A few weeks ago I was at a conference in Tucson, Arizona. Two things really surprised me while I was there. First, quite a few people ordered egg-white omelets for breakfast. Huh? Didn’t they get the memo that dietary cholesterol doesn’t increase the risk of heart disease, or even raise blood cholesterol levels? Egg-white omelets are so 1995!
Second, I noticed that a number of people were slathering themselves with sunscreen and wearing long sleeve and pants or wide-brimmed hats every time they stepped out the door in order to avoid the sun.
This kind of “sun phobia” is the unfortunate—but inevitable—result of national guidelines in many countries over the past 30–40 years advising strict restriction of sun exposure.
Too much sun exposure isn’t a good thing, but not enough may be even worse. Read this to find out why.
These guidelines were based on the observation that light-skinned people of European ancestry living in Northern Australia had the highest risk of malignant melanoma, the deadly form of skin cancer, in the world. However, as you’ll see below, applying guidelines that were originally developed for people living in an area with a high ultraviolet (UV) index, such as Northern Australia, to areas with limited sunshine and a much lower UV index (such as many parts of North America and Europe) is not only unnecessary, it may be harmful.
Not Enough Sun Exposure May Be Just as Harmful as Too Much
What’s more, they found that women with normal sun exposure habits were not at significantly increased risk for malignant melanoma or melanoma-related death. (1) This is consistent with the results of a previous Swedish study that followed 38,000 women for 15 years and found that sun exposure was associated with reduced risk of both cardiovascular and overall death. (2)
I’d like to emphasize that these studies are observational in nature, and thus do not prove causality. It’s possible that the women who got more sun had healthier diets and lifestyles than those who avoided the sun, and those factors led to the lower mortality, rather than the sun exposure.
However, it’s also possible—and probable, in my opinion—that completely avoiding does increase the risk of death. There are several possible mechanisms that explain why:
Vitamin D
One of the primary benefits of sunlight is its ability to stimulate vitamin D production. Vitamin D deficiency is a major predisposing factor in at least 17 varieties of cancer, as well as heart disease, stroke, hypertension, autoimmune disease, type 2 diabetes, depression, birth defects, infectious disease and more. (3) It’s not a stretch, therefore, to imagine that women who avoid the sun have lower vitamin D levels (especially in areas with limited sun, like Sweden) and thus a higher risk of death.
Blood Pressure
Scientists observed a connection between sunlight and cardiovascular disease as far back as the 1970s, when clinical trials on hypertension showed that blood pressure was consistently lower in summer than winter. (4) Later studies showed that the both the prevalence of hypertension and average blood pressure is directly correlated with latitude; in other words, those living at northern and southern latitudes (with less sunlight) had more hypertension and higher average blood pressure, while those living closer to the equator had less hypertension and lower average blood pressure. (5)
Clinical experiments have also provided direct evidence that ultraviolet light reduces blood pressure. In one study, researchers exposed one group of people to lamps that gave off ultraviolet light as well as heat, and another group to lamps that only gave off heat. In the group that received both heat and ultraviolet light, blood pressure dropped significantly after just one hour of exposure. (6)
For example, a drop of 20 mmHg in systolic blood pressure (blood pressure is expressed as a fraction, i.e. 120/80, and “systolic” refers to the number on the top) leads to a two-fold reduction in the overall risk of death in both men and women between the ages of 40 and 69. (7)
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Inflammation
Sunlight may also reduce the risk of cardiovascular disease—and by extension, the risk of death—by putting the brakes on inflammation. (8) These beneficial effects of sunlight are likely to extend to other organs and tissues as well, since both blood pressure and inflammation have widespread effects in the body.
Immune Function
Another effect of sunlight that isn’t mediated by vitamin D is its ability to regulate immune function. Studies have shown that the the more hours of sun there are where you were born, the lower the risk you’ll develop multiple sclerosis. (9)
Other Effects
Exposure to sunlight may improve endocrine function, elevate mood (via its effects on certain brain chemicals like serotonin) and increase DNA repair capacity, all of which could conceivably extend lifespan. (11)
The “Goldilocks” Effect: How Much Sun Exposure Is “Just Right”?
With all of this in mind, how much sun exposure is “just right”? How can we minimize our risk of skin cancer while optimizing vitamin D levels and getting the additional cardiovascular and immune benefits of sunlight?
