The Sunscreen Debate — Are We Blocking Our Way to Better Health？
Episode Stats
Summary
Rowan Jacobson, a science journalist who spent years investigating the health impacts of sun exposure, joins us to talk about the underappreciated benefits of ultraviolet radiation, and why sunscreen should still play a role in your routine.
Transcript
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Brett McKay here and welcome to another edition of the Art of Manliness podcast.
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You probably think of the health effects of sunlight as a mixed bag.
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On the one hand, sun exposure helps your body make vitamin D, but on the other, it can cause
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skin cancer. To get around this conundrum, dermatologists frequently recommend avoiding
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sun exposure when you can, slathering on sunscreen when you can't, and taking a vitamin D supplement
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to make up for the lack of sunlight in your life. Yet in seeking to solve one problem,
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this advice may open up many others and be contributing to ill health in the West.
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Today on the show, Rowan Jacobson, a science journalist who spent years investigating the
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health impacts of sunlight, will impact the underappreciated benefits of sun exposure,
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and that, crucially, they're not primarily a function of the production of vitamin D
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and can't be replaced with a pill. We talk about what else is at work in ultraviolet radiation's
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positive effects on blood pressure, autoimmune diseases, insulin resistance, mood, and more.
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We also get into how to weigh these benefits against the risk of skin cancer, why health
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officials in Australia, which has the highest rate of skin cancer in the world, have changed
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the recommendations around sun exposure, and if there's a role sunscreen should still play
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in your routine. After the show's over, check out our show notes at awim.is slash sunlight.
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So you are a journalist, and for the past few years, you've been researching and writing about
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the benefits of sunlight to our health and how the injunction to religiously slather on sunscreen
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might be causing unintended health consequences. Let's talk about the health benefits of sunlight.
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I'm sure listeners have heard and know that sun exposure increases vitamin D levels in the body.
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How does that happen? Like, what is it about sunlight that causes vitamin D levels to go up?
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Yeah, it's kind of this interesting phenomenon where we really are photosynthesizing. Like,
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we don't do it like a plant does it, but we are synthesizing these compounds with the help of
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photons from the sun. So, like, the way it works, so I guess for starters, vitamin D is a hormone that
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is used for all kinds of different reasons in the body. Like, it's kind of misnamed as a vitamin because
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it's not like the other vitamins, which are these little things that you get in food. It's a hormone
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that we use for lots of different things, and it's essential to health. And we mostly make it in our
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skin. And the way that evolution worked this process out is that it makes these molecules
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that are, like, similar to cholesterol. They're sterols. It makes these molecules that are, like,
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a couple of chemical processes, chemical steps away from becoming vitamin D. And that's as close as we
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can make on our own. And we do that in the skin. And then what we rely on the sunlight to do is the
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sun hits those molecules, breaks open one of the little chemical bonds between the molecules,
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so that that molecule can then change its form into a different form, which is vitamin D, or
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actually pre-vitamin D. And then that molecule goes into the body and gets transformed into the
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type of vitamin D that we use after going through the liver and sometimes the kidneys, too. So,
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it's this incredibly complicated process. But the upshot is that there's this one step that we need
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sunlight to break open the bond for us so that we can change that molecule into something else.
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So, I know sunlight is made up of different types of UV radiation, including UVA radiation and UVB
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radiation. Is there a specific type of radiation that causes that reaction?
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Yeah. For vitamin D, it's all the UVB, which is particularly a narrow wavelength of UVB, about,
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like, 295 to 310, 315 nanometers. So, yeah, there's UVA, UVB, UVC. UVC gets filtered out by the
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atmosphere entirely, which is a good thing because otherwise it would be really deadly.
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UVB is that next wavelength. And then UVA has a very different size wavelength to it. And so,
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we get both UVA and UVB on our skin. UVB is the one that can hit those molecules and break apart
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What does our body do with vitamin D once it's turned into vitamin D?
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So, most famously, it's essential for bone mineralization. And this was discovered way
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back when kids were getting rickets in, like, during the Industrial Revolution, suddenly people
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who had always been outside farming were in these cities. The cities were really sooty. So, even if you
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were outside in the city, you weren't really getting any sunlight. Then the kids were working
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factories. So, suddenly all the kids were getting rickets, which is when your bones are soft,
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too soft. They don't get hard enough because they don't have enough calcium in them. And then you
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get these bowed legs. It's bad. You don't want to get rickets for sure. But a lot of kids were in
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the Industrial Revolution suddenly. And they figured out that that was because they weren't getting
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proper bone mineralization. They weren't getting that calcium into their bones. And vitamin D does
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that. And that discovery was a huge health step forward because we were able to pretty much eliminate
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rickets, famously, because of cod liver oil. So, cod liver oil is a good source of vitamin D. So, they
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started giving the kids cod liver oil. And that gave them just enough D to not get rickets. They also
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started putting babies in the sun. You know, like, there's these crazy photos from back in the day of, like,
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these little cages hanging out the windows of tenement buildings. And you would put your baby in
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that cage for a little while just to, like, get a little sunlight on the baby.
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That's interesting. So, people hear that, okay, I just need vitamin D. I don't want to sit out in
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the sun because I don't want to get a sunburn. I don't have time for that. I don't want to get skin
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cancer. So, I'll just take a vitamin D supplement. And that'll take care of me. And I'll get all these
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benefits that come from vitamin D. One of them is just bone mineralization. And then there's been
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these other health benefits that have been associated with vitamin D. So, if you have
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elevated vitamin D levels, you have better metabolism, you reduce your cancer rates,
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things like that. So, yeah, why not just take the vitamin D supplement?
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Yeah, right. And this is the message and the advice we've been receiving from dermatologists for
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a couple of decades now is, like, we know that sun exposure causes skin cancer. We know that it makes
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vitamin D. We know we need vitamin D. But no problem. Avoid all sun exposure.
