Time to sunburn(deepnote.com) |
Time to sunburn(deepnote.com) |
"There is little evidence that sunscreen decreases 25(OH)D concentration when used in real-life settings, suggesting that concerns about vitamin D should not negate skin cancer prevention advice. However, there have been no trials of the high-SPF sunscreens that are now widely recommended. What's already known about this topic? Previous experimental studies suggest that sunscreen can block vitamin D production in the skin but use artificially generated ultraviolet radiation with a spectral output unlike that seen in terrestrial sunlight. Nonsystematic reviews of observational studies suggest that use in real life does not cause vitamin D deficiency. What does this study add? This study systematically reviewed all experimental studies, field trials and observational studies for the first time. While the experimental studies support the theoretical risk that sunscreen use may affect vitamin D, the weight of evidence from field trials and observational studies suggests that the risk is low. We highlight the lack of adequate evidence regarding use of the very high sun protection factor sunscreens that are now recommended and widely used."
EDIT Forgot my link: 1. https://www.hhs.gov/sites/default/files/call-to-action-preve...
Sunscreen definitely prevents sunburns, and almost certainly delays visible skin aging/weathering. Those may be enough benefits for some people.
But the people/populations using more sunscreen are also having more skin cancer. Some theories compatible with these observations are:
• While preventing sunburn pain, sunscreen doesn't prevent the actual cancer-causing skin damage - and thus by allowing more time to be spent in the sun, actually worsened skin cancer rates. (This may have especially been a problem for the 1960s-1990s, when it was thought that only sunburn-causing UVB contributed to skin cancer - so sunscreens only blocked UBV. That encouraged increased exposure to the mostly-unblocked UVA, now understood as an equal contributor to skin cancer. More recent sunscreens block UVA as well.)
• Known carcinogens commonly used in sunscreens, or present as contaminants, are actually causing increased rates of skin cancer.
Anyone whose true worry is skin cancer should use shade & limited times of exposure - not sunscreens. (Ensuring a spaced-repetition of gradually-increasing exposure, to develop a natural tan without ever reaching a peeling burn, is also likely naturally protective against skin cancer.)
Further, while endogenous Vitamin D production relies on sun exposure, and low Vitamin D is correlated with health problems, oral Vitamin D supplementation may not replace all the benefits of sun exposure.
Generally, large population studies show positive effects of moderate sun exposure on many health outcomes, including overall longevity, heart disease, and non-skin cancers. Meanwhile, Vitamin D supplementation studies have usually not found that such supplementation alone reverses the correlations of many diseases with low Vitamin D. Thus, Vitamin D may not be the only mechanism by which sun's benefits are achieved.
So rigorous sun-exposure-minimization, even if it does reduce (often benign or increasingly survivable) skin cancers, may increase overall mortality through higher heart disease & other cancers. (Your HHS report mentions 9,000 skin melanoma deaths per year. There are 650,000 heart-disease deaths and 600,000 other cancer deaths.)
Get sun. Use shade, clothing, & timing to ensure it's not so much sun that you peel. Use sunscreen sparingly, only when you can't moderate sun exposure other ways.
UVA has also been shown to lower blood pressure. This is probably the result of UVA causing the release of nitric oxide from skin stores, which promotes widening of blood vessels. It also acts as an antioxidant to prevent damage to cells.
People who don’t get enough sunlight have altered cellular defense mechanisms that predispose them to excessive inflammation, which can result in autoimmune diseases.
One could argue you can supplement to replace VitD, but are you supplementing your children? From what age? How regularly? What's the quality of the supplementation? How do the poor maintain access to supplementation?
Then you run into the problem that long term, large(r) doses of Vitamin D causes kidney problems.
A study ( https://pubmed.ncbi.nlm.nih.gov/21430082/) found an association between low vitamin D levels and the development of type 2 diabetes. For every ten-unit decrease in blood vitamin D levels, we found a 10% increased risk of developing this form of diabetes over the following five years. when they gave supplements of vitamin D to patients with low vitamin D levels who were already at risk of developing diabetes, there was no overall improvement in their sensitivity to insulin. Nor was there a change in their blood glucose levels compared with those given inactive tablets.
