1. Research shows the most popular vitamin supplements aren't useful. This turns out to include D supplements.
2. This is strange because "People with low levels of vitamin D in their blood have significantly higher rates of virtually every disease and disorder you can think of"
3. One theory to explain this is that Vitamin D was acting as simply a marker for sun-exposure. This is put forth by Richard Weller.
4. To add evidence, Weller found that exposing people to sunlight for 30 minutes reduced blood pressure and increased nitric oxide levels.
5. Article dispells concerns about sun exposure by pointing that the type of skin cancer one is likely to get from the sun is actually very safe (carcinomas) as compared to melanoma (1-3% of cases).
6. Cites a study 30,000 Swedish sunbathing women and found greater health and decreased odds of dying from a melanoma.
7. Observes the counter-intuitive nature of sun-exposure being harmful to a species that evolved outdoors.
8. Questions the validity of SPF recommendations when they don't factor in race / skin-tone.
9. Observes an example of "common knowledge" being wrong with margarine which was wrongly perceived to be healthier than butter for a long time. Suggests the very thing may be happening here.
2. Regular safe sun exposure has many positive benefits and very few negatives (a very very small chance of getting a type of cancer that is normally deadly, but for reasons we don't fully understand, is much less deadly to people who get regular sun exposure).
3. Avoiding sun exposure entirely has many negative effects and will kill you.
4. Intermittent extreme sun exposure (the kind that causes sunburn) actually is terrible, and will lead to the bad skin cancers that will actually kill you.
5. Sunscreen may do more harm than good, both to people and the environment. It's certainly not a magic bullet.
6. Sun exposure needs (and risks) vary heavily by skin colour, and while it's good for everyone to get regular safe sun exposure, it's critical for people with darker skin.
In other words, if (like a lot of Americans) you take vitamin D supplements, avoid the sun most of the year, then slather on a ton of sunscreen for your once a year summer vacation, you're basically doing everything as wrong as you possibly can, and getting the worst of all worlds.
And apparently this is supported by new research, and most countries have already adopted it, with the main outlier being the US, primarily due to industry pressure/greed/inertia.
> then slather on a ton of sunscreen for your once a year summer vacation, you're basically doing everything as wrong as you possibly can, and getting the worst of all worlds.
Agreed but Sunscreen might still be better in that case. See point 4 (Intermittent extreme sun exposure (the kind that causes sunburn) actually is terrible). These people would be sure to get bad sunburn if they lay on the beach all day only 2 weeks out of the year.
Of course, even if unhealthy sun exposure + sunscreen is better than unhealthy sun exposure on its own, it doesn't mean it's better than avoiding the unhealthy sun exposure patterns at all.
I feel like there's a fair bit more to figure out here. A lot of us live far from the equator with jobs and hobbies that keep us indoors a lot. Observing that regular safe sun exposure is healthy is great, but I don't even like beaches. It's easy to criticise bad ideas (vitamin D supplements, tanning beds, etc.) but harder to figure out the best compromise.
As a general principle, 7 does not seem valid (consider the case of sugar consumption). Life expectancy has increased and causes of death have changed. Cancer is now a much greater issue, while diseases of malnutrition are rare in the developed world.
Given that melanoma is so rare, it might be valid in this particular case, but it absolutely makes sense that sun exposure could have a mixture of positive/negative effects in prehistoric times, but a different mix today.
Another factor that's relevant to some of us: as someone of Northern European descent living in the southern US, I'm not in the environment that selected for my pale skin (and my ancestors didn't wear t-shirts in February). This effect might go in the opposite direction for dark-skinned folks living in Northern Europe.
I have very light skin and red hair. My kids have mid range skin, and half their genes come from near the equator. I find it incredible that the pediatrician's recommendations for sun exposure and sunscreen are identical for them as they were for me. Especially since every person in my wife's family who lives far from the equator is vitamin D deficient.
The reduction of sun exposure is vicious -- for white people, especially pasty-white hackers like me, it can only take a few minutes to burn. So the medical community recommends we stay inside and lather up to stay pasty. And take a "pharmacopoeia" for the resulting depression, hypertension, cancer, reduced disease immunity...
But if I spend time outdoors year-round, my skin takes on an olive tone, my freckles get darker, and when summer comes around I can enjoy the sun without fear of burns. But that's free health care, and the medical industry makes money hand over fist with that pharmacopoeia.
I'm going to give the medical community the benefit of the doubt here, and particularly, the dermatological community. Skin cancer is something in their domain, and so of course it's a big deal for them, but I think they're missing the forest for the trees.
The other side of the argument is that you might not have visible burns, but you are still being exposed to high-energy radiation that will damage the DNA of skin cells, making you more prone to skin cancer. This risk can be somewhat mitigated by going for regular skin checks as you age. All things taken into consideration, I'm also in the "have fun in the sun" camp.
Prehistoric humans were under a hell of a lot more environmental and physical stress than we are. Being healthier, not dying later, is going to be the objective of evolutionary pressures during that time.
> 7 does not seem valid (consider the case of sugar consumption)
How much refined sugar do you think people were eating in the environment of evolutionary adaptation?
(Although, I agree that causes of death change as life expectancy changes, and things that didn't matter before start to matter now that the low-hanging fruit has been picked)
The issue is that people nowadays may live in a place with a lot more UV than their ancestors adapted to -- consider an Irish family that moved to Arizona, for example. The same principle of "more available than evolution prepared you for" seems also to apply.
I don't think "refined" matters, except so far as once you refine sugar, you can add it to all kinds of foods, driving consumption up. That's exactly my point--eating some fruits or honey is good for your health when every calorie is valuable. Eating tons of sugar when it's cheap and added to everything is bad for your health. Just because eating some sugar was helpful in the past doesn't imply that our bodies have evolved to process arbitrarily large amounts of sugar with no ill effects whatsoever.
