Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
29 Apr

Why Some Sun Exposure Will Protect You from Deadly Skin Cancer

THE SUNHow does sun exposure relate to skin cancer risk?

The simplistic, popular story is that sunlight exposure has a linear relationship with cancer, similar to how we view smoking. None is safest and each additional minute in the sun will increase our chance of getting cancer. Many people (maybe most) therefore live in a world with danger lurking beyond every shadow, umbrella, overhang, and roof. You let your kid go outside without a layer of sunblock so thick he looks like he’s been smashed in the face with a whip cream pie, and you’re a terrible mother. And don’t even think about the beach unless you’re wearing a burqa. It’s even got a scary name: ultraviolet radiation. Radiation! Isn’t that the stuff inside nucular bombs?

The relationship between sun exposure and skin cancer is far more complex than you’ve been led to believe. While clearly too much sun is a causative factor in skin cancer of all types, it’s not clear what “too much” means. Is there a U-shaped curve where none is bad, some is good, and too much is bad again? What about other factors, like skin color, hair color, propensity to tan versus propensity to burn, and time of day?

We already know that living in areas that get more UV radiation seems to be protective against other types of cancers, like prostate cancer, lung cancer, colorectal cancer, leukemiabladder cancerpancreatic cancerbreast cancer, and lymphoid cancers (I probably could have kept going, but my fingers were getting tired).

Okay, but what about cutaneous malignant melanoma (CMM)? It’s not the most common kind of skin cancer, but it’s by far the deadliest. Is it worth the tradeoff if we increase our risk of CMM?

When we combine the estimated number of annual diagnoses for the cancers I just mentioned in the US, we get a staggering figure: 1,071,000. What about melanoma? 76,100. Incredible, huh? Getting adequate amounts of ultraviolet radiation (scary!) may very well reduce the incidence of cancers that are afflicting over a million Americans each year. Even if the dermatologists and sun alarmists are right and melanoma risk increases linearly with sun exposure and ultraviolet availability, the protection we get against so many other cancers (and the tan, and the sublime feeling of the sun on your skin) might make the tradeoff worth it. That’s clearly, objectively true, at least on the population level. Melanoma just isn’t as large an absolute threat as the totality of other cancers.

Every reader of this blog is likely aware of the importance of vitamin D in the body. The vital pro-hormone, which also comes in supplement form, helps regulate skeletal, cardiovascular, immune, hormonal, and dental health. A deficiency can cause rickets, osteoporosis, muscle wasting, and various hormonal deficiencies. Low levels are linked to heart disease, autoimmune diseases, all cause mortality, and many cancers. These are the systemic effects that get the most attention, but what if the dermatologists and sun alarmists were wrong, or at least a little misguided in their binary opposition to any and all sun? On the surface, it seems counterintuitive that an act that has so many proven anti-carcinogenic and health benefits – getting enough sunlight to optimize vitamin D levels – would increase our chances of getting another type of deadly cancer. It’s possible, but it’s odd.

And there are some other curious facts that muddy the neat, tidy relationship between sun and skin cancer:

Vitamin D (produced in response to UVB exposure) kills melanoma cells. Researchers posit that vitamin D levels around 70 nmol/L may be optimal for protection against melanoma.

There’s also the recent study that suggests smart sun exposure has beneficial, anti-cancer effects at the skin level. Contained within our skin cells are RNAs that do not synthesize proteins, called non-coding RNA. When vitamin D is produced in the skin cells, it triggers these non-coding RNA to go into protective mode. They reduce carcinogenicity and induce tumor suppression. It’s unclear whether oral vitamin D “makes it into” the skin to have the same protective effect. If anything, supplementary vitamin D will deliver the systemic benefits to bone, heart, immune system, and endocrine system thereby reducing the amount we have to produce at the skin level to get the desired anti-carcinogenic effect. But you still need some sun exposure to get it.

Okay, given what we know about vitamin D, it’s easy to buy that it can be protective to a point. Some sun is helpful. Cool. Surely, though, those who get the most sun get the most skin cancer. You have to imagine that outdoor laborers, lifeguards, and other people who spend all day outside in the sun, have way more skin cancer than indoor workers. Right?

It doesn’t seem to be the case:

  • “Recreational” sun exposure – weekend outings, vacations, and other forms of intermittent exposure to the sun – is usually associated with greater melanoma risk than chronic sun exposure.
  • “Occupational” sun exposure – the kind outdoor workers or other groups who spend lots of time in the sun on a regular, consistent basis – is associated with lower rates of melanoma. In fact lifetime sun exposure is associated with a lower risk of melanoma.
  • In Ireland, non-melanoma skin cancer is increasing among the young, urban, and affluent. The authors suggest that the young, urban, and affluent have more free time on their hands, and they’re spending it outdoors. Okay, but the biggest increases in skin cancer in this demographic are occurring in clothed body parts – the swathes of skin that get the least amount of sun exposure.
  • Body parts that get the most sun have the lowest rates of melanoma.

It actually makes sense that going from habitual sun avoidance (working inside all week, getting out on the weekends every once in awhile when you can find the time) to full-on sun exposure (vacation in the tropics, an all day beach excursion) would be bad for you. Indoor skin simply isn’t ready for high UV exposure, and it will burn more easily in response to it. Sunburning definitely increases the risk of melanoma.