Just follow these guidelines for you and your family members:
- If you have fair skin, aim for spending about half the amount of time in the sun that it takes for your skin to turn pink (without sunscreen) two to three days a week. This could be as little as 10 minutes for those with very fair skin. If you have dark skin, you may need up to two hours per day to generate the same amount of vitamin D (which is why supplementation may be necessary for those with darker skin).
- Never burn yourself in the sun. Cover yourself with light clothing, wear a hat, shade yourself with an umbrella, tree or canopy, wear sunglasses, and/or use a safe sunscreen to prevent sunburn if you’re going to be exposed to sunlight for a prolonged period. (But see the section below for important information about sunscreen.)
- Pay attention to the time of day, latitude and season. This probably goes without saying, but you need less sun exposure at mid-day during the summer on the equator to generate a given amount of vitamin D than in the late afternoon during the winter in New York City. Vary your exposure accordingly.
- Infants under 6 months old don’t have much of the protective pigment (melanin) in their skin. It’s best to avoid direct sun exposure at mid-day, use protective clothing and a hat, and limit exposure to the morning or late afternoon hours. Infants may be particularly susceptible to the toxic effects of some sunscreen ingredients, so use clothing or shade when possible.
Sun protection is important if you plan to be out in the sun for a long enough time to get burned, but most sunscreens on the market are not beneficial or even safe. Stephan Guyenet explains on his blog how typical sunscreen fails to prevent melanoma, the deadliest form of skin cancer. Most commercial sunscreens have a slew of chemical ingredients such as fragrances, parabens, alcohols, chemical solvents and petroleum oils that break down when exposed to sunlight.
Unfortunately, even natural sunscreen materials like zinc oxide could be problematic. (12)
Ultimately, the best way to protect yourself from melanoma—while ensuring you still get the benefits of sun exposure—is to tan gradually, without burning.
Final Thoughts
It’s entirely possible that public health recommendations that significantly restrict sun exposure may be doing more harm than good in regions with limited sunshine and a low UV index, such as many parts of Europe, the UK, and North America. Yet many people are unaware that the advice they’ve been given about avoiding sun exposure doesn’t reflect the current scientific evidence on this topic.
This reminds me of the situation we’re in with dietary fat and cholesterol. The mainstream media and medical establishment spent decades scaring us away from egg yolks, cheese, meat, and other high-fat, high-cholesterol foods. The result of this advice was an increase in the consumption of highly refined carbohydrates—which, ironically, contributes to the epidemics of metabolic and cardiovascular disease that fat and cholesterol restriction was supposed to address.
As I mentioned in a recent podcast, the current evidence suggests that (on average) dietary cholesterol and saturated fat do not affect blood cholesterol levels or increase the risk of heart disease. Yet I think it’s safe to say that most people still perceive a breakfast of cold cereal, toast, and OJ to be “healthier” than bacon and eggs. It took years to convince people that natural fats found in real foods are bad for them, and unfortunately it’s probably going to take years to relieve them of the burden of that misunderstanding.
I’m afraid the same will be true for sun exposure. I often see parents putting sunscreen on their kids as soon as they step out the door, or adults that wear long sleeves and big hats whenever they go outside. Current research doesn’t support this, but I think it’s going to take a while for the public policy to change and the message to get out. (Though you can help speed that along by sharing this article with people you know that are still sun-phobic.)
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I have always loved sunbathing and never bought the whole sun-is-dangerous story but I’ve also been careful not to burn. I am still sunbathing (when I can) and I just love it! I always feel “better” after doing it and I plan on continuing to sunbathe as long as I am able. My husband loves it, too!
Grew up in Florida. Moved north to upstate NY in my 40s, after 15 years there I got a melanoma in a spot on my body that was never exposed to sun. Now retired in Fl and trying to get sensible sun exposure for vitamin D.
In Australia there is an epidemic of skin cancer: every kid knows ‘Slip Slop Slap’ before their ABCs! Yet in spite of a huge campaign to use sunscreens, long sleeve shirts, bathing onesies, hats and sunglasses, it would seem the already high rates of skin cancer to have doubled.
Don’t sunscreens decrease the skins’ ability to produce vitamin D by blocking UVB radiation?
