The Risks & Benefits of Sensible Sun Exposure

The Risks & Benefits of Sensible Sun Exposure
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We don’t have to choose between the lesser of two evils: skin cancer versus internal cancers from vitamin D deficiency.

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By the turn of the 20th century, the vitamin D deficiency disease, rickets, was rampant, thanks to city life, with the shade of buildings, and coal soot in the air. The dairy industry jumped at the opportunity to fortify milk with vitamin D, and so did the beer industry. “Beer is good for you,” read the ad, but beer “with Sunshine Vitamin D is extra good…” So, drink it “every day.” Now, there are healthier fortified options like vitamin D-fortified orange juice, but to reach recommended intake levels, it could take 15 to 20 cups of fortified milk, beer, and/or juice every day. So, to get those kinds of doses, it really comes down to sun, or supplements.

Sunlight supplies 90% to 95% of vitamin D for most people. The threat of skin cancer is real. However, it’s mostly from chronic excessive sun exposure and sunburns. There’s little evidence that minimal, sensible exposure to sunlight will considerably increase the risk of skin cancer—though why accept any risk when you can just get your vitamin D from supplements? But for the sake of argument, what if there were no supplements available?

What if you were just trying to balance the positive and negative effects of sun exposure? On one side, you have entities like the American Academy of Dermatology, that recommends that no one should be exposed to direct sunlight without sun protection. After all, the UV rays in sun are proven carcinogens, responsible for about half of all Caucasian malignancies, blaming the tanning industry for downplaying the risk.

Even those who accept research dollars from the tanning industry acknowledge that excessive sun exposure can increase skin cancer risk, but argue for moderation, advocating “sensible sun exposure,” and blame the sunscreen industry for overinflating the risk—though it’s harder to impugn the motives of the dermatologists, who are essentially arguing against their financial interest, since skin cancer is their bread and butter. The concern raised by UV advocates is that “sunphobic propaganda” may do more harm than good, pointing to studies like this.

A Swedish study found that those diagnosed with skin cancer tended to live longer and have less heart attacks and hip fractures. The media, of course, loved this, with headlines like “sunbathers live longer,” though only natural UV exposure was associated with reduced mortality. Artificial UV exposure, like tanning beds, was associated with increased mortality. Well, then, this probably has nothing to do with vitamin D, then. Why would those that run around outside enough to get skin cancer live longer? Maybe it’s because they’re running around outside. More exercise may explain why they live longer. And here in the U.S., more UV exposure was associated with a shorter, not longer, lifespan.

There are modeling studies that suggest that at least 50,000 American cancer deaths may be attributable to low vitamin D levels that could be avoidable with more sunlight exposure that would only kill, at most, 12,000 Americans from skin cancer. So, on balance, the benefits would outweigh the risks.

But again, why accept any risk at all when you can get all the vitamin D you need from supplements? In fact, where did they get those estimates about vitamin D preventing internal cancers? From intervention studies involving giving people vitamin D supplements—not exposing people to UV rays. So, it’s not much of a controversy after all. The issue is framed as needing to choose between the lesser of two evils: skin cancer versus internal cancers from vitamin D deficiency, but ignores the fact that there’s a third way. When we were evolving, we didn’t live long enough to have to worry about skin cancer, and vitamin D was not available at the corner store.

And if you just want to look more attractive, how about eating more fruits and vegetables? When high kale models were pitted against high UV models, the golden glow from carotenoid phytonutrients won out, and the same has been found in Asian and African-American faces. So, may I suggest the produce aisle to get a good healthy tan…gerine.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Image thanks to Barni1 via Pixabay.

By the turn of the 20th century, the vitamin D deficiency disease, rickets, was rampant, thanks to city life, with the shade of buildings, and coal soot in the air. The dairy industry jumped at the opportunity to fortify milk with vitamin D, and so did the beer industry. “Beer is good for you,” read the ad, but beer “with Sunshine Vitamin D is extra good…” So, drink it “every day.” Now, there are healthier fortified options like vitamin D-fortified orange juice, but to reach recommended intake levels, it could take 15 to 20 cups of fortified milk, beer, and/or juice every day. So, to get those kinds of doses, it really comes down to sun, or supplements.

Sunlight supplies 90% to 95% of vitamin D for most people. The threat of skin cancer is real. However, it’s mostly from chronic excessive sun exposure and sunburns. There’s little evidence that minimal, sensible exposure to sunlight will considerably increase the risk of skin cancer—though why accept any risk when you can just get your vitamin D from supplements? But for the sake of argument, what if there were no supplements available?