Plus, indoor workers still receive UV exposure, just differently. They might see the sun in the morning, through the windows during the day, and after work in the late afternoon. Both morning and late afternoon sunlight have very little vitamin D-producing UVB; it’s almost entirely UVA. Midday sun (you know, the sun they tell you to avoid at all costs) is the only kind with appreciable levels of UVB. And even though office workers get modest levels of sunlight through windows, those windows filter out the UVB and leave only the UVA.

As explained in a 2008 paper (PDF), isolated UVA degrades cutaneous vitamin D while failing to produce any to replace it. So these indoor workers aren’t making any vitamin D and what little they do produce is being broken down from all the UVA they receive.

But wait: although UVA promotes melanoma progression, UVB initiates its formation. Animal models show this. And the connection between sunburns (which are caused by UVB) and melanoma supports it. So isn’t UVB the real problem?

As stated earlier, intermittent and excessive exposures of UVB (“recreational sun exposure”) which often result in sunburns are the problem. It just so happens that the people most likely to get recreational, intermittent, condensed sun are the people who work indoors and go most of the year with low vitamin D – from lack of consistent UVB and from excessive low level window-filtered UVA. People with occupational exposure are getting UVA and UVB in consistent doses, enough to keep the vitamin D levels topped off and nip any budding melanoma cells before they can progress.

How does all this translate to the real world?

Don’t fear a healthy base tan. Contrary to popular opinion, a tan isn’t “already too late.” People who tan well (as opposed to the sun-sensitive types who burn easily) have greater resistance to skin cancer and people who maintain a year-round tan have a lower risk of melanoma.

Avoid burning. Burning is still bad. It’s negative feedback from your body regarding your excessive exposure levels.

Go out at noon. This is when UVB and vitamin D production are highest. The popular advice “that sun exposure should be avoided for three to five hours around noon and postponed to the afternoon” is likely “wrong and may even promote CMM.” Another way to determine UVB availability: go out when your shadow is shorter than you.

Don’t go from zero to sixty. Don’t go from spending the past three months indoors to tanning for hours-long stretches. Work your way up gradually, minute by minute. Start small, especially if light skinned/red haired/blond.

Move around. Don’t “lay out.” You don’t want to expose a single body part to the sun for an extended amount of time. Go do stuff that exposes different parts of your body: garden, lift weights, hike, swim, that sort of thing.

Consider vitamin D supplementation. It delivers the desired systemic effects to bone, heart, immune system, and endocrine system, thereby taking a load off the skin, which can save some D3 for its own protection, and increasing your resistance to the sun. Anecdotes frequently report increased resistance to sunburns upon vitamin D supplementation.

Get your nutrition in check. There are many “internal” measures you can take to increase your skin’s resistance to sun damage. I outlined several of them here.

Get your sleep in check. Our resistance to the sun follows a circadian rhythm, with our defenses strongest in the first half of the day. So you might not want to go tanning after an all-night bender, nor do you want to get too much UVA-rich sun in the late afternoon when your defenses are down.

I hope I cleared up some confusion. If not, feel free to send along any questions.

Thanks for reading!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. You know, there’s been a few things I’ve done over the years that’s counter to CW: don’t stretch before your muscles are warm, you do not need 8 glasses of water a day, coffee is not the diuretic everybody tells you, don’t fear the sun: fear the sunscreen!

    Not sure if there’s some ancestral memory that told me these things, or whether I was just going against the grain (ha!), but lately there’s been a lot of evidence to support those viewpoints. Maybe, deep down, we should listen to ourselves more often?

    Cody wrote on April 29th, 2014
    • I agree, Cody. I never stretched before running–it didn’t feel good. Stretching a bit if I felt like it partway through the run, if something was a bit tight, that felt right. I ran for 32 years without injury. Same with the coffee and water. That always sounded nutty, that a 115 pound woman should drink 8 glasses just like a 300 pound man, or that coffee would dry you up. Never cared to force things.

      Joy wrote on April 29th, 2014
    • Ha! Pretty much coffee and wine are the only liquids I drink. Unless I’m actually thirsty and then I drink water.

      Diane wrote on April 29th, 2014
  2. Nice! Stay in the sun as long as your body’s innate warning system kicks in – getting flush (and hopefully a little before). If you HAVE to go out for long periods then make sure to use FULL SPECTRUM sunblock. These two points are pretty critical for most people.

    Dr. Anthony Gustin wrote on April 29th, 2014
    • Or once you reach that point, cover up. I’m still a little wary of slathering that crazy list of ingredients on my skin…

      Stacie wrote on April 29th, 2014
  3. how long should we be supplementing with Vit D before a week long trip to Mexico?

    Merky wrote on April 29th, 2014
  4. Mark,

    with regard to maintaining a year-round tan and melanoma risk, you seem to have misread the conclusion of the study you link to:”Maintenance of an all-year tan provided no protective effect against melanoma” (“…after adjustment for tendency to burn.”) – Or am I missing something here?

    Karl wrote on April 29th, 2014
    • In addition, it should probably be mentioned that, while things appear to be paradoxical with regard to CMM, non-melanoma skin cancer risk seems to indeed be consistently and linearly linked to lifetime sun exposure – the curious case of the Ireland yuppies and their clothed body site-cancers notwithstanding.

      Karl wrote on April 29th, 2014
    • It doesn’t seem likely that someone with a strong “tendency to burn” would maintain a year-round tan, so I don’t see how they could “adjust” for this unless there’s some goal-seeking going on in here.