To add some "anecdata" to the discussion, vitamin d supplements changed my life. I learned that my vitamin d levels were super low (7 ng/ml, when less than 20 ng/ml is deficient) from a routine blood test. Within a month of taking vitamin d, my afternoon fatigue went away, it became much easier to wake up in the morning, my energy levels generally increased, and my mysterious colds that I was getting every 1-2 weeks that winter stopped.
I strongly recommend getting your vitamin d levels checked!
Yes, I had low levels as well in the winter only, and supplements made a big difference in my mood in the winter (and I verified my levels were back to a normal zone).
So while these studies may be showing that vitamin D doesn't affect cancer, heart disease or strokes... that doesn't mean it's useless. YMMV.
"Most people can make enough vitamin D from being out in the sun daily for short periods with their forearms, hands or lower legs uncovered and without sunscreen
...
you should be careful not to burn in the sun, so take care to cover up or protect your skin with sunscreen before your skin starts to turn red or burn.
People with dark skin ... will need to spend longer in the sun to produce the same amount of vitamin D as someone with lighter skin."[0]
First of all, thanks, your summary is literally better than the article itself :-)
P.1 is not correct (it correctly reflects the article contents, but not factually correct). Research mentioned states vit. D supplements doesn't seem to reduce risks of cancers, and cardiovascular diseases - which doesn't mean they aren't useful.
5 is not quite right. According to the article, your melanoma risk does rise with sun exposure, but for some reason that is not explained, you are substantially less likely to die from it if you have more sun exposure. The article does not clarify how much the incidence increases though, and whether it offsets the 8-fold decrease in mortality.
I thought the article mentioned early on that the issue are sunburns. If for example you are a pastry, white person usually hacking indoors and then you suddenly go on vacation in the Caribbean and are in the sun without protection or adjustment period, that's a problem. If on the other hand you get a reasonable amount of sunlight year around that's what supposedly leads to better health outcome.
With regard to sunbathing in Sweden, it sounds like the study was originally designed to track many variables for possible influence on blood clots. Tanning behavior ended up having a high correlation with lower all-cause mortality. I haven't looked into whether they controlled for variables like socioeconomic situations that allow for more suntanning, though that seems likely before publishing such a conclusion. What seems less likely to have been controlled when just looking for contributors to blood clots, would have been whether the subjects' skin tanned easily.
Many light-skinned people do not easily tan at all, and even complain that their skin seems to go straight from white to red. In Sweden, there are many people who do tan easily in spite of having very light skin. It seems like that could very easily have been a confounding factor. The genes that make you bun easily or tan easily seem like they would have a significant effect on ones decision on whether to sunbathe or not. Likewise, I can imagine that those genes could also affect all-death mortality rates.
personally I used to burn pretty easily (light skin, freckles) When I was much younger and spent most my time indoors. However I took up multiple outdoor activities and after quite some time in the sun it’s rare for me to burn even after hours in the sun with no sunscreen, and if I do burn it heals fairly rapidly.
So outside genes there may be some sort of adaptation going on.
True. Another thing to consider is that regardless of the health effects, sun exposure ages your skin; sometimes dramatically so.
A compromise would be to use sunscreen on your face and neck (since they don't produce that much vitamin D anyway, if I'm remembering a study correctly), but leave the rest of your body uncovered. Perhaps add sunscreen to your hands too.
It usually goes as "Vitamin D is not useful for healthy individuals" which is a nice example of circular reasoning (probably because they get enough sun exposure or have good levels of Vit. D from other sources)
Oh yeah and tests checking Vitamin D's effects on things it was never claimed to help, like "found no impact on cancer, heart disease, or stroke." (Maybe cancer, but still)
You will still get some Vit D through sun even with sunscreen on
> Yes, but skin cancer kills surprisingly few people: less than 3 per 100,000 in the U.S. each year.
Tell that to people in Australia or some other country directly below the Ozone layer hole
But the news that production of NO is more important than Vit D is certainly interesting
Yep and that's a UV index of 13 [Extreme] even whilst cloudy.
Australia and New Zealand have the highest melanoma rates in the world. We thus have a paranoia of "taking care not to burn", during office hours when UV is most intense.
The problem here is that UVB levels, required for vitamin D synthesis, decrease dramatically before 9am and after 6pm, whereas UVA does not. The best option for vitamin D synthesis is short sun exposure around midday.
That's a misconception, if I remember correctly. The ozone layer is over Antarctica. UV levels here (Australia) are high because the air is quite dry and clean (so I have heard). During summer (i.e. now) the UV index reaches 13 daily.
That's literally the first time I see that visualisation. Check this out:
Does the Antarctic Ozone Hole ever come over Australia?
No. The ozone hole has only ever been observed to be well south of the Australian mainland and Tasmania. In fact, during springtime, when the hole is in existence, ozone levels over southern Australian cities are at their highest.
It surprises me that people believe that margarine, a concentrate of vegetable raffinates fats, is healthier then butter.
I believed it was common knowledge how bad margarine is for our body... at least in Italy, where we always use olive oil of butter - I don’t know anybody that would prefer margarine here!
This article is based on the work of Richard Weller who is trying to monetize them at Relaxsol[relaxsol.com]. I didn't find any disclosure of this in the article.
The mainstream view is in a paragraph buried deep: "“I don’t argue with their data,” says David Fisher, chair of the dermatology department at Massachusetts General Hospital. “But I do disagree with the implications.” The risks of skin cancer, he believes, far outweigh the benefits of sun exposure. “Somebody might take these conclusions to mean that the skin-cancer risk is worth it to lower all-cause mortality or to get a benefit in blood pressure,” he says. “I strongly disagree with that." It is not worth it, he says, unless all other options for lowering blood pressure are exhausted. Instead he recommends vitamin D pills and hypertension drugs as safer approaches."
There are quotes from organizations that advocate sun exposure which are not linked to Weller:
Cancer Council Australia’s official-position paper (endorsed by the Australasian College of Dermatologists) states, “Ultraviolet radiation from the sun has both beneficial and harmful effects on human health.... A balance is required between excessive sun exposure which increases the risk of skin cancer and enough sun exposure to maintain adequate vitamin D levels.... It should be noted that the benefits of sun exposure may extend beyond the production of vitamin D. Other possible beneficial effects of sun exposure… include reduction in blood pressure, suppression of autoimmune disease, and improvements in mood.”
