Vitamin D: Slathering More Sunscreen Equals Buying More Sunscreen, Study Finds

But Don't Let Unbridled Reductionism Stand in Your Way

Virtually everything I see out of dermatologists is crap. And while I understand fully how they are necessary, given our current state of affairs, needing to save lives made victims of their own pronouncements (in my view), it's a vicious circle that irritates me unlike much else.

I begin with an evolutionary foundation and context, in everything. Like just about everything else that hasn't found an ecological niche in the deep blue or underground (actually, they do too; artistic license), our life depends on the sun (that's a small-S, and a 'U'). So imagine: there's an entire massive industry devoted to its defeat. Running from it, protecting against it, avoiding it at fear of peril. It's the greatest example of what I have long termed Upside Down World I can imagine. There you go: truth, stranger than fiction, and all that shit.

It's also a morass of confounding variables. Inasmuch as the sun is our very life in every conceivable way, how can one possibly begin to construct a reductionist case against it without necessarily incorporating so many confounding variables, such that any conclusion reached is not chalked up to much ado about nothing?

It has been an interest of mine for a long time. While I supplement with vitamin D3 year round, about 4K IU per day on average, that's only because as a modern man, I don't get anywhere near the sun exposure I'd have gotten as did our evolutionary ancestors over the last few million years, who lived life largely outdoors. So even though I was in the sun from about 10-noon this morning, over at the swim & racket club, I'm now safely in the shade outside, standing at my desk on the patio. Can't have my computer overheating. ...And sweat dripping on the keyboard would likely make for an excessively short post. So we supplement. We make do.

Here's the news piece by the moron regurgitator Enjoli Francis at ABC News/Health:

Possible Link Between Vitamin D Levels and Skin Cancer Risk, Study Says

A new study that links higher vitamin D levels to a higher risk of skin cancer simply emphasizes what doctors have been saying all along: Don't forget the sunscreen.

There. At this point, the advertisers have been paid off. Bet she didn't read the full text of the study, as I did, nor think a teensy bit, as I did. She got handed marching orders and marched. That's it.

I had considered doing a more thorough disection of the study. Here's the abstract.

OBJECTIVE: To examine the association of serum 25-hydroxyvitamin D (25-OHD) with the risk of nonmelanoma skin cancer (NMSC), defined as squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).

DESIGN: Cohort study.

SETTING: Health maintenance organization. Patients The study included 3223 white health maintenance organization patients who sought osteoporosis- or low-bone-density-related advice from 1997 to 2001. Interventions Vitamin D levels were ascertained at the time of the initial appointment, and a sufficient vitamin D level was defined as a baseline serum 25-OHD level greater than or equal to 30 ng/mL (to convert to nanomoles per liter, multiply by 2.496) and as a deficient vitamin D level less than 15 ng/mL.

MAIN OUTCOME MEASURES: The NMSC cases diagnosed between 1997 and 2009 were ascertained using claims data, considering first occurrence of specified disease outcome and complete person-years of follow-up since baseline. Charts were abstracted for histologic subtype and anatomical location.

RESULTS: More patients were vitamin D insufficient (n = 2257) than sufficient (n = 966). There were 240 patients with NMSC: 49 had an SCC, 163 had a BCC, and 28 had both. Vitamin D levels greater than 15 ng/mL ("not deficient level") were positively associated with NMSC (unadjusted odds ratio [OR], 1.7; 95% confidence interval [CI], 1.04-2.7), and this association was sustained after additional risk factors were adjusted for (adjusted OR, 1.8; 95% CI, 1.1-2.9). The 25-OHD levels were similarly positively associated, though statistically insignificant, with NMSC occurring on less UV-exposed anatomical locations (adjusted OR, 2.2; 95% CI, 0.7-7.0), whether for SCC (adjusted OR, 3.2; 95% CI, 0.4-24.0) or for BCC, although the risk estimate for BCC was lower (adjusted OR, 1.7; 95% CI, 0.5-5.8).

CONCLUSIONS: An increased baseline serum 25-OHD level was significantly associated with an increased NMSC risk. This association was positive, though nonsignificant on less UV-exposed body sites, and UV exposure remains a likely confounder. The complex and confounded relationship of vitamin D, UV, and NMSC makes classic epidemiological investigation difficult in the absence of carefully measured history of cumulative UV exposure.

...So I got a copy of the full text within minutes of putting out the word on Twitter (thanks, Tweeps). But after reading the full text I was left with that where's the beef? kinda feeling. Let's do it in bullets, totally generally.