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And yeah, your body won't make enough vitamin D, but you just take vitamin D pills to make up for
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that and problem solved. So, that was this overly simplistic understanding for a while. But to test
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it, what you have to do is do these trials where you get a lot of people so that you have some,
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you know, statistical power to get randomness out of there and give half the people vitamin D pills
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and the other half just get a placebo and see what happens. And so, now some huge, huge trials have
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been done multiple years, tens of thousands of people involved in the trials. And we have
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extremely strong definitive evidence that those vitamin D supplements do not help to improve any
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disease. Just they totally failed in a way that, you know, science rarely gets results that are so
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definitive. Like, there's no question. They just, they didn't improve a single condition,
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which was really surprising because, like you say, people who have high levels of vitamin D in
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their blood have lower rates of, like, pretty much every disease you can think of. So, we really did
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think, oh, vitamin D is not just for bones. It must be essential for all these other things in the human
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body and for preventing all these other diseases. So, then these supplement trials, when they failed,
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then everyone had to kind of go back to the drawing board and say, like, no, wait a minute. How can it be
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that people who have naturally high levels of D in their blood have lower rates of all these diseases?
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But if you artificially raise people's amount of D in their blood with supplements, it doesn't do
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anything. And you probably, you already know the answer. Right. Well, yeah, it's the sunlight that's
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doing it. Vitamin D, vitamin D is just a marker that you're getting a sufficient amount of sunlight.
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Right, exactly. So, it wasn't causative. It was just correlation. Like, the people with the lower
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rates of disease had a higher D because they were getting sun exposure. But now we know it wasn't
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the D that was causing the lower rates of disease. It was something else about sun exposure.
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Okay. So, people probably heard this idea that vitamin D improves a bunch of health conditions.
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But it turns out it's not the vitamin D. There are other things going on, other pathways with the
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sunlight itself that creates those health effects. And we're going to talk about how the sunlight can
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improve those different facets of our health. That's not to say that vitamin D is not important.
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You can get it from the sun or from a supplement. And as you said, we need vitamin D so we don't get
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things like rickets. You don't want rickets. So, we need vitamin D for that.
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Yeah. And vitamin D is probably important in other ways. Like, pretty much every cell in our body has
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vitamin D receptors in it. So, they're there for a reason. Like, our cells are all doing things with D,
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but we only need so much probably. So, you don't want to be vitamin D deficient. But this idea that
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really cranking up your level of D was going to somehow like chase all these diseases out of your
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body, that has turned out to be false. So, D is important, but you probably get enough through
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sunlight, most of us. But it depends. Like, it depends where you're living. And so, yeah. So,
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that's only part of it. So, could there be other things that sunlight is doing for you? And now,
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we have quite a bit of evidence that, yes. It turns out there's dozens of different processes
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and pathways that are triggered by sunlight hitting skin that have lots and lots of different effects
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on the human body. And we're really just learning about them. But so, this is the impasse. So, now,
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the dermatologists are going to have to readdress this whole formula that they gave to people. Like,
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don't worry about the D. Get the D through the supplement because it doesn't work. And all those
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health benefits that we're chasing, probably you need actual sunlight for that.
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Well, let's talk about some of these health benefits that people are starting to see
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there's a connection to sunlight. One of them is blood pressure. There's a connection between
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increased amounts of sunlight exposure and decreased blood pressure. And there's a guy,
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it's actual, it's a dermatologist who found this connection, a guy named Richard Weller.
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Tell us about him. What's the connection between sunlight and blood pressure?
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So, he's a fascinating guy, a dermatologist in Scotland. But he does work in Ethiopia every year
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and has for decades. And he started questioning the conventional wisdom on sun exposure and vitamin D
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after doing all this work in Ethiopia, where, you know, Ethiopia, like, huge amount of sun because
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it's in the tropical zone, in the equatorial zone. And it's up at like 6,000 feet. So, it gets a huge
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amount of sunlight. And he says he never treated a skin cancer there. Never saw any because he was
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treating people with very dark skin and they just weren't coming down with skin cancers.
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So, that was like the first step where he started questioning some of the conventional wisdom.
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But then, in terms of blood pressure that we had known for a long time in these observational
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studies, that people living in areas that got more sun exposure had lower blood pressure.
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So, like high latitudes where you don't get as much sunlight, higher blood pressure. And everyone
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sort of had sort of said like, well, you know, it's probably just temperature because your blood
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pressure is definitely lower in warmer temperature areas. So, everyone kind of like chalked it up to
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temperature. But then, back, I don't know, in the early 2000s, I think it was, some scientists
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discovered that, actually, it was earlier than that, scientists discovered that nitric oxide,
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which is a very simple molecule, is actually a really important signaling molecule in the body.
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And that nitric oxide will cause the muscles in blood vessels to relax and to dilate. So,
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nitric oxide is a really like potent vasodilator. So, it will expand those blood vessels and lower
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blood pressure. And that was, like, I won a Nobel Prize for that, like back in the 90s, I think.
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But what people only realized more recently and what Richard Weller's research helped to show was
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that our skin actually has these huge stores of nitrates in them, which is sort of a precursor to
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nitric oxide. And when sunlight hits skin, it breaks up those nitrates into nitric oxide and sends them
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into the body and lowers blood pressure. And he did these experiments on his grad student. Like,
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first, they showed it in mice. And I'm like, huh, it works. And then he did experiments on grad
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students where he shone UVA. He wanted to prove it wasn't vitamin D that was responsible for this,
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because everybody chalks up everything about sunlight to vitamin D. So, he used UVA instead of
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UVB, because UVA light does not create vitamin D. So, he took his grad students and shone UVA light on
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their arms. And he also put, like, foil, like, metal foil on half the students so that they were
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getting the heat of the UVA, but not the actual beams of the UVA, because he wanted to prove that
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it wasn't just heat either, because we know heat can lower blood pressure. And sure enough, the
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students who got the actual rays of UVA light, their blood pressure went down more than the students who
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just got the heat. And they've since done other studies looking at, like, the huge chunks of people in
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both the U.S. and U.K. And yeah, it's now very clear that sun-hitting skin produces nitric oxide,
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which lowers your blood pressure. And blood pressure is the, like, number one risk factor
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for lost years of life and mortality worldwide. So, anything that lowers blood pressure can be a
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pretty big deal. And that's a cheap intervention. It's free.