And though polyunsaturated fats are essential in our body, never in our history have we consumed polyunsaturated oils (and their highly processed versions at that) in large quantity like we do now: excessive polyunsaturated oil intake replaces the saturated fats of the cell membranes—which in turn reduces the integrity of cell membranes.
So, we’ve not only lowered our food sources of vitamin D, and filtered the very free version of vitamin D needed for it’s conversion in our body (sun), we’ve also changed the way the very structure of the lipid bilayer in our skin cells to receive and convert any vitamin D that might come in.
Perhaps like much of nutrition, sun exposure is neither good nor bad just in or out of balance.
Excellent comment!
I live in Beijing, China and you haven/t seen any culture as phobic about the sun until you meet the sunophobic Chinese females . Not the males.. All you can see is a sea of umbrellas. And watch out you don’t get poked in the eye as you walk by.
I often wondered why the men don’t use umbrellas as much as the women do.
China has a long history where the upper class avoided the sun. The lower class was associated with sun exposure. Many chinese have their daughters avoid sun for marriage purposes. I have heard some young chinese people being very critical of this behavior. They even think the too pale skin does not look good.
I have systemic lupus erythematosus. I love the sun but my doctors all tell me to stay out of the sun because it may trigger or worsen a flare? Should I completely stay out of the sun?
This is amazing… I was recently diagnosed with extremely low Vit D and given an Rx for 50,000 units once a week. I am fair skinned and have always tried to protect myself from the sun.
Hi, Just a heads up. It you were prescribed vitamin D, and at such a high dose, it’s likely a synthetic vitamin D2 rather than the D3 that you need. Suggest looking at the prescription, and if it’s D2 and/or synthetic, find some D3 (along with K2 and the other things mentioned to help the D3) to take instead.
Last year I wasted a couple of months trying to get my levels up taking doctor prescribed vitamin D2, so thought I’d mention.
I just wear soccer jersey and shorts and don’t worry about the sun. You only need to cover up if you are laboring 100% in the sun (hard work without movement) for an hour or longer. I only bother with sunscreen on the face if I’m out for awhile – its the only place I burn with a shirt on.
I’ve been using the d-minder app on my iphone for the past month and I’ve started recommending it to others (it’s also available for android). The primary use is to keep a running record of your vitamin D levels — with food, supplements, and sun exposure as the inputs and various body factors as the outputs.
That would be value enough for me, but I find (as a fair-skinned person) that the sun exposure tracker is valuable by itself. Let the app know about your skin tone, what clothes you’re wearing, and how cloudy it is, and then the app takes the time of day and your latitude and computes the UV for the day. Press “start” and you’ll get 3 audible tones — one for your minimum exposure, one for “hey, you’re starting to burn”, and one for “you’ve made your maximum D for the day.”
I started using the app shortly after getting a D level from my doctor and I’m excited about comparing their estimate of my current level with my actual level down the road.
And it’s completely circumstantial, but I’m feeling better since going out and getting in the sun more (for sensible 20 minute sessions)
Neat! Thanks for sharing!
Having lived in Tucson for 12 years, it should be understood that that city has the highest incidences of skin cancer in the USA. My forearm scars bear vivid testimony.
Prudent precaustions are mandated in that 1/2 mile high desert.
A cheeky comment I know but I’ve always wondered what the health profiles of lifelong naturists might be compared to the population as a whole. Could the regular exposure to the sun have positive or negative affects on overall health?
This is just an observation. Here in Antigua many of my friends sailed out in the 60s to take part in the burgeoning yacht charter trade. The evils of sun exposure were relatively unknown and many worked and played out in the full Caribbean sun day in, day out for years and got dark, dark tans.
Now, in their old age some of them have easily treated superficial skin blemishes but not one has had anything threatening like melanoma. And yet the sun ‘abuse’ was about as extreme as you can get.
Yesterday I spent an hour in the sun @ Colorado. No sunblock. My white shoulders were a little over-pink but doesn’t bother me. A visor protected my face. If I don’t get a 1/2 hour of sun every day I feel terrible. Ideally I would do this every day gollowed by a 2 hour nap. Although it’s sunny here and a high dry altitude the winters make me depressed. I can spend long winter days outdoors without a tan. Supplementing with Vit. D does nothing for me. I’m eating lunch outside right now
> Supplementing with Vit. D does nothing for me.
There are many reasons for this.
