Vitamin D Health: Why You Shouldn't Shun the Sun

For the last 30 years or so, doctors (dermatologists in particular), health officials, beauty experts and many product companies have been demonizing the sun. They've told us to avoid it because without sunscreen, exposure to the sun's rays will damage skin and cause cancer. But this oversimplification distorts the facts. In the past few years, numerous studies have shown that optimizing your vitamin D levels may actually help prevent as many as 16 different types of cancer including pancreatic, lung, breast, ovarian, prostate and colon cancers. And the best way to optimize Vitamin D levels is through safe, smart and limited sunscreen-free exposure to the sun.

For hundreds of thousands of years, man has lived with the sun: Our ancestors were outdoors far more often than indoors. We developed a dependence on sunshine for health and life, so the idea that sunlight is dangerous does not make sense. How could we have evolved and survived as a species, if we were that vulnerable to something humans have been constantly exposed to for their entire existence? Is it possible that our bodies are made in such a way that the sun is really a lethal enemy? Not in my opinion. Like all living things, we need sunshine, and it feels good for a reason. Much as plants harness the sun's rays through photosynthesis, our bodies use sunlight to help the skin produce the vitamin D it needs to build bones, quell inflammation, bolster the immune system and protect against cancer (including skin cancer).

Why demonize the sun?

Western medicine has made a practice of telling us to abstain from things that are bad for us in extreme quantities, when in fact those same things⎯fat, salt and sunshine for example⎯are very good for us when consumed wisely and in moderation. In the case of sunshine, our UV paranoia is contributing to a silent epidemic: Vitamin D deficiency. It's silent because most people don't know they are deficient. And it's deadly, because this deficiency can lead to cancer and a multitude of other diseases. But we've been brainwashed into believing that even small amounts of sunshine will harm us, and told to slather on sunscreen, which blocks vitamin D production and exacerbates the Vitamin D deficiency induced by our modern, indoor lives.

Studies show that as many as three out of four Americans suffer from Vitamin D deficiency. A study published in 2009 in the Archives of Internal Medicine (a leading scientific journal), found that 70 percent of Caucasians, 90 percent of Hispanics and 97 percent of African Americans in the US have insufficient blood levels of vitamin D. Indeed, it's thought to be the most common medical condition in the world, affecting over one billion people and we now have research showing just how essential vitamin D is to health.

U.S. and Norwegian researchers have found that people who live in higher latitudes are more prone to vitamin D deficiency and more prone to developing common cancers and dying of them. It's now thought that this is due in part to the body's inability to make enough activated vitamin D to help regulate cell growth and to keep cell growth in check. Independent scientific research has shown that whether you live in a sunny or not-so-sunny climate, exposure to the sun and its UVB radiation will increase your production of vitamin D and help lower the risk of a host of debilitating and fatal diseases -- including many cancers, heart disease, high blood pressure, Type I diabetes, multiple sclerosis and depression.

And now the experts are concerned that we're passing an epidemic of vitamin D deficiency down to a new generation. Studies have shown that vitamin D deficiency may imprint on an infant for the rest of his/her life. Infants that are vitamin D deficient at birth can remain vitamin D deficient for the first several months after birth, which may put them at risk of developing many chronic diseases much later in life.

What is Vitamin D and how much do you need?

Although called a vitamin, it is not. Vitamin D is in a class by itself, behaving more like a hormone. It is made in the skin, gets into your bloodstream and then goes into the liver and the kidney where it becomes activated as a key steroid hormone called Calcitriol. It then goes to the intestines, bones and other tissues, effecting metabolic pathways and the expression of myriad genes. Vitamin D's active form can interact with almost every cell in the body directly or indirectly, targeting up to two thousand genes, or about six percent of the human genome. It is necessary for numerous cellular functions, and when the body does not have what it needs to function optimally, it follows that we experience a decline in health and put ourselves at risk of disease. We now know that almost every cell and tissue in our body has vitamin D receptors, which raises the question: Why would those receptors be there if they weren't meant to have an effect?

Our vitamin D needs vary with age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual reactions to sun exposure, and our overall health. As a general rule, older people need more vitamin D than younger people, large people need more that small people, fat people need more than skinny people, northern people need more than southern people, dark-skinned people need more than fair skinned people, winter people need more than summer people, sun-phobes need more than sun worshipers, and ill people may need more than well people.

The best way to determine whether or not you are deficient is to have your vitamin D blood levels measured and replenish accordingly.