Australia’s official advice? When the UV index is below 3 (which is true for most of the continental U.S. in the winter), “Sun protection is not recommended unless near snow or other reflective surfaces. To support vitamin D production, spend some time outdoors in the middle of the day with some skin uncovered.”
New Zealand signed on to similar recommendations, and the British Association of Dermatologists went even further in a statement, directly contradicting the position of its American counterpart: “Enjoying the sun safely, while taking care not to burn, can help to provide the benefits of vitamin D without unduly raising the risk of skin cancer.”
Is it strange that I get some level of measurable joy out of reading something official that contains a rational and balanced take on a subject such as:
"... A balance is required between excessive sun exposure which increases the risk of skin cancer and enough sun exposure to maintain adequate vitamin D levels..." ?
I'm not used to seeing articles / stories / write-ups / or even paragraphs that seem to contain acknowledgement of both sides (or all sides, depending) of a situation. Everything seems like an advertisement or a paid / sponsored article these days so it's almost like a balanced write-up / an author projecting a rational and honest viewpoint is this rare and refreshing change-of-pace for me? Maybe it's not that weird but I've never really taken the time to consider it so I've definitely never asked any friends, family, or co-workers about it. Any thoughts?
Australia here, I didn't know that! Or that, for women, Denmark and Norway (and NZ) have higher rates than Australia. Scandinavia rates surprisingly highly all round. Wonder why that is.
Always they say take pills. People should seriously look into criticism of massive overprescribing of statins. It's crazy this advice always comes in place of natural substitutes (low carb keto diet, prudent sun exposure. No.. just take pills that's surely healthier). Here's a reference for alternative viewpoint on statins & cholesterol if anyone is interested:
Yeah the comments about pills in this bit were really perturbing.
"There’s a pharmacopoeia of drugs that are extremely effective at lowering blood pressure, so to draw the conclusion that people should expose themselves..."
Feels like we are one step away from, Don't risk your health by eating fruits and vegetables, take LIPITOR® instead!
Western health is fucking broken, I'd even go so far as to say it's actually sick.
It's not about any treehugger detached crap, it's just basic observation that the human animal and the natural world are tied, that we've buried under commercial and political interests most basic notions of what healthy human is, and how society pushes people through a funnel that makes them sick, hoping to later fix that with financially viable solutions(i.e.: having a pill for every malaise that emerges).
Health is just something hollistic in nature. In other words seems like we incentivize patching instead of refactoring.
The first line recommendation is always diet and exercise. Pills are second line.
Some docs burn out and just start giving pills first line because 99,999% of patients do not ever do the diet and exercise, even after repeated counseling rounds.
And the stipulation in this discussion is that maybe we're going to learn in the next decade that going outside should have been a first line recommendation, with pills second line.
There's melanoma risk with sun exposure- but there's e-coli with produce, and a bevy of sports-related injuries.
> The first line recommendation is always diet and exercise. Pills are second line.
It would be nice if this were true. We've started to get soft industry press-pushes suggesting putting statins in the drinking water supply about every three years for the last decade.
Doctors, with their few minutes per patient, are not in the position to teach or really influence people's habits. Teachers should teach- about exercise among other things.
In some countries they actually do give such referrals. But it's rare in the US because most insurance plans don't cover such treatments. That is starting to change to a limited extent; my retired father receives a discount on his medical insurance for going to the gym every week.
Also, parents should parent. And people should take care of themselves. I'm not saying doctors should start teaching anything. I am definitely saying that they should NOT be prescribing statins flip-ly when getting someone to diet and exercise is the correct answer.
Instead, he recommends taking a supplement shown to be next to useless...
This is a tough argument, because AFAICT this is the full argument:
1. We can do positive things for what the sun hurts, e.g. we can treat high blood pressure.
2. We can't stop melanoma.
3. Therefore, avoid the sun, and take medications to treat the resulting complications.
That's an argument that takes one risk (Melanoma) and contrasts it with other risks minus the efficacy of their treatments. I have no idea how ANYONE has worked out that equation, as no working is shown.
Personally, I really like the sun, and the lifestyle that comes with it. Doesn't seem like a small increase in Melanoma risk is worth giving all that up, especially when the cost is taking more medication for years as a result.
I wonder about the effects of breathing sunscreen.
In affluent, white, suburban United States it is very common to see the religious application of sunblock to children in the specific form of aerosol spray delivery.
Every day at the park stand still for a big cloud of aerosolized sunblock all over your face and arms, etc.
Speaking more generally, my wife and I often discuss this or that terrible practice of health or habit or child-rearing from our own parents' generation and I am always inclined to extrapolate forward: "what are we doing right now that our kids are going to look back on with horror and amazement?" For a long time the sunblock regime has been near the top of the list ...
In the 90s we used to use purple sunscreen on the kids which then turned clear after exposure to air. It made it easy to get a complete, uniform coating. I never see that for sale anymore, just waiting for the news why.
Had a long conversation with a skin cancer specialist about the harmful effects of sunscreen.
While he agreed that there can be some nasty chemicals found in sunscreen he ended the discussion with the parting words "At the end of the day it's the people that _don't_ use sunscreen that we see here in the clinic, not the people that do"
I think if you read most can instructions, and go by the American academy if dermatology, you aren’t suppose to spray directly on you, but rather spray on your hand and rub in.
Obviously few people do this, but I hate the cloud method. Breathing in chemicals and microbeads of titanium oxide or whatever right into your lungs does seem like something we won’t be doing in the future.
> How did we get through the Neolithic Era without sunscreen? Actually, perfectly well.
It's modern times. We optimize for long individual lives, not propagation of the species. As lifespans increase, so should efforts to avoid cumulative, damaging radiation.