      For those of us who do burn, but who also tan if we get frequent short exposures which then protect us from burning if we get a longer exposure, it seems like there could be a protective affect, as well as the protective affect for all the other non-skin cancers mentioned…

      Superchunk wrote on April 29th, 2014
      • “It doesn`t seem likely that someone with a strong “tendency to burn” would maintain a year-round tan,…” – maybe so, but that doesn`t mean you can`t mathematically adjust for it. Still, I get where you`re coming from; the conclusion of the study seems counterintuitive to me, too. Alas, being counterintuitive isn`t necessarily synonymous with being wrong.

        Karl wrote on April 29th, 2014
  5. Ever since I had my vitamin D levels checked (low–allergic to dairy–go figure!), and supplemented with enough D-3 to raise my levels into the 80’s, I haven’t had to wear sunscreen at all while outside mowing, pulling weeds, yakking it up with neighbors over the back fence, etc.

    Wenchypoo wrote on April 29th, 2014
    • Have you found a supplement that works. I supplement 4000iu a day and have my healthy fats in check and all that. Blood test still showed slightly low D3 levels. I can only surmise I am using low grade supps.

      BFBVince wrote on April 29th, 2014
      • 4000 IU/day probably isn’t enough for you. Vitamin D levels depend on a variety of things – age, general health, weight, etc. Some people just don’t absorb D as well as others, either from supplements or from the sun. Try upping your daily dosage to 8000 or 10,000 IU. You can take 10,000 IU every day just about indefinitely. I took 12,000 IU every day for well over a year with no harmful effects. I now take 8000 to 10,000 IU daily to keep my level around 75 ng/ml.

        Shary wrote on April 29th, 2014
      • Vince,

        what kind of Vit D you are supplementing with? Prefer the D3,not the D2!

        Where are your levels now, below 40ng/ml? How long did you wait between starting the supp and testing?

        Markus I wrote on April 29th, 2014
        • I am using Nature Made D3 (cheap stuff from the grocery store). I don’t remember the exact level but I know it was lower than optimal, around 40 is what I think. The doc’s suggestion was try a different brand? Thanks for the comments, this article is well timed as it pours in NYC.

          BFBVince wrote on April 30th, 2014
        • Vince,

          either you did not wait long enough to get an equilibirum between intake and consumption of Vit D or you are simply taking not enough. 2-3 months would be a fair amount for that. If you are taking the pills already longer reach out for a higher dose, e.g. 6000 IU.

          What’s your weight? All my calcs are for the 140-180 pound range…so feel free to add proportionally for another weight!

          Actually you are at 40 (ng/ml I assume?) .What result had your initial measurement? What’s the timespan between those two lab tests?

          Markus wrote on April 30th, 2014
      • I take Biotics Research Bio-D-Mulsion Forte® (2,000 IU) which are emulsified drops that you put on the tongue & are absorbed into the bloodstream that way, therefore bypassing the digestive system. They are very well absorbed, so you don’t need too much. I used to take 2 drops daily (4000iu) & my vitamin D results came back as 115mg/mL (far too high!) I never go out in the sun, hardly ever expose any bare flesh to the sun and don’t eat fish or dairy due to allergies, so I found that hard to believe. Anyway I stopped the vitamin D for 2 months & tested again. The level had gone down to 88mg/mL which is still on the high side, so I left off supplements for another month & then started back taking one drop every other day (making it 1000iu a day) & tested again. The levels are now optimal but not excessive. However, I do find it hard to believe that I only need 1000iu a day, although I am very small, so maybe that is why? The other thing I wonder though, is if I have a polymorphism, so that although the level seems okay in the bloodstream, maybe it is not actually reaching my cells? However, when I was on the 4000iu a day, I was getting frequent headaches which I now don’t get which is a sign of vitamin D toxicity, but I also wonder if it is because I don’t have enough magnesium to support the D?

        Christine wrote on May 2nd, 2014
        • I am 6’4″ ~200lb so not small. I have never heard of Biotics research, very interesting. I’ll probably up the dose on my D3 pills till the bottle is gone then look to switch to something a little more effective. Dr. Rhonda Patrick has really been stressing the importance of D3 on so many processes in the body (Magnesium too). I would definitely stress taking magnesium before bed every day.

          BFBVince wrote on May 2nd, 2014
  6. thoughts on tanning? say 10m a week for an office dweller?

    gary martins wrote on April 29th, 2014
    • Go for a walk around your office’s neighborhood a few times a week at lunch man!

      Eric wrote on April 29th, 2014
      • I already do this, given I work in an office I’m fully clothed hence very little light exposure (I live in New Hampshire where it’s quite cold most of the time)

        gary martins wrote on April 30th, 2014
        • I live in LA and I have the same same problem minus the cold. I can go for a walk at lunch time but only my face, neck, and hands are exposed.

          PatrickP wrote on April 30th, 2014
        • Same problem here in Michigan…especially this year.

          I guess that’s why I finding issue with Mark’s comment about “not laying out”.

          Mark said, “Move around. Don’t “lay out.” You don’t want to expose a single body part to the sun for an extended amount of time. Go do stuff that exposes different parts of your body: garden, lift weights, hike, swim, that sort of thing.”

          But when you gardening or hiking much of your body is covered or shaded by other parts of your body…when I hike my legs rarely get exposed to the sun…the most exposed parts are my face and forearms. And with swimming…if I’m actually swimming, my face is the only thing out of the water. Even a day at the beach, if you’re not laying out gets mainly your back, face, shoulders, chest and arms…the most regularly exposed stuff.