What if you were just trying to balance the positive and negative effects of sun exposure? On one side, you have entities like the American Academy of Dermatology, that recommends that no one should be exposed to direct sunlight without sun protection. After all, the UV rays in sun are proven carcinogens, responsible for about half of all Caucasian malignancies, blaming the tanning industry for downplaying the risk.

Even those who accept research dollars from the tanning industry acknowledge that excessive sun exposure can increase skin cancer risk, but argue for moderation, advocating “sensible sun exposure,” and blame the sunscreen industry for overinflating the risk—though it’s harder to impugn the motives of the dermatologists, who are essentially arguing against their financial interest, since skin cancer is their bread and butter. The concern raised by UV advocates is that “sunphobic propaganda” may do more harm than good, pointing to studies like this.

A Swedish study found that those diagnosed with skin cancer tended to live longer and have less heart attacks and hip fractures. The media, of course, loved this, with headlines like “sunbathers live longer,” though only natural UV exposure was associated with reduced mortality. Artificial UV exposure, like tanning beds, was associated with increased mortality. Well, then, this probably has nothing to do with vitamin D, then. Why would those that run around outside enough to get skin cancer live longer? Maybe it’s because they’re running around outside. More exercise may explain why they live longer. And here in the U.S., more UV exposure was associated with a shorter, not longer, lifespan.

There are modeling studies that suggest that at least 50,000 American cancer deaths may be attributable to low vitamin D levels that could be avoidable with more sunlight exposure that would only kill, at most, 12,000 Americans from skin cancer. So, on balance, the benefits would outweigh the risks.

But again, why accept any risk at all when you can get all the vitamin D you need from supplements? In fact, where did they get those estimates about vitamin D preventing internal cancers? From intervention studies involving giving people vitamin D supplements—not exposing people to UV rays. So, it’s not much of a controversy after all. The issue is framed as needing to choose between the lesser of two evils: skin cancer versus internal cancers from vitamin D deficiency, but ignores the fact that there’s a third way. When we were evolving, we didn’t live long enough to have to worry about skin cancer, and vitamin D was not available at the corner store.

And if you just want to look more attractive, how about eating more fruits and vegetables? When high kale models were pitted against high UV models, the golden glow from carotenoid phytonutrients won out, and the same has been found in Asian and African-American faces. So, may I suggest the produce aisle to get a good healthy tan…gerine.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Image thanks to Barni1 via Pixabay.

Doctor's Note

That’s the gist of what the last 15,950 studies on vitamin D have added to our understanding. Unless something particularly groundbreaking comes out, you can expect the next update in 2021. If you missed the first five videos in this new series, check them out here:

The physical attractiveness is from carotenoid deposition in the skin. Check out my videos:

If you haven’t yet, you can subscribe to my videos for free by clicking here.

144 responses to “The Risks & Benefits of Sensible Sun Exposure

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  1. Still doesn’t answer the question, how much sun is too much and what is the optimal sun exposure for caucasian individual ?

    Personnally I’m working in a restaurant all day, I never get sunshine, so I take my vitamin D pills as recommanded (2400 IU of D3 from a vegan brand). And I get the point of minimizing risk. But… Holidays are coming through, I plan on getting naked on the sun :D (not entirely naked of course but you get what I mean..). So maximum sun cream for short period ? If I was planning a longer trip will it be better to get tanned (naturraly) little by little with short exposure without sun cream ?

    So now I have way more questions concerning the protection of being tanned. Is natturally tanned people (black people with high melanin in the skin) living in Africa in the sun all day get more skin cancer or not ? If not, is it possible for caucasian to get a similar protection without the risk associated with sun exposure ?

    Stay tunned (not tanned) for the next videos ? :D




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    1. Well, this is a site that is focused on nutrition rather than health issues generally (like sun exposure) so I wouldn’t expect videos here to address such points.

      Anyway, skin tone (and phototype) differs even among Caucasians, latitude is important as is height above sea level, the season, cloud cover and atmospheric pollution. And how much skin you expose. So, there are no simple answers. I suspect that there are no hard and fast answers either.