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Yeah, it is. It's free. And, you know, it's a cost-benefit ratio, because when you're exposing
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yourself to light, you are raising your risk of skin cancer. But skin cancer kills very few people.
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It's a very, very small factor in mortality. And blood pressure and all the cardiovascular-related
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diseases is, like, number one cause of mortality in the world. So, yeah, it's probably a very good
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Yeah, we're going to talk more about the real risk of skin cancer later.
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But with these blood pressure experiments, it was UVA radiation that produces nitric oxide?
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Yeah. Well, so he used UVA because he wanted to prove it wasn't related to vitamin D.
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But since then, I think they've found that UVB does it too. Like, all the UV produces nitric oxide.
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So, yeah. So, the blood pressure lowering effect is... And I don't even like dividing it up too much,
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because anytime we start to, like, boil it down to this sort of human-created simplicity,
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it reminds me of, like, fat, carbs, and protein. It's like this human construct that turns out to
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So, sunlight can reduce blood pressure. There's also been research showing that
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sunlight can strengthen immune function or improve immune function. Can you tell us about that research?
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Yeah. And that's really fascinating to me. And that was one of the... That research was one of
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the main reasons the Australian authorities decided to revise their sun exposure recommendations.
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But then this is, again, is something that's been known for a while. We've got 20 or 30 years of
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research on this. And it's just, in science, like, Department A is not necessarily talking to
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Department B. So, the immunologists were, like, way down this path of researching sunlight's effect
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on the immune system. And the dermatologists were just not ever getting the message on the other side
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of the campus. But anyway, so what we know is that we have a lot of immune cells in our skin,
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which makes sense, because the skin is the first barrier to the outer world. So, the skin is constantly
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dealing with pathogens and cuts and all kinds of, you know, assaults to the body. So, there's constant
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immune action happening in the skin. And UV is another sort of, like, minor assault that we get every
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day, that we've been getting every day for as long as humans have been humans. So, the skin has evolved to deal
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with it. So, it gets a little dose of UV, and then it heals that damage. And healing that damage is
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basically an anti-inflammatory response. So, the UV is a tiny bit of inflammation, and it triggers an
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anti-inflammatory response in the skin. All these immune cells get created. They reduce inflammation.
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But then what's really interesting, which is a more recent discovery, is those cells then migrate from
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the skin into the body through the lymph nodes and reduce inflammation throughout the body. So,
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it's the systemic anti-inflammatory response that's triggered by a little bit of UV. And that's
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important because one thing we're learning more and more is that a lot of the classic diseases of
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modern civilization have roots in inflammation. Like, we sort of have a lot of chronic inflammation going
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on all the time. So, something, and again, like you said before, a free intervention that can reduce
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inflammation could be a fantastic health benefit. And I feel like we intuitively understood this,
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you know, maybe a century ago. I love reading these old history books, biographies, and there's
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always this instance where some famous guy gets sick as a kid, and the doctor's like, well, you need to
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take him out to the desert or go to the ocean side and get lots of sun because you got tuberculosis,
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that'll help heal you. I think if they're just spending time in the sun, probably did a lot to
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help strengthen their immune system. Yeah, exactly. There was this whole age of heliotherapy where,
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like you said, tuberculosis, rickets, of course, and some other diseases, psoriasis, you know,
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people would be sent out into the sun or they'd be sent up into the mountains in Switzerland to cure
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these diseases. And it worked. They didn't quite understand why it worked, but it was somewhat
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successful. So sun was definitely considered by the leading doctors to be a benefit to health.
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And then that all started to flip in the 30s and 40s as everyone realized, they discovered the
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mechanisms by which UV can cause skin cancer. And then slowly, decade by decade, the message that
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sort of the drumbeat got stronger and stronger, stay out of the sun so you don't get skin cancer.
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And we're kind of at this like peak moment of that. Another way sunlight can improve your immune
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function, you know, vitamin D. Again, vitamin D plays a role in your immune system. If you get
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sunlight, you're going to increase your levels of vitamin D, which also contributes to your immune
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system. Exactly. And yeah, that's an important point. Like all of these pathways are probably
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way more complicated than we think. Like it's not going to be one very simple step by step by,
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like this to this to this. A whole lot of stuff happens when sun hits skin and all these signaling
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molecules and hormones, they don't necessarily just do one thing. Like in different situations,
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they'll do different things. You've got this like very complex effect happening with nitric oxide,
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which can also be anti, it can be used to kill pathogens. So you've got nitric oxide, you've got
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vitamin D, you've got these direct effects on immune cells. And one of the other things,
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like vitamin D, when we're all told to take vitamin D pills, that's because everybody thought
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there was just one type of vitamin D. And most dermatologists today still think that.
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But one of the things we've learned in the past 10 years is that there are more probably like 20
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different, slightly different versions of vitamin D that the body makes with sunlight. And they, you
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know, they all have slightly different side chains on these molecules, but they all do slightly
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different things. And we really don't understand how that works. But we do know that a bunch of those
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like non-canonical types of vitamin D, you can't replace those with a pill that is going into the
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stomach and then to the liver. It just doesn't work. It will not make these other flavors of vitamin D.
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Related to the immune system, there's also been research showing that sunlight exposure can help
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with autoimmune diseases. So this is when your immune system goes haywire and starts attacking
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your body. So things like psoriasis is an autoimmune disease, arthritis, rheumatoid arthritis,
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MS is another disease like that. But like sunlight seems to help with those conditions.
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Yeah, for sure. Again, it's that anti-inflammatory effect. And it's really strong with MS, which is a
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disease where the body's immune system starts attacking the sheaths around the nerves that
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protect the nerves so that signals can be sent, electrical signals can be sent. The body mistakes
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the little sheaths around those nerves for an invader and starts attacking them. It's just this
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classic overreaction of the immune system. And cell exposure really effectively slows down that
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process for MS. Like you look at the observational studies based on latitude and sun exposure and people
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living at high latitudes have usually several times the risk of MS compared to people living at lower
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latitudes. And prevalence is higher in winter than in summer. And it's also like you can even track it with
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birth birth month where people born in like spring at the end of like a long winter have higher rates
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than people born in early fall. Same thing for psoriasis, type 1 diabetes, like you said, and some
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other autoimmune diseases. And there's some clinical trials going on right now where they're tracking this
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because basically this has mostly been observational studies. So you really, in order to prove it,
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to like really have like the gold standard of evidence, you need to have some clinical trials
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where you've shown that it works. But we do know from some early clinical trials that just a little
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bit of narrowband UVB therapy, so using a light that only shines UVB in this very narrow wavelength that
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doesn't cause skin cancer, it reduces all the biomarkers of inflammation in the blood of these
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patients that have MS and other things. So yeah, it looks good so far. That's really interesting.
