Kayla Young
Tanning has a bad reputation among dermatologists, especially those in the United States. Most argue that all sun exposure is bad, and what you’re doing when you’re tanning is burning the skin. They argue that tans are unsafe, could lead to skin cancer, and should be avoided. But are there any benefits of tanning, and is that the entire picture? What about vitamin D and other factors?
In several countries, the recommendations for sun exposure are changing due to new data. It appears that the United States is lagging in updating its policies. In this article, I’ll look at the latest research on sun exposure, suntanning, and the potentially significant benefits of sunbathing. And of course, I’ll look at the risks of suntanning, as well!
Contents
What are the Benefits of Tanning and Sun Exposure?
There are several benefits to tanning and sun exposure, though many argue that the risks outweigh these benefits. Let’s look at the major benefits to start.
Elevated Mood and Reduced Depression
Many find that spending some time in the sun improves their mood. Sun exposure produces serotonin, which is known to improve mood. Serotonin is the primary chemical targeted by most antidepressant medications.
Synced Circadian Rhythms
The biological clock has become a hot topic in the age of the smartphone. All that blue-wavelength light exposure, especially at night, can make sleep more difficult. This can lead to poorer health.
Actual broad-spectrum sunlight exposure governs human circadian rhythm. Our natural instinct is to wake in the morning in the presence of the sun and sleep in the evening when its dark. It turns out that sun exposure is best in the morning due to the working of the circadian rhythms of the body (note: these studies are on rats so far, but studies on humans are coming).
Seasonal Affective Disorder Protection
Many of us suffer from Seasonal Affective Disorder (SAD). We find that the lack of sunlight in the winter harms our mood and health. Exposure to sunlight can improve SAD symptoms.
Improved Body Image and Energy
It’s easy to ignore this, but the reality is that many people feel that they look better when they have some color. 81 percent of young adults feel that a tan improves their appearance. Dermatologists often argue that this doesn’t matter. They argue that by suntanning you are harming your skin regardless of how you feel about yourself.
But still, improved body image connects to an improved mood, energy levels, and outlook on life. Ignoring this obscures the larger picture.
Elevated Vitamin D Levels
Sun exposure (from UVB radiation) is associated with elevated Vitamin D levels. And Vitamin D levels are associated with reduced risk of many diseases. These include stroke, high blood pressure, and diabetes.
There is much more information on the relationship between Vitamin D and health markers below.
Potential to Burn Calories
Yes, you read that right. There is at least some preliminary evidence that tanning can burn calories. Regardless, it would be much more efficient to go for a run in the sun than to lay about in the sun, but it’s interesting research nonetheless.
Reduced Risk of Rheumatoid Arthritis
Those who receive more sun exposure have a decreased risk of Rheumatoid Arthritis (RA). That said, if you have RA, some medications to treat RA can make the skin more sensitive to sun exposure and more likely to burn. If you’re already taking RA medication, you need to be extra cautious about your sun exposure.
Sunburn Protection
A good base tan does provide a small amount of sun protection, something like an SPF 3. Those who have a solid base tan are less likely to get a sunburn if they forget to put on sunscreen due to the protection already on the skin.
Keep in mind this protection is something like an SPF 3, not an SPF 30 like most sunscreens.
Protection from Some Cancers
Yes, sun exposure can increase your rate of skin cancers, including the deadly melanoma. But it can also reduce the risk of several other cancers. These include colon cancer, Hodgkins lymphoma, ovarian cancer, pancreatic cancer, and prostate cancer.
Improved Skin Condition
Ultraviolet Radiation is used to treat several skin conditions, including psoriasis and vitiligo. And many find that the sun will help fight those pesky acne breakouts.
Yet many researchers argue that sun exposure actually contributes to acne, so there is debate here.
Have We Have Been Looking at the Sun All Wrong?
Ok, I hope you haven’t been looking at the sun. That’s not a good idea. But I argue in this article that sheltering the body from all sun exposure is a bad idea. Perhaps a really bad idea, especially for those with darker skin tones.