I'm betting, not just in this case, but the act of your body making it's own VitaminD creates benefits we are not yet aware - that oral consumption of a pill isn't going to compensate for.
nevermind MOST of VitaminD pills use soybean oil or some other horrible Omega-6 ridden, cheap seed oil as it's delivery method.
Outside time in the sun is helpful in ways not tied to VitD, as well. circadian rhythms are regulated by bright light exposure. You can't get these lumens by waking up and sitting inside all day. The heat from the sun is capable of reducing physical stresses on the body’s cells and by increasing heat production.
Another important potential effect of sunlight is UV-induced suppression of the body’s immune system. Solar radiation does this by altering the activity of the white cells involved in turning on the body’s defence mechanisms. This may seem like a negative, but it's vital for people to reduce inflammation and when considering how the earth's population spreads out autoimmune disorders (higher percentages the more you get away from the equator), this may be a secondary factor on top of VitaminD.
IMHO -
people need to find a balance with sunscreen and sunshine. if you know you're going to risk a burn, put it on and reapply when necessary.
if you're worried about cancer, eat some cruciferous vegetables regularly to make sure you get lots of sulforaphane which protects against skin cancer. Get regular derma checkups.
but when looking at auto-immune issues (that once you have one, your supplementation isn't going to undo it), the depression issues, and so forth - isn't worth skipping out on sunshine.
Skin cancer may be the most preventable but it's also a fairly unlikely cancer, as far as cancers go - and while it's one of the scarier cancers, catching it early with derma appointments is key to survival. Catching it early has a high survival rate.
An auto-immune issue, on the other hand, will shorten your life and make you suffer along the way, increasingly, for the rest of your life. It's not just a death sentence. It's a slow-slog through hell on the way there. Most people never go into a permanent remission of Ankylosing spondylitis or MS. It just slowly destroys you, it handicaps you, and then it kills you. And along with all that suffering, is your kids, parents and partners suffering right along with you. Yay - therapy sessions for everyone.
It's not just auto-immune issues. Depression, anxiety, even certain cancers themselves all have some relation to low vitamin d.
IMHO - sunlight needs to have it's saturated-fat moment where we realize that a lot of the fear mongering simply wasn't warranted. And that the cures for some diseases end up being the catalyst for many others that are far more likely.
How many people are afflicted with an autoimmune issue? how many with debilitating depression? Compare those numbers to skin cancer. Compare the deaths. Compare the suffering.
Then try to find a balance.
>Nonsystematic reviews of observational studies suggest that use in real life does not cause vitamin D deficiency.
yeah, but that's an observational study.
I'm not anti-sunscreen and if you burn or get dark/deep freckles easily, I'm even more "pro" sunscreen for you.
But when looked at the number of diseases and problems correlated to Vitamin D deficiency and looking at the relatively low risk of contracting melanoma (as scary as that cancer can be if caught late), to me it's a balancing act.
Consuming mass amounts of VitaminD over long periods of time, orally, can cause kidney problems.
If you look at auto-immune issues globally, the percentage of the populations that have them sky rocket the further you get away from the equator. Depression, anxiety, even certain cancers themselves all have some relation to low vitamin d.
Sunlight, the type that allows UV-B to penetrate your skin, is a human necessity.
And like a lot of things we need (Vitamin C and E, or polyunsaturated fats, carbohydrates, etc), too much of it will cause you problems and/or kill you, not enough of it will cause you problems and/or kill you. And trying to anecdotally perform some balancing act without constantly running tests on yourself, is difficult.
My rule of thumb is put on sunscreen if you are out long enough to risk a burn, re-apply when necessary. Otherwise, soak up the rays.
What counts as massive?
And is consuming massive amounts of Vitamin D necessary to prevent deficiency?
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Exception: Location not foundSo having an SPF of 50 increases a time 50 fold, which really puts things into perspective. Never leave the house around lunchtime without sunscreen.
Note: you do need to wait a few months for the fatty acid composition of your skin to turn over.