My Top 10 Tips for Healthy Sun Exposure and Optimizing your Vitamin D Levels

• Have a healthy respect for the sun. It is powerful medicine with potentially dangerous side effects on your skin. Treat it like medication, using the lowest dose necessary, but don't avoid it completely. Never fall asleep in the sun without protection.
• Always avoid sunburn. It is sunburn, not healthy sun exposure that causes problems. Repeated sunburns, especially in children and very fair-skinned people, have been linked to melanoma. Whereas there is no credible scientific evidence that regular, moderate sun exposure causes melanoma or other skin cancers.
• Prepare your skin and build up tolerance gradually. Start early in the year (spring), or early in the morning before the sun is strongest and slowly build up the amount of time you spend in the sun.
• Get 15-30 minutes of unprotected sun exposure two to four times a week. Each of us has different needs for unprotected sun exposure to maintain adequate levels of Vitamin D. Depending on your age, what type of skin you have, where you live and what time of the day and year it is, your need will vary. The farther you live from the equator, the more exposure to the sun you need in order to generate vitamin D. For instance, a fair skinned person, sitting on a New York beach in June, in the middle of the day, for about 10-15 minutes (enough to cause a light pinkness 24 hours after), is producing the equivalent of 15,000-20,000 IU's of Vitamin D. But the same person living further north in the U.K, or Canada would need 20-30 minutes to get that light pinkness, which is all one needs. Also, people with dark skin pigmentation may need 20 - 30 times as much exposure to sunlight as fair-skinned people, to generate the same amount of vitamin D. For more specifics, I recommend the tables in The Vitamin D Solution by Dr. Michael Holick.
• Get frequent, short exposures. Regular short exposures have been found to be much more effective and safer than intermittent long ones. Note that you cannot generate Vitamin D when sitting behind a glass window, because the UVB rays necessary for vitamin D production are absorbed by glass.
• After your 15-30 minutes of sun-block free time in the sun, you must protect yourself. If you're going to be out in the sun for longer periods, wear a hat to protect your face and light colored clothing that blocks the sun and keeps you cool. When you do apply sunscreen, use one with fewer chemicals. Check out the Environmental Working Group's list of safer sunscreens. Remember that even weak sunscreens block the ability of your skin to manufacture vitamin D, so once you have applied it, you will not be making vitamin D.
• Boost your "internal sunscreen" by consuming anti-oxidants and beneficial fats. These strengthen skin cells, helping to protect them from sun damage. Eating lots of vegetables and fruits such as blueberries, raspberries, goji berries and pomegranates and supplementing with green powdered mixes and fish oils are great options when going into the sun.
• Have your vitamin D blood levels checked regularly. The correct blood test is 25OH vit D or 25 hydroxy vitamin D test. Be aware, however, that current "normal" range for vitamin D is 20 to 55 ng/ml. This is much too low! Those levels may be fine if you want to prevent rickets or osteomalacia, but they are not adequate for optimal health. The ideal range for optimal health is 50-80 ng/ml.
• Don't rely on food alone for your vitamin D needs. It is almost impossible to get your vitamin D needs met by food alone. Fatty wild fish (not farmed), like salmon and mackerel are the best food sources, but you would have to eat huge quantities of them daily to get anywhere near what your body needs. Although fortified milk and orange juice do contain vitamin D, you would have to drink at least 10 glasses of each daily and I don't recommend doing that.
• Take Vitamin D3 supplements if necessary. In the winter or if you don't get enough healthy sun exposure or if your blood levels are low, make sure you supplement with at least 2,000 IU's a day of Vitamin D3. Although I recommend moderate sunbathing, vitamin D supplements provide the same benefits as sunshine (in terms of Vitamin D needs). But, if taken in too large a dose, they can cause vitamin D toxicity, whereas sun exposure does not. It is impossible to generate too much vitamin D in your body from the sun: Your body will self-regulate and only generate what it needs, which just reaffirms to me that we should get our vitamin D from sensible sun exposure. Here are specific guidelines for replenishing Vitamin D.

Conclusion

Although irresponsible sunbathing is unquestionably harmful and precautions need to be taken, regular, moderate, unprotected sun exposure is essential for good health. It is free, easy to get and good for you when used intelligently. It is the only reliable way to generate vitamin D in your own body, which we now know to be an essential ingredient for optimizing health and preventing disease.

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Frank Lipman MD is an internationally recognized expert in the fields of Integrative and Functional Medicine. A practicing physician, he is the founder and director of the Eleven Eleven Wellness Center in NYC, where for over 20 years his personal brand of healing has helped thousands of people reclaim their vitality and recover their zest for life.