      Also, getting a tan will probably not decrease risk to levels found in people with naturally higher levels of melanin.
      http://www.skincancer.org/prevention/tanning/is-a-tan-ever-a-good-thing
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671032/
      http://www.the-scientist.com/?articles.view/articleNo/42205/title/The-Dark-Side-of-Melanin/
      http://www.skincancer.org/prevention/skin-cancer-and-skin-of-color




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      1. Melanin does confer UV protection and lowers the incidence of skin cancer in “Hispanics” and “African-Americans” in comparison to “Whites”. Humans evolved to have more melanin or less melanin depending on sun exposure, because of the corresponding survival benefit. Tanning is the body protecting itself, so it must decrease the risk by some magnitude.

        https://moffitt.org/File%20Library/Main%20Nav/Research%20and%20Clinical%20Trials/Cancer%20Control%20Journal/v15n3/248.pdf

        And as cited above:
        Photoprotective Role of Melanin:
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671032/
        “Epidemiological data strongly support the photoprotective role of melanin as there exists an inverse correlation between skin pigmentation and the incidence of sun-induced skin cancers (1) and subjects with White skin are approximately 70 times more likely to develop skin cancer than subjects with Black skin (67).”

        So, maybe not the same protection as a darkly pigmented person, but given the same sun exposure, tanning has to offer some protection over someone without a tan.

        A more important question is overall health and cancer rates. For example, “Blacks” suffer from low Vit. D levels and all the diseases that result or contribute to disease from low levels – from insufficient sun exposure. So, while it may be true that there’s no such thing as a “healthy tan”, I think one can be a healthier individual with a tan. It’s not just skin cancer that one needs to worry about, but optimizing all human systems to avoid all illnesses. Getting enough sun is one part of that complex puzzle.

        Sunlight prevents cancer, study says:
        http://www.bmj.com/content/324/7339/696.5.extract?HITS=10&sortspec=relevance&hits=10&stored_search=&maxtoshow=&andorexactfulltext=and&FIRSTINDEX=0&fulltext=cancer+vitamin+d&resourcetype=1&searchid=1116858384296_11381&RESULTFORMAT=




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        1. Thanks. Interesting stuff. On the other hand, the tanning process itself causes DNA damage which increases cancer risk. Also there is a difference between people with naturally higher levels of melanin (constitutive pigmentation) and people with higher melanin because of tanning (facultative pigmentation). I am not sure that we can assume both have the same level of protection for a given melanin level.
          http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671032/

          You may possibly be healthier with a tan if you live in Florida and spend a lot of time outdoors. But it would be a net advantage. Achieving equivalent protection without suffering the DNA damage caused by tanning might well be preferable. However, if you live in Montreal and work indoors, I suspect the equation is very different. Also, reasonable sun exposure is not necessarily the same thing as tanning.

          I do not know the answer on these issues. But I suspect tanning is a damage control mechanism. If so, my opinion is that it would probably be prudent to avoid or minimise the damage in the first place.




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    2. Hi Adrien, The best resource that I know of which deals with sun exposure, skin type, locations and season is a book by Dr Holick called The Vitamin D Solution. Dr Holick is an endocrinologist involved with vit D research throughout many decades. There are charts in the book. Unfortunately I could not find online access. ALso you can have a look at the comment by Daniel Morris, another NF moderator in this thread. Hope that is helpful.




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    3. Want a good tan?

      I once took 25000 IU beta-carotene / day during summer and got a really good tan….this was during the census…and a census worker (?) came around asking among other things if I was black. So go for it?




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    1. But no shorts would be even better,lol. Shorts and no shirt and bikini for women is good enough though. I like to go all the way full nudity myself. Feels the best! I’m lucky to have a private location in my backyard.




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  2. So, I just read on someone’s comment the other day, about the sun protection qualities of Astaxanthin.. I had never heard of this antioxidant before (must live under a stone) but apparently there was a lot of hype about it a few years ago. It would seem that it would enable us to stay out in the sun longer for more Vit D uptake. I don’t like the reductionist approach but this does seem to have other health benefits too.




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        1. Yeah but while these veggies are very beneficial and should be consumed, there is no evidence that they will provide protection against skin cancer due to sunburn. So the question here is 1) does astaxanthin protect skin wrinkle, then the answer is yes based on some studies, and 2) does it protect against skin cancer, and the answer is “I don’t know”. I haven’t read any research that said it does, but I am no expert. Btw, astaxanthin is only in seafood and algae if you want to consume them.




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          1. Just based on past experiments, whole foods tend to out perform the extracts or single nutrients. I trust whole foods. And beet root I believe there has been some studies showing protection against radiation.