No, I’m not a dermatologist, and I’m not even a scientist. I am a blogger familiar with skincare and the effects of the sun on my skin, mood, and life. I also love to research scientific data and follow the data where it leads.
Based on this new data, many countries throughout the world have updated their sun exposure recommendations. The major skincare societies and dermatology societies in the US have not updated their guidance, and appear to be behind the times in many ways regarding sun exposure and sunscreen recommendations.
I argue here that the changes occurring throughout the world are good policy updates. They are only the beginning of a revolution in how we see the sun, and how we should be viewing sun exposure.
Sunlight may be the new Keto diet!
What is the Risk of Too Much Sun?
There’s really only one major risk, and one lesser risk (wrinkles in advanced age). The major risk is the one everyone knows about: the dreaded skin cancer. Skin cancer kills thousands each year in the US, and many more throughout the world. And most of these cancers are caused by sun exposure, especially sunburn.
The risk of death by skin cancer looms over the benefits list above.
More than 5 million people each year are diagnosed with skin cancer in the United States alone. That’s a lot of people, but looking only at general skin cancer numbers isn’t particularly helpful. There are four major categories of skin cancer, with different risk levels. Looking at these cancers individually gives a much clearer picture of the disease.
Actinic Keratosis
Actinic Keratosis most commonly manifests itself as a batch of scaly lesions on the skin, caused by exposure to Ultraviolet Light (UV). Actinic Keratosis is a precancer. If left untreated, AK may turn into a more dangerous type of cancer like Basal Cell Carcinoma or Squamous Cell Carcinoma.
This is a precancer and may turn into another cancer over time.
Basal Cell Carcinoma
Basal Cell Carcinoma is an uncontrolled growth in the basal cells of the skin. BBCs frequently look like cold sores or other skin bruises, but they don’t go away over time. These growths almost never metastasize and are generally considered not dangerous cancers.
However, as mentioned by Dr. Brandith Irwin at Skintour.com, BCC can be quite debilitating and can require multiple surgeries to correct. That means a lot of hassle, upheaval, misery, and nervousness.
Squamous Cell Carcinoma
Squamous Cell Carcinoma is the second most frequent type of cancer and is caused by the uncontrolled growth of the squamous cells of the epidermis, the outermost layer of the skin. They often manifest as wart-like lesions, and occasionally bleed.
If ignored, SCC can grow, metastasize, and be deadly in some cases. If caught early and removed, there is little risk to Squamous Cell Carcinoma.
Survival Rates of non-Melanoma skin cancers
An estimated 4,420 deaths from skin cancers other than melanoma and NMSC are expected to occur in the United States in 2019. This is a large number, but this includes skin cancer incidents not necessarily related to sun exposure.
According to Cancer.Org, about 2,000 people in the US die each year from Basal Cell and Squamous Cell Carcinoma, though the number has been falling. As they state, many of these incidents are in elderly people who don’t have their skin checked, or in those who have other immune system deficiencies.
Surprisingly, those diagnosed with carcinomas have a higher life expectancy than the average person. People who develop carcinomas tend to spend a significant amount of time outside. They tend to have better health biomarkers than average.
About 90% of skin cancers in the US are Basal Cell and Squamous Cell Carcinomas, with the remaining 10% making up the much more serious melanoma.
Melanoma
Melanoma is a highly dangerous form of skin cancer. It is caused by excessive UV radiation on the skin, especially from sunburn, especially in youth. Tumors can develop in the melanocytes that give skin its pigment. Melanomas often resemble moles on the skin and can develop from moles over time.
If caught early before it spreads to the lymph nodes, Melanoma is almost always curable. But if not caught early enough, Melanoma is often deadly.
In the US, the Age-Standardized Rate of Melanoma is 12.7 incidents per 100,000 people. According to the American Academy of Dermatology, “The five-year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 99 percent.”
The death toll is still quite grim. Again, according to the AAD, “In 2019, it is estimated that 7,230 deaths will be attributed to melanoma [in the United States].”