To bring his approach to a wider audience and not just his NYC patients, he recently created Eleven Eleven Wellness and Total Renewal, a leading edge integrative health program to get your health on track.

To hang with Frank, visit his blog, follow him on Twitter or join his Facebook community today.

He is the author of REVIVE: Stop Feeling Spent and Start Living Again (2009) (previously called SPENT) and TOTAL RENEWAL: 7 key steps to Resilience, Vitality and Long-Term Health (2003).

Dr. Lipman lectures throughout the world on chronic disease prevention and sits on the Board of two non profits from his native South Africa, the Ubuntu Education Fund and Monkeybiz. He also has an intense passion for World music and is a frustrated DJ.

 

 

 

Follow Dr. Frank Lipman on Twitter: www.twitter.com/drfranklipman

Comments

[sun2go]

05:49 PM on 07/15/2010

Here are 9 other recent peer-reviewed papers on the topic of artificial ultraviolet sources (tanning beds) and their benefits.

In defense of the sun: An estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance. Grant WB. Dermatoendocrinol. 2009 Jul;1(4):207-14.

Sunbeds as vitamin D sources. Moan J, Lagunova Z, Cicarma E, Aksnes L, Dahlback A, Grant WB, Porojnicu AC. Photochem Photobiol. 2009 Nov-Dec;85(6):1474-9.

Variability of pre-vitamin D(3) effectiveness of UV appliances for skin tanning. Sayre RM, Dowdy JC, Shepherd JG. J Steroid Biochem Mol Biol. 2010 Apr 14. 25-Hydroxyvitamin D, cholesterol, and ultraviolet irradiation. Metabolism. 2008 Jun;57(6):741-8.

25-Hydroxyvitamin D, cholesterol, and ultraviolet irradiation. . Metabolism. 2008 Jun;57(6):741-8.

Ultraviolet irradiation corrects vitamin D deficiency and suppresses secondary hyperparathyroidism in the elderly. J Bone Miner Res. 1998 Aug;13(8):1238-42.

Tanning can be an alternative source of vitamin d in high risk populations. J Nutr Sci Vitaminol (Tokyo). 2008 Feb;54(1):105.

Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci U S A. 2008 Jan 15;105(2):668-73. Epub 2008 Jan 7.

Treatment of vitamin D deficiency with UV light in patients with malabsorption syndromes: a case series. . 2007 Oct;23(5):179-85.

Reintroduction of a classic vitamin D ultraviolet source. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):686-8. Epub 2007 Feb 12.

[sun2go]

05:45 PM on 07/15/2010

“DO NOT try to get a tan by visiting a tanning studio. The rays from their UV lamps are extremely harmful and the tan produced does not have the protective effect of a sunlight-induced tan.” This is a false and deceptive statement.

Tanning beds typically have an output range of 3-5% UVB vs UVA, the same ratio as outdoor sunlight. They provide the same photo-protective tan as outdoor exposure can. This can be measured by the amount of 25(OH)3 (Vitamin D3) circulating in the body, just as you would expect from moderate outdoor exposure.

A recent study showed that indoor tanners had vitamin D levels 90% higher than non-tanners, their PTH levels were 17% lower, and bone density was significantly higher.

Tanning is associated with optimal vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density. Tangpricha V, Turner A, Spina C, Decastro S, Chen TC, Holick MF. Am J Clin Nutr. 2004 Dec;80(6):1645-9.PMID: 15585781

[anniebuddy]

02:48 PM on 06/27/2010

Being that the skin is the largest body organ, ever look at all those chemicals in sunscreen? I wonder how much they've been tested for long term use. I prefer au naturale ... avoiding excess exposure to the sun.

[kitty61]

11:48 AM on 06/27/2010

Living proof here, thinking I did all the right things about keeping out of the sun and always putting on sunscreen, Vitamin D really low and this happens over years, not just due to lack of sun exposure but age and other factors which I am fully aware of now.

I just didn't understand that having sunscreen 30+ on all the time or being in the shade although I spent a lot of time outdoors was not the same as actually being "in the sun", Sometimes well meaning campaigns have unintended health outcomes for a generation being almost and I hesitate to say it "brainwashed" about being outdoors safely, It seems for the last 25 years it has been a scare campaign that any exposure to the sun was unhealthy.