Similarly, heavy meat consumption gave early humans an advantage, but you shouldn't adopt that caveman behavior for a 100-year lifespan - it doesn't "work" at that scale.
Most of the average lifespan increases we've seen have come from reduced infant and childbirth mortality, not from making the elderly live to be even more elderly. There has certainly been some of that, but it's far less significant than the infant and childbirth mortality improvements.
>Rowbotham and Clayton (JRSM 2008;101:454–62) make a very important point when they draw attention to the life expectancy at birth compared to life expectancy at 5+ years of age.1 They state ‘… life expectancy in the mid-Victorian period was not markedly different from what it is today. Once infant mortality is stripped out, life expectancy at 5 years was 75 for men and 73 for women.’ In 1995 Griffin2 produced a comparison of life expectancy of mature men (15+years of age) at different points in history over the last 3000 years
>The change in life expectancy of mature men^ has not changed as dramatically over 3000 years as might be expected, although this data must of necessity refer to privileged members of society.
Note also that being economically or socially privileged would have given these men better access to nutrition, however it would have also given them better access to contemporary 'medicine' which may very well have been more hazardous to their health than no medical intervention at all. How many wealthy people in the past were poisoned by their well-meaning doctors? I'd wager more than were saved.
^ (The numbers for women are very different, because women used to frequently die during childbirth, but this is comparatively rare today.)
> Most of the average lifespan increases we've seen have come from reduced infant and childbirth mortality, not from making the elderly live to be even more elderly.
You're missing my point.
Lifespans are increasing. The reason why is irrelevant.
Regardless, the result is that you have more time to accumulate irreversible damage than your ancestors did, so their habits re: the sources of that damage are not necessarily prescriptive.
There's probably a hard limit on radiation exposure, and that means you'll have to spread it out more than your ancestors did to enjoy the same risk of cancer - ex: same number of hours in the sun but over a longer lifespan = shorter individual trips under the sun, but (inevitably) more of them.
You've missed my point, the increases in human lifespans have come from greater success at reproduction (surviving childbirth, and surviving being a child long enough to reach sexual maturity), which is rather contrary to what you've suggested.
Furthermore:
> "As lifespans increase, so should efforts to avoid cumulative, damaging radiation."
The elderly are not living much longer than they ever did before, so this is basically nonsense. It makes sense if you assume that 200 years ago men were dropping dead in their 40s like those naive life expectancy statistics would lead to to believe, but that's not what was going on. The life expectancy of a mature male has barely changed at all in the past few thousand years, so the relative importance of avoiding cumulative damage like radiation has not increased either.
Yes, we all know about that. You're getting too hung up on me saying "lifespans increase." Forget that I said that. Imagine I instead said, "we are optimizing for health in old age more than the ancients did."
> the relative importance of avoiding cumulative damage like radiation has not increased either
It wasn't important at all back then because they didn't know about it.
Do you want to die in agony in your 70s from metastasized skin cancer, or peacefully in your sleep at 80?
My point is that propagation of the species, old age, and rampant melanoma can all exist simultaneously - so what people did in the past re: sun exposure isn't necessarily good advice for us today.
Wow, 75 for men and 73 for women! That's crazy. I wonder why Wikipedia doesn't seem to indicate this on the otherwise comprehensive life expectancy page.
I did find this fascinating and sad bit on that page though:
"Actual life expectancy in Botswana declined from 65 in 1990 to 49 in 2000 before increasing to 66 in 2011. In South Africa, life expectancy was 63 in 1990, 57 in 2000, and 58 in 2011. And in Zimbabwe, life expectancy was 60 in 1990, 43 in 2000, and 54 in 2011."
Apparently this is mainly due to HIV. I thought the effect would maybe bring down life expectancy down by 3 or 5 years, not 17 or 16. That's insane.
The fact that humans evolved without access to sunscreen is just a starting point, when someone is considering whether to use sunscreen or not. You chose to take issue with that one sentence, while ignoring everything else in the article. And the article suggests that if you actually want to optimize for a 100-year lifespan, you certainly shouldn't douse yourself with sunblock, every time you go outside.
Interesting news almost completely buried in overpolarized nonsense: sunlight is beneficial beyond vitamin D.
Of course, sun burns are still bad for you, and excessive tanning will make you look old at a young age. So yes do use sunscreen in moderation but don’t avoid the sun.
"So yes do use sunscreen in moderation but don’t avoid the sun."
I find it to be much simpler, faster and aesthetically pleasing to just wear a hat and a very lightweight long-sleeved shirt.
Same for the kids. Assuming you're concerned about sun exposure (we're not) it's much easier to hand them a long-sleeved swimshirt (rashguard) than lather their entire bodies up with sunblock ...
When my family was on vacation in Greece the lifeguard told me he could always recognize the American kids because they were the only ones wearing shirts in the pool.
I wonder if we are seeing the results of getting sun being vilified. I know a lot of makeup now has an SPF rating, which means many women are wearing sunscreen nearly 100% of the time.
Is it though? Do we actually have the data that says so, or do we have data that has tons of other factors mixed in, where sunlight exposure happens to be correlated with better health?
> So yes do use sunscreen in moderation but don’t avoid the sun.
Using sunscreen (according to the article) is equivalent to avoiding the sun, as it blocks production of Vitamin D.
> Is it though? Do we actually have the data that says so, or do we have data that has tons of other factors mixed in, where sunlight exposure happens to be correlated with better health?
What other kind of data would you need, or expect to see?
Shouldn't the onus be on people claiming that, given the reality of human evolution and existence, blocking sun exposure is the way to go?
The article points out risks mitigated by sun exposure (and their corresponding mortality rates), and the main negative (Melanoma) and its lower incidence. On net I think the "minimize sun exposure" advocates have a weaker argument.
As article points out this is eerily similar to low-fat, cholesterol fear mongering from decades ago. Funny a similar recommendation (blood pressure pills) is given by doctors here.
