Published May 14, 2019. Updated May 29, 2019

As a mother of three and a toxic exposures specialist, I have grappled with my sun exposure strategies. Knowing that there is no such thing as nontoxic sunscreen and that our bodies need sun exposure for vitamin D, I have wondered what is best for my children as I slather them with heavy sunscreen that is not natural.

With sunburns, skin care, and vitamin D deficiency (and related health issues) all on the rise, I summarized how I balance all this into the seven strategies below. 

As I "meditate" on our May skin detox theme, I may update this post with enlightened thoughts throughout the month, since I haven't thought about sunscreen and sun protection since summer 2018!

— Sophia Ruan Gushée

We need sunshine for vitamin D

Healthy sun exposure is critical for our bodies' vitamin D levels, which is more commonly known for its essential role in our bone health. But vitamin D may be connected to even more aspects of our health.

Vitamin D deficiency is being studied for its possible association with a long list of health issues, such as blood pressure, heart disease, diabetes, cancer, mood disorders, respiratory issues, and dementia (Harvard Medical School 2017). Vitamin D may be essential for our immune systems as well.(10)

And we are vitamin D deficient

Vitamin D deficiency has been on the rise. Estimates of those who are vitamin D deficient range from 42%(2) to 80%((3). A 2012 article (4) estimated that approximately half of the world's population—or 1 billion people worldwide—are deficient in vitamin D.

We can get vitamin D through our diets—like from fatty fish (such as tuna, mackerel, and salmon), foods fortified with vitamin D (such as dairy products, soy milk, and cereals), beef liver, cheese, and egg yolks. However, sufficient Vitamin D is hard to get through natural whole foods.

Vitamin D supplements: benefits and risks

Vitamin D supplements can help those most at risk for deficiency, like breastfed infants, older adults, people who don't get enough sun exposure, and those with darker skin. However, excess vitamin D levels can increase health risks for things like fractures, falls, and kidney stones. Vitamin D can also be toxic in excess levels. 

Ugh. How do you balance all the benefits and risks of sun exposure and vitamin D requirements?

Talk to your physician about how much vitamin D is recommended for you and your family members. Recommended doses will be influenced by our sex, age, and other things (like if you're pregnant). I've seen recommendations for adults range from(9, 10):

• 200-600 IU each day for adults 50-70 years and younger
• 400 IU daily for those 50-70 years old
• 600-800 IU each day for adults over 70
• Dr. Andrew Weil recommends 2,000 IU of vitamin D per day
• Recommended doses for children from birth until 5+ years of age have ranged from 200-600 IU per day
• For perspective, 4 ounces of cooked salmon contains approximately 600 IU of vitamin D

When selecting supplements, recommendations include D3 (cholecalciferol) rather than D2 (ergocalciferol). Try to find manufacturers that avoid harmful preservatives and fillers.

Confused? It's confusing! Please decide with your physician. The science of absorption is another challenge that few, if any, people understand fully.

Mr. Sunshine is the best source of vitamin D

Sun exposure is the best way to stimulate our vitamin D production. Vitamin D from sun exposure "may last at least twice as long in the blood compared with ingested vitamin D," according to an article published in a peer reviewed journal, Journal of Pharmacology & Pharmacotherapeutics (JPP)(4). That same article states:

"most people need 1,000 to 1,500 hours of sun exposure throughout the spring, summer, and fall"

—Journal of Pharmacology & Pharmacotherapeutics

 
But skin cancer is the most common cancer in the US

Skin cancer has been increasing in incidence across the world over the past decades (WHO 2019). In fact, it is the most common form of cancer in the United States (CDC 2018), affecting more than 3 million Americans in 2012, according to the most recent statistic (American Cancer Society 2019).