Who Gets Melanoma?
One would think that melanoma incidence rates are higher for those of us who work outside than those who work in an office. If all sun exposure is bad, then those who get the most sun should have the highest incidence of melanoma.
But this is not the case.
In fact, those who spend the majority of their days outside have a lower incidence of melanoma than those who work inside. This is because the primary risk factor for melanoma is occasional significant sunburns, especially those received when young. Tanned people have a lower incidence of melanoma because they don’t tend to get sunburns. And there’s even some data that sunscreens do a better job of protecting against the less dangerous Squamous Cell Carcinoma as opposed to Basal Cell and Melanoma.
Dr. Richard Weller suggests that “there is evidence long term sun exposure associates with less melanoma.”
Most people have now learned that vitamin D is important for the body for a variety of reasons. And many have heard that the primary source of vitamin D is the sun.
What are the Health Benefits of Vitamin D?
Higher rates of Vitamin D are associated with:
- Lower blood pressure
- Lower rates of diabetes
- Improved Mood
- Healthy bones and teeth
- Immune system, brain, and nervous system health
- General cardiovascular health
- Lower rates of cancer
That’s a pretty good list!
Many debilitating maladies including diabetes, heart disease, high blood pressure, and breast cancer occur more often the further from the equator. And they also increase in frequency during the winter months, when solar radiation is at its lowest.
Similarly, a study of the incidence of Rheumatoid Arthritis (RA) found that RA occurs much more frequently among those who live in the northern US than it does among those who live in the south. Also, those in the north get RA earlier in their lives.
So these negative impacts are caused by lack of Vitamin D, right?
Vitamin D is produced in the skin and through the eyes in the presence of UVB Rays from the sun. However, the near-universal recommendation among cancer societies and dermatologists in the United States is to use sunscreen to block those UVB Rays and increase vitamin D levels through supplementation.
But what if that advice is wrong, or at least unhelpful?
The problem is that vitamin D supplementation is widespread already. But vitamin D acquired through supplementation doesn’t provide any health benefits at all.
A large meta-analysis of 290 vitamin D studies found that supplements did nothing to improve health. The lead author, Dr. Philippe Autier, stated: “Unfortunately, there is probably no benefit to expect from vitamin D supplementation in normally healthy people.”
And an even larger study of 25,000 people dosed with high doses of vitamin D over a 5-year time frame found… essentially no benefits to Vitamin D supplementation.
How is this possible?
Potential Math Errors
One possible explanation for this is that the original Vitamin D studies were found to have a major statistical error that under-estimated the recommended Vitamin D supplementation amounts by a huge amount.
It is quite possible that these studies were giving people far too little Vitamin D for it to do them any good. It’s unclear whether the people in these studies were given the appropriate approximate 8895 IU/d quantity. But if they were not, these studies should be re-run.
Sun Exposure and Mortality
Some researchers have proposed another answer, and it is at least somewhat heretical. This idea is that vitamin D is not a substance that improves all the health markers mentioned above. Instead, it is now believed that vitamin D production moves in the same direction as other health markers that are changed by sun exposure. These include Nitric Oxide (NO) levels, serotonin levels, and blood pressure levels.
Skin Cancer Researcher Dr. Richard Weller is one of those suggesting that we have vitamin D all wrong. He has been studying how the chemical Nitric Oxide works inside the body. NO is a molecule produced by the body in the presence of sunlight. It lowers blood pressure, which is good. But vitamin D supplementation does nothing to impact Nitric Oxide levels. Just like NO levels, vitamin D levels increase in the presence of sunlight. Researchers may have misidentified vitamin D as causing these improvements, while in reality it is simply associated with them.
This is a potential explanation of why vitamin D supplements don’t do anything to improve those other biomarkers.
Dr. Weller did an experiment where he exposed healthy subjects to the equivalent of 30 minutes of raw, unpasteurized summer sun with no sunscreen. Nothing to block any of the UVA or UVB radiation.
