David Eifrig Jr. MD
I have just returned from an island off the coast of Georgia. The island is the easternmost piece of land in the state of Georgia. Luckily, we stayed just down the street from a great breakfast dive called "The Breakfast Club." This is a famous place and unique in many ways including the hours. When the chef (can you really call a short order cook that?) decides to close he closes. Today he closed at 12:30. Yesterday, he stayed open until 2:00. If you've ever spent much time on an island in the semi-tropics you'll find nooks and crannies with people like this..."living on island time."
As this summer comes to an end and the sunsets arrive earlier and earlier, I am reminded about those living either on an island or near a beach, and I truly begin to wonder about the sun and whether it is good for us. While walking the beach this week, I contemplated the hype about sunburns and skin cancer. How much SPF was I supposed to put on? How often? Should I really stay completely out of the sun at noon? When I realize how little of it makes sense, I know its time do some more research and then share my thoughts with you.
If you think about it, the sun and sunlight HAS TO BE HEALTHY for us. As it turns out, our bodies actually use the sunlight to produce chemicals that are highly critical in our body's function and our mental well-being. The sun's ultraviolet radiation, UV for short, comes in several different wavelengths of light. UV-B rays, the ones thought to burn, are the ones that trigger the production of the major chemical so critical to our health. The chemical is Vitamin D and it is critical in our kidney function, bone formation, blood pressure, immune system function, etc...
In actuality, it is not truly a vitamin since it can be made by human skin and thus need not be added to our diet. In fact, almost every cell in our body has a receptor for Vitamin D. More importantly, this vitamin is chemically a steroid called cholecalciferol, (aka Vitamin D3). It is produced in the skin and then converted to a long-lived molecule in the liver, and then finally into a short-lived active molecule 1,25-dihydroxycholecalciferol. The chemical is fat-soluble and, as such, could be consumed and stored in the body in excessive amounts if too much is taken in supplement form. One of its critical roles is in controlling the balance between calcium, phosphorous, and bone "remodeling." Some people think the reason fractures are so common in the elderly is due to decreased sunlight inside nursing homes and the hospital. I actually agree with this idea.
But back to the issues surrounding the sun. The hype surrounding sun and skin cancer is remarkable. Several high profile websites propagate the hype with phrases such as:
1. "90% of skin cancers are preventable"
2. "skin cancer is at epidemic proportions in the U.S."
3. "well-known behaviors can reduce the risk"
Shamefully, they don't tell you how good the sun is for you or how harmful the chemicals are they recommend using to "prevent cancer." In fact, sunscreen does not even protect you from the form of skin cancer called melanoma -- the deadly skin cancer but also the least common. (Genetics play a huge role in this form of cancer and paradoxically the sun may help prevent it!)
Some of the chemicals in sunscreen include:
1. Titanium dioxide -- absorbed into the skin --"a potential occupational carcinogen."
2. Octyl methoxycinnamate -- kills mouse cells in much lower concentrations than those found in sunscreen.
3. Benzophenone -- used in industrial processes to initiate chemical reactions -- a prolific producer of free-radicals
4. 4-methyl-benzylidene camphor (4-MBC) --causes estrogen-like effects and developmental effects in animals
5. Adimate-O -- is a nitrosamine, which are major players in stomach cancers
6. Homosalate -- may cause aspirin (salicylate) poisoning
7. Oxybenzone -- causes low sperm counts and liver toxicity in animals
What no one tells you is that most of the chemicals in sunscreens are as likely if not more so to do harm to your system than the sun itself. And the shocking news is that melanoma (the deadly skin cancer) is on the rise in the countries that have been increasing their use of sunscreens.
Even more proof that sun, skin cancer, and the hype about it is wrong can be found if you look at states that have the highest amount of sunlight and the highest incidence of melanoma (or vice versa) and guess what? The states' rankings don't correlate with each other. For example, Delaware, which is #3 on the highest incidence list, gets around 100 days of sunshine per year, whereas the #46 to #50 states (low incidence of cancer) receive around 100 days per year as well. Clearly the pathophysiology of skin cancer is poorly understood.
But more importantly I want to tout the fact that the SUN IS GOOD FOR YOU... there are many studies showing that exposure to the sun:
1. decreases the risk of melanoma (a paradox for many)
2. decreases the risk of colon cancer
3. decreases the risk of breast cancer
4. decreases the risk of ovarian cancer
5. decreases the risk of prostate cancer
6. decreases the risk of lymphoma
7. decreases the risk of multiple sclerosis
8. decreases depression in the winter
9. causes a regression of solar keratoses
Now having said all this... I can tell you that if you have more than 50 moles on your body OR the moles that you do have are unusual in shape, size or color then you are at much greater risk and getting sun on those moles can trigger their transformation to cancer. Similarly if you are lighter skinned, red, or blonde-haired... then you are at increased risk (albeit small and the risk decreased with regular exposure to the sun for short periods of time).
What do I do?
1. I try to get some sun on my body every day (my face is usually the most convenient during working hours).
2. I try to not use sunscreen unless I am going to be outside for a much longer time than normally, for example a 3-4 hour period. In those times, I will use an SPF4 or less to reduce my exposure to these toxic chemicals. (The number represents the amount of "supposed protection," the higher the number the more chemicals)
3. I also am very careful to NOT use sunscreen that has OMC (Octyl methoxycinnamate) -- I found a while ago that it causes a rash days after application and also seems to make me react to the sun with more redness than other sunscreens.
4. Prior to any winter trip to a sunnier climate, I will stimulate my melanin producing cells (the ones that darken to give us a tan) by getting sunlight on my body (see #7) several times before going on the trip -- even if this means a few tanning-booth sessions. (Tanning booths however don't have the full spectrum of the suns rays, which could be both good and bad.)
5. I am always careful to reduce the amount of sun I get during the peak burning times of 11:00 a.m. to 2:00 p.m., especially if I haven't been out much in the sun. I don't avoid this time but am just careful. For example, I usually put my convertible top up during this time.
6. I try and wear sunglasses and a cap to reduce the amount of direct light to my eyes (there is a link to cataracts and other eye diseases), although I do make sure my eyes get some of that healthy daytime light by occasionally not wearing glasses during daylight hours. The eyes are connected to a bunch of brain structures related to sleep, happiness, body rhythms, etc...
7. If it is the middle of winter and I'm feeling a little blue... in the middle of the day I try and find a nice warm brick wall, out of the wind, and just sit and get sunlight on my face and skin as much as possible...
It's such a simple thing that it doesn't seem very important. But... I look for simple, cheap, and safe things to improve the long-term quality of my life. Sunlight is one of those powerful healing sources. Don't feel guilty about the sun.
Here's to our health,
Dr. David Eifrig Jr.