There are some studies that suggest this is true, such as: https://pubmed.ncbi.nlm.nih.gov/7561154/ (note: N = 13)
And Oregon State "Essential Fatty Acids and Skin Health" primer, which goes over what's going on in healthy skin. https://lpi.oregonstate.edu/mic/health-disease/skin-health/e...
Their conclusion:
> Supplementation with n-3 fatty acids in particular exerts protection from photodamage and photoaging.
This is the first time I'm hearing about a link between omega-6 oils and sunburn.
You've got to be careful to really apply multiple layers of sunscreen with UVA protection in order to get the skin-cancer-reducing benefits. A thin layer does not do it. Thick layers required, and be warned, you sunscreen label may be lying to you about how much protection it offers.
If only I could just buy sunscreen without having to worry about any of this shit.
Buy a higher quality sunscreen (there are multiple reddits for this exact purpose) and you will not get poisoned by benzene and it won't be greasy and smelly.
Fast forward a few years and I'm back to where the first few days mowing the yard will see me get burned. Give it a few weeks and I can go longer without a hat.
I would not rely on it overall tough.
This year i am experimenting with rashguards and big stupid floppy hats.
There are plenty of sunscreens out there which are not greasy and don't stink and you won't notice once you apply it.
sunbath is a noun, sunbathe is a verb
You can wear very lose light cotton clothing, hats and avoid too much direct sun. Further, going out regularly will typically keep a tan (for most).
The Amish have notoriously low rates of cancer and don’t use sun block AND work outside all day. I typically try to imitate their methods.
Sure, they are an adaptation. One that's best avoided _while you can_
Every time you get a "sunburn" and your skin turns red? That's DNA damage. The body is good at repairing that, but not perfect. Best not to take damage in the first place. And if you do, to at least reduce the total radiation amount.
We shouldn't be singling out people based on their appearance of course. But there should be more awareness that skin damage is cumulative, and skin should be protected as much as possible.
I regret not having done so when I was younger. As much as I hate sunscreen.
I don’t know much about the process but always classified it myself as damage/scars. Though I could see calling non-sunburn induced freckles scars or damaged skin (or undesirable) as being inaccurate and just insensitive to people born with freckles.
For example we of course have these types of “glasses” for infrared which is fine for humans because we give off significant quantities of infrared radiation, but lesser known is we also emit light in the visible spectrum, it’s just not enough intensity for our rods/cones or inversely our rods/cones are not sensitive enough to observe the visible light we emit. Anyway your invention would be cool, even if it just ratcheted up the existing visible light spectrum enough we could see ourselves glowing in the dark…it would give people a new appreciation for Carl Sagan’s quote that we are made of stardust.
<quote>
There is a popular misconception that SPF relates to time of solar exposure. For example, many consumers believe that, if they normally get sunburn in one hour, then an SPF 15 sunscreen allows them to stay in the sun 15 hours (i.e., 15 times longer) without getting sunburn. This is not true because SPF is not directly related to time of solar exposure but to amount of solar exposure. Although solar energy amount is related to solar exposure time, there are other factors that impact the amount of solar energy. For example, the intensity of the solar energy impacts the amount. The following exposures may result in the same amount of solar energy:
- one hour at 9:00 a.m.
- 15 minutes at 1:00 p.m.
</quote>
> It's a common misconception that speed determines how fast you get to your destination, but actually distance also matters. So speed does not reflect time to destination. Instead, speed lets consumers compare the level of relative quickness and that 60mph is quicker than 6mph.
Obviously we need to hold other factors constant. It's not a useful point in when talking about speed and I don't see the point in talking about SPF. And it certainly doesn't mean that time to destination is inversely proportional to speed.
As the article discusses it also depends on your skin. If you are a fair ginger then yeah, sunscreen is your life. If you are more swarthy then you can get away with some midday sun.
No you can't. Or rather, you shouldn't. If you have more melanin you obviously have more protection. But your skin will still get damaged by a midday sun, and it will age faster than normal.
This misconception that darker skin does not need protection is really harmful. Maybe that allows you to skip sunscreen for short periods of time, or in early morning, late evening. Not midday, unless "some sun" means just a few minutes.
and chances are you have a deficiency.