He found that Nitrous Oxide levels increased and blood pressure decreased. Due to the strong relationship between blood pressure levels and heart disease incidence, this improvement in blood pressure was remarkable.
As mentioned above, heart disease kills almost 200 people per 100,000 in the United States. A reduction in blood pressure is essentially the same as a reduction in total heart disease incidence and is hugely beneficial. This research finding could potentially save millions of lives per year worldwide.
But What About the Skin Cancer Risk from Sun Exposure?
Yes, there is skin cancer risk due to this sun exposure. But as stated above, the skin cancer death incidence per 100,000 people is 3, compared to 200 from heart disease. The relative rates are much lower.
What About Other Health Risks from Sun Exposure?
Another researcher, Dr. Pelle Lindqvist of the Karolinska Institutet, found striking associations between sun exposure and health outcomes among women. He conducted a study of the sunbathing practices of 30,000 Swedish women over the course of 20 years. He found that both blood clots and diabetes occurred less frequently in those women who spent more time in the sun. And remember, these are light-skinned Swedish women he was studying.
Of course, melanoma rates were higher among the subset of women who got more sun exposure. But the increased risk of melanoma was swamped by the lower incidence of diabetes and stroke. Those who spent more time in the sun were much healthier than those who spent less time in the sun.
And even the increased risk of melanoma was nuanced. Those who spent more time in the sun were much less likely to die from melanoma than those who spent less time in the sun but who still developed melanoma.
Putting the Pieces Together
In the end, Lindqvist found that over the 20 year study, those who hid from the sun were twice as likely to die as those who spent the most time soaking up the sun.
As Lindqvist’s team put it in the conclusion of their 2016 Journal Of Internal Medicine study, “Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking.”
Let’s break that down.
The end result of his study implies that not getting enough sun exposure is as bad for you as smoking cigarettes. Hiding from the sun is as bad as smoking.
So Are the Dermatologists Wrong, then?
Dermatologists are not wrong regarding skin cancer. Day in, day out, they see people dying of melanoma. Most of these melanomas are caused by sun exposure, and sunscreen could have prevented them.
But the total incidence of melanoma is pretty low, relative to other killers like heart disease, diabetes, and stroke. And the dermatologists don’t treat the much larger group of people dying of heart disease and diabetes.
If we can reduce the incidence of heart disease and stroke by getting some extra sun exposure, we will all be much, much healthier.
Yes, there is a higher risk of melanoma, but sun-worshippers are less likely to die from it. And that increased risk is dwarfed by reductions in the risk of other, more dangerous diseases.
Of course, many dermatologists disagree with these studies and research findings. The American Academy of Dermatologists (AAD) continues to take the position that all sun exposure is bad. Their advice is that everyone should be applying a high-SPF sunscreen during all sun exposure and taking supplements to ensure vitamin D levels are adequate.
But in other corners of the world, including Australia, New Zealand, and many parts of Europe, Dermatologists and Cancer Societies have been updating their guidance and altering their recommendations in response to the new data. Even the US EPA has less restrictive recommendations than the AAD. The AAD has been lagging in reviewing their guidance — just as the FDA is slow to update its sunscreen recommendations.
As suggested in Outside Magazine, maybe Sunscreen is the new Margarine!
Better Sun Exposure Recommendations
Countries like Australia, New Zealand, and organizations like the World Health Organization (WHO) have been gradually updating their sun exposure recommendations as the new data has come in. These recommendations are quite helpful. They make some attempt to balance out the risks of overexposure to the sun and the benefits that are now being shown.
Australia’s National Cancer Control Policy (ANCCP) is an excellent resource and is what I will focus on here. The National Cancer Control Policy uses UV Index as the basis for their recommendations. The UV Index is an index created by the WHO that shows how powerful the sunlight is in any location around the world.
In Australia’s case, there is an app called SunSmart that forecasts the UV Index throughout Australia. For those who don’t live in Australia, check out Sunburnmap. It is a site that gives a forecast of UV Index throughout the world.