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  3. Your argument for supplements over sun exposure rests on the assumption that the sole benefit of sun exposure is vitamin D production. What about other potential benefits such as the lowering of blood pressure through the release of nitric oxide or the reactivation of Coenzyme Q10? You also don’t address whether the risk of skin cancer from sun exposure might be mediated via the diet. Might those individuals with the “golden glow” you mentioned in the video be receiving more than cosmetic benefits from the high levels of carotenoid phytonutrients in their skin. Might those carotenoid phytonutrients in their skin also be conferring some level of skin cancer protection thereby changing the risk/reward equation of sun exposure for those who eat a healthy diet?




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    1. Some years ago I saw a dermatologist about a something that had popped up on my skin, to see if it could be a cancer. He asked where I had lived as a child. It was a sunny climate, much more so than where I live now, but I told him I had a lot of sun exposure in my early 30s when I used to bale hay all summer wearing a bikini. He insisted it was the sun exposure from childhood that would be causing cancer some 50 or so years later. So – if it takes that long – does it really matter what we do today, at least those of us who aren’t going to live 50 more years? On warm summer days I try to spend 10-15 minutes stretched out in the privacy of my back yard in my undies making a little D to store up for our long period with sun so low and temps too cool to bare much skin. But I also supplement D3 and K2, summer and winter, and go by tests to see if I have enough.




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      1. Sun radiation (as all radiation) is cumulative, while it is true that we are more vulnerable as kids, still all the radiation you get throughout your life will keep accumulating until you get to the tipping point.

        People tend to forget that the sun is nothing but (I don’t remember the exact number) trillions of H bombs per second. Of course most of the radiation doesn’t reach us thanks to the earth atmosphere and magnetic field (we would wiped out right away otherwise) but part of the damaging radiation still reach us, some of the UV photons. And are highly damaging, that’s why our skin takes so much trouble trying to build a barrier against it. Because it penetrates the skin as if were nothing and damages the organs beneath.

        I would follow Dr. Greger advise. Look for the carotenoid tan instead. :)




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        1. So I can add in all those trips to the shoe store as a child when we played with the X-ray machine, and, worse yet, PET and CT scans from the cancer experience, pus my wild Arkansas tractor-in-a-bikini hours, dental X-rays, all sun exposure, and, and, and…I’m doomed!!! But Dr G says I have so many heartbeats, and my heart rate is pretty good for an old gal. O geez, it get complicated!

          But thanks for the explanation. I really hadn’t been adding solar radiation with all the rest.




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          1. At this point, might I suggest a musical interlude??

            Please, remember, its hard to eliminate all risks; we can do our best through a whole foods plant based diet, moderate daily exercise and sun exposure, stress management strategies, preventive care, and being kind to ourselves!

            This opinion is my own as a volunteer moderator!




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            1. That was kinda fun. However, there is also the hearing loss that makes it hard to hear the words to music when the instrumentals are louder. Oh well, it’s hell getting old…but not that much. I’m healthier than many my age and planning to stick around for quite awhile longer.




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  4. I have been following this series with some interest. I had been supplementing with B12 and D, but I stopped taking the D because Dr. John McDougall had come out so vociferously against it ( https://www.drmcdougall.com/misc/2010nl/mar/vitd.htm ), and I live in So Cal so it doesn’t take much sun exposure to do the trick, but after this series by Dr. Greger, I am going to add it back into my regimen. Thank you for the research…




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    1. I’m in a similar situation, though not in a sunny climate. I took Vitamin D through the winter and because of McDougall I stopped taking it now that there is light out, even though I don’t get enough of it. The more I see on McDougall lately the more I believe he just uses studies and science to justify his position, this is definitely not the only case he misrepresents.




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        1. Call me simplistic but I find it hard to comprehend that supplementation alone could adequately replace the intricacy of most naturally evolved systems simply because we can’t be sure what we’re missing.




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          1. I’m with you, Vege-tater. So little is really known and the confusion over hormone D really points that out. It seems to be the latest and greatest thing now. What next?




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    2. Dr McDougall contradicted himself. At the beginning of his article, he cited that Vit D supplement raises mortality, citing some old research from 1995, 1997… Then he said that tanning bed is the second choice! Geez, tanning bed is UVA and not UVB, and is causing cancer. Then he said that supplement should be the last resort. So if supplement is bad then why it is the last resort if it should be avoided altogether.

      I don’t consider Dr McDougall opinion on Vit D after he recommends tanning bed. For me, that should be avoided altogether even if it means vit D deficiency.