Most vitamins tell you to take 2,000 IU. Upper limits are typically stated to be 4,000 IU. But there's been no established harmful upper limit either.
This leads a lot of people into thinking more is better, this is doubly true if they have some kind of pre-existing condition that's linked to low VitaminD and they're desperate to heal themselves. They read quack stories on the internet about how 10,000 IU doses help cure MS and they do it too.
It's also made worse by so-called "smart" and "qualified" people like Dr Rhonda Patrick essentially turning herself into some pop-health guru and when she tells people what she supplements with (5,000-6,000 IU), many people feel she knows what she's talking about and copies her. But the reality is, she takes A LOT of supplements and she has zero idea how they all mix with each other, especially at the supplementation levels in which she's consuming them.
of vitamins that can be abused, VitaminD is mostly safe. But a lot of folks go a bit crazy with it and have hurt themselves.
VitD supplements are also, often, in soybean oil, which is horrible for you. VitD needs to be consumed with a fat, so If you're going to supplement, you spend the extra money for it suspended in coconut oil instead.
Why do you want to avoid this damage?
Sun exposure and solar elastosis (sun damage to the skin) is associated with reduced mortality from melanoma:
https://academic.oup.com/jnci/article/97/3/195/2544082?login...
and a literature review which backs this up:
https://adc.bmj.com/content/91/2/131.short
And sun exposure reduces all-cause mortality:
We are already aware of a direct benefit: the skin's production of Vitamin D uses up bodily cholesterol. External supplementation doesn't do that.
(I agree there are likely others we'll document later.)
Either way the multiplicative one is clear: 30 minutes of midday exposure with 30 SPF is approximately equal to 1 minute of midday exposure and so is minimal. That's helpful to know! And 50 is only moderately better than 30, but 30 is a lot better than 10 - the FDA page says nothing about this.
I merely want to provide a fuller explanation of what SPF is from an authoritative source, in this case the FDA.
So my question is how bad is it, really? Straw man arguments of folks being ridiculously tanned from tanning beds aside, is there much trustable discussion over mild tans?
Edit: Probably better asked in terms of my blister analogy. Is there benefit to getting tanned similar to building up callouses? Or is it purely cosmetic?
50% reduction in melanoma: https://pubmed.ncbi.nlm.nih.gov/21135266/
40% reduction in squamous cell carcinoma: https://pubmed.ncbi.nlm.nih.gov/10475183/
See, generally, https://www.skincancer.org/skin-cancer-information/skin-canc...
Perhaps you were thinking of basal cell carcinoma, the most common type of skin cancer. There does seem to be a lack of experimental evidence wrt BCC: https://www.hindawi.com/journals/jsc/2012/480985/ The skincancer.org FAQ conspicuously skips around that hole.
Your "50% reduction in melanoma" link is interesting, but pretty small & low-powered - and followup comments (such as https://ascopubs.org/doi/10.1200/JCO.2011.35.5727) highlight potential major problems in study design. For example:
• Study wasn't originally designed to detect effect on melanomas - that endpoint was added later. (This, alone, suggests possible p-hacking.)
• Instructions thus didn't even direct sunscreen application to the areas melanomas most often occur. Yet, at followup both control & intervention groups had a disproportionate number of melanomas in exactly the areas where application had been directed (and most applied, by self-reports, in both groups). As the commenters note, this is actually consistent with the theory that sunscreen encourages overexposure moreso than it protects.
• Small changes in arbitrary study choices - like to what extent back/leg melanomas were considered (when those areas weren't part of the encouraged sunscreen-application area), or whether a 1, 2, or 4 year exclusion of early events applied – remove the claim of 'significance', suggesting a very fragile result.
If the protective relationship of sunscreen were real, it'd have lots of studies with robust results. Or, the massive increases in recent decades in SPF factors, sunscreen purchasing/use, and sun-avoidance messaging and practice would've reduced melanoma rates. Instead, melanoma rates keep going up. To me, that's far more powerful evidence than a repurposed study with 11 more melanomas (but fewer invasive ones!) in a slightly-less-sunscreen-using control group.