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What about insulin resistance? Does sunlight affect that? That's a big problem these days.
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Huge, huge. Yeah. Insulin resistance, diabetes, all the metabolic syndrome stuff where like your
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body's not metabolizing very actively. It's just sort of slowed down, getting a little groggy and
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your cells aren't accepting, you know, they're resisting insulin. Yes. Sunlight has been shown
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in studies of both mice and observational studies of people to have a pretty solid impact on reducing
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risk of diabetes and insulin resistance. And in terms of why, like it's probably some of those
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same things we've been talking about. I think there's probably an inflammatory component to diabetes
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and insulin resistance as well. And so this probably reduces that a little bit. But then the other part
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of it, and I think you can apply this to a lot of things we've been talking about. If you want to like
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pull back and think about big picture, there's this really fascinating study a few years ago that looked
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at all the genes in the human body and when they were being expressed. So then when they were being
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cranked up and when they were being kind of turned off in terms of like month of the year. And what they
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found was that about a third of the genes in the body have a seasonal component. So they're either
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being cranked up in summer or in winter. And generally what they saw was that the inflammatory
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genes were being cranked up in winter and anti in summer. So winter, like evolutionary, the theory would
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be that in winter, that's when, you know, flu and all these other infectious diseases are on the rampage.
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We're spending a lot of time cooped up together in spaces where we're more likely to share diseases
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with each other. Summer is a low disease time. So it makes sense in winter to crank up your
00:24:03.040
inflammatory genes to deal with all these pathogens and to basically try to just survive winter. And
00:24:09.600
then summer, things are good. You're out in the open air. You can reduce all that inflammation.
00:24:15.500
But of course, the signal for that is one of them is sun hitting skin, sun hitting skin and sun
00:24:20.840
hitting retinas. So if we are living our lives indoors and aren't getting exposure outside,
00:24:26.420
our bodies might be, in a sense, thinking that it's biological winter all the time. So they're
00:24:32.460
acting like it's biological winter and they're there. So they're staying in this inflammatory state.
00:24:36.320
So that would be like the theory underlying why this would be the case. But it's just a theory right
00:24:41.260
now. We're going to take a quick break for a word from our sponsors.
00:24:44.280
And now back to the show. What about sun exposure and its connection to sleep and mood?
00:24:55.180
That one is for sure. Like no question. And nobody even argues with this one.
00:24:59.020
And it's through different mechanisms. It's probably partly through the skin,
00:25:02.000
but a lot of it is through the eyes. But yeah, we know for sure that getting that hit of light in
00:25:07.720
the morning is what sets your circadian rhythm, sets your biological clock, tells you that it's morning,
00:25:14.780
it's time to crank up your system and be really active and high functioning. So if you're outside
00:25:19.960
in the morning and you're getting a lot of bright light, then that melatonin that your body makes
00:25:26.040
that's for sleeping at night will quickly get reduced and you'll get alert for your day.
00:25:31.340
And then also you're on the schedule where at night the body will know to turn up the melatonin so
00:25:38.080
that you sleep well. And when you don't get that strong diurnal change in light, then your circadian
00:25:46.480
rhythms can get messed up. And you can't get it being indoors. It's interesting. I didn't start
00:25:51.680
paying attention to this until I was reading some of these researchers who specialize in this stuff.
00:25:55.900
But even a cloudy day outside is way brighter than with your lights on indoors. It's not even close
00:26:03.560
by like 50 times, a hundred times in terms of lumens. So you really need to be outside to get
00:26:09.780
that signal that tells your body to wake up and sort of crank up the whole system. And then the
00:26:16.220
opposite at night. And the connection to the mood, people are already aware of seasonal affective
00:26:20.460
disorder happens during the winter. There's less sunlight exposure. And so people kind of get in the
00:26:25.180
funk. You're probably familiar with this. You live in Vermont. Totally. Vermont falls and
00:26:29.380
winter. I remember we lived in Vermont, my wife and I, shortly after I graduated from law school,
00:26:33.420
we were there in the fall. I remember it was like four o'clock in the afternoon. It's dark. I'm like,
00:26:38.360
it's four o'clock. Why is it? It gets depressing. It got depressing.
00:26:42.460
It does. I mean, and you can fight it, right? You know, you go out, you ski, you do whatever you can
00:26:47.880
to like embrace the day, but it's still, it's like, it's not that natural an environment for human
00:26:53.680
beings at some level. So you got to figure out ways to get around that. And yeah, people do.
00:26:58.900
Yeah. Their hormones are strongly affected by that. So again, you kind of go into hibernation mode. It's
00:27:04.040
kind of like what we were talking about earlier. All that darkness is a signal to the body to just
00:27:08.120
like shut down and endure. Like, cause normally, you know, in winter food is often tight. Like
00:27:14.480
before, you know, before all our modern conveniences, you really did want to sort of put
00:27:19.540
the system on minimal mode until things got better. So I think we still are dealing with
00:27:25.820
that. So the best thing and the way to fight it is either like you can have artificial lights
00:27:30.840
that are bright enough that they can affect that SAD or, or you go outside as much as possible
00:27:38.300
Yeah. Yeah. So yeah, I saw some research that sunlight can increase levels of serotonin,
00:27:43.280
which is a feel good neurotransmitter releases endorphins that can also help you feel
00:27:48.420
high in you for, I mean, if anyone's been to the beach or in a hot sunny, it just like,
00:27:52.460
it just feels, you just feel good. You just feel so groovy whenever you catch some rays.