      For sure, getting outdoor is always the best but we are talking here about people who cannot get outdoor during the day because of their job, or will get sunburn too easily.

      Btw, Dr Greger mentioned that all studies showing the benefits of Vit D are done using Vit D supplement.

      Pills Are the Last Choice to Raise Vitamin D Levels

      Some people are unable or unwilling to get outdoors or unable to afford to use a tanning bed. The elderly and infirm confined to nursing homes, long-term care facilities, and their own homes are at an especially high risk of developing deficiencies. Adequate oral daily supplementation is as little as 200 IU of vitamin D for healthy adults not exposed to sunshine. Darker skinned and elderly people require more. Common recommendations are for 2000 to 4000 IU daily of over-the-counter vitamin D to correct vitamin D blood levels. Signs of vitamin D toxicity appear only after daily doses exceeding 10,000 IU. (1 mcg vitamin D [cholecalciferol] = 40 IU). Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D (34). Remember the topic of this newsletter: The benefits from taking pills are very limited and there are adverse side effects. The lesson is: Natural is best when it comes to food and sunshine.




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        1. Not that I think highly of Dr Oz :) but I agree with him in this case, i.e. there is no “safe” tanning bed, UVA or UVB, and both cause skin cancer. In addition, they damage skin collagen and elasticity and structure. And 15 minutes out in the sun is enough for most people unless you have dark skin and can tolerate the sun. Listen to your body and if you get sunburn no matter what color your skin is, it’s time to get in.

          http://www.doctoroz.com/blog/mehmet-oz-md/safe-tanning-beds-think-again




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      1. Yes he does. I referred to that article because it was handy, but the first time I heard talk disparagingly about vitamin D supplementation was at a lecture he was giving.

        His heart is in the right place, but he really get’s worked up about things. I have found that he is like a Pit Bull with a pork chop when he get an idea stuck in his head. He is very passionate, but sometimes it seems to cloud his judgement and he can be very passionately wrong… :-)




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    3. If you read about complex systems and chaos, then you will become aware that almost all doctors are clueless as to be able to predict disease or outcomes.




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      1. Yet with UV radiation the outcome is pretty dependable, that’s why it is used successfully in sterilization systems. Wipes lifeforms.

        And in the case of plants, they developed so many kinds of antioxidants to survive being exposed to sunlight without being destroyed.




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    4. Thank you for this post. I have the same issue. I tend to follow Dr McDougall. Especially on potatoes. :)
      Did Dr Greger used to recommend omega-3 in algae form but now discontinued the advice? If so, then I’m more concerned.




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      1. Dr. Greger’s advice changes as new studies and information roll in. He’s careful about which studies he trusts, and knows who’s funding them. It’s why I tend to trust him more than other doctors who have “been saying the same thing for 40 years”. I believe he now recommends algae oil for DHA supplementation, particularly for pregnant women (gold algae over spirulina or blue-green algae).




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      2. Tobias: To my knowledge, Dr. Greger’s advice on algae-based DHA/EPA pills has remained unchanged for years. You can see the advice on his 2011 Optimal Nutrition Recommendations (http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/ ) and the same advice can be found in his new book, How Not To Die (https://www.amazon.com/How-Not-Die-Discover-Scientifically/dp/1250066115/ref=sr_1_1_twi_har_1?s=books&ie=UTF8&qid=1468275663&sr=1-1&keywords=how+not+to+die ).




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        1. Looks like you’re right, though it seems research has changed and it’s not heart but brain functions only, as per this 2016 video on EPA etc. I’m not sure which video is the follow up on.




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    5. Hi Joe. I think we know that what is important is that we follow current research (may change tomorrow) and not what a doctor says per say. What does the research say.




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        1. j: I like the answers you have already received to your question. Here is yet one more perspective: It is worth keeping on top of the science, because some details do change over time. However, one of the themes I have picked up from the various NutritionFacts videos is that the big picture for the scientific body of evidence has remained unchanged for decades. Yes, what you hear in the media changes all the time. But what the overall science says in terms of what a healthy diet looks like has been fairly constant. So, no worries.

          I would say, follow the research on the big stuff ( = a whole plant food diet of beans, intact grains, veggies, fruit, nuts, seeds, mushrooms and a B12 supplement) and then go with the flow on the other stuff, using your own judgement as necessary/where the science is not yet clear.