          Laying out exposes all of your body…not overexposing just some parts…and I would think that would help you get your Vitamin D faster and thus not need as much time in the sun versus activities that mainly expose your face and arms.

          Jenna wrote on April 30th, 2014
  7. Very informative article, Mark. I didn’t know that the UVA coming through windows broke down vitamin D in the skin. That fact alone is worth the article.

    As I was reading your article I kept thinking, “Well, I can’t avoid working indoors, and in Seattle sunlight is as precious as gold. What can I do?”

    Thanks for offering a solution at the end. I supplement with vitamin D, and I take fermented cod liver oil. I do not burn easily anymore, but then again I am cautious around sunlight. Your article cleared up a lot for me, and now I have a strategy for my very pale-skinned son.

    C L Deards wrote on April 29th, 2014
  8. There can’t be much of a link between skin cancer and sunshine – I’ve had skin cancer twice yet live in the UK!

    Stevemid wrote on April 29th, 2014
    • …contended no one with a basic understanding of pathogenesis ever.
      (“There can`t be much of a link between lung cancer and smoking – I have lung cancer, yet have never smoked.”)

      Karl wrote on April 29th, 2014
      • It seems your understanding of pathogenesis is better than your basic understanding of humour.

        Stevemid wrote on April 29th, 2014
        • That`s quite possible – after all, I`m a German Aspergerian.

          Karl wrote on April 29th, 2014
        • (Sorry for the blunder.)

          Karl wrote on April 29th, 2014
        • No problem! Self deprecating humour is quite a British trait I believe.

          :)

          Stevemid wrote on April 29th, 2014
  9. I am extremely fair skinned. I have literally gotten a sun burn in the car in the traffic on the way home from work. Just not sure how to play this one…

    BJ wrote on April 29th, 2014
  10. A moment of vanity here . . . no mention of wrinkles and age spots due to sun exposure :(

    Closet Librarian wrote on April 29th, 2014
    • YES. Thank you for pointing this out. I always make sure to get my limbs nicely exposed to the sun, but the face–never!!! It’s endocrine-disrupting sunscreen all day, every day. I am frankly annoyed that Mark never addresses the wrinkles issue (sorry Mark.) I’m not worried about skin cancer, but I don’t think anyone can assert that sun exposure won’t exacerbate wrinkles, though I’d love to be wrong about that.

      tkm wrote on April 29th, 2014
      • I can’t remember in which article, but I’ve heard Mark address this issue before. He said something along the lines of “definitely cover up the face if you are worried about wrinkles”.
        I usually prefer to wear a hat rather than put on sunscreen.

        Prime Time wrote on April 30th, 2014
      • I’ve been searching for the article for a while, but I really can’t find it. I was sure I heard him say that, but I’m starting to think I heard that somewhere else and I’m putting words in his mouth.

        Prime Time wrote on April 30th, 2014
        • thanks for trying!

          tkm wrote on May 1st, 2014
  11. From what I’ve read and personal experience, it is essential to get enough K2 when taking D. Somewhat hard to get K2 from food, especially if you don’t do hard cheeses. (I do eat them.) When I have supplemented with D3 without K2, I have gotten a bunch of kidney stones. Every time. Mark has written about K2.

    Harry Mossman wrote on April 29th, 2014
    • Also, sunlight on your skin is what turns cholesterol into sulfates, absolutely necessary for many, many cellular processes. Check youtube for Dr. Stephanie Seneff’s seminar on the subject. She is also an expert in the science of Glyphosates (Roundup) and their effects on living organisms. Dr. Seneff is an MIT scientist and a member of the WAPF.

      Gordon P. wrote on April 29th, 2014
      • I recently listened to a podcast: Is Sulfur the Missing Link in Heart Disease and IBD? by Steven Wright. Steven interviews Dr. Stephanie Seneff.

        http://scdlifestyle.com/2013/03/sulfur-heart-disease-and-ibd

        I thought this was very interesting – one of the better podcasts I’ve heard, lately (it’s a year old, though).

        I was drawn into listening to it based on the importance Dr. Terry Wahls has put on sulfer containing foods.

        I’m not throwing out my vitamin D supplements, but, it seems like my general attitude toward supplements has been a bit misguided.

        John Es wrote on April 30th, 2014
  12. A while back I read what I thought was a crackpot theory at the time. the author felt that it was the fact that people were now wearing sunglasses that was leading to the higher incidence of skin cancer – he had some stats from Australia that showed the rise in skin cancer in relation to when sunglass use began and linked to sun exposure. Something in there about the pineal gland was not getting the natural light stimulation to trigger some kind of protective effect when the eyes get exposure to sunlight. The sunglasses block this exposure so the gland does not realize the intensity of the sun and while you still tan – or burn- the protective effect is not triggered. interesting to see if any basis for this.

    TWA2W wrote on April 29th, 2014
    • That’s news to me, but, I *have* quit wearing sunglasses. Except, I wear the orange ones at night.

      John Es wrote on April 29th, 2014
      • Interesting. The Inuit up in Alaska made sunglasses out of seal bone so they would not go snowblind.
        I own a sunglass shop myself, and I also use BlueBlockers at night, but I recently quit wearing the sunglasses during most of the day. I do know that many American Indian fisherman also went blind at a fairly early age from looking into the water too much. I would like more info. on this stuff!

        Nocona wrote on April 29th, 2014
    • I read something similar but I only remember it in relation to sunburn not skin cancer. Still it would make sense.