The squamous study is also murky, though not as much. Its abstract notes, "There were no significant differences in the incidence of first new skin cancers between groups randomly assigned daily sunscreen and no daily sunscreen (basal-cell carcinoma 2588 vs 2509 per 100,000; rate ratio 1.03 [95% CI 0.73-1.46]; squamous-cell carcinoma 876 vs 996 per 100,000; rate ratio 0.88 [0.50-1.56])." The same number of people got new skin cancers in both groups! It's only the secondary count of tumours where the control group had more. I'm unsure that's an important protective effect.
But going back, I really should have said: "no data showing more sunscreen reduces deadly skin cancers". There's a reasonable amount of evidence sunscreen reduces various kinds of mild skin-tumours, much like the obvious-to-the-naked-eye effectiveness against sunburns.
But for melanomas/death-by-skin-cancer – the top worry of most sunscreen users – any effect is either very weak, non-existent, or possibly even inverse.
I am curious to see a citation for this claim.
> Generally, large population studies show positive effects of moderate sun exposure on many health outcomes, including overall longevity, heart disease, and non-skin cancers. Meanwhile, Vitamin D supplementation studies have usually not found that such supplementation alone reverses the correlations of many diseases with low Vitamin D. Thus, Vitamin D may not be the only mechanism by which sun's benefits are achieved.
I am also curious to see these studies, and wonder if they control for other variables like physical activity.
I think it's an incorrect framework to say that you have to choose between skin cancer and heart disease, you can avoid both through different lifestyle choices.
Um, you missed the most obvious explanation (assuming that's even true): People who have an elevated risk of skin cancer (due to geographic location and/or skin type) are likely to use more sunscreen for that very reason, but despite their sunscreen use they're still at an elevated risk of cancer because sunscreen cannot eliminate all risk.
It's really no different than saying that people who are receiving more IV chemotherapy are also dying of cancer more often than people who aren't.
The public has been bombarded for decades with the health message to avoid the sun, and a deep tan has become less fashionable. (My younger friends, especially, treat minimizing tans/exposure as an almost religious obligation.)
Sunscreens have broadened the wavelengths they block – they used to mostly skip UVA, thinking it harmless – and upped their SPF factors. (In the 1980s, I recall SPF15 as the max - now it's SPF30, SPF80, SPF100.) Sales & usage of sunscreen keep growing.
But melanoma case rates are still on a long-term rising trend. Deaths have finally improved slightly in the last few years - likely from earlier detection & better treatment.
If the population's generally the same, but slathering on far more sunscreen every decade – but cases still go up & mortality barely budges – there's little hint of effective protection.
It is not so simple to come to this conclusion. You would have to establish that time spent in sun per person has not gone up, that per person use of sunscreen (good quality sunscreen) has gone up by a measurable amount, that it is being used properly, and the cancer is happening on areas where sunscreen was used. In addition, you would have to control for people living longer.
Note that the US population in less sunny and cold areas (Midwest and Northeast) has stalled for 3 decades compared to explosive growth in population in the South and West (sunny, warm areas).
https://www.outsideonline.com/2380751/sunscreen-sun-exposure...
(Most recently discussed on HN at https://news.ycombinator.com/item?id=23086211)
Similar doubts have existed for decades – here's a 1993 variant reporting some of the trends that already didn't add up, back then: https://www.motherjones.com/politics/1993/05/melanoma-sunscr...
Another branch reply provides more sources about sunscreen chemicals & sun-longevity correlations: https://news.ycombinator.com/item?id=27520144
Depending on your skin type, "Get Sun" may not be good advice, especially if you make a mistake. A single significant sunburn in your teens significantly increases your lifetime risk of getting a skin cancer, of which melanoma is just one. My wife developed melanoma and is in remission. She is fair skinned and very sun-cautious -- typically using clothing as a primary barrier with sunscreen. Like anything risk assessment and risk tolerance is key and difficult to assess.
Another factor to consider is that mortality doesn't always tell the story. Some surgical procedures introduce significant scarring. Treatment for a stage-2 melanoma will often include removing lymph nodes, which introduce other complications. Also be careful, as past diagnoses of cancers were not great. That melanoma that moved into an organ may not have been classified correctly in 1960.