What I'd hope to see is randomized studies or studies that exploit some random variation for identification. The studies mentioned in the article all appear to rely on regressions controlling for observables. But of course there could be plenty of unobservable factors that are driving the result: the type of people that spend a lot of time in the sun are healthier for other reasons. I haven't read Weller's work though so maybe he has some RCTs too or maybe someone else does.
The article they cite claims that people who were less exposed to sun had higher disease risk [1]. As far as I saw, the cited article does not include sunscreen use in the analysis. So it might very well be that sun exposure while wearing sunscreen might have the same benefit, minus the increased skin cancer risk and accelerated skin aging.
EDIT: Besides that, there is very likely a huge confounding effect that was probably not properly corrected for. The persons in the "high sun exposure" group were much healthier than in the "avoiding sun exposure" group right from the start (Table 1)!
It's remarkable how much attention is given to the quantity of the desirable Sun exposure, and how little thought is spent on the quality of the light.
Absent sunscreen the UV-heavy mid-day Sun in the tropics gives me a sunburn in 15 minutes, while a morning exposure at the same locale remains perfectly safe for all the three hours that the morning lasts. The turning point is when the Sun crosses 45% boundary (when a match stuck in the sand becomes taller than its shadow), so my schedule is beach-time 6-9am and 3-6pm, while the rest of the time is spent sleeping, eating, working, and sightseeing.
I wish I could sell you some dietary supplement with this fantastic advice, but none is needed. Well, maybe a branded box of matches is in order?..
I can attest to this because right now I'm about 13 degrees above the equator, in the Philippines. On top of that, I'm Anglo and my ancestors are uniformly from the region now known as the United Kingdom, so my complexion is quite fair. The midday sun is very bright and harsh here in SE Asia. I stay out in the middle of the day as much as possible, but get a lot of sunlight in the early morning and late in the afternoon.
Typical caucasian skin - not pale, not dark. The places were Hawaii and Costa Rica, but it should work the same anywhere in the tropics - just make use of the match-sand trick to adjust for the local timezone.
Or even more broadly, is active in general terms, not necessarily just outdoors and not necessarily just physically.
I think it's likely that being active is positively correlated with good health. probably for two reasons. One is it is probably good for you to keep active. Too, if you have health issues, you probably are more likely to just stick around the house and not do as much.
Long-term (3+ years) supplementation of vitamin D significantly decreases all-cause mortality [1]. So yeah, take the supps if you don't get enough sunlight. But personally I am convinced that sunlight exposure, and additional near-infrared "supplementation" are preferable. Nitric oxide release is a double whammy because it reduces stress within cells, and promotes endothelial health (as mentioned in the article).
> 2) Studies also show that vitamin D deficiency is related to many illness. Taking supplement protects against them.
That's hardly a "rebuke". First, I'll note that you carefully used the word "related" instead of "causing" or "a major factor". Then again, you omitted "Studies show that..." from your second sentence, probably because there are no studies showing that people with Vitamin D deficiency, taking supplements, are doing any better than the ones that don't.
In fact there is a meta-study, quoted by the article, that suggests they don't:
Health wise , so much we are told turns out to be upside down.
Say, chlosterol. In 1977 the Framingham Study told us higher HDL levels and lower LDL levels are associated with a reduced risk of coronary heart disease. Not to mention later studies showing statin lowers LDL not only coronaries but other cardiovascular diseases and even stroke (10.1002/14651858.CD004816.pub5). Well, turns out higher cholesterol only correlates with heart disease under 50 years old. Damning it all is a 2016 study showing above 60 actually higher LDL correlates with longer life... And then it turns out though niacin brings down your cholesterol but has no effects on cardiovascular events. And then Pfizer abandoned a drug which raised HDL -- but actually raised the risk of such events. Whopsie! https://www.nytimes.com/2006/12/03/health/03pfizer.html The whole good/bad cholesterol thing is total, absolute bunk science proven wrong multiple times from multiple angles. (Hope I didn't get wrong the various lower/higher things.)
Also, in general, evidence is mounting that all food related studies are useless simply because humans with different genomes (surprise!) react differently to food and we do not understand yet which genes correlate with which food causing what. I mean, this makes so much sense, imagine that someone asserted that seven billion beings with different genetic composition reacts the same to all foods. That's absolutely laughable and yet, you are getting these advices of what to eat and what not to eat in general. What is beginning to become clear is that we do not know anything at all about how humans react to the food they intake. First we started with trying to see how they react to "fats", "carbohydrates", "proteins" and so on. But turns out foods are not just those but also vitamins and then it turns out no matter how you put together fats, carbohydrates, proteins and vitamins it still won't resemble anything food like. We go to smaller and smaller components trying to find the composition of food -- but it just doesn't work. So you have an unknown on the food end and another unknown on the human end and yet we are told to follow certain diets. Which of course change every decade or so when it all falls apart.
So for those of us in the winter (like right now in NYC), what are we supposed to do for health, to protect against the diseases whose rates are increased by lack of sufficient sunlight?
If vitamin D supplements aren't the solution, are we supposed to get UV lamps for daily exposure at home after getting out of the shower? Totally serious question -- anyone got any ideas? I'm actually surprised the article didn't cover it.
Vitamin D supplements do help your immune system, reducing respiratory tract infections, and seem to help with some autoimmune diseases. There have also been some positive findings regarding clinical depression, and improved bone health.
Currently there is no evidence that they help with cancer or cardiovascular disease, but that doesn't mean that someone who is deficient should not try to solve that deficiency with supplements.
Dosing the supplements is the difficult part, ingested Vitamin D absorption is different from person to person, and it's further complicated by variable sun exposure and skin production. 4000 IU per day should be a safe dose, but it's probably not enough with zero sun exposure during winter...