[shineonscotland]

10:01 PM on 06/26/2010

shine on scotland campaign way ahead of you ryan mclaughlin ben saying this for the last year www.shineonscotland.org.uk please follow

[Pete59]

04:21 AM on 06/25/2010

For those wishing to study the epidemiology of MS with latitude, I would start with

Hammond SR, English DR, McLeod JG. The age-range of risk of developing multiple sclerosis. Evidence from a migrant population in Australia. Brain 2000; 123: 968-974

It is freely available and a nice piece of work. Then track the references back and use Google Scholar to see who referenced this paper.

[manoflamatzah]

07:03 PM on 06/25/2010

Interesting... statistical information does make you wonder about local factors that can affect diseases. Just look at a map of Parkinsonism complared to areas where the most agriculture, for example: http://www.elements4health.com/us-parkinsons-disease-rates-highest-in-agriculture-regions.html .... still, the vast majority of people with MS I suspect would get it irregardless of latitude, although it may be one of a number of factors that contribute to it. Personal genetic history is likely far more relevant. Many people get the irritating basal and squamous cell carcinomas, melanomas are becoming more frequent with time, and EVERY DAY I have to deal with the consequences of skin exposure in my patients - torn skin, large painful bruises, etc. That is the big picture. One is better off just taking a vitamin D supplement at reasonable doses. As far as the other potential benefits of vitamin D - I have seen all the fads through the years come and go - anti-oxidants, laetrile, DHEA, ephedrine, folic acid supplements, vitamin E, etc. Turning yourself into a guinea pig by using mega-doses of vitamin D simply does not make much sense to me. Sunscreens? Probably do not protect you from melanoma, just the others. Again, the risks of using them are small, potential benefits much larger, although I myself do have some concerns about these crazy nuw nanotubular technology sunscreens that have come out - not sure if we will be sorry in the future for using them.

[Pete59]

04:34 AM on 06/27/2010

The point made by the article is that these people are genetically similar, and uniformly from the same part of the world. The only difference is where they live. They show that by moving to a different place they modify their risk of MS and that this modification varies linearly with latitude, so your statement ' I suspect would get it irregardless of latitude' is untrue . There are a number of factors in the development of MS, probably genetic, viral and latitude. Assuming that the latitude is connected to vitamin d level this is the risk factor that can be modified. A similar effect in reverse can be seen with people for Somali who have moved to Canada. This work should really also take into account factors such as the number of cloudy days in the summer and how people dress.

I do not recommend anyone to sun bathe. I would recommend anyone to supplement to at 5000IU a day or possibly 10,000IU a day. I would recommend a maximum of 30 minutes (depending on skin type) sun exposure at midday before covering up. If the person is pale skinned I would recommend 6 months of supplements before trying sun exposure, and then for only a few minutes. If your skin fades quickly you do not have enough vitamin d.

[Pete59]

04:50 AM on 06/27/2010

Interestingly, The geographic distribution of Parkinson's disease mortality in the United States. Lanska DJ. J Neurol Sci. 1997 Sep 1;150(1):63-70. shows a North South effect but only in the white population. Vitamin d levels may or may not have a significant effect on Parkinson's but the evidence is limited. The other work to look at is vitamin d and colon cancer where the reduction is risk is significant (60 to 70%) and the work linking vitamin d to the immune system (MRSA infections, asthma, respiratory infections).

[Ohsheglows]

01:12 PM on 06/24/2010

I'm wondering what your thoughts are on the controversy surrounding sunscreens and the idea that they actually do more harm than good?

[manoflamatzah]

08:25 PM on 06/23/2010

ALSO beware - there could be SERIOUS METABOLIC CONSEQUENCES to overdoing the vitamin D. Using it in moderation is reasonable,however. And no, I have no stock or other interest in sunscreen, rather than applying it to my own skin and that of my family.

[Pete59]

04:40 PM on 06/24/2010

The only metabolic consequences of too much vitamin d as a supplement is that very high levels of 25(OH)D in the blood causes the blood calcium levels to rise. This has never been observed with daily doses equal to or below 10,000IU a day. Cases where this happens with lower supplement doses the person has an underlying disease that converts 25(OH) to 1,25(OH)D in an uncontrolled way. As the symptoms are obvious it has the advantage that the person goes to see a doctor and the underlying problem can be treated before it can do harm. All other cases of toxicity involve stupidly high does.

Oddly using the bodies normal method of producing vitamin d (the sun) you cannot overdose.