      Oh do tell me this sun loving girl need not feel guilty about it. It certainly is good for the soul.

      JJ wrote on April 29th, 2014
  13. I live on the coast or Northern BC, Canada, where we get very little sunshine (relatively speaking) and very short days in the winter. It definetely takes a toll on mood and sleep. How does using a tanning bed for frequent short periods of time compare to exposure to real sun. I would love to tan frequently but my husband is worried that short periods of intense sun is much more damaging than exposure to the sun. Have you found any studies on this? Thoughts?

    Christine U wrote on April 29th, 2014
  14. Thanks again Mark for a great topic. However there is no reference to melanin, the light scattering compound that is produced by melanocyte cells in the skin. Our bodies produce this pigment to protect from damage from over exposure. More here: http://en.wikipedia.org/wiki/Melanin

    ZnO is a natural light scattering, melanin mimicking, compound that works as good if not better than any patented/expensive compound in commercial sunscreen. Or modern world has us escaping winter in Montreal to the Mayan Riviera. Sunscreen is necessary for extremes. I agree that consistent gradual exposure is best to let our skin protect ourselves naturally.

    jack lea mason wrote on April 29th, 2014
  15. > Get your nutrition in check.

    If the re-emerging metabolic (vs. faltering somatic) theory of cancer turns out to be correct, an LCHF diet with ample ketone precursors may well be highly protective against cancer of all kinds, including skin.

    Boundless wrote on April 29th, 2014
  16. Is there a relationship between omega 6 consumption and the propensity to sun burn?

    Anyone have any experience here?

    tw wrote on April 29th, 2014
  17. I was looking at that article you linked. I liked how the comments to her rant were almost universally negative. It seems that the word about Vitamin D is getting around. :)

    Wildrose wrote on April 29th, 2014
  18. I just have to say: As soon as I read the opening paragraph and scrolled down enough to the comment for tweeting, I did it! Without reading the REST OF THE ARTICLE!!! Did I just spread a dangerous word…like a cancer? ;) That article Mark linked to (you’re a terrible mother!) is so misinforming. It’s sad what people read for their news on what is good for us and what is not: and especially in this case, how self-critical we need to be because we’re just “irresponsible” if we “send [our children] off into the sun’s damaging rays] without applying sunblock. Laughable.

    I posted a comment and linked to THIS article! :) Thanks for all you continue to do Mark (and Minions!)

    Kevin Grokman wrote on April 29th, 2014
    • My son had blonde hair and blue eyes but can tan fairly quickly at the beginning of the summer. The only HORRIBLE burn he got was in Mexico when a concerned relative put sunscreen on him. He got such a horrible burn from the chemicals it felt like he was on fire and there was sand under his skin, and he didn’t even get any sun exposure. Grrrrrrrr, ask a parent before putting on sunscreen people!!!! Oh well, he knows to not allow anyone to put it on him now.
      I now make him go barefoot as much as possible in the warmer weather and we build his color carefully so he doesn’t have to have any kind of burn from either the sun or chemicals.

      2Rae wrote on April 29th, 2014
      • I now make him go barefoot as much as possible in the warmer weather

        Freedom. Let him try it. He might like it.

        Eric wrote on April 29th, 2014
  19. I burn easy, so in the Fall I start with the tanning beds, and build myself up to 15 minutes a week (high power beds). This gives me a good base, and I then enjoy my Mexico trips a lot more. I can take my shirt off for half and hour or more everyday and have fun on the beach.

    Tanning beds help a lot with SAD. I used to live in Juneau, and that place never gets much sun, but winter is really tough. Tanning beds really cheer you up. (So do natural light tubes over your desk, counter, etc.)

    I have never found supplementing with any amount of vit. D to be helpful with sun protection, though higher doses do make my skin ruddier.

    Rick wrote on April 29th, 2014
  20. I saw a significant difference in the way my skin reacted to the sun last summer (my first summer after being mostly primal). It was amazing. I tanned so well that people at work asked if I was still working full time (because apparently I looked like I played outside in the sun all day). Granted, I did spend a lot of time outside after work, and I live in Anchorage so the sun is still pretty strong from 5-7…but still, I really think my healthy eating habits had a lot to do with my ability to tan and not burn. Even on a trip home to Nebraska I didn’t burn. Just another reason to be primal! Hurray!

    Stacie wrote on April 29th, 2014
    • Stacie, a lot of us Primal-ettes have had that experience with the sun. Nice. I sat out in the sun for quite a bit last summer and nary a burn on any day. I go to AZ to visit my folks and no burns there either. I’m going to try to tan a bit more thru the tanning bed if we are still here in the cold dark north during fall/winter this year. I really do better in a warm and sunny area, my dream is to move soon…..
      Did you hear that Universe? Let’s get that worked out…. a move to the warm sunny (insert a nice sunny place where good primal food is plentiful).

      2Rae wrote on April 29th, 2014
      • Me too! After only 6 weeks primal eating we went on a family holiday and my husband and I both tanned quickly and easily, then held the colour far longer than usual on our return. This was quite literally groundbreaking for me as I had given up all hope of ever getting much of a tan. I read a theory on one site that it is partly down to the coconut oil in the diet, no idea if this is true…

        Pip wrote on May 1st, 2014
        • I do not take coconut oil but have experienced much better tanning since supplementing with vitamin D3. I believe what is happening is that when you are very deficient, your body ‘wants’ to absorb as much possible sunlight and therefore does not create melanin to block it. In addition, vitamin D3 up-regulates several systems in the screen that are protective against UV radiation.