  1. OK, there's a higher rate of non melanoma skin cancer, NMSC (treatable, rarely fatal), in people with higher vitamin D levels, amongst people presenting for potential osteoporosis, an established association with overall low vitamin D status (compromised calcium absorption).
  2. How does it compare with rates in the general population (not answered)?
  3. They assessed vitamin D levels at admission, but average follow-up to assess NMSC was 10 years. What were vitamin D levels upon presenting for NMSC (I could not tell)?
  4. Dietary factors, anyone? Did they adjust for "eating like a hunter gatherer," who don't generally present for NMSC, in spite of living near the equator and spending vast amounts of time outdoors? Need you ask?
  5. Did they attempt any reconciliation with the vast and growing body of evidence suggesting that vitamin D levels are negatively associated generally with all cancers -- deadly ones too -- and other diseases of civilization? More VitD = less cancer. Need you ask?
  6. How come above 30 ng/mL of 25(OH)D was a general group and not broken out further? What's the big difference between 31 and 29? I'll tell you why. 30 is considered "normal." Why is it considered normal? Because that's the average of vitamin D deficient people, which is epidemic. The cancer epidemiology suggests that above 50 is where you want to be.
  7. How about any speculation that there might be a range where one might be protected from NMSC (alone) from being out of the sun most of the time, but more susceptible from being in it just enough to cause surface tumors but not enough to protect?
  8. It was a 10 year follow up on average. How about corrections and comparisons for all cancer. And how about total mortality?

I could go on and on, but isn't seven the perfect number? Oh, shit, there's eight. But to follow up on point 2, I did put out another Tweet about NMSC rates in the general population and though this is unconfirmed, it appears that about 2 million people per year present. The follow up period of the study was about 10 years, so crudely, it comes out to about 6.5% (dividing 20 million by 300 million), which is right in line on average with the observations from the study.

Now let's look at the money. We don't have to do that for ABC News, because we can rest assured that they get big bucks from any global conglomerate who's any global conglomerate. But from the full text, there were "no financial disclosures to report." Right after:

This study was supported in part by a Dermatology Foundation Career Development Award in Health Care Policy (Dr Eide).

And so I Googled Dermatology Foundation, clicked over to Corporate "Partners" (so telling), and voila:

Screen Shot 2011 08 18 at 2 44 56 PM
The Great and the Benevolent

I'm not generally against big business, only against big business (corporatism) that seeks to partner with the State (fascism). But look, this is pretty simple. They toss money at all sorts of "foundations" who then contribute or sponsor "research," the dumbshits like Enjoli Francis at ABC News/Health give them a headline and an article they probably wrote themselves, that includes the admonition to buy more, and the vicious circle continues...and you slather the sun screen on your kid at even the rarest of outings in the actual sun, totally unaware that you're "protecting" the tyke against a generally non lethal for of cancer while at the same time, putting him at risk for almost all the others, including melanoma.

Incidentally, I consider sunscreen on the nose, forehead, ears and other places particularly susceptible to NMSC a wise move. This is simply technological monkey wrenching with nature and is not going to compromise your overall vitamin D absorption.

I'll close at this point, but here are three posts you might want to check out, from a while back, all done in one day during a dozen post marathon December 30, 2008.

Melanoma, Sun, and Its Synthetic Defeat (Sunscreen)

Vitamin D Deficiency and All Cancer

Vitamin D Deficiency and Type 1 Diabetes

Here's an interesting chart from that first post:

6a00d8341d0fcc53ef010536a63e98970c 800wi
Hard to Show a Stronger Correlation Over 75 Years

Well, again, I just think it's plain silly to implicate the very single factor responsible for life on Planet Earth more than any other, by wide margin: the sun.

How's life on Mars workin' out for ya?

...Alright, just a parting shot to the Grant Whores responsible for this latest bit of Modern Ignorance:

Melody J. Eide, MD, MPH; Dayna A. Johnson, MSW, MPH; Gordon R. Jacobsen, MS; Richard J. Krajenta, BS; D. Sudhaker Rao, MB,BS; Henry W. Lim, MD; Christine C. Johnson, MPH, PhD

Do note that lead researcher Melody J. Eide, MD, MPH has been at or near the top of the Dermatology Foundation's list of "Research Award Recipients" since 2008.

Wonder what else she's cooking up for big corporate payback. The victims are faceless and nameless.

Comments

  1. Nice job, Richard. I am going to use this post as a great example to my high school anatomy & physiology students of how we all need to dig deeper when we hear these preposterous claims. In fact, maybe I will just give them copies of the study and the claim and let them dig for the truth before I show them your post. Bravo!