- a bunch of studies have shown Vitamin D strongly correlates with health
- however more studies show supplementation of Vitamin D does not give the same outcomes
- Thus probably Vitamin D is not the cause, rather just an indicator for sun exposure, and sun exposure is what’s good for you
- lots of research showing sun exposure has many befits and avoiding it has high risks
- as for melanoma, it’s less common than you think and the risk is mostly sunburn not sun exposure in general
- this is more serious for people with darker skin whose bodies are better adapted to more sunlight and have much lower risk of skin cancer but need more sunlight to get the health benefits
Conclusion: go outside a lot and get sun, just do it gradually and don’t shock your system with sunburn. If you’re not getting sunburn then your melanoma risk is very low while the other benefits are very high.
That is interesting to read, and it also feels really common-sense to me. I definitely feel better when I’m getting good sun exposure, and I can feel it in the winter when I’m not. Most interesting to me is the studies showing Vitamin D supplementation is not effective for health benefits. That’s too bad because my D levels tend to be low and I have supplemented in the past, but not shocking because it’s never really felt different to me when supplementing.
One other point to highlight: Many of the doctors quoted in the article couldn't dispute the data (reminiscent of nutrition conventional wisdom) but inexplicably advocated not to get benefits mentioned from sun, but instead take statins/blood pressure drugs.
This is ridiculous, and if one looks into the criticisms of these drugs, mirrors the terrible advice peddled by same doctors as nutrition advice, to the detriment of millions. Why does this mentality persist, always and everywhere take blood pressure drugs? Madness.
Well, I’ve come to see it that western primary care doctors main job is to try and match your symptoms to a pill that can help.
I’m not trying to disparage all the doctors or say they do nothing else.
But if you look at it like that, then a lot of the behavior makes sense. “I don’t know about sun exposure, but I’m confident this pill will help you, so avoid the sun and take the pill.”
A more charitable view would be, "Currently I have better evidence in the literature that this medication would be more helpful than sun exposure, which in large quantities has more evidence of harm than benefit."
That's not an indictment of physicians, that's a recognition that our evidence base is skewed (for a variety of reasons). But there is good evidence that at least for some people, sun exposure above some level does more harm than benefit. You're saying the average primary care doctor should just toss that out. Who says this isn't the latest whim to be disproven in 20 years?
The evidence base for lifestyle interventions sucks because it's much harder to measure and pharma has certainly been able to tip the scales, no question. That should change and I hope it does. But when I have a patient come in and ask, we go with what we've got.
> A more charitable view would be, "Currently I have better evidence in the literature that this medication would be more helpful than sun exposure, which in large quantities has more evidence of harm than benefit."
That's indeed a very charitable view. The more realistic view, in my experience is "I just go with the mainstream as nobody got fired or sued for going with the mainstream and I don't really have the time, nor the inclination to keep up with the latest studies".
> Who says this isn't the latest whim to be disproven in 20 years?
A million years of evolution, spent in extreme sun exposure, without sunblock?
I've long suspected that the "Always put on sunblock" advice is bollocks and have never used the substance. Partly because of common sense (evolution of human species) and partly because of simple observation. All my grandparents and their relatives were raised in villages (and quite a few still live or lived there till they passed away), with serious sun exposure, working on the field, long before the age of sunblock. Yet, none of them had skin cancer. Other cancers, diabetes, heart attacks, strokes, yes. Skin cancer - not a single one of them. Why is that, if the sun is so dangerous?
And while you may dismiss my anecdata, note that the article says "outdoor workers have half the melanoma rate of indoor workers"!!
So, for me this isn't the "latest whim", we're just going back to common sense.
It's much more akin to "nobody ever got fired for going with IBM". Nobody gets sued for recommending the conventional wisdom. You need to show your doctor that you're a reasonable person--and not a walking lawsuit--before they'll trust you enough to recommend their own judgement.
It's sad, but understandable. A malpractice lawsuit is a life-changing and career-derailing risk that most of us don't have a clear corollary for.
Well, for starters, the Centers for Medicare & Medicaid Services uses “what percentage of people with qualifying conditions get the right pill” as a quality measure, which reduces your income as it goes down.
Docs can’t fight CMS. That’s not “western medicine,” that’s the US government.
I think it's emotionally hard for doctors to recognize the cases when the product they peddle (medicine) is actually worse than the solution they have no control over (a more natural lifestyle). I think this leads to systematic bias towards intervention.
Maybe it is just going outside and being active that's the benefit, and the "sun" part is just a correlation. People that spend a lot of time in the sun aren't just sitting in front of a computer while doing so, they are moving more. How about research that shows people with the same amount of outside time doing the same types of things, but one group wears sun block, the other doesn't?
I think that these hard to prove health factors vary a lot depending on a persons genetics, diet, and lifestyle. Big studies with small statistical results using an average of outcomes is not going to be very useful for you, a single individual. 100% of people who don't eat Vitamin C get scurvy. This is useful information for an individual person. A study of 20,000 people over 20 years that finds that people with a vitamin D level below a certain number died on average 100 day earlier than the ones with vitamin D above that level is useless to an individual.
Maybe with individual genetic testing some more useful things can be learned about health for individual people, but for now the low hanging fruit of health studies has been picked. Instead more focus on how individual people can figure out what works for them should be done.
I think this is worth looking into. There may be some direct benefit from sun exposure, but it's very difficult to extricate it from other benefits of good regular outdoor activity.
In public health there's been an interest in looking at park access for kids to improve activity and overall wellbeing, and I wonder if a similar effect is being observed here.
I always thought there should have been an enormous evolutionary pressure for humans to have different skin tones in different geographies. If sunlight is bad for skin than we should all be black or tanned all the time. However, if you don't live in a sunny area and you have a tan you might not getting enough Vitamin D. Vitamin D must be very important in order to make us evolve to have different skin tones and to tan according to the seasons.
>Vitamin D must be very important in order to make us evolve to have different skin tones
I'm no expert, but I believe it's thought that white skin must have evolved from sexual selection (i.e. lighter skin was thought more attractive), since it happened too quickly for any other explanation.
I have a small blacklight installed in my home, and I turn it on a couple of hours a week when I watch TV. It definitely makes me feel more relaxed, though I'm unsure of the actual mechanism. Vitamin d is not the problem since I take plenty of it in the form of supplements and fatty fish. Recently I discovered that blue light can help break down bilirubin in the blood, and since I have Gilbert's syndrome, that might be one explanation.