Personally, my advice is go outside, dress appropriately and use a mineral-based sunscreen if you're going to be out for more than a half hour or so. Don't go swimming at solar noon. Don't tan. Wear a rash-guard at the beach. Wear a hat at the ballgame.
Also, as anyone who burns easily will be well aware, sunscreen is almost impossible to use properly in the real world. You need to cover every inch of your skin and reapply every 60-90 minutes and make sure not to let it wash off by going in the water too soon or sweating too much, make sure not to rub it off with clothing or towels, etc.
The first part of your advice makes sense in light of this - shade and clothing are much more practical ways to stay safe if you’re outdoors all day and burn easily.
“Use sunscreen sparingly” is just stupid advice to be giving though. There is much more evidence to it helping than doing any harm.
https://www.webmd.com/skin-problems-and-treatments/news/2020...
Contamination of sunscreens with common dangerous byproducts of industrial processes like benzene is common:
https://www.washingtonpost.com/lifestyle/wellness/benzene-su...
By comparison, shade contains no carcinogens.
Sun exposure correlated with longer life (even while also being correlated with more cancer deaths!):
https://www.health.harvard.edu/blog/heres-something-unexpect...
An earlier broad survey also finding natural sun exposure decreasing all-cause mortality (but not use of tanning beds, despite similar effects on Vitamin D production, again suggesting D-supplements alone don't replicate the sun):
https://cebp.aacrjournals.org/content/20/4/582
I'd agree, it is hard to disentangle these correlations with things like general levels of outdoor activity and socializing.
But even so: if people who are healthy for other reasons tend to spend more time outside in sun, maybe it'd be a good idea to join them, & perhaps absorb their other habits as well, rather than live in fear of the sun? (Maybe even the sun is damaging on many levels, but the other benefits of activities inherently done more under the sun offset those effects, even if just via mood/optimism?)
I'd say instead that it's an incorrect framework to embrace an illusion of total control "through different lifestyle choices" without tradeoffs. Every activity has a mix of risks and benefits. Certain vigorous activities with a higher risk of accidental death may deliver other fitness and social benefits. If an extra 5 hours of sun every week doubles melanoma death risk, but reduces cardio/cancer death risk just 1%, that sun would still be a net-mortality benefit.
Such tradeoffs are real & everywhere. Trying to engineer both benefits – "can I do everything other healthy people do usually do outdoors indoors? can I find the least-dangerous sunscreen? will vitamin D supplments, perhaps with a bunch of other diet changes, simulate the sun's benefits?" – also includes costs, in research time, psychological focus, neurotic behaviors, etc, for diminishing returns.
I suppose I am assuming callouses aren't really bad for you? Is that not true?
That is, I've been assuming there is a spectrum from no exposure to too much. Just as it is with plants. Now, plants obviously need some exposure for photosynthesis. People don't have that, but are there benefits to some base level exposure?
And again, I get the point on burning. And again, that is why I bring up blistering. Something that is obvious in it being bad damage for your skin. Whereas moderate dosing the same behavior could instead give you a callous, which I have never heard called out as bad damage to your skin, though it seems it is a form of damage.
But as a longtime observer of trends, I'm pretty confident: people of all ages are conspicuously, consciously avoiding the sun more than in the 60s-80s. Indoor time has risen. Our palest most-sun-sensitive subgroups haven't increased as a proportion of the population - they've shrunk, compared to darker-skinned populations with lower base rates of melanoma.
If contra my impressions, sun exposure time has gone up, that could be due to overconfidence in sunscreens, one of the effects I'm concerned about.
If sunscreens provided the protection claimed, & this drumbeat of "slather it on always!" was an effective message, shouldn't there have been some dent in melanoma rates over the decades?
Lung cancer deaths have gone down with smoking warnings & reduced sales.
Motor vehicle deaths per mile traveled have gone down with new rules & education.
Melanoma rates seem to go up no matter how much more sunscreen is touted, is sold/used, or is strengthened in SPF or formats/staying-power.