00:27:57.320
Yeah. And it's direct, like your skin and brain are producing endorphins or producing dopamine.
00:28:01.540
Like dermatologists talk about how unfortunate it is that people get addicted to sunlight because,
00:28:06.720
because of these things, but it's like, well, there's a reason, you know, your body isn't
00:28:11.220
just making those on a whim. There's a reason. So you don't want to get too much, but you do want
00:28:15.580
to at least pay attention to those natural signals that we have.
00:28:18.420
Okay. So I think we've talked a lot about the health benefits of sunlight increases vitamin D,
00:28:22.560
but vitamin D, what we've talked about is not necessarily connected to all these other health
00:28:27.940
benefits, like reduced blood pressure, reduced metabolic syndrome, et cetera. That is from
00:28:34.580
sunlight itself. Vitamin D is just a marker that you're getting enough sunlight and people might
00:28:40.220
be hearing this thing. Oh, okay. Yeah. I'll grant you that there's all these health benefits that
00:28:44.540
come with sunlight, but we know for a fact that it frequently causes skin cancer. So why risk the
00:28:52.960
exposure to get those benefits? You know, just put on the sunscreen and that's the stance. We've talked
00:28:58.000
about this throughout this conversation. That's the stance the American Academy of Dermatology
00:29:01.600
has taken, which says you should apply sunscreen every day on skin, not covered by clothing. If you will
00:29:08.880
be outside. And I think it's interesting because I'm 41. So if you're my age, sunscreen really wasn't
00:29:15.760
a big thing when I was growing up. Maybe my mom would say, well, you're going to go to the water
00:29:20.000
park all day, put on some sunscreen. But I don't remember putting sunscreen on that much when I was
00:29:25.280
a kid. So when did this message to always wear sunscreen arise? Like what was behind it?
00:29:30.220
Yeah. And so what was behind it was simply that one fact that we know that UV exposure triggers
00:29:38.000
skin cancer, raises your risk of skin cancer. So based on that one thing is why we've been told to
00:29:44.420
continually to keep reducing our amount of sun exposure to basically zero now. Or let me add,
00:29:50.960
skin cancer also, you know, wrinkles, sunspots, like there's this cosmetic stuff,
00:29:56.320
the cosmetic damage that UV causes as well. But in terms of health, then skin cancer is the one
00:30:02.600
thing that you have to worry about. And yeah, it's interesting that the message has gotten more and
00:30:07.480
more strident with each decade. And people have been using more and more sunscreen with each decade,
00:30:12.580
but skin cancer rates are higher than ever. So the etiology is probably more complicated than they
00:30:18.400
think, but it is definitely very well established that sun exposure causes skin cancer. But in terms of
00:30:24.640
what you want to do about it, it's not clear that a little bit of sun exposure is really that
00:30:31.320
problematic. And there's quite good evidence that there are more benefits than risks for that small
00:30:36.740
amount of sun exposure. So then it's a question of like, where do you set the, you know, the pendulum
00:30:41.760
has swung way far as far as it could in one direction where, I don't know, if you look at a lot of the
00:30:47.520
recommendations in like popular magazines and newspapers, the dermatologists are literally saying,
00:30:52.480
even in winter on a cloudy day, if you're going to be indoors all day, still put on sunscreen.
00:30:57.840
There's no science behind that. They're just trying to get people into the habit of doing it.
00:31:01.680
And I think the worry is that people aren't very good at following directions. So if you want them
00:31:07.200
to put on any sunscreen, you got to tell them to put on a lot all of the time and hope that they'll
00:31:12.300
listen to you, you know, one out of every three times or something.
00:31:15.900
In your articles, you talked about that the conversation about skin cancer is a lot nuanced. I think
00:31:20.400
people hear cancer and they just think, okay, cancer equals death automatically. And they probably
00:31:24.880
think melanoma when they think skin cancer, but there's different types of skin cancer.
00:31:29.660
Melanoma is the worst one you could get, but the stuff that's often caused by sun damage,
00:31:35.040
it's like basal cell carcinoma. Those are actually pretty treatable. Like you can actually just go to
00:31:41.620
a dermatologist and it's like an outpatient surgery.
00:31:45.380
Yeah, that's correct. There's three different kinds of cancers that are the main ones. Basal cell carcinoma,
00:31:50.080
squamous cell carcinoma, and melanoma. And basal cell carcinoma is by far the most common cancer
00:31:56.920
in the world. It's probably more common than every other cancer put together. That's the one, you know,
00:32:02.420
you always see these like, you know, public service warnings, like one in every three people
00:32:07.680
will get skin cancer. And that's what they're talking about is basal cell carcinoma. It doesn't
00:32:12.160
actually really have any health impacts 99.9% of the time. That's the one, yeah, you go in,
00:32:18.600
you get it cut off, you're, you're done. So in a way it would be better if it wasn't called cancer
00:32:24.460
because like you were saying, that word really scares people. Richard Weller, that dermatologist
00:32:29.320
we, uh, we mentioned, he actually told me that, um, when one of his patients comes in and he
00:32:34.120
diagnoses a BCC on them, he then says, congratulations, because your life expectancy
00:32:39.120
just went up. And what that means, that doesn't mean BCCs are actually good for you. It means the
00:32:46.400
people who are getting BCCs tend to be quite healthy because, you know, they're like, it's
00:32:51.260
like your dad who's playing golf in Florida every day. He's getting sun exposure. He's getting a lot
00:32:55.700
of exercise. He's getting BCCs, but he's quite healthy. So yeah, Richard Weller says he cuts a lot
00:33:01.780
of BCCs off a lot of very healthy old people. SCCs, squamous cell carcinomas are a little bit more,
00:33:08.240
little bit more to worry about than BCCs. But again, usually you just, it's just cut it off,
00:33:13.280
outpatient procedure. That's it. Melanoma is the one that kills people and that's the one you need
00:33:19.280
to worry about, but it's much, much less common than the other two. It's like one to 2% of skin
00:33:24.480
cancers are melanoma and the rest are BCCs and SCCs. So there's a little bit of a bait and switch that
00:33:29.720
you see in the public messaging where people will say, skin cancer is incredibly common. One out of
00:33:34.300
three people will get it. And then they'll say melanoma kills, you know, like 10% of the people
00:33:40.060
who get it. And if you don't look carefully, you'll think that skin cancer is both extremely common and
00:33:45.480
extremely deadly, but it's not. There are some that are extremely common and are no big deal.