The ANCCP makes the following recommendations about UV exposure:
If the UV Index is less than 3
“In late autumn or winter… where the UV Index is below 3, sun protection is not recommended. During these times, to support vitamin D production it is recommended that people are outdoors in the middle of the day with some skin uncovered on most days of the week. Being physically active while outdoors will further assist with vitamin D levels.”
They are stating that not wearing sunscreen is recommended if the UV Index is less than 3. Translating that to the United States, most of the United States during the winter months, and at the beginning and end of all days throughout the year, is below a UV Index of 3.
If the UV Index is 3 or Greater
“During summer… all states experience long periods during the day when the UV Index is 3 or above… During these periods, a combination of sun protection measures (broad brimmed hat, covering clothing, sunscreen, sunglasses and shade) is recommended when outdoors for more than a few minutes. In summer, most… adults will maintain adequate vitamin D levels from sun exposure during typical day to day outdoor activities.
In those [areas] where the UV Index is 3 or above in the middle of the day in autumn, winter and spring, a combination of sun protection measures is recommended when outdoors for more than a few minutes at those times. In these locations, most… adults produce sufficient vitamin D from UV exposure during typical outdoor day to day activities.”
The recommendation here is to use sun protection measures when outdoors for more than a few minutes. Even if the UV Index is above 3, the ANCCP suggests that it is ok for people to be outside for a short time without any sunscreen or other protection.
Balancing Risks and Benefits of Sun Exposure
The ANCCP formally acknowledges the benefits of sun exposure in their position policy. They write:
“A balance is required between excessive sun exposure which increases the risk of skin cancer and enough sun exposure to maintain adequate vitamin D levels.
It should be noted that the benefits of sun exposure may extend beyond the production of vitamin D. Other possible beneficial effects of sun exposure that may not be related to vitamin D include reduction in blood pressure, suppression of autoimmune disease and improvements in mood.” (emphasis in original)
Contrasting the ANCCP Recommendations with the American Academy of Dermatology
The AAD’s position is that “the American Academy of Dermatology does not recommend getting vitamin D from sun exposure”. They recommend “a comprehensive sun protection plan that includes seeking shade, wearing protective clothing, and applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.” When it comes to vitamin D, the AAD “recommends getting vitamin D from a healthy diet that includes foods naturally rich in vitamin D, foods and beverages fortified with vitamin D, and/or vitamin D supplements.”
There’s no acknowledgment of any potential benefits of sun exposure. And no comment on why supplementation of vitamin D doesn’t seem to help anything.
However, as mentioned above, it could be that the recommendations for supplementation of vitamin D were way too low.
What Does SPF, or Sun Protection Factor, mean?
We’re all familiar with the bottles of sunscreen that state “SPF 30” or “Broad Spectrum SPF 50+”. But what does that mean, exactly?
SPF stands for sun protection factor, and it pertains only to the impact of UVB rays on the skin. UVA rays are not part of the equation. It’s also not an exact measurement, but more of a ranking by the degree of lessened impact of UVB radiation on the skin. This is because sunscreen works differently depending on the natural skin shade and status.
Another key part of the SPF recommendation is that the actual amount of sunscreen people use is almost always less than what we’re supposed to. Often we use 1/2 to 1/4 the amount we are supposed to be smearing all over ourselves. Consequently, if people use an SPF50 sunscreen but don’t put enough on, they’re really getting more like SPF 25 protection, or even less.
SPF For Light-Skinned People
For example, let’s imagine a person with light skin who has not been exposed to any sun recently. Let’s say this person’s skin takes 15 minutes to burn when exposed to raw sunlight. Then let’s put an SPF 10 sunscreen on them. The net result of the SPF 10 sunscreen, assuming it is properly applied, is that 1/10 of the UVB rays will get through the sunscreen layer and actually impact the skin.
Another way of putting it is that it took 15 minutes to burn with no sunscreen on. With an SPF 10, it would take 150 minutes of exposure to burn (15-minute burn time x 10 SPF = 150 minutes protection). With an SPF 30, it would take 450 minutes (15 minutes burn time x 30 SPF = 450 minutes protection).
