Sunshine is a Public Health Threat?

You may recall my disdain in the article Defining the Enemy which detailed how, in an annual review published in the Annual Review of Public Health, Competing dietary claims for weight loss: finding the forest through truculent trees, Dr. David Katz (an Associate Professor Adjunct in Public Health Practice at the Yale School of Public Health) called research into diets that are not aligned with the current recommendations a 'public health threat'.

Perennially reinventing our destination for weight control in the form of the “hot” diet du jour is a discredit to our common sense, a digression from our cultural imperatives about confronting challenges, an indictment of our collective judgment, and a neglect of a robust base of evidence characterizing the effects of dietary pattern on the health of human beings across the life span. But it is something far worse. It is a bona fide public health threat in and of itself.

Well, now it seems that good old sunshine - or atleast the recommendation to get some exposure without sunscreen for Vitamin D - is also a public health threat.

Today the American Academy of Dermatology released this to the media - Comprehensive Examination of Scientific Research Supports American Academy of Dermatology's Stance That Harmful Effects of Sunlight Outweigh Benefit of Vitamin D Production.

Within the press release is a chilling paragraph - "Any individual or organization that advocates intentional sun exposure as the preferred means of producing vitamin D is doing a tremendous disservice to the public," said Dr. Gilchrest. "Ultraviolet (UV) radiation is a known carcinogen that is responsible for photoaging and for well over 1 million skin cancers each year in the U.S. While some researchers and professional groups are now questioning whether higher vitamin D levels should be recommended for optimal health, no responsible group or individual is advocating UV exposure as a remedy. Dr. Wolpowitz and I hope that this detailed review will put to rest these erroneous claims that sunlight is somehow good medicine."

How in the world have we gotten here?

Not only are those researching dietary alternatives for various diseases and disorders public health threats, now anyone saying "sensible exposure to the sun - that is, limited exposure without sunscreen - is an effective way to meet your Vitamin D requirements" is also a public health threat too!

And what, pray tell, is the "right" answer for getting adequate intake levels of vitamin D according to the American Academy of Dermatology? You guessed right if you said fortified processed foods and supplements.

How exactly did we manage to meet our vitamin D requirements before the industrial revolution gave us the technology to fortify our foods and produce pills?

Oh, ummmm, food and sunshine.

The two sources we're now told to avoid - animal foods like egg yolks - and a nice, 10-to-15 minute daily stint in the sun without sunscreen blocking the UV-rays that stimulate vitamin D production from within the body.

So, I wondered - what organizations, publications and individuals should be considered "dangerous" and irresponsible because they're suggesting we have a problem with adequate vitamin D or are promoting this radical idea that sunshine can be good medicine?

In the fall of last year, a review of the NHANES III data, published in Ethnicity & Disease, found "Serum levels of 25(OH) D3 are below the recommended levels for a large portion of the general adult population and in most minorities. Need exists for a critical review and probable revision of current recommendations for adult vitamin D intake to maintain adequate 25(OH) D3 levels."

In Octorber 2005, a review in the Southern Medical Journal reported that "Vitamin D is very important for overall health and wellbeing. A major source of vitamin D comes from exposure to sunlight. Measurement of 25-hydroxyvitamin D in the blood and not 1,25-dihydroxyvitamin D is used to determine vitamin D status. A blood level of 25-hydroxyvitamin D of at least 20 ng/mL is considered to be vitamin D sufficient. Vitamin D deficiency increases the risk of many common cancers, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and type I diabetes."

In November 2005, the Journal of Nutrition published a review that stated bluntly, "Vitamin D deficiency is now recognized as an epidemic in the United States." That even continued to say that "The major source of vitamin D for both children and adults is from sensible sun exposure."

Research findings published in September 2005, from the UK in the Archives of Diseases in Childhood concluded "Hypovitaminosis D was common among healthy adolescent girls; Non-white girls were more severely deficient. Reduced sunshine exposure rather than diet explained the difference in vitamin D status of White and Non-white girls."

And let's not miss the October 2005 publication in Current Rheumetology Reports that said, "Extensive research suggests that vitamin D deficiency is common and represents a global health problem."

Oh, it gets worse - JAMA actually published a fact sheet in November that included the bold statement that "Sun exposure for 10 to 15 minutes at least twice a week usually provides adequate amounts of vitamin D."

In October 2005 the British Journal of Nutrition published findings that stated, "Human vitamin D status primarily depends on skin exposure to the UVB spectrum of the sunlight."

Gosh, even the government, through the NIH publication Dietary Supplement Fact Sheet: Vitamin D, is promoting this wayward idea to have some exposure to sunlight - "Sun exposure is perhaps the most important source of vitamin D because exposure to sunlight provides most humans with their vitamin D requirement...An initial exposure to sunlight (10 -15 minutes) allows adequate time for Vitamin D synthesis and should be followed by application of a sunscreen with an SPF of at least 15 to protect the skin. Ten to fifteen minutes of sun exposure at least two times per week to the face, arms, hands, or back without sunscreen is usually sufficient to provide adequate vitamin D."

Even BUPA, the UK's leading provider of private health care insurance, maintains that "Despite the obvious dangers of unprotected sun exposure, we do need some contact with sunlight as it helps with the production of vitamin D...The vitamin forms under the skin in reaction to sunlight, with the best source being summer sunlight."

So, the above references illustrate that A) we're experiencing vitamin D deficiency in our population and B) sensible exposure to sunshine is a reasonable recommendation.

I wonder if the old adage, follow the money, applies here?

It seems the American Academy of Dermatology is heavily dependent on corporate "partners" that include pharmaceutical companies manufacturing vitamins sold to the public and to food manufacturers for fortification, as well as companies invested in development and sale of sunscreens.

Who'da thunk it?