Your not using D3
You didn’t take vitamin K2 MK7
You don’t have enough calcium in you
You don’t have enough vitamin A
Vitamin D3 requires K2, A and calcium.
Here is one brand formulation
Vitamin D3 (as Cholecalciferol) 2,000 IU 500%
Vitamin A (as Retinyl Palmitate) 3,000 IU 60%
Vitamin K2 (as Menaquinone-7) 100 mcg 125%
Tocotrienols (as DeltaGOLD® Tocotrienols) 5 mg
I originally came from England and now live on the Mid North Coast of NSW Australia, at Lighthouse beach, Port Macquarie. I am fair with blonde hair. Despite that, I walk on the beach every morning ,Winter or Summer and spend time sitting on the beach or by the river before midday. I have a healthy tan all year round, and I am often told how well I look. I stick to a Paleo eating plan, and also take D3 for my immune system I am almost 70, and feel about 50!
I’ve heard a number of speakers teach of the value of essential fats, or “vitamin/cataplex F,” in preventing sun-damage. I have found I tolerate the sun more when I regularly apply a thin layer of olive oil to any areas that will be exposed a week before going in the sun. I learned this at Bastyr University in a class on essential oils.
Ingesting and applying more essential fats, in conjunction with lots of veggies that also give a good omega-oil balance is what my super fair-skinned Florida friends do, with their kids. None of them wear sunscreen. It’s amazing their tolerance to the sun. An hour at high noon! When we were kids I remember us using sunscreen, and she’d still burn. She ate more trans-fat junk back then though. 🙂
You’re right. The proper Omega-6 in your diet will protect against burns. Your skin has almost all Omega-6 and virtually no Omega-3 in it, most of our diet contains adulterated Omega-6 which leads to sun sensitivity.
I have a difficult time in the sun. On the one hand I love being in the sun, it lifts my spirits and I enjoy the warmth on my skin. On the other hand I am rather sensitive to it – I have suffered from polymorphic light eruption (not heat rash) all my life and spent most of my childhood summers smothered in sunscreen and long sleeves and sun hats.
I recently have used a device to measure heart rate variability (HRV) and noticed that my HRV becomes v poor after 10 – 20 minutes outside. This is way before any rash develops. My pulse goes up and has none of the variation it should have with my breath. I have experimented and it is definitely the effects of the sun and not anything else. To be honest it freaked me out a bit because I know how beneficial the sun is but it showed me clearly how even a little is provoking a strong reaction in my body. It’s difficult to know what to do for the best. PME is inflammatory so does that negate the usual anti inflammatory effects of being in the sun?
I would be interested to hear if anyone else has any experience like this, or suggestions re the pros and cons of sun exposure for someone in my position.
At the moment I am just trying to be balanced about it and not have too much exposure in one go and the rest of the time, just to enjoy being outside but stay in the shade as much as I can.
Speaking as one of those often maligned Dermatologists, even if you don’t mind keeping us busy having the only occasionally fatal skin cancers like squamous cell and basal cell carcinoma cut off and stitched up, at least protect your face. Who wants to go back to their class reunion looking 10-20 years older than their peers with a face covered with wrinkles and scars? 😉
Dear Pete,
I mean no disrespect, but I’m seeing more research about skin cancer rates going up despite all the sunscreen use. Medial journal abstract here says what I suspected to be true: http://www.jabfm.org/content/24/6/735.full
Spreading fear of wrinkles is what my Avon Lady mother used to do. She’s just as wrinkled at 80 as anyone else who ate as well as she did throughout her life. I love her to death because 50 year later now she confesses that maybe those creams weren’t so important.
Healthy eaters seem to age the best. Maybe it’s the food they eat that re-creates their skin in a good way on a daily basis. ….But that’s not medicine. (Nothing ‘ceutical about it.)
Don’t worry. There is enough cheap junk food available to ensure you will continue to have cancers to cut out.
Hi Miranda, thanks for the reference-it was a nice balanced article. First, though, remember that association does not imply causation. Second, if you read it from start to finish, you will notice that it is talking about CMM (cutaneous malignant melanoma) which I was not speaking about. Also, they did relate CMM to sunburns and UVA radiation, which the older sunscreens didn’t block, and they ended up saying that REGULAR use of sunscreens will prevent the sunburns that are associated with melanoma. And of course, UVA blocking sunscreens are available now. I do agree with your beloved Avon lady, that those creams didn’t do anything to prevent wrinkles later on. I also agree with your comment about healthy eaters, and actually I don’t want to do surgery on patients. Would MUCH rather that they avoid the need entirely!