          Peter Andrews wrote on May 2nd, 2014
  21. This post was quite interesting to me as I have been fighting ocular melanoma for almost five years now. I grew up in the upper midwest without an inordinate amount of either sun protection or sunburns. I do have light blue eyes, one of the common risk factors for developing a melanoma on your retina.

    When first diagnosed my vitamin D levels were so low (9) that my docs made a point of telling me to get more sun exposure (and to supplement). I’ve read studies that show that people fighting cancer generally have better outcomes with more sun exposure/vitamin D, so I try to get outside every day and don’t make a particular effort to cover up or use sunscreen, unless I will be in a rare high-risk situation for sunburn, like a day at the beach.

    I also don’t put sunscreen on my kids except for the higher-risk situations, because there are other more common cancer risks on both sides of our family.

    Allison wrote on April 29th, 2014
    • I started tanning in January this year to gradually build up tolerance. OK. I live in California. I haven’t used sun screen yet and haven’t burned even though I was sometimes out for 3-4 hours in mid-day April.

      I’ve also stopped using soap to wash — just cold water. I wonder how that affects your sun tolerance?

      miata wrote on April 29th, 2014
      • Mercola had an article that basically said that the Vitamin D is formed in your skin oils, and that if you take a shower with soap and hot water, you’ll be washing all that precious Vitamin D off. Wait overnight to let the oils soak into your skin.

        Dances with Bacon wrote on April 30th, 2014
    • Sunshine is life itself. Without it nothing would live, period. Sunscreen use is more the result of successful marketing propaganda than actual necessity.

      I grew up in Colorado, where there’s plenty of sun. As a child, I ran around all summer in skimpy clothing, minus sunscreen because nobody used it in those days. Sometimes I burned, but mostly I just got brown. To this day I never use the stuff because it’s just plain nasty. I detest smearing all those chemicals on my skin. I have had the occasional not-too-serious sunburn over the years, which never amounted to anything except an unsightly case of peeling skin. I have never had even the slightest hint of anything that could become skin cancer.

      For people who are fair-skinned or don’t tolerate much sun, or if you’ve gotten enough sun and are turning pink, have the good sense to cover up and leave the chemicals on the shelf, Your body doesn’t need that gunk.

      Shary wrote on April 29th, 2014
    • Off the subject of vitamin D and sunshine but perhaps helfpul.

      Science magazines Breakthrough of the year in 2013 was a type of immunotherapy that has apparently ‘cured’ some people with metastatic melanoma. Check these links:

      http://www.medscape.com/viewarticle/810688_3

      http://www.sciencemag.org/content/342/6165/1432.full

      Peter Andrews wrote on May 2nd, 2014
      • Thank you for this link. Yes, the new drugs are amazing. I just finished a three month course of ipilimumab a few weeks ago, with basically no side effects, and as of last week the scan showed very good news. If the ipi doesn’t ultimately work there are still three or four other newly available drugs that were not on the market when I was diagnosed. I am fantastically lucky that I got this disease when I did and not ten years ago.

        Allison wrote on May 2nd, 2014
  22. I believe that consumption of seed oils, which are extremely inflammatory, and often rancid contribute to the formation of skin cancer (and all other cancers).

    Debbie wrote on April 29th, 2014
  23. I am red-haired, fair-skinned, have autoimmune problems and live in Australia! For years I did the avoid sun at all cost regime which resulted in Vit-D deficiency. I improved my diet (went Paleo) and deliberately spent short periods of time out in the sun (without sunscreen) every day. My last blood test showed Vit-D levels in the normal range.

    What I take from this article is that regular short-periods of sun exposure during the middle part of the day is the way to go. That’s what I’ve been doing. If I need to walk/work in the sun for longer I wear a hat and cover up.

    Barbara wrote on April 29th, 2014
    • I’m autoimmune in Australia, too! Photosensitive. I find I’m much less bothered by the sun since I’ve been eating AIP paleo (much more pared down that primal).

      I’d never go out in the middle of the day – have always been told it’s too dangerous. I’m going to give it a go throughout winter and spring, see if I can build up a tolerance without kicking off a flare.

      Hannahbelle wrote on May 1st, 2014
  24. Here’s the thing though. I’m a life-long resident of Southern California. I’m blond, too. I hate sunscreen. I’m 49 and have sun-damaged skin. I’m wrinkly, splotchy and get frequent pre-cancerous lesions. People I know from North Dakota have such creamy perfect skin compared to me. Obviously all my sun exposure hasn’t been all that benign.

    Diane wrote on April 29th, 2014
  25. I am not a standard office worker (I am a massage therapist), but I do work indoors (and in my case, in a windowless room)…. My solution to sun exposure, when it is warm enough at least is to take my lunch down to the park one block down from the clinic. I sit in the sun and eat it and enjoy the peace and the fresh air.
    Can’t do this in the depths of winter in Calgary though, but last week and the early part of this week it has been warm enough to sit out.
    I don’t tan deeply, but I cannot remember the last time I got burned (as a kid I think…) I just go a pale biscuit colour and stay there. And I haven’t used sunscreen in years.
    For the person who asked about wrinkles – I suspect you are more likely to get wrinkles around the eyes at least from squinting in the sun – I always wear sunglasses to protect against that. I am 44 years old and have very few wrinkles, in fact I have been complimented on my “beautiful skin” and been mistaken for being at least 10-15 years younger than I actually am. A lot of the time, if you get wrinkles will be determined by how much elastin you have in the connective tissue in your skin – more elastin means fewer wrinkles, and incidentally fewer stretch marks for ladies who get pregnant.

    salixisme wrote on April 29th, 2014
    • The sun often gets blamed for causing wrinkles, but in reality it’s more a function of heredity. However, too much sun can definitely make matters worse if you’re already inclined in that direction.

