The Nutrient We all Desperately Need but Rarely get Enough of!

Colorado is known for its beautiful mountains and bright sunshine. And for anyone that lives here, it is a well-known fact, that you do NOT spend a lot of time outdoors without being covered in Sunscreen unless you want a bright red sunburn. The sun in Colorado is bright and our elevation puts us a mile closer to the sun, not to mention that reflection off the fresh powder. It doesn’t take long to realize that a small amount of sun goes a long way around here! But even for those that aren’t lucky enough to live in Colorado, it is ingrained into our thinking that the sun is something to be protected from. Sunburns not only age the skin quicker but lead to skin cancer - which in cases such as melanoma can be deadly. Sunscreen nowadays has been added to make-up and skin care products, tanners, has been made specifically for babies, or those who sweat during sports…Shelves upon shelves are lined with ways to protect your skin from the sun. But ironically, the longer we have been protecting ourselves from the sun with sunscreen, the more apparent it has become that sunscreen isn’t necessarily preventing as much cancer as we once thought. 1 In addition, many chemicals found in sunscreens are actually linked to cancer itself! So what gives? Does this mean stop using sunscreen and risk a sunburn, or worse yet, stay covered up and hide indoors? Not so fast!

So let’s back up… Why do we need the sun? Sure it’s pretty, gives us light, and that feeling of warmth on your back feels oh so good.. but do we actually need it? We actually DO! Our bodies’ main source of Vitamin D is actually from exposure to the sun (actual sunlight without a layer of clothing or sunscreen in between). Exposure to UVB rays produces D3 (otherwise known as cholecalciferol) in the skin and it is shuffled to the liver to become Calcidiol which then makes its way to the kidneys to become 1-alpha,25-dihydroxyvitamin D3 (Calatinol), the active form of Vitamin D. This active form is extremely important in the body and plays many roles. First of all, it regulates the concentration of minerals in the blood- particular calcium. This is important to help build bones and keep them strong and healthy. Vitamin D also plays a role in the immune system which is our army to fight against bacteria and viruses. It also helps with muscle function, reduces inflammation, and it plays an important role in regulating genes. This in particular is critically important in the risk of cancer in the body. Unfortunately, one study published in 2009 in the Archives of Internal Medicine (a leading scientific journal), found that only 23% of people in the US had the minimum sufficient blood levels of Vitamin D to provide general health, meaning 70% of Caucasians, 90% of Hispanics and 97% of African Americans have insufficient levels. 4 Insufficiency of Vitamin D is one of the most common medical conditions in the world, affecting over one billion people.

So if sunscreen isn’t adequately preventing all skin cancer and some sunscreens are actually adding to cancer occurrence, does Vitamin D level play a role in cancer prevention?

Having adequate vitamin D levels is incredibly important in the body. Research is showing that around 70% of cancers can be prevented by having enough Vitamin D in the body!5 And when it comes to skin cancer, there is a distinct connection between low vitamin D levels and melanoma.6 In some studies, women with higher amounts of UVB exposure had a 50% LESS likely chance of developing breast cancer, and men with a 50% LESS likely chance of developing fatal prostrate cancer. In another study, it was found that patients with melanoma that had MORE sunny vacations prior to diagnosis had a BETTER survival rate. And another recent study showed that those with a higher annual average of sunlight exposure had LOWER melanoma mortality rates than non-sunnier locations.7 Additionally, those that avoid sun exposure compared to those that don't, have an almost twofold higher mortality rate (not just from cancer but in general).8

Say what!? This information can be confusing and sound downright backwards… more sun, means less cancer!? But the truth is that like many things in life, it is a careful balance between too much and not enough. It seems that sun exposure creates risk for melanoma mostly through episodic sunburns and tanning beds – especially for those with already higher risk (genetic component, fairer skin, etc.). And those that do end up with melanoma, have a less severe progression and higher survival rate when their vitamin D levels are higher than those that have lower counts.8 In addition, maintaining adequate vitamin D levels also reduces risk MS, type 1 diabetes, rheumatoid arthritis, thyroid disease and inflammatory bowel disease.9 Getting a sunburn ISN’T good for your health (or cancer risk), but slathering chemicals all over your body ISN’T such a great alternative either. Most research shows that direct sunlight between 10 am and 3 pm, 2-3 times a week sans sunscreen will allow plenty of vitamin D to make its way into your body. Your body will also tell you when it has had its fill of vitamin D (hello, pink skin) and when it’s time to cover up, head inside or grab your zinc-oxide-based sunscreen or other natural sunscreen. The goal is to get direct sunlight on your bare skin, without getting a burn.