[manoflamatzah]

08:20 PM on 06/23/2010

Try, try again - The advice here to go in the sun for increasing vitamin D levels is VERY BAD ADVICE. Basically obtaining a "base tan" does not make it any safer - indeed, tanning is the body's response to try to protect itself. Later on in life, you will just end up with paper-thin skin that tears with minimal provocation, have scars from the excision of numerous squamous and basal cell carcinomas, and you will increase your risk of melanoma. Can you get melanoma even if you protect your skin? You betcha - I even had a lady who had one inside one of the sinuses in her face - and I doubt sunlight ever had touched that area. Still this is unusual, and sun exposure clearly increases your risk and covering is the best way to prevent it. There is no clinical evidence to mass-screen people for vitamin D levels, nor is it recommended by any of the major preventative health guidelines. While it may have functions other than calcium metabolism, the evidence is not conclusive. As an internist, I protect my skin as best I can, use sunscreen on areas that aren't covered, and I take 2000 IU vitamin D3 to compensate.

[Pete59]

04:32 PM on 06/24/2010

As an internist I would recommend you go and read the literature properly before commenting, and I don't mean the press releases that seem to make up most of the reviews in the popular literature. There is significant epidemiological evidence that distance form the equator is an independent risk factor in many internal cancers. The effect of latitude on multiple sclerosis has been known since the 1940s and recent work has shown that increased vitamin d reduces relapse rate and the risk of MS. The paper that claimed there was no link between vitamin d levels and cancers published a few weeks ago, was interesting in that they measured the vitamin d level once and tried to relate this to the development of cancers. As people change behaviour over 30 years this is a bit silly.

If you do avoid the sun to that extent you will need more than 2000IU a day try 5000IU a day.

[manoflamatzah]

05:43 PM on 06/24/2010

You are clearly off the wall. Just because there may be a statistical difference based on lattitude, this does not at all mean that it is because of sunlight. You could make the same case for gravitational differences there, the plant life, etc. It is pretty useless rationally discussing simple science with a bone-headed zealot.

[kitty61]

11:53 AM on 06/27/2010

You only need to spend 10-15 minutes per day, and it should be early morning when the sun is not at its strongest, unless you are a Doctor, I think I would rather take a doctors advice and discuss the health outcomes for myself, everyone has different consequences for Vit D deficiency, and your family history could play a big part in the decisions you make with your doctor about safe sun exposure.

[manoflamatzah]

04:17 PM on 06/27/2010

I agree that there is less risk early and late in the day, no doubt about it. And you will make some vitamin D. However, I still believe that keeping your skin out of direct sunlight is the smartest way to go, and just use a vitamin D supplement. And I have to tell you, most of my physician colleagues would agree with me.

[manoflamatzah]

12:20 PM on 06/23/2010

hmmmm....seems i have been censored. censoring appropriate dissension is dangerous. The advice here is very bad.

[LateForTheSky]

10:51 AM on 06/23/2010

Living in Colorado at a mile high is very different than living at sea level. Please take this article with a grain of salt in terms of unprotected sun exposure. One size does not fit all.

[MJensen]

09:11 AM on 06/23/2010

Great article!!! I'm so sick of the media going on about the supposed dangers of the sun. I live in northern Europe and can honestly say I feel so much better in summer when it's sunny. I also go on sunbeds in winter/spring as I heard this help vetamin D levels too.

[NevaforLeadership]

09:24 AM on 06/23/2010

Just yesterday I read about a young woman who is terminally ill with cancer. Cause? Sunbeds. You can imagine her feelings of horror abut what she has done to herself and her young family.

If you want to look old long before your time to look old, with an added high risk of cancer, keep using those sunbeds.

As the doctor said, "It is powerful medicine with potentially dangerous side effects on your skin. Treat it like medication, using the lowest dose necessary, but don't avoid it completely."

Where I live, for a good part of the year there is no sunlight to enjoy, so Vitamin D fortification and supplements are a necessity. No sunbeds required.

[MJensen]

11:41 AM on 06/23/2010

But surely sunbeds (used sensibly of course) can have the same benefits as natural sunlight?! It's still the same UV that produces vitamin D. Rather a bit of sunlight than supplements that can have harmful side effects.

[manoflamatzah]

11:23 AM on 06/23/2010

see my notes above..... you will be sorry for this in the future.

[GBO]

08:50 AM on 06/23/2010

USA!!!
http://news.bbc.co.uk/2/hi/health/10375877.stm

[noladebby]

04:53 AM on 06/23/2010

I get my sunblock free time every day! Good article.

[dobberdoss]

01:40 AM on 06/23/2010

Thankyou sir for a logical and balanced article