      Shary wrote on April 30th, 2014
  26. But what about babies? Where I live, it’s a criminal offence to put your baby under direct sunlight any amount of time before 6 months old. (I’m exaggerating but seriously, it’s almost as if it’s criminal). Is it true that a baby will have vit D reserves if the mother’s diet was adequate?

    Coco wrote on April 30th, 2014
    • A breastfed baby gets vit d through the milk. HOWEVER pregnant mothers in Australia are now routinely tested for vit d deficiency after a study showed something remarkable like 70% of pregnant women were vit d deficient. That’s how my deficiency was picked up, he’s nearly 18mo old now but I still supplement daily, between 6-10k iu.

      Hannahbelle wrote on May 1st, 2014
  27. HAH, I got in an argument with someone yesterday about sun being good for you, not bad, but didn’t have the arguments other than “Don’t burn” and “vitamin D is good”… no more arguments need. Copy/paste link.

    Ben wrote on April 30th, 2014
  28. Always feel better physically and mentally with a bit of sun. I would go for a ‘little and often’ approach to sun exposure if I didn’t live in the UK – it’s more like 8 months off, 4 months on! Difficult to keep a natural base tan…

    Luke M-Davies wrote on April 30th, 2014
  29. Yea, I’m a redhead in Seattle. I too take issue with the “don’t lay out” instructions. Today, for instance, is a rare beautiful spring day, the sun clear & high. But it’s not all that warm. I will lay on my protected back porch for about 10 minutes, in shorts & a tank top, with my face & hands covered since they already get way to much sun. This is my best option, because after that I’m just gonna put on pants & a sunhat & a shirt with the sleeves rolled slightly up. There’s really nothing to be had in useful exposure in that, the normal outfit. Also I downloaded an iphone app yesterday called dminder – still working it out. But it’s kind of clever. You put in your age, blood level of D or supplement level, what you’re wearing (shorts, bikini, whatever), it tells you from your location when the sun is at an angle to give you D. you start a timer & it counts off how much you’re getting, then an alarm goes off to tell you to get the heck out of the sun before you burn. I don’t know if this is a keeper, but it was interesting to see that it thought I only needed about 8 minutes.

    Punty wrote on April 30th, 2014
    • Interesting! just looking up this app….

      Pip wrote on May 1st, 2014
  30. Very provocative article on the sun’s influence on cancers and melanomas, I am a 71 year old active man who has spent all of my life outdoors either working or hiking or kayaking or some other activity and I have maintained a seasonal tan to the extent that one can do in the Midwest as the seasons change. I have noticed a change since I moved to the Panhandle of Florida in 2001 in that my forehead and my nose, in the past couple of years, do not seem to want to tan but rather those skin areas tend to turn red and burn. Repeated use of SPF 30 sun block doesn’t seem to hinder the burn effect nor does daily exposure over a period of days/weeks cause the burn to peel and “turn into a tan”! My forehead area is blotchy with small areas of burn sprinkled in with a normal colored tan. My nose simply has not been able to hold a tan for the past 2 or 3 years. Understand that I wear shorts and T-shirts almost throughout the entire year here and one would suppose that being tanned practically the whole year long would be some kind of deterrent to burning after the tan is dark and been almost permanent for months on end.

    Is there any suggestions for what to do since I don’t seem to be getting back to my “normal” mode of tanning on my face and I do not want to risk skin problems on my nose or forehead in the future. I don’t wear hats as I have a problem with headaches for some reason within a half hour of donning a ball cap or straw hat or anything that fits on my head that is tighter than a knit watch cap. And, since I spend alot of time on the water kayaking, I really do not feel that a hat will stop much of the reflected rays off the water, that’s maybe an old farmer’s tale but I definitely do feel the difference in intensity of the rays of the sun when I am out paddling.

    Thanks for any hints or tips from those who may have found relief from this problem, I am presently using a prescription sunblock called, Vanicream Sport SPF 35 which was prescribed to me by a dermatologist at our local VA clinic. Oddly enough, the active ingredients in the sunblock are 3% Octinoxate and 11% Zinc Oxide which I can remember using as a life guard in my teen years to plaster on my nose while up “in the chair” on bright afternoons. We had no clue ZO was a sunscreen back then, we just thought it looked “cool” to have a white coating on our noses as we sauntered around the pool spinning our whistles on our index fingers!! Back then the chicks seemed to dig it!! Ha! The innocense of youth!!

    Old Clockguy wrote on April 30th, 2014
  31. As a melanoma survivor I find this post completely infuriating. You are wrong. Any change in the NATURAL color of your skin. … the color your skin is meant to be ,the color you are born with, is SUN DAMAGE and means you have hurt your skin! There is No SUCH THING as a healthy tan or a”base tan.” Just because your skin can tan doesn’t mean you should. Always protect your largest organ.