00:33:50.300
And there's one melanoma that can be deadly, but it's uncommon. And BCCs definitely caused by sun
00:33:57.440
exposure. The more sun exposure you get, the more BCCs you will get. Melanoma, it's a different
00:34:02.140
story. It's not as simple as just chronic sun exposure. Melanoma tends to turn up in people who
00:34:08.300
get intermittent sun exposure. People have pale skin and basically go to Cancun on vacation and
00:34:13.720
get fried. That's kind of like the perfect formula for melanoma. And worst thing of all, probably for
00:34:19.080
you and me, it's mostly associated with sunburns in childhood and adolescence. So I had some sunburns,
00:34:28.280
some really bad ones. Me too. Me too. I grew up in Florida, you know, and so 13 year old kid growing
00:34:33.680
up in Florida is going to get a fair amount of sun. I had a few where like your skin just peels like
00:34:37.780
paper. Yeah. It hurt. But then when it peels, that was kind of satisfying. And it's just so weird. It's
00:34:43.860
kind of fun, but it's not good for you. They definitely, like every researcher I've talked to
00:34:48.100
across the board says, just don't burn. Like burns are bad. So one of the arguments you're making in
00:34:54.000
your articles and in your research is that this sunscreen absolutism that we have in the United
00:34:59.260
States, where it's like, you got to apply sunscreen, even if you just go outside for a little bit,
00:35:03.080
just all the time, even in wintertime, what it's doing. Yeah. We might be staving off these skin
00:35:08.180
cancers like basal cell carcinoma, but those, it's not going to kill you. You can get just the
00:35:12.440
surgery, you take it off, but we're missing out on those other health benefits that come from
00:35:17.320
sun exposure. Cause when you block the sun with sunscreen, you're missing out on the vitamin D
00:35:22.360
production, the reduction in blood pressure, immune system improvement, et cetera.
00:35:27.780
Yeah, possibly. It depends on the sunscreen. And this is a, this is one, one of the interesting
00:35:32.280
nuances here, I think is, you know, back when sunscreen was like SPF 15 or whatever, it doesn't
00:35:38.600
block a hundred percent. It blocks maybe like 90%. So there's still about 10% getting through.
00:35:43.480
And so maybe like on a day at the beach, that might've actually been the perfect formula where
00:35:48.000
that sunscreen was letting you get a great amount of, of a UV, but was still preventing you from
00:35:54.460
getting burned. So now of course we've got SPF 50 or even SPF a hundred sunscreens. And you know,
00:36:02.560
the advice is even on a cloudy winter day, put it on. So there's this real push to make
00:36:08.360
sure that people never, never get any photons hitting their skin. So that's probably going
00:36:13.860
to have to change. But I actually think sunscreen can be, you know, an ally in making sure you do
00:36:19.580
get the right amount of sun. Cause if it gets you outside without burning, um, it could actually
00:36:24.420
be a benefit. Something you mentioned in one of your articles, this sunscreen absolutism,
00:36:28.740
the dermatologists, they don't discriminate on your melanin level. So even if you're black or
00:36:35.960
Hispanic, where you have a lot of melanin and you don't burn as easily, they still say, yeah,
00:36:40.740
you got to wear SPF 50 sunscreen. You're like, well, that doesn't make sense.
00:36:46.900
Right. And this is the thing that's going to have to change. I think, uh, and I think probably
00:36:50.440
pretty soon, like that advice to, to always like put on heavy duty sunscreen every day, indoors
00:36:56.700
or outdoors. That's probably not a bad recommendation for people with the very palest
00:37:02.640
skin. Like people who have red hair, freckles who evolved their, you know, their ancestors
00:37:07.780
came from places at very high latitudes that were getting very little sunlight and kind of
00:37:13.100
evolved skin to harvest whatever light they could get. Like people who never tan, always
00:37:19.080
burn. That advice makes sense for them, but not for everyone else. And the world is mostly
00:37:24.080
populated by everyone else. So people with really dark skin on the other end of the spectrum
00:37:30.280
basically do not get skin cancers from sun exposure, do not have any of these risks, but also
00:37:37.700
have, uh, because they have more natural sunscreen, basically need more sun in order to produce vitamin
00:37:44.080
D and some of these other compounds. So for them, the recommendations make no sense. And then there's
00:37:48.780
a bunch of people in the middle who have maybe more of like a Mediterranean skin tone, uh, an Asian skin
00:37:54.400
tone who have a little bit more risk from, of skin cancer than people with super dark skin, but really
00:38:00.680
very little. And, uh, also probably have a lot to, to gain from moderate sun exposure. And you don't
00:38:06.880
need, that's the other thing we should probably talk about is you don't need too much to get some of
00:38:09.980
these benefits. Yeah. We'll talk about the daily recommended dose of sunlight here in a bit.
00:38:14.320
So in America, we have a very, you call it sunscreen absolutism, no matter what, how you spend your
00:38:20.220
time, whether indoors or outdoors, whether you're pale, dark, wear sunscreen, health officials in
00:38:27.220
Australia have taken a different tack. They've gotten more nuanced with sunscreen use. And this
00:38:31.820
is interesting because Australia is a place that has notoriously high levels of UV exposure in skin
00:38:37.040
cancer, but health officials in Australia are saying, maybe you don't use sunscreen all the time.
00:38:44.140
So what are they recommending? Yeah. You know, and it's so funny because of probably the last
00:38:49.700
place on earth you would expect to be the first place to take the plunge on changing the
00:38:54.800
recommendations would have been Australia. Cause as you say, their skin cancer numbers are off the
00:38:59.460
charts, highest in the world, like more than twice as high as us or UK. And it's because they have
00:39:05.660
predominantly pale skin population in an extremely sunny place. So it's a really bad match.