  2. Shows what a little digging and some primary school arthritic will do! Encore! People need to think more.

  3. Wondering if anyone else has had a negative reaction from supplementing D3. I’ve tried several times, but it ends up giving me mild depression (was using Carlsons’ drops at 2K IU a day). I asked my doc to check my levels but he refused saying there was no reason to order that lab for me. I don’t see how my levels could be too high though as I am rarely in the sun.

    • Have you spent significant time in the sun? you can absorb huge vitD in a short time. It always leaves me in an uplifter, euphoric state.

      That ought to be your baseline, as a human animal. You’d have been selected for extinction a long time ago if your ancestors couldn’t tolerate the sun.

    • You can purchase a kit from this place (http://www.grassrootshealth.net/) to check your own levels checked. I routinely take from 2000 – 6000 IU of D3 per day and try to get sun when I can, so I get my levels checked every 6 months to make sure they are in the optimum range. I think the test runs about $60. There is a lot of research on that site about vitamin D. I’ve never heard any connection with depression. I, like Richard, seem to get a boost, especially from the sun.

    • Hi Sue,

      There are other nutrients, such as vitamins A and K (but not only those) that are needed to make vitamin D effective and safe. I have a blog post on that here, which includes numerous testimonials from people who have problems with vitamin D supplements:

      http://www.westonaprice.org/blogs/2010/12/16/is-vitamin-d-safe-still-depends-on-vitamins-a-and-k-testimonials-and-a-human-study/

      Since I’ve written that I have received a lot of other such testimonies, which I’ll try to put together in one place some day.

      If your doctor won’t order a test, I’d suggest using Health Check USA. You’ll have to pay for the test yourself (unless you can get insurance to reimburse you), but you don’t need a doctor’s permission. They have you go to a local Lab Corp, which you can often do without even having an appt. Lap Corp will get your results to you the next day usually. I did this to get a full iron panel and paid $60 for it.

      Here’s their site:

      http://www.healthcheckusa.com/

      Chris

      • Yea, it might be a good idea to do a small post on what I supp and why. In addition to the D, I take K2, as well as CLO. Actually, my Carlson D comes encapsulated in CLO. I also take another CLO cap about half the time. And of course, I get plenty of A from my meat rich diet.

      • Lute Nikoley says:

        I supplement with 2000 iu of D3 in the summer and 4000 iu the rest of the year. I also take Super K and Cod Liver Oil. My last 2 test had me at 93 & 90. I have no side effects.

    • Try taking D alone rather than Carlson’s. A and D compete for absorption. Maybe A is winning out and you’re not absorbing much D.

  4. I have been building a superb tan this summer. I am lucky in that it will continue through the winter this time. I used to live in Michigan but will be in Orlando and anywhere else with the sun this winter!

  5. Primal Toad, I’m in the same situation: enjoying the sun during the summer here in the midwest and then heading out to a warmer climate. I’m heading west though, out to California. The lack of sun & warm weather for 75% of the year is too depressing.

  6. I’ve had more basal cell carcinomas removed than I can remember — it’s been at least 6 or 7, and the first ones showed up about a decade ago in my early 20s. I did use a lot of sunscreen growing up, tho, but since I had the first couple of them taken off, I prefer sun-protective clothing over sunscreen. I am very fair-skinned, but I also know that I’ve probably been vit. D deficient my whole life. It is my sense that vit. d deficiency has probably led to my life-long tendency to easily burn, and all the skin cancers … but also probably impacted my skin’s ability to produce more vit. d for itself — because I spent quite a bit of time in the sun as a teenager, but it doesn’t seem to have helped all that much with the deficiency — but probably with the cancers! I’ve been supplementing Vit. D through fermented cod liver oil for about a year now, I crave it like crazy even tho it’s totally disgusting, and this summer I have for the first time in years made a priority to get a little sun almost every day — meaning 5-10 minutes, once or twice/day — any more than 20 without sun-protective clothing and I still burn. Unfortunately I still had a new carcinoma removed in the last month … so I’m not sure if what I’ve been doing is a good or bad thing. I think that the most recent one probably appeared, tho, before I started vit. D supplementation and definitely before the more active sun exposure this summer.
    On the bright side, my dermatologist is actually one of the few doctors I still respect. He’s not at all on board with any of my dietary “craziness”, but he always listens to me, and believes that I know my body better than he can — he says I’m the patient with the “award” for discovering the smallest basal cell carcinoma on their own back — he didn’t think it was cancerous, but took it off anyway. And when he does remove moles, he’ll avoid using anesthesia at my request — I just don’t want any more toxic chemicals in my body than I already have swimming around in there!