Well, Chris advocates moderate sun exposure without burning, and a healthy diet, so I feel that your comment is unnecessarily fear mongering. Skin cancer seems to be more complex than just staying out of the sun. As for wrinkles, I live in the north and don’t really go out in the sun much, and I already have wrinkles in my 20s . . I think the missing key for me is gelatin, which is still only really advocated by traditional nutrition circles, since in the mainstream glycine and other collagen nutrients are considered nonessential. I think maybe endogenous production is not high enough for some people. My dermatologist was the first doctor who actually ordered tests to rule out whether or not I had PCOS based on my dermatological symptoms, so I’m sure there are dermatologists who have a more functional/holistic approach to skin health, and it would be great to see that applied to the various skin cancers, instead of just the old ‘stay out of the sun’ advice that leaves people with deficient Vitamin D levels. I think you’d agree that moderate sun exposure is healthy?
Catherine, thanks for your comment, but “fear-mongering”, really? 🙂 I haven’t even dipped my toe into fear-mongering, and don’t intend to by describing, for instance, what locally invasive or metastatic squamous cell carcinoma which is clearly related to sun exposure, can look like. You don’t want to know! On the flip side, I don’t object to “moderate” sun exposure, moderate being based on skin type. I think that the jury is still out on the difference between the effects of sun exposure-induced and supplement-induced vitamin D, but it’s a really interesting question. Sorry about your premature wrinkles-easy to fix with laser if desired, or if just from hyperfunctional expressions with Botox (unless you are of the “I earned them” camp. Certainly IMHO an early indicator that you should watch your “moderate” sun exposure though. I don’t believe I said anything about “stay out of the sun”… As you say, more complex than “just” sun exposure…but you might want to “listen to your body” if you are young and already showing skin damage. Your choice, of course. btw, glad your Derm picked up the PCOS! Not sure how that relates to the discussion at hand but bully for her/him for catching it early so you can avoid the consequences of metabolic syndrome at least.
Pete. I’m hearing you and completely appreciate your input and your polite and friendly disposition 🙂
Thanks, Tricia! While intensely interested in the subject, and a Dermatologist for many years, I actually occupy a somewhat “balanced” middle position and don’t feel the need to advocate any extreme views. It is challenging sometimes though when people like to segregate into polarized camps. We often are so into our beliefs that we want to proselytize. I made that mistake in the past, for instance about high carb diets being beneficial, or smoking being bad, then gave up trying to convince people of anything, realizing that I can be proven wrong later and people will make their own choices anyway. I think Chris takes a similar refreshing viewpoint based more on science than polemics. He just presents the evidence and let’s you choose your own path.
Hey Pete, in retrospect I may have read into your comment too much, so, sorry about that. My point about the PCOS was that I don’t malign dermatologists doing their jobs, since my own dermatologist was clearly competent enough to test for PCOS even though I do not show the more obvious symptoms of metsyn (ie/ I am thin). I think we may be speaking past each other, so I don’t think you quite understood what I was getting at, since I was not very clear. You stated “easy to fix with laser if desired” when I mentioned wrinkles, which is basically the opposite of what I was getting at, ie/ prevention, as opposed to treatment. The question is, why wrinkles so early in life? When I say that I don’t get much sun, I really mean I basically avoid it: never been burned, only light golden tans throughout childhood, and now I am pale year-round. So what factors influence wrinkles other than sun exposure? (rhetorical question) This is the same question for skin cancer, ie/ is there anything other than moderate sun exposure that dermatologists can recommend? After all, people get skin cancer in areas that barely get any sun. There do seem to be other factors that interact with skin cancer risk: omega-6, saturated fat, and antioxidant intake. Perhaps dermatologists should look towards these preventative factors as well as advocating moderate sun exposure. Diet is easily modifiable, and preliminary research shows it has a potential to have a pretty large impact on skin cancer, but at this point we really need more research. The “stay out of the sun” comment was not accusing you, but rather making a point that a lot of people now recommend zero sun exposure, or only while wearing sunscreen, etc. It has an interesting parallel to the whole saturated fat situation, as Chris mentioned, and is counterproductive when considering that sun increases the Vitamin D levels that reduce cancer risk.