SPF For Dark-Skinned People
Now let’s imagine a person with darker skin who has not been exposed to any sun recently. This person’s skin takes 40 minutes to burn when exposed to raw sunlight.
If they put on SPF 10 sunscreen, they would get 400 minutes of protection (40 minute burn time x 10 SPF = 400 minutes of protection). If they put on an SPF 30 sunscreen, they would get 1200 minutes of protection (40 minute burn time x 30 SPF = 1200 minutes protection).
Broad-Spectrum Sunscreens
As mentioned above, SPF pertains only to UVB radiation and does not talk at all about UVA radiation, which is now known to be dangerous as well. At the moment, the FDA does not require sunscreens in the US to protect against UVA radiation.
This rule is rather odd!
The FDA currently allows sunscreens to be sold that do not protect against UVA radiation. But they do allow sunscreens that have been shown to protect against UVA radiation to be sold under the label “Broad Spectrum.”
There is good data showing that UVA radiation is harmful, yet the FDA continues to allow the sale of sunscreens that don’t provide UVA protection. It seems like they should require all non-Broad-Spectrum sunscreens to be removed from the market, yet they have not!
The FDA is behind the times here, and other countries have much better and more up-to-date sunscreens than what is sold in the US.
Regardless, to ensure that you are protected from UVA radiation as well, you need to use a Broad Spectrum sunscreen.
Is Higher SPF Sunscreen Automatically Better?
Sort of. The higher the SPF, the fewer of the sun’s UVB rays hit the skin. This means that exposed skin protected by a higher SPF will receive a lower dose of UV radiation based on the power of the sunscreen. If you’re going to be out for a long time, a Higher SPF is better, though you’re always told to reapply every 2 hours, regardless.
But if you’re only going to be out for 2 hours, total, the difference between a properly-applied SPF30 and SPF50 are essentially zero. And don’t forget, only “Broad Spectrum” sunscreens will protect against UVA rays, as well!
Does a “Base Tan” provide any sun protection?
Many who love to tan have found that a base tan will provide protection from sunburns. A base tan is a tan that has been built up through regular sun exposure in small intervals. Unfortunately, a base tan only provides an SPF of about 2 to 3. Base tans that formed from sunbathing and getting both UVA and UVB radiation provide more protection than base tans created from tanning beds.
Bronzing bulbs more-closely mimic natural sunlight, and are usually compatible with regular tanning beds.
Regardless, this translates to not that much protection. But let’s run the numbers for a bit.
Let’s go back to our two hypothetical people, the lighter-skinned person who burns in 15 minutes, and the darker-skinned person who burns in 40 minutes.
If the lighter-skinned person had a good base tan that gave them an SPF of 3, they would be able to stay out in the sun for 45 minutes without any protection, without causing any sunburns. No, that’s not a ton of time, but it’s not nothing, either! And there are no chemicals being put on the body, nothing that can be washed off, and no chance of improper application.
A light-skinned person with a base tan might be able to spend 45 minutes outside without any protection. That’s plenty of time to, for example, go for a jog, take a walk, play a game of pickup basketball, etc. It’s clearly not enough to protect against a full-day trip to the beach! But often in modern life, we aren’t spending more than 45 minutes at a time in the bright sun. And once that 45-minute number is reached, it’s time to cover up, put on the sunscreen, and continue on.
Now let’s look at the dark-skinned person, and suppose they also have a base tan. They were able to spend 40 minutes without burning before. And now with a solid base tan with an SPF of 3, they can spend up to 120 minutes in direct sun without burning, just with a base tan. Two hours sunscreen-free, with just an SPF of 3. That’s a soccer game or a good weekend gardening session.
How Does Skin Color Factor into Skin Cancer Risk and Sun Exposure Benefits?