And sunscreen ingredients pose risks too

In May 2019, an article was published in the Journal of the American Medical Association (JAMA Matta et al, 2019) about a small study that found sunscreen ingredients to have penetrated the skin and entered the bloodstream of the study's participants. (This was no surprise to me.) This study examined four common sunscreen ingredients:

1. avobenzone
2. oxybenzone
3. octocrylene
4. ecamsule

Dr. David Strauss, director of the division of applied regulatory science at the Center for Drug Evaluation Research at the FDA and one of the study’s co-authors, was quoted in a TIME magazine article with this response: 

We really have a paucity of data on whether there are adverse health effects of these ingredients or not.

So which active ingredients are safe?

Read sunscreen labels for zinc oxide and titanium dioxide. They are generally considered safe and effective. There is concern about nanoparticles, and avoid spray sunscreen since it's easier to inhale those chemical formulas.

7 sun protection strategies

Balancing the benefits and risks of sun exposure and sunscreen, below are tips for a practical approach.

1. Stay out of the sun during its most damaging times. You can download an app to inform you of the hours during which UV rays are the most damaging. I use the free one by Ultraviolet ~ UV Index.
2. Use shade. This can help reduce sun damage and the need for sunscreen. Stay indoors when the sun's rays are too risky. Use large-rimmed hats, sunglasses, parasols, and sun protective clothing.
3. Plan healthy sun exposures for your vitamin D levels. You can download an app to help. I use Dminder.
4. Use the Environmental Working Group's database to make sure your sunscreen is among the safest ones known. Remember: zinc oxide and titanium dioxide are considered are safest options; avoid nanoparticles; and avoid spray sunscreen products. You can visit it at this web address: https://www.ewg.org/sunscreen/
5. Apply sunscreen appropriately. As you can see in the video below, most people do not apply enough sunscreen or apply it sufficiently. I showed the video below to my kids because they definitely do not apply enough sunscreen and I know they don't protect their eyelids. 

6. Talk to your doctor about the best vitamin D approach for you and your family. You want to avoid taking excess levels, try to get it through diet and healthy sun exposure. 
7. Include foods that can help boost your body's natural defenses against the sun. Foods that contain lycopene can help.(11)

For the rest of May, we will explore sun protection strategies and skin care routines from women I know who share similar values in practical nontoxic living. In the meantime, you can get started by incorporating the tips above.

References

(1) Harvard Medical School 2017. Ruiz, Emily S. MD, MPH. "Vitamin D: Finding a balance." JULY 21, 2017. Harvard Medical School. https://www.health.harvard.edu/blog/vitamin-d-finding-balance-2017072112070

(2) Wheeler, Stephanie. "42% Percent of Americans Are Vitamin D Deficient. Are You Among Them?"July 1, 2018. Mercy Medical Center. https://www.cantonmercy.org/healthchat/42-percent-of-americans-are-vitamin-d-deficient/

(3) Dminder. http://dminder.ontometrics.com

(4) Nair, Rathish and Arun Maseeh. "Vitamin D: The “sunshine” vitamin." J Pharmacol Pharmacother. 2012 Apr-Jun; 3(2): 118–126. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/

(5) World Health Organization, 2019. "Skin cancers." https://www.who.int/uv/faq/skincancer/en/index1.html

(6) CDC 2018. "Skin Cancer Statistics." Page last reviewed: May 29, 2018. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

https://www.cdc.gov/cancer/skin/statistics/index.htm

(7) American Cancer Society 2019. "Key Statistics for Basal and Squamous Cell Skin Cancers." Last Medical Review: April 1, 2016 Last Revised: January 8, 2019. American Cancer Society. https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/about/key-statistics.html

(8) JAMA Matta et al, 2019. "Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients." JAMA. Published online May 6, 2019. https://jamanetwork.com/journals/jama/article-abstract/2733085

(9) Mayo Clinic, 2017. "Vitamin D." Oct. 18, 2017. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-vitamin-d/art-20363792

(10) Weil, Andrew MD. "Vitamin D Supplements & Foods." https://www.drweil.com/vitamins-supplements-herbs/vitamins/vitamin-d/

(11) Cooperstone et al, 2017. "Tomatoes protect against development of UV-induced keratinocyte carcinoma via metabolomic alterations." Scientific Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506060/