    • Exactly the sort of comments needed. Always confounders.

      Smce I have been supping over the years, I find I maintain a bit of a tan in the winter and that I am far more resistant to burn.

      • I’m totally down with this. I do have something of a, uhm, corollary, though. My grandmother was from Ireland and my father’s parents moved to New Mexico in the 30s. My father, uncle, and cousin (uncle’s son) all got skin cancer, melanoma. In my father’s case the second melanoma managed to get pretty deeply into his neck (yeah he hates going to the doctor, as do I), with some serious consequences. All the guys on my father’s side are pretty much outdoors/sports fanatics, running, hiking, swimming, tennis, you name it, as long as it is outdoors. My father and uncle spent every waking moment outside as kids and my cousin runs marathon-training distances per week. None of them ever worried about sunblock as far as I know.

        I think sunscreen is very bad, blog whore link. But if one’s heritage is half perfidious Albion and half Emerald Isle, one has to be careful about serious amounts of sunlight, especially when it is around 6000 ft above sea level although I’ve no idea how much UVB gets block by those last 6000 ft of atmosphere, sunlight feels a lot more intense in Albuquerque than on the beach.

        This doesn’t violate evolutionary fitness in any way, of course. My father’s side of the family is well adapted to spending plenty of time outdoors in Northern Europe. And, come to think of it, probably eating (and obtaining a large amount of vit D from) fatty fish.

      • Oops, meant to post this in a new thread.

  7. One dermatologist I visited instructed me to wear sunscreen when I am working on my computer to protect myself from the rays it emitted. Funnily enough, I never went back to her.

    • I have yet to see anything from a dermatologist to sway me from thinking that they are far and away the most reductionist, worthless SECT of the entire medical religion.

  8. There you go insulting whores again.

    If you pay a whore for sex, you will get sex. If you pay a scientist via a grant, you might not get science.

    By my reckoning the sex whore has higher integrity than your grant whores.

    We need a better insult for these doctors of deception.

    • Bill, I agree and the same logic applies to common thieves. It’s 20 years now I’ve used roughly the same logic to explain how they are more HONEST than politicians.

      I’m sure you can follow that train.

  9. Oh, finally some useful posts.

  10. Nice one Richard!

    I’ve had a blast since I’ve started reading your blog almost a year ago. Instantly I’ve tried not using shampoo, showering gels and similar nonsense. Was more than a bit sceptical of course, but turned out I’m cleaner, don’t smell and don’t worry about my skin, which has dramatically improved since then.

    About this post, this year’s was the first holiday I decided to ditch _all_ sunscreen and evening lotions or whatever. I didn’t avoid sun at all. My skin’s never been better and my keratosis pilaris is just about gone (hopefully forever). I’ve always had a bit darker skin than most, so nobody believes me that sunscreen is nonsense if one is careful and using a brain, they think they’ll melt in the sun, or whatever. Perhaps this post might get them thinking.

    Thanks for the effort, and keep up with all the attitude!

  11. coxnegative says:

    Nice post. Somehow related to your point 6, what´s your take about Christ Masterjohn´s post a while back about pushing VitD levels too high (http://www.westonaprice.org/blogs/2010/05/31/are-some-people-pushing-their-vitamin-d-levels-too-high/). He recommends at least 30-35 ng/mL, but that´s it: Going higher means that “we enter the land of speculation”. His reasoning seems damn solid to me.

    You know, he is a smart guy and his opinion deserves all my respect. In fact, I went down from 53 ng/mL to 37 ng/mL after reading his post. I did this by reducing from 6K UI to 4K UI. I kept 15 mins daily of sun exposure though.

    • On this issue, my money’s on Hollik, Cannell, et al. But I agree it’s not established. Plenty of epidemiology, though, and it’s epidemiology I put higher confidence in because of how cancer rates are so well associated with latitude. The higher north or south from equator, the higher the cancer rates.

  12. Hi Richard, you stated ” Incidentally, I consider sunscreen on the nose, forehead, ears and other places particularly susceptible to NMSC a wise move. This is simply technological monkey wrenching with nature and is not going to compromise your overall vitamin D absorption.” Does this apply to the scalp too for those of us lacking in the hair department? Those are typically the only places I burn so I use sunscreen there if I’m going to be in it for more than an hour or so.

  13. Two years living in Europe, outside 10 hours or more every day with no sunscreen and no burns, convinced me that the stuff is bogus.