According to this article, Vitamin D supplementation is showing not to “work,” and the theory is that the correlation with health is actually as a marker for UVB exposure. If your black light is putting out UVB then maybe that’s what’s helping you?
This article gives a short, uncited and unorthodox summary of UVA vs UVB effects. Most chemical effects may be unknown, but a few are well-characterized like pyrimidine dimer related mutations from UVB that are also seen in skin cancer sequencing samples. UVB has therefore been thought to be directly carcinogenic (likely indirectly as well through other mechanisms), whereas UVA is often associated with photo aging (longer wavelength, penetrates deeper through epidermis into dermis leading to solar elastosis) and may have carcinogenic role that is less chemically obvious compared to the dimers.
A quick search on Amazon reveals UVB lamps are mainly either expensive ($250) and for people with skin problems, or else cheap and low-powered ($30) for reptiles.
There doesn't seem to be anything for a kind of full-body health use?
I find it odd that Examine.com[0] hasn't been mentioned yet.
There have been studies of vitamin D supplementation; these have been specifically about supplementation and not just correlation with blood levels of vitamin D.
I'm sure that sun exposure has additional effects past vitamin D production given how messy biology is, but it's not clear to me that unprotected sun exposure is the best way to get those additional effects. For example, if blocking UVA and letting in some amount of UVB gets the benefits of both sunscreen and sun exposure, then I'm all for it. However, it doesn't seem like we have enough information to make an informed decision yet.
Concerning the Swedish study:
Why would those that run around outside enough to get skin cancer live longer?
Maybe it’s because they’re running around outside. More exercise may explain why they live longer.
And here in the U.S., more UV exposure was associated with a shorter, not longer, lifespan.
Estimates about vitamin D preventing internal cancers are from intervention studies involving giving people vitamin D supplements (not exposing people to UV rays).
Related: many of the components of sunscreen break down into free radicals in the process of absorbing UV, which are in effect (but perhaps not in practice) more damaging than UV exposure itself.
Quick source I dug up, but there's many more (and the industry appears to be aware of this issue and is doing R&D): "Sunscreens Inadequately Protect Against Ultraviolet-A-Induced Free Radicals in Skin: Implications for Skin Aging and Melanoma" [1]
According to another research[1] vitamin D supplementation actually changes a lot of taken in adequate (by orders of magnitude higher than the official RDA) doses regularly (and it also affects mood). So I conclude that what we need is to also supplement nitric oxide, not just vitamin D alone.
I had never feared sun and don't even use sunscreens but I neither live in a particularly sunny area nor have enough spare time for regular sunbathing so supplements still are the only way to get enough.
I was really enjoying this article, which is intelligently written (even though it's obvious the author has made up their mind and is trying to convince me, I happen to agree with them). That is until this line:
> From its inception in the mid-1800s, margarine had always been considered creepers, a freakish substitute for people who couldn’t afford real butter.
When did "creepers" become a word journalists can use in a non-ironic way?
Wanna share my experience, the TL;DR is that if you feel well you shouldn't expose yourself to the sun or use parasol or sunscreen, because only narrow UV spectrum is good, and sun doesn't care.
I've had a severe form of psoriasis, majorly on scalp. Over 1/3 scalp looked like it had been rubbed with a sandpaper to near-bleeding sores. I tried to different docs, nobody told me what it is, I had no option but to do my own research.
I found that it can be treated with ultraviolet, but not all of UVs are good for you, there are UVA, UVB and their sub-spectrums. The only good for health UV is UVB with a narrow peak at 310nm wavelength. Those tanning beds for bronze effect are wide band UVA+UVB and not good at all neither for vitamin D, nor for your health in general.
So I had bought a UVB 310nm medical lamp, shaved my head, and started using UVB since june, it's been a half year experiment on myself. I started with long, over 10 minute sessions to figure out a limit where I do get burned (>10 minutes). Later I reduced down to 5 min, two times a week, and almost haven't used UVB recently. I don't have vitamin D blood meter, my criteria is a state of my skin, i.e. absence of pain on palpation, less itching, no bleeding sores, no reddening. Looks like UVB works for me, what I can tell from my experiment.
In comparison with sun, UVB lamp with timer showed to be more safe, IMO. Three hours outdoors w/o sunscreen gives a sunburn very likely; but a 5 min/day UVB lamp exposure seems to be safe.
I have a few tiny colored skin patches over body, didn't cover them or anything, just ignored them; they have become less distinguishable after UV. However, if you have patches like birthmarks, you must track their borders. When borders become blurred, that's a not good sign, you gotta them checked by your dermatologist. I think there could be some app to track colored skin patches, there is a bunch of open source libs for that[1].
if this turns out to have weight im going to need to switch my routine, but i'll probably continue to use sunscreen on my face (but maybe not my arms anymore). the anti-aging effects are important to me, but particularly on the face, so there might be a nice middle ground here, as long as you're wearing a t-shirt.
Protecting the face is rational, for many people it gets the most sun exposure of any part of your body. Heard from my dermatologist two of the most common skin cancer locations in our community are the lower lip and lower eyelid, which of course are two facets of your face that are most perpendicular to the sun at peak UV hours.
I figure, and this is just me, that if you want to get sun exposure, it's probably best to expose more skin for less time. If the risk is LNT, it's all the same. If it's not, you lower the total risk.
How much are UVA and UVB blocked by the atmosphere in higher latitudes during winter months? UVB is blocked by the ozone layer, so I would expect in winter even less reaches the Earth's surface.
That's exactly the tautology: "Moderation" is "the amount that is good for you." So there are no exceptions to "moderation is good for you." How else would you define "moderation" in this context without a reference to the amount of something that is beneficial? It's not as if "moderate" is an amount that exists out of context that can be applied to both donuts and broccoli without knowing which one of those is good for you.