    Meghan papatyi wrote on April 30th, 2014
  32. Marko, interesting article and lots of common sense stuff. Most of it seems to fit that old stodgy and true rule “all things in moderation”. Of course in the good old U S of A we generally think “if a little is good…more is better”. Or, we go to our health professional who says “none is best”.
    I was intrigued by the reference to Sun Glasses introduction and an increase in Cancers. I believe, intuitively that your eyes are your indicators for Sun exposure. Blue eyed and trouble being in the bright sun? Maybe that is telling you not to be in that much sun… Brown eyes and never feel even squinty in the sun? perhaps you also have darker skin and tan easily? In any case Sun glasses and Sun screen seem a bit “un-natural” to me. It’s “not nice to try and fool Mother nature”… I am going to increase my Vitamin B (un-naturally I guess..) as this Northern Michigan gray is not allowing much Sun for another couple months.
    Keep up the good fight Mark. -rodriquez

    rodriquez wrote on April 30th, 2014
  33. I’m still confused by this. I’ve been following CW for my entire life because I’m fair, freckled and have red hair, light eyes, precancerous moles, and I live in southern CA, I’m a dermatologist’s dream patient. I was religious about sunscreen and now at (almost) 33 I can see how much better my skin has fared than my peers who tanned. It’s definitely not hereditary for me, my mom’s got very wrinkled skin from growing up tanning and living by the beach.

    So I am still wanting to apply (natural zinc based) sunblock daily, but worry I’m not getting enough vitamin D. I burn less easily since going Primal but I still burn, freckle, and get more moles if I go out and sit in the sun for more than ten minutes, even with sunblock. A base tan would really wrinkle me up, I’m sure.

    From an ancestral health perspective, I figure I’m not evolved to live in such a sunny climate. My ancestors were adapting to getting weak sun for only part of the year. So I can’t believe it’s okay for me to go out and try to get more exposure or as much as someone with darker skin.

    Ginger wrote on April 30th, 2014
  34. Go out at noon? GASP!!! Instantly I’m reminded of that sticker that was prominent when I was a kid. It showed a sun with sunglasses and said, “From 10 till 3 stay away from me!”

    But I always feel best after spending a day in the sun.

    BT wrote on April 30th, 2014
  35. “Nucular” bombs? Hmmm…

    Bear wrote on May 1st, 2014
  36. The problem with the sun and me is all the sunspots or stains on my face. I prefer to put on an EWG sunscreen like Thinkbaby and avoid the sun in the middle of the day. I do my gardening later and get my vit D thru the rest of my body…legs, arms.
    Does that sound OK?

    Maria wrote on May 1st, 2014
  37. with Irish parents that have had basal cell carcinoma and malignant melanoma, not convinced sun is healthy for me. It’s hard for me to tell how much sun is too much, I burn so easily. But that being said, had a golden tan when I was a kid.

    MissZ wrote on May 1st, 2014
  38. i am fair skinned, of irish heritage, and grew up in the caribbean- before the invention of sunscreen. if there were white people on the island with skin cancer i never heard about them or saw them. my father wore a hat and a t-shirt to the beach to protect his bald spot and his shoulders. we all wore t-shirts if our shoulders felt burned. then he came home one day with a new product- PABA. that is what he said it was. he slathered it on his bald spot and shoulders and ditched the hat and t-shirt. and he got skin cancer. on his bald spot and shoulders. i have always thought that the cancer came from the sunscreen product and not the sun.

    allison wrote on May 2nd, 2014
  39. As usual, the frustrating part is that there is nothing clear, it’s all kind of muddled & you do what you can with it.
    – check out an old farmer sometime. My grandfather’s face & neck was brown & leathery, if you saw him without his shirt (rare in the extreme) his torso skin was pale white & elastic. So obviously sun exposure will cumulativly age your skin, which is a bummer.
    – As for high sun killing melanoma, it makes total sense that evolution would have found a way to protect us from the sun, which we have been in a LOT before electric lights.
    – on the other hand, we all know stories of people who’ve had skin cancer spots removed in their later years. What’s up with that? What’s up is that if you have a kid by age 15, then you’ve got grandkids at age 31. Nature is done with you. Go die already. Many of our health problems today are simply age related. We didn’t used to live long enough to suffer from many of them.
    – I’m a redhead. ZERO tanning here. Yet I get the vite D argument. So what to do? Quit freaking out over the thought of laying in the sun for hours. I downloaded an app for timing my sun need based on my latitude & time of day & it says right now, if i’m taking 1000mg as a supplement, then I only need 10 minutes a day in the sun. Fine. That’s a long way from committing to BBQ.
    – What about that pineal gland argument? What about that british study saying your burn more if you wear sunglasses because your brain isn’t getting tru info about the brightness so it doesn’t put up defenses as well?
    – ok then, what about the things saying protect your eyes or you get sun damage on the retina?

    My personal takeaway is – ok so I only need 10 minutes a day this time of year. That’s not so drastic. I don’t feel I’m risking my hide too much. Also I’m going with the sunglasses. We have had 4 days of brilliant sun in Seattle & I’ve had a migraine every damned day. Some people have….I don’t know I guess problems in the brain & how it handles light, & for me, bright sun can make me get a migraine, so the tradeoff of wearing sunglasses is worth it.

    And at night I use my mexican retin-A. Because as a midlife woman, raised on sugar & white bread, heading into the wrinkly years, this is yet one more very tricky path.

    Punty wrote on May 2nd, 2014
  40. Research shows, those Melanom patients with the lowest Vitamin D Levels, have the biggest depth of their cancer spots and the most metastatic stadium. Their the least treatable.

    bill wrote on May 3rd, 2014

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