Virtually all skin cancer societies and dermatology societies in the United States ignore skin color in their recommendations. They give the same advice to all people when it comes to sunscreen. All sun exposure is bad. And all of us, regardless of skin color, should use a high SPF sunscreen before any sun exposure. We should regularly reapply that sunscreen to ensure skin protection.
But the reality is that skin cancer incidences are much lower among populations with darker skin color. Among Caucasians in the US, the incidence of melanoma is 22 in 100,000 people. For African Americans, the rate is 1 in 100,000 people.
This disparity is enormous and hard to ignore. But dermatologists are quick to remind us that mortality rates are higher among African Americans who get melanoma than among Caucasians who get melanoma.
Those with dark olive skin and black skin tend to get melanomas on the hands, under the fingernails, and in other spots that are hard to treat and are particularly high risk. This cannot be ignored.
Still, the disparity in melanoma incidence is breathtaking.
Should African Americans and Olive-Skinned People Use Sunscreen?
The incidence of diabetes, heart disease, stroke, and high blood pressure are all much higher among African Americans than they are among Caucasians. And if the research presented above on the positive impacts of sunlight on these maladies is correct, the more sun exposure, the lower the risks of getting these diseases.
Yet most cancer societies recommend those with olive and black skin still wear sunscreen, just as much as those of us with light skin. As the American Academy of Dermatology puts it, “all people, regardless of skin color, protect themselves from the sun’s harmful ultraviolet rays by seeking shade, wearing protective clothing, and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.”
Does this make any sense at all?
If we ignore the new research, it does make sense for all people, regardless of skin color, to wear high SPF sunscreen and supplement with Vitamin D. This position is that there are no health benefits, but there are real risks.
But if the new research is correct, those with darker skin have been given poor advice that has caused a great deal of harm. Those with dark skin should be getting more sun exposure. They could reduce their incidence of diabetes, heart disease, etc. with sunlight. After all, the risk of melanoma among those with dark skin is extremely low to start with.
Those with dark complexions have a huge potential upside to getting more sun. And very little downside.
Sunscreen Messaging and Marketing
It’s easy to understand why dermatologists make blanket statements that everyone, regardless of skin color, should wear sunscreen. Up until recently, there was very little argument that there is any harm in wearing sunscreen, so why not? And making more nuanced recommendations turns the messaging statements into a mess.
Much easier to simply say everyone should be wearing SPF30+ at all times, and be done with it. And if they go under the assumption that there are few benefits to sun exposure, what’s the harm in having darker-skinned people protect themselves as well?
Are Sunscreens Safe to Use? What are the Disadvantages of Sunscreen?
Are all those chemicals we are smearing onto our skin safe? Maybe not! There may be some health and environmental disadvantages to sunscreen use.
A few particular sunscreen ingredients, Oxybenzone, Ecamsule, Octocrylene, and Avobenzone, have recently been found to get absorbed into the skin, blood, and breast milk at higher rates than originally assumed. In fact, there are up to 12 questionable sunscreen ingredients under review. Some experts are suggesting that these chemicals could lead to hormone disruption and even skin cancer.
The FDA originally tested the sunscreens for blood absorption based on the assumption that they will be used once or twice per week. But now the AAD is suggesting that sunscreen should be used basically all the time. This completely changes the amount of these chemicals getting absorbed into the skin! The FDA hasn’t fully determined that these chemicals are unsafe, but there is at least some concern, and more research is being done.
There could even be risks to a developing fetus from these chemicals when used by a mother while breastfeeding or pregnant. The American Academy of Pediatrics has gone so far as to state for pregnant mothers “You may want to select a sunscreen that does not contain the ingredient oxybenzone, a sunscreen chemical that may have hormonal properties.” Check out this article for information on tanning while breastfeeding. And see our recommendations for pregnancy-safe sunscreens.
Oh, and Oxybenzone may be potentially killing coral reefs, too. It has been banned in Hawaii.
The current recommendation by most medical bodies is to stick with sunscreens that use Zinc Oxide as their primary ingredient. Of course, these don’t protect the skin as well as the Oxybenzone sunscreens, and they tend to leave an ugly whitish cast to the skin that can be unflattering.