Catherine, thanks for your clarification. You may have ruffled my tail feathers a bit. lol I’ve spent my life trying to stay on the leading edge of not only Derm and cosmetic Derm, but also fitness and health, and I suppose that I don’t like the feeling of being stereotyped as a Derm who is blinded by the issue of sun damage/skin cancer and clueless about vitamin D and it’s relationship to other cancers. Actually, the issue of nitric oxide production through sun exposure is interesting also! In any event, just like with skin cancer, I would much rather you avoid wrinkles, though if that doesn’t happen, as I pointed out, they can be addressed for cosmetic and self esteem reasons. Actually, it sounds like you have done a much better job of protection than I did, having been raised in the Coppertone generation. I am wholly in favor of your healthy diet/fats/exercise also as I firmly believe that the foundation for healthy skin comes from within. When you say “diet is easily modifiable” however, I am frequently discouraged by how little people want to hear about it, (or else listen politely and ignore it) excepting when I am “preaching to the choir!” And if I am brave enough to bring up the issue of excess weight, I am treading on really thin ice even as a doctor. The interesting societal drive to “be happy with our bodies appearance” no matter how it affects our health is a shipwreck in progress. Maybe they just think that they didn’t come to a Derm for dietary advice, so I have cut back on it. I don’t have a great answer to what else you should be doing for prevention of sun damage. I suppose you could consider a genome or epigenome that is inefficient in UV damage repair, second-hand smoke, air pollution, (I live in L.A.) indirect sun exposure, impure thoughts…no, just kidding! 😉
I had a mole test positive for melanoma when I was 54 and when my sister-in-law heard about it she said “You got melanoma? You’re the one who is always trying to stay out of the sun.” My oncologist told me that there was nothing I could do diet wise or by supplementation to reduce my odds of a repeat event. I started researching on the web and ended up supplementing with vitamin D and some other things that are deemed to fight cancer and so far haven’t had a recurrence. It’s been 8 years and I take 10,000 IUs of D3 a day and that keeps my blood level at about 80 ng/dl and I don’t worry about staying out of the sun anymore. Now I enjoy any opportunity to get sun exposure ( without burning) and I take conventional wisdom with a grain of salt.
I’d take vitamin K also
I’d throw in some vitamin K2 MK7 to your regimen to take advantage of the synergistic effects.
I have three young kids. I don’t use chemical sunscreens but I do see moms spraying stuff all over babies less then one year all the time! Even in January, all the time!!! I try to be polite and say that vitamins d is good but people have been taught that the sun is evil! Marketing about the dangers of sunscreen for kids has got to increase just like the importance or organic foods. Many new moms are very picky about what their babies eat but still fear the sun.
I live in the interior of Alaska. We experience 9 months of winter where much if the season has zero sun exposure. While it may be light outside for 3 hours, the sun may never rise above the horizon. I recently bought a tanning bed with much reluctance. My mind was torn; I feel this may help with the depression I experience during winter, but what about skin cancer? I am finishing up an MPH so I really felt like a hypocrite! When I have visitors, I feel I should hide it. After reading this article I am a bit empowered. Presently, the sun shines nearly 24 hours so I have not used it much but I am excited to see if it will make a difference this coming winter!
What about people who have had several skin cancer (basal cell). Do the recommendations change?
My husband, a fair-skinned red head spent summer roofing shirtless in Texas when he was young. He’s had many spots removed, as well as the basal cell carcinomas. He’s very averse to being in the sun now.
I’d love to know from Chris or the gang if the recommendations change in this scenario. Thanks!
I would have covered myself working on a roof all day. Red heads are going to be more sensitive to sun also so I would have taken added measures or avoided long exposures.
There is a Black Topical Salve formerly known as Cansema that helps with skin cancer and many other skin things.
Gingers are a completely different story. A couple minutes max of midday sun showing lots of skin, the rest of the time shade or cloths which block uva are a must. Gingers also have a harder time converting the hormone, so making sure to have lots of calcium & cholesterol, and a properly functioning bile system are crucial. This goes without saying, but it’s probably a wise thing for gingers to seek northern climates (or southern south america) as the sun is more manageable in those climates.