00:39:10.980
So they get tons of skin cancer, but they also have some of the longest lived people
00:39:14.680
on the planet. So right there, it tells you that maybe like sun exposure isn't so bad for you,
00:39:21.300
even if you do have pale skin. So Australia, I think the reason that they ended up being the first
00:39:25.540
ones to change, to go away from the zero fund policy is because they've had to deal with this
00:39:30.580
like melanoma and skin cancer is in their face every day. They've had to like process it the most.
00:39:35.980
So maybe they're a little less scared of it in a sense. And I think it was more obvious to them
00:39:41.380
because they do a lot of research on it. They have a lot of the top skin cancer researchers in the
00:39:46.000
world and they could see that a lot of people were clearly getting more harm than benefit from
00:39:53.440
this zero sun policy. They were also saying that there was a lot more vitamin D deficiency in
00:39:58.560
Australia than they would ever expect for such a sunny place. So they actually started worrying that
00:40:02.800
people had taken the message to heart maybe too much. So they wanted to change their messaging
00:40:08.340
so that it was no longer this one size fits all message that only applied really to, should only
00:40:14.240
have applied to people with super pale skin. And they kind of broke up their messaging into three
00:40:19.740
groups, people with pale skin, people with dark skin, and then people in the middle and different
00:40:24.600
recommendations for each one. Pale skin, yeah, still use your sunscreen all the time pretty much.
00:40:28.660
But when the sun's not so bright, try to at least get outside with sunscreen on to get whatever.
00:40:34.340
They were focusing on D, but they know it's this other stuff too, to get whatever sun you can.
00:40:38.680
Middle group, get small amounts, still use sunscreen anytime the sun is pretty bright. But yeah,
00:40:46.140
work the edges of the day, the edges of the season, and make sure you are getting some direct
00:40:52.180
exposure. And then people with dark skin, they basically said like, you just should focus on
00:40:57.380
getting lots of sun. You don't need sunscreen except when you're going to be outside for an
00:41:02.520
extended period on a bright day. So that was quite controversial. And they caught a little bit of
00:41:08.620
hell for it. But I think they'll turn out to be the first penguin in the water, and then all the
00:41:13.880
other penguins will start to join them. Are you seeing a shift happen amongst American
00:41:18.860
dermatologists yet? No. So far, none. UK, yes. UK is starting to shift a little bit. Europe,
00:41:25.560
a little bit. America is going to be last on this for whatever reason. It's just kind of how we do
00:41:30.080
things. Yeah. So let's talk about how we can get sun exposure without increasing the risk of skin
00:41:35.760
cancer. Because some people might hear this news that, okay, sunlight's great for you. I'm just
00:41:39.920
going to get sun all the time and never wear sunscreen. That's not what these health officials
00:41:44.680
in Australia are advocating for. So based on the conversations you've had and the research you've
00:41:49.420
done, how can we get sun exposure and get all these health benefits without increasing our
00:41:54.620
chances of getting different types of skin cancer? Yeah. And on this, I'm quite sympathetic
00:41:59.380
with the dermatologists. Because yeah, you tell people that 10 minutes of sun is good for them.
00:42:04.360
And sure enough, some of them will go out there and get like six hours of sun. Because if a little's
00:42:08.960
good, then a lot's better, right? So that is definitely something worth worrying about. But I feel
00:42:15.060
like you just have to give the straight information, right? And then hopefully it's clear enough that
00:42:19.840
people can follow it. So Australia, when they put out their new position statement, they actually
00:42:25.040
have all these tables in the back. It's worth looking at that document that they created.
00:42:31.140
And the tables show for places with different UV indexes. So that's going to depend on where you
00:42:36.840
are in the globe and what season it is and the day, right? Like for your skin type and UV index,
00:42:42.740
how many minutes of exposed sunlight do you need to get a healthy vitamin D dose? So those will
00:42:49.800
translate to the US too. So those are worth checking out. But what it comes down to is for
00:42:55.780
most people on most days, you're either going to get it just walking about your day or you can get
00:43:01.480
it with, you know, 10 minutes or to 20 minutes of focused exposure. Yeah. And if you have darker skin,
00:43:08.260
you might have to extend the amount of time you're out there getting that sun exposure to get the
00:43:11.800
benefits. Quite a bit. And then the other part of it though, is that in higher latitude places,
00:43:16.420
like here in Vermont, we don't get any UVB. All the UVB is filtered by the atmosphere, like November
00:43:22.340
through March, probably. There's just too much atmosphere that the sun is coming through at that
00:43:26.780
low angle. So we don't get any UVB for like four months of the year. So, and you can save,
00:43:31.360
your body will save it up a little bit, but that's where you see a lot of vitamin D deficiencies is at
00:43:36.840
higher latitude, colder places. All right. So those Australian tables are a good place to
00:43:41.700
check to see how much sun exposure you should get each day and in each season, because it's going
00:43:45.880
to differ. And then when to use sunscreen, but in general, what are some good general guidelines for
00:43:51.520
using sunscreen? Because you're not, I mean, even though you're against sunscreen absolutism,
00:43:56.540
you're not against sunscreen altogether. So when should people put on sunscreen?
00:44:02.160
Anytime you think you might be out long enough to get a burn. And as I think you and I can both
00:44:06.580
test too, it's easier to get a burn than you think. Like you think, oh, I'm not going to get burned.
00:44:10.520
And then you get burned. It's easy to just get a little more than you think you're going to get.
00:44:14.520
So it makes sense to play it cautious and use it anytime, you know, you're going to be out for a
00:44:20.020
while. And unless it's like, you know, if it's winter, that's a whole different deal.
00:44:25.220
Yeah. All the dermatologists you've talked to who are sort of, you know, pro getting sunlight,
00:44:30.140
not using sunscreen all the time, they all agreed. You do not want to get sunburn. Like you want to
00:44:34.640
avoid sunburn as much as possible because that's what, that's what caused all those problems.
00:44:38.220
Yeah. That's just your skin cells dying and freaking out. And yeah.
00:44:43.400
Yeah. So for me, you know, I work from home. I typically don't wear sunscreen at all because
00:44:48.480
I'll just go outside, get some sun when I'm doing my early morning walks, doing chores and errands.