Sometimes, there just isn’t sunlight (insert the winter blues), or our busy lives prevent us from getting outside (work, work and more work). Although the best way to get your D is through the sun, the most important thing is to get your vitamin D in anyway you can. A small amount of foods contain Vitamin D such as fatty fish or eggs or some fortified foods, but it is pretty darn difficult to consume enough. Supplementation is the next best option. The best way to know how much vitamin D to supplement is to get your level checked at your next visit to the doctor. A simple blood test can show you were you fall - and the aim is to get your levels between 50-70 ng/mL. During the winter months, the amount you need to supplement will often be higher. It is worth mentioning- that vitamin D can be over-supplemented so it is important to be cautious! Make sure you choose a supplement of Vitamin D3 and take it with a fat containing meal for best absorption.

Moral of the story? For better immunity, hormonal health, strong bones, reduced inflammation and reduced cancer risk- get your vitamin D levels up!

We can do this by: - Get daily sunshine in small doses without getting a sunburn during the mid-day. (Don’t be so quick to load up on sunscreen and allow some direct sunlight to hit you skin everyday).

- Use natural or zinc oxide sunscreens for excess sun exposure.

- Supplement Vitamin D3 with a fat containing meal and monitoring blood levels with 1-2 yearly checks to ensure the correct dosage and optimal levels between 50-70 ng/ml.

Get outside and Happy Sunshine!

References:

1. Sánchez G, Nova J, Rodriguez-Hernandez A, Medina R, Solorzano-Restrepo C, Gonzalez J, Olmos M, Godfrey K, Arevalo-Rodriguez I. Sun protection for preventing basal cell and squamous cell skin cancers. Cochrane Database of Systematic Reviews 2016, Issue 7. Art. No.: CD011161. DOI: 10.1002/14651858.CD011161.pub2 2. Hossein-Nezhad A, Spira A, Holick MF. Influence of vitamin D status and vitamin D3 supplementation on genome wide expression of white blood cells: a randomized double-blind clinical trial. PLoS One. 2013;8(3):e58725. 3. Gil, Á., Plaza-Diaz, J., & Mesa, M. D. (2018). Vitamin D: Classic and Novel Actions. Annals of Nutrition and Metabolism, 72(2), 87–95. https://doi.org/10.1159/000486536 4. Ginde, A. A., Liu, M. C., & Camargo, C. A. (2009). Demographic Differences and Trends of Vitamin D Insufficiency in the US Population, 1988–2004. Archives of Internal Medicine, 169(6), 626–632. https://doi.org/10.1001/archinternmed.2008.604 5. Sharon L. McDonnell, Carole Baggerly, Christine B. French, Leo L. Baggerly, Cedric F. Garland, Edward D. Gorham, Joan M. Lappe, Robert P. Heaney. Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml Are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study. PLOS ONE, 2016; 11 (4): e0152441 DOI: 10.1371/journal.pone.0152441 6. Berwick, M., & Erdei, E. O. (2013). Vitamin D and melanoma incidence and mortality. Pigment Cell & Melanoma Research, 26(1), 9–15. http://doi.org/10.1111/pcmr.12015 7. Burns, E. M., Elmets, C. A., & Yusuf, N. (2015). Invited Review Vitamin D and skin cancer. Photochemistry and Photobiology, 91(1), 201–209. http://doi.org/10.1111/php.12382 8. Lindqvist, P. G., Epstein, E., Landin-Olsson, M., Ingvar, C., Nielsen, K., Stenbeck, M., & Olsson, H. (2014). Avoidance of sun exposure is a risk factor for all-cause mortality: results from the Melanoma in Southern Sweden cohort. Journal of Internal Medicine, 276(1), 77–86. http://doi.org/10.1111/joim.12251 9. RIVAS, M., ROJAS, E., ARAYA, M. C., & CALAF, G. M. (2015). Ultraviolet light exposure, skin cancer risk and vitamin D production. Oncology Letters, 10(4), 2259–2264. http://doi.org/10.3892/ol.2015.3519