Covering Up with Clothing and Hats
All of this leads to a renewed focus on covering up with clothing. Protect yourself with clothing and a broad-brimmed hat, and seek shade during the high UV-Index times. This may be a better solution than constant sunscreen use.
What About All the Time Before Sunscreen was Invented?
Humans evolved somewhere around 2 million years ago in the African Savannah. About 200,000 years ago, modern homo sapiens evolved. From 200,000 BC to 1950, there was no sunscreen. And for a significant amount of time, there was no clothing, either! Constant sun exposure, day in day out, for the whole life. This is the standard for humanity up until the dawn of civilization about 10,000 years ago was the norm.
And really, it’s only been in the last 100 years or so that a significant portion of the world spends most of its time indoors, working in offices and living inside.
Does it make sense that every human in history was at extreme health risk due to skin cancer, even though for the vast majority of human history, all human skin was exposed to constant UV radiation with no protection?
No, it does not make any evolutionary sense. Air, sun, water, food, sex. These are the ingredients of most of life on land.
Do Modern Hunter-Gatherers Have a High Incidence of Skin Cancers?
As stated at Darwinian Medicine, “All of the evidence I’ve seen suggests that the incidence of cancer is very low among hunter-gatherers and traditional, non-westernized people.” This result, perhaps most similar to ancient humanity, among people who spend virtually all their time exposed to the sun.
And what about other health indicators, like heart disease and diabetes? These diseases are virtually unknown among hunter-gatherers. As medical doctor Giacinto Libertini stated in 2013 paper, “It is worth noting that, in Ache people in wild conditions, the main causes of death for modern western populations (heart attacks, diabetes, hypertension, etc.) are absent. Moreover, cases of death by cancer are not reported, although, in the group “adult aged 60+ years”, some deaths attributed generically to unspecified causes or to “old age” could be the result of neoplastic diseases.”
This research on hunter-gatherers meshes pretty well with the research of Dr. Wellers and Linqvist. Of course, it’s impossible to draw any real conclusions from this coincidence, but it’s worth noting.
Differences Between Modern Hunter-Gatherers and Other Modern Humans
One of the major differences between those people who live in present-day hunter-gatherer societies and those of us who live in cities and suburbs is that the hunter-gatherers get continuous sun exposure every day, all day. Those of us who work in offices get very little sun exposure, even those of us who like to exercise outside or otherwise get a tan.
The constant sun exposure hunter-gatherers (and those of us who work daily outdoors) receive appears to provide a protective buffer against skin cancer risk. It also apparently improves other biomarkers of health like blood pressure, stroke risk, and diabetes risk.
Sunburn was probably not even a concept up until the dawn of civilization when humans spent significant time indoors. Everybody had a natural tan before that.
Conclusion: Rethinking The Sun’s Role in Human Health
If I have convinced you that perhaps the sun is not an object of pure evil and that there are significant benefits of tanning, that doesn’t mean that you should just throw the sunscreen away and go for a 5-hour sunbathing session in the bright sun.
It appears at least some of the improvements come from regular, constant sun exposure day in day out.
And the real significant danger from the sun is the severe sunburn, not the careful base-tan.
It appears that using clothing, hats, and shade to cover up has been underrated, and should absolutely be a bigger part of the solution.
How to Stay Safe in the Sun
- Use a UV-Index Forecast System like Sunburnmap to keep track of the UV Index
- Follow the Australian SunSmart UV-Index Recommendations
- Try to stay out of the sun during the hottest parts of the day, when the UV Index is particularly high
- Cover up with clothing, a broad-brimmed hat, and seek shade
- Building a base tan may not be as bad as currently assumed, and will provide a small amount of protection (SPF3)
- Use sunscreens that have Zinc Oxide as their primary ingredient
- Make avoiding sunburn your priority, as opposed to avoiding all sunlight
Good luck, and enjoy the sun!