00:44:53.100
I will wear sunscreen when I'm going to be out for a long time, especially if I'm going to be at
00:44:56.800
altitude. So like, you know, my wife and I just went backpacking. I slather on the sunscreen.
00:45:01.720
You get, it's so easy to get sunburn when you're up in the mountains, you know, 10,000, 11,000,
00:45:06.140
12,000 feet, because you don't have the atmosphere filtering the radiation. So constantly applying
00:45:11.160
sunscreen then. And then when you're, when I'm skiing, cause like the sun reflects off the snow
00:45:17.760
and it's easy to get sunburn. And it's hard there because you think it's cold. So you really can't
00:45:21.640
feel anything, but you go in and your cheeks are red and you're like, ah, didn't put on enough
00:45:26.060
Yeah. Yeah, for sure. I, yeah, totally. All those things. And yeah, like anytime, also anytime it's
00:45:31.900
going to help you get outside because you know, one of the criticisms that people get in these
00:45:36.000
observational studies that where it's like, oh, these people who are getting all the sun exposure
00:45:40.600
are healthier in all these ways and they have better longevity, blah, blah, blah. And one criticism
00:45:45.240
will be, well, but how do you, how can you tell it's the sun exposure? I mean, maybe there's just
00:45:50.080
things about being outside people that are exercising. Like in those studies, you always try to control for
00:45:54.740
exercise. So you're comparing people who are exercising the same amount, but still like there
00:45:58.880
could be other things about being outside that are just good for you. So, but so like, I don't see
00:46:03.820
the problem in that if the answer, you know, if the answer is get outside, right? So if sunscreen is
00:46:09.940
going to help you spend less time indoors, then I think it's all to the better.
00:46:14.800
Is anyone exploring, I don't know, like special sunscreens or ways people can get the benefits
00:46:20.060
of sunlight without raising their risk of skin cancer?
00:46:23.080
What people are doing is like, there's a lot of experiments using these narrow band UVB
00:46:28.820
lamps that a couple of companies are making now. I think this is going to become a big deal. So
00:46:34.000
they were first used for psoriasis treatment, I think. And they just produce a very narrow band of UV
00:46:40.460
somewhere around like 300, 310 nanometers. It's been used, you know, in psoriasis patients for a long
00:46:47.120
time, decades. And we know it does not cause skin cancer. It's not the type of wavelength that
00:46:52.700
damages DNA, but it does produce vitamin D. And it also seems to have these good immunological
00:47:00.620
effects. Like psoriasis is an autoimmune disease where your skin is being attacked by the immune
00:47:05.380
system. And it definitely has an excellent effect on psoriasis. It seems to work for MS. It even worked
00:47:13.120
for COVID, it seems like maybe. So I think you're going to see a lot more of like people using UVB.
00:47:21.340
So then there's not even an issue with skin cancer, but I'm still not convinced that you get all the
00:47:26.240
benefits from UVB lamps that you would get from sunlight.
00:47:29.860
Here's a controversial question. Tanning beds. Can you get the benefits of sunlight from a tanning bed?
00:47:36.960
Yeah, that's an interesting one. I don't know. I don't know the answer yet. So I'm working on a book
00:47:41.380
about all this. It'll be out in a couple of years by the time I've done all the research,
00:47:45.320
written the manuscript, and then gone through the production process. But I'll definitely have a
00:47:49.240
chapter on tanning beds in there. Right now, I don't know enough. I do know, like tanning beds do
00:47:54.260
raise your risk of skin cancer. So dermatologists are strongly anti-tanning bed. But they do definitely
00:48:01.600
give you some of the benefits, especially like, you know, the endorphins for sure. They give you that
00:48:06.620
hit of feeling good. They will improve your vitamin D a little bit. But again, because it's not
00:48:12.000
same as sunlight, I'm somewhat skeptical of them. But I don't know enough to say whether they're just
00:48:19.080
plain bad or whether they might have a use. Yeah. A few years ago here in Oklahoma,
00:48:24.260
we had a winter where it was just gray every day for like two months. And I was getting pretty
00:48:30.420
depressed. I was getting some seasonal affective disorder. I got brown skin. I'm swarthy.
00:48:34.620
So I need a lot of sunlight to get the benefits. And my wife said, you should just go to a tanning
00:48:40.760
bed. And I'm like, tan? I've never done that before. That's like what they do on Jersey Shore.
00:48:45.460
Like, I'm not going to. And so I did it. I did like the least amount. So I did the least amount
00:48:49.880
of time. I think it was just like two minutes. I mean, it was really short. And I felt better
00:48:54.580
afterwards. Totally. Yeah. But I'd be curious. Same thing. Yeah. I'd be interested
00:49:00.100
to see if instead of like tanning bed salons, you have UVB light salons where you stand in front of
00:49:07.240
a UVB light instead of going to a tanning bed to get the health benefits of sunlight.
00:49:12.620
Yeah. I'm curious too. And I suspect that the tanning beds are going to go in that direction,
00:49:16.040
whether it's more than just the UVB or just the UVB. But I bet they're going to try to,
00:49:21.200
you know, curate their wavelengths a little bit to try to maximize the good and avoid the bad.
00:49:27.040
And that's just a guess. Well, Rowan, this has been a great conversation. Is there some place
00:49:31.320
people can go to learn more about your work? For me, it would be rowanjacobson.com.
00:49:37.340
Rowanjacobson.com. And then look out for that book you've got coming out.
00:49:45.560
And in the meantime, if you're listening, go out and get some sun. You're a plant. That's one of the
00:49:49.880
cool takeaways. I forget. Like, we're little plants. We need water and we need sun.
00:49:55.540
Yeah. Well, Rowan Jacobson, thanks for your time. It's been a pleasure.
00:50:01.180
My guest today was Rowan Jacobson. You can find more information about his work at his website,
00:50:04.600
rowanjacobson.com. Also check out our show notes at aom.is slash sunlight,
00:50:08.660
where you can find links to resources. We delve deeper into this topic.
00:50:18.380
Well, that wraps up another edition of the AOM podcast. Make sure to check out our website at
00:50:22.340
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00:50:25.400
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00:50:43.400
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