially when you’re young,” says Weller. “But there’s evidence that long-term sun exposure associates with less melanoma.”

...So Lindqvist decided to look at overall mortality rates, and the results were shocking. Over the 20 years of the study, sun avoiders were twice as likely to die as sun worshippers.

...Weller’s largest study yet is due to be published later in 2019. For three years, his team tracked the blood pressure of 340,000 people in 2,000 spots around the U.S., adjusting for variables such as age and skin type. The results clearly showed that the reason people in sunnier climes have lower blood pressure is as simple as light hitting skin.

When I spoke with Weller, I made the mistake of characterizing this notion as counterintuitive. “It’s entirely intuitive,” he responded. “Homo sapiens have been around for 200,000 years. Until the industrial revolution, we lived outside. How did we get through the Neolithic Era without sunscreen? Actually, perfectly well. What’s counterintuitive is that dermatologists run around saying, ‘Don’t go outside, you might die.’”

...Meanwhile, that big picture just keeps getting more interesting. Vitamin D now looks like the tip of the solar iceberg. Sunlight triggers the release of a number of other important compounds in the body, not only nitric oxide but also serotonin and endorphins. It reduces the risk of prostate, breast, colorectal, and pancreatic cancers. It improves circadian rhythms. It reduces inflammation and dampens autoimmune responses. It improves virtually every mental condition you can think of. And it’s free.

...current U.S. sun-exposure guidelines were written for the whitest people on earth... Africans in Britain and America are told to avoid the sun.”... [WIND: racism at work at least in the form of white-centric medicine?] People of color rarely get melanoma. The rate is 26 per 100,000 in Caucasians, 5 per 100,000 in Hispanics, and 1 per 100,000 in African Americans... At the same time, African Americans suffer high rates of diabetes, heart disease, stroke, internal cancers, and other diseases that seem to improve in the presence of sunlight... they have much to gain from the sun and little to fear.

WIND: photobiomodulation is a thing. Stick with the conventional if you wish—FUD sure sells well and how can you . But I’ll be getting my daily dose of sunlight.

Ask your dermatologist about sun exposure. Any intellectually honest one that can do even rudimentary risk assessment should have serious reservations about denying yourself sunlight each day in an amount appropriate for you skin, time of year, altitude, etc. IMO, a doctor who advises avoiding the sun at all costs is a crackpot. Ask them about photobiomodulation, a field barely studied but with more and more being discovered. And all the scientific evidence is against them! But “trained” doctors are just that—intellectual curiousity and objective inquiry are quite another.

Think about that “protect your skin from the sun every day” advice. That is is more about follow the money than any credible science should obvious because of its absolutism, particularly its abominable take on people of color (more on that below).

What exactly happens to your skin when you avoid all sun, and then one fine day, you get a bad burn because your skin has not seen an UV in ages? Versus getting some exposure every day and never burning? Tanning is as natural as anything could be, it’s what we evolved to do. No surface organism exists that has not had to deal with the sun, and with millions of years get the formula right it is outrageous hubris to assret otherwise.

Then there is the “feel good” part. There is so much real evidence that photobiomodulation is how the human organism evolved and that sunlight should be thought of more like a nutrient.

I’ve long felt that right around April I feel better and better as I get more sun exposure. Always, by late April (northern hemisphere), everything just perks up like magic. Just when I am getting a lot more sun. Like clockwork. I’ll be damned if I’m going to slather up with some chemical (or worse, those nasty nanoparticle oxides that cannote be removed from sun things).

I have a deep skepticism of sunscreen, but I do use it to keep from burning (nose and face mostly), but only to avoid excessive sun (altitude, time, granite or snow, etc). Hats and clothing take care of it, excepting the face.

The hype around skin cancers fails to account for the tiny proportion of deadly melanoma. Or nasty stuff like crap-grade-food-in = bad-health-and-cancer-out—things like PUFAs and processed foods and magnesium deficiency, all of which are just too many insults for the body to tolerate.

If the following isn’t blatant malpractice and crackpot medicine to the detriment of people of color, I don’t know what is:

When I asked the American Academy of Dermatology for clarification on its position on dark-skinned people and the sun, it pointed me back to the official line on its website: “The American Academy of Dermatology recommends that all people, regardless of skin color, protect themselves from the sun’s harmful ultraviolet rays by seeking shade, wearing protective clothing, and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.”

Same story, different details

We’ve heard this story (crackpot ideas held up as “science”) from the medical establishment before:

Am I willing to entertain the notion that current guidelines are inadvertently advocating a lifestyle that is killing us?

...Eventually, better science revealed that the trans fats created by the hydrogenation process were far worse for our arteries than the natural fats in butter. In 1994, Harvard researchers estimated that 30,000 people per year were dying unnecessarily thanks to trans fats. Yet they weren’t banned in the U.S. until 2015.

...early sunscreen formulations were disastrous, shielding users from the UVB rays that cause sunburn but not the UVA rays that cause skin cancer. Even today, SPF ratings refer only to UVB rays, so many users may be absorbing far more UVA radiation than they realize. Meanwhile, many common sunscreen ingredients have been found to be hormone disruptors that can be detected in users’ blood and breast milk. The worst offender, oxybenzone, also mutates the DNA of corals and is believed to be killing coral reefs...

I remember the nasty sunscreen I was using in the 1980's and 1990's. Probably disposed me to skin cancer!

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