  14. I’m a recent convert to ditching the shampoo and soap. So far, so good!

  15. I also joined D action. The study is a 5year commitment to get blood levels checked twice a year, and fill out a questionnaire each time. It is self funded at $65 a pop. Big pharma would not fund anything they can’t patent and charge big bucks for.
    Since supplementing D3 (7500 iu/day) my 25hydroxy D levels have crept up to just under 100.
    I used to sunburn in less than half an hour, now mow the lawn shirtless (3 hrs) without burning.
    I never understood why, if humans ran around naked all day, every day, they didn’t all succumb to skin cancer before they could reproduce!

  16. Swedish says:

    I have pale skin and coconut oil is great for me to build up a tan, I never use sunscreen. I have also stopped using soap, schampoo and toothpaste. Richard, do you use toothpaste ?

    • Swedish:

      Yea, sometimes. I have some tree oil thing I got from whole foods. Otherwise, I just use a dry brush, which is more effective that wetting it, first. And when I travel, just the brush.

      • Are you aware that tea tree oil (and lavender) are estrogen mimics? They have feminizing effects. I avoid toothpaste, shampoo, mouthwash, and deodorants that contain them.

      • Looks like it doesn’t after all. It’s Nature’s Gate and says it contains cranberry, pomegranate, white tea, grape seed, aloe, ginger and bisabolol.

        Another one I have is JASON, which has fennel & peppermint.

  17. Oh and BTW, Richard, if you dare to expose Abbott Labs again, we will send in the black ‘copters, gnome sayin’?

  18. Gary Katch says:

    I’m thinking that the modern ritual of obsessive skin cleaning followed by the liberal application of chemicals is a bad double-whammy. We have a plethora of products to strip one’s skin of all its natural oils and kill as many bacteria as possible. This is followed by the artificial hydrators, creams and lotions to try to undo the washing.

    I went soapless last year and my skin is doing fine. I’m also part of the D*Action vitamin study. After my last blood test I decided not to supplement at all going into the summer. Being recently retired, I’ve had more time to get afternoon sun. However, I am having a very difficult time getting a tan! I wonder if my more natural state has left me more protected, as some other commenters suggested. I am of Ukrainian descent living in Montreal, so I’m probably at a good latitude for my pigmentation.

  19. Thanks for this, Richard. I just spent a weekend backpacking with girlfriends who slathered on the industrial-strength sunscreen and proselytized about it. I can tell they felt very good about themselves for being so virtuous. I mumbled something about how the best sunscreen is a suntan. Who’s the only one out of four who came back without a sunburn? Oh yeah. Me. Don’t even get me started on the cholesterol garbage I had to sit through.

    It’s so funny you say that about the sun, I say it too. How can the giver of all life on Earth be so wrong for us? Answer: It’s not. Besides, how do we explain that the incidence of melanoma is higher in sunscreen users?

    Derms aren’t the only ones who suffer from such myopia. Medical specialties are always focused on their own goals to the exclusion of everything else, often including common sense.

  20. Susan@PrimalRecipe says:

    I’m a white girl – as white as one can get. And I try to ease into the sun every summer. But by now, I can do a good stint of time in the sun without needing sunscreen. And I always feel great after. The only time I use it is if I am going to be out on the lake in a boat for a few hours or in some other extreme situation like that. Otherwise, it ain’t pretty. So while I agree that sunscreen can be all about making money on doesn’t need to be applied every time you leave the house, it really saves me a few times each summer.

    • Good point. Being on the water for an extended time can be very extreme due to the reflective nature of the water. Snow too, but that might actually be a way to get good UV during the winter on a sunny day.

  21. Don’t badmouth dermatologists too much. A good early excision of a possible melanoma can save your life. I had a thin melanoma excised in my 20′s. Now I get some sun for the vitamin D, and get some shelter with sun filtering clothing & a hat, but I also get my hide inspected regularly, both by my husband and a dermatologist.

    Nonmelanoma skin cancers don’t scare me so much. But if you’re pale with a history of excessive burns as a kid, and you’ve got a new dark spot that starts changing colors and spreading, yeah a dermatologist can save you from a world of hurt.

  22. People evolved in the sun, and I’m pretty sure that hunter-gatherers, who spent most of the day – well, all of it – outdoors, all died of melanoma – or used some liquid plastic on their skins! The skin is an indicator – if it’s unconfortable, it’s dangerous – if you are not adapted to strong sunlight, then go inside after adequate exposure or use sunscreen (I had to on holiday in Cyprus – otgerwise I’d come back red and not brown!)

    but some medics say that you have to wear sunscreen INDOORS for the light filtering through the windows. What’s next, Big Pharma, living in a coffin? We’re not vampires!

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