Edit:
Also there isn't really a healthy amount of doughnuts you can eat, so by your definition, a moderate amount would be zero. Which isn't really what the 'everything in moderation' rule means.
The human evolution argument is interesting to think about because humans are the only fur-less mammals so any advantages to sun exposure are unique to us.
Naked mole-rats beg to differ. Although yeah, I don't think they get much sun exposure. But apparently they never get cancer, maybe we could learn from them.
While I appreciate the note of contradiction, it would be super helpful to those of us less familiar with the research if you would specify what parts are wrong or pseudoscience. I must admit the article seemed somewhat convincing to me, although my prior was strongly in favor of sunscreen so it hasn’t flipped me all the way to bathing in the noon sun for five hours without any protection.
You're living up to your user name, but I dislike reading someone wishing death on someone else, particularly on HN, from which I expect better. Like the other reply, I would also be interested in a more thoughtful rebuttal rather than this kind of vicious ad-hominem attack.
When you live in a culture that used to worship the sun and many friends and relatives have died and or been scarred by skin cancer, you lose tolerance for people pooh poohing UV exposure. Blatantly misrepresenting advice as he does (saying sun exposure is recommended) is absolutely ghastly.
I rate him just a tad less awful than Andrew Wakefield, the anti-vaxxer.
What qualifies you to pass on such harsh judgement? What research on the topic have you done?
I'd be very interested in having the article debunked, but I can't corroborate the accusation that sources have been "totally misrepresented" and "misquoted". Granted, I've merely given it a cursory glance.
The article basically insinuates that you shouldn't use sunscreen, that you should expose yourself to the sun for health reasons and that Vitamin D supplements are actually useless.
Insinuates is the correct word here, as the article dances around the point without providing much evidence. I can believe that people with sun exposure tend to be healthier. But at no point does the author make the case that these people would be even healthier if they didn’t use sunscreen. The link is tenuous at best, and the whole sunscreen part seems thrown in to genrerate a headline.
Eh, the author did give some examples of bad chemicals in some sunscreens, so it's possible that there are negatives to using them.
Here's what I took away:
- don't use sunscreen most of the time (though if you care about aging effects, go for it on your face)
- avoid getting sunburns, and use sunscreen as necessary given your desired time in the sun
- check labels of sunscreen and get familiar with the common active ingredients
That's basically what I do already, though I'm going to make an effort to spend more time in the sun because I work at home, and therefore get minimal sun exposure normally.
As someone who lives in a sunny Mediterranean country, there's nothing wrong with a few minutes' walk without sunscreen in the midday sun, but the hours of sunbathing (even with sunscreen) don't look very pleasant to me.
People's own feeling on how the sun feels on their skin without sunscreen might be a great indicator of how good it is for you and an individual. Most people don't pay much attention to that, I would guess, but as a person with fairly light complexion (German, French, English, Irish, + minor unknown other) that grew up in sunny northern New Mexico, I find that the direct sun on a summer day feels good for just 5-15 minutes, while on a cold winter day I enjoy it much longer.
I agree, that's what I go by as well. After a few minutes it becomes uncomfortable in the summer, and I look for shade. The only exception is when you're swimming in the sea, when you don't really feel the sun's rays.
This article breaks Betteridge's law. The answer is not "no", but it might not be "yes". In fact, the article promotes the viewpoint that sun exposure is actually good for you, whereas butter is probably not essential.
If the sunscreen recommendations turn out to be too strong, this would be good news for me, as I have never liked having to apply sunscreen and dislike the scolds who push it on me when I don't feel I need it. But the article glosses over the fact that people who tend to burn rather than tan get more melanomas, and that melanoma can be a very insidious cancer. So, if I know I'm going to get a lot of exposure (beach, air show, whatever) I am going to use sunscreen to prevent burns.
Yes I think it's good not to be carried away and burning yourself is definitely not good. What's certainly good for you is getting consistent, long term exposure that's compatible with your levels of tan.
That was my take on it, also. If you’re a very light-skin person living in Australia (probably because your ancestors have come there from gloomier places like Ireland and Scotland) then it’s probably a wise choice to not let go of using sunscreen. On the other hand, it seems that vitamin D supplements do nothing for the darker skin people who happen to work in places like Seattle or even Amsterdam (I have a former colleague who used to complain about the latter as always being cloudy).
We went to the Gold Coast a few years ago and I got terrible scars (that are still visible) after one hour of just walking around and looking for a bottle shop with no sunscreen on my skin. It definitely hurt my body as well as my holiday plans.
I find it helpful to know if the answer is no. Betteridge's law suggests you can avoid reading the article because the headline writer is trumping up the findings.
The new margarine? Nah. No one was ever a fan of margarine. Feels more like the new sugar. Public was told to give up X (fat) in favor of Y (sugar) only to find said recommendation was paid for by Industry Y.
The species has survived this long for a reason. What Mother Nature has to offer us is good for us. Why do we keep believing we can get it more better?
1. Research shows the most popular vitamin supplements aren't useful. This turns out to include D supplements.
2. This is strange because "People with low levels of vitamin D in their blood have significantly higher rates of virtually every disease and disorder you can think of"
3. One theory to explain this is that Vitamin D was acting as simply a marker for sun-exposure. This is put forth by Richard Weller.
4. To add evidence, Weller found that exposing people to sunlight for 30 minutes reduced blood pressure and increased nitric oxide levels.
5. Article dispells concerns about sun exposure by pointing that the type of skin cancer one is likely to get from the sun is actually very safe (carcinomas) as compared to melanoma (1-3% of cases).
6. Cites a study 30,000 Swedish sunbathing women and found greater health and decreased odds of dying from a melanoma.
7. Observes the counter-intuitive nature of sun-exposure being harmful to a species that evolved outdoors.
8. Questions the validity of SPF recommendations when they don't factor in race / skin-tone.
9. Observes an example of "common knowledge" being wrong with margarine which was wrongly perceived to be healthier than butter for a long time. Suggests the very thing may be happening here.