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          1. Thea I think this is a good point and one to keep foremost in our minds. We often debate these topics in isolation and forget that that’s not how our bodies work. How we metabolize or convert any particular substance is dependent on a number of factors which can vary quite a bit from person to person. In clinical practice I very often run into patients whose bodies didn’t read the studies I’ve been privy to and they act in ways that are not at all what I would expect or predict. The more I practice the more I understand that I have to encourage my patients to get the major stuff right, namely eat food, mostly plants and not to much (In my best Micheal Pollan voice) and figure out the rest by trial and error.




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          2. “I would say, follow the research on the big stuff ( = a whole plant food diet of beans, intact grains, veggies, fruit, nuts, seeds, mushrooms and a B12 supplement) and then go with the flow on the other stuff, using your own judgement as necessary/where the science is not yet clear.”

            Well said, Thea. A healthy lifestyle is more important than focusing on the individual nutrient. Hormone D is the in thing now. What next. One thing to remember is that most research is done on people consuming the SAD way. I’m not against supplements if that is what an individual needs but suddenly the science says everyone needs D.




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          3. Thank you for as always putting things in perspective and helping clarify complex issues with reassuring wisdom, Thea.




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  5. There are some excellent comments and questions already. I hope to add to the posts and respond to a few at the same time.

    If you go through Dr Greger’s videos on vitamin D, one thing stands out, there is lots of variability in the science and also recommendations from different groups of health professionals and governments around the world and this changing regularly as more is published on vitamin D.

    There is variability in the level of vitamin D synthesis from the sun, based on skin colour, age, general health, time of year and where you live and probably other factors that I forgot to mention.

    There is variability in people’s levels after taking the same amount of vitamin D supplement.

    Given the same blood sample, labs around the world will differ in the vitamin D levels they report.

    Different groups of health professionals and governments disagree on the optimal blood levels of vitamin D.

    Studies do not often investigate the protective effects of phytonutrients from whole foods when investigating skin cancer and therefore may not be considered in suggestions or recommendations.

    Then, there is the vitamin D industry, industry funded research and the media.

    This is why providing suggestions or recommendations at a public health level is difficult let alone at an individual level.

    People will agree that it is very important to NOT let your skin burn and NOT become damage from sun exposure in the short or longterm. This will differ based on a factors such as skin colour and where you live in the world.

    Thus vitamin D from sun or supplements and skin cancer risk or bone health can be very confusing and frustrating to some when they ask a question and don’t get a straight or precise answer.




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  6. Hi DOC. Are there ingredients that should be avoided when buying Vitamin B12 or hormone ” vitamin D “? I’m worried about all these chemicals going inside me!! could you please advice us or direct us to a reliable pharmacologist…… thanks a lot for sharing all this knowledge with us, words cannot express how grateful i am.




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  7. so – I bought some Rite Aid brand vitamin D3 – 2000 IU. Is it best to swallow these whole or should I pop them in my mouth?




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      1. And most importantly with Vit D, take with food! Even a small amount of fat in the meal makes a huge difference in the absorption of a fat-soluble nutrient such as D.




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  8. I don’t understand the part at the end about fruit and veggies and skin tone models. Are they saying those who eat more fruit and veg and a darker “tanner” skin tone?




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    1. Yes, sort of. More exactly the studies suggest that eating more vegetables and fruits containing carotenoids will give you skin a more yellow tint, or “golden glow”, no matter what your ethnic background. See the 3 older videos on this topic (links shown at the bottom of the Doctor’s Note, which is just underneath today’s video).




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    2. Hi Duke, Those who ate more fruits and veggies got a healthy glow from all the carotenoids etc than land up in the skin, and this was perceived as more attractive than those who tanned.




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  9. Is there a list of vitamin D supplement brands that have been tested to be near the level of vitamin they claim? There was mention of supplements being tested in one of the recent videos. Thanks!




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    1. I cannot recommend what supplement people should use because it sounds like I am selling something :) But there is an independent lab called ConsummerLab.com that tests the content of supplements. They seem to be impartial and scientific but it is a paid service. I am not a paid member but I subscribe to their newsletter and there are free info to read. Myself, I buy my supplements through Amazon.com and I read people reviews before I buy something. I will make sure that the reviews sound authentic before I read.




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  10. Given John Ott’s body of research, along with Ilyas Washington’s recent research on chlorophyll metabolites’ action in mammalian cells, I am inclined to think that sunlight cannot be distilled into a supplement, just as fruits and vegetables cannot be. We evolved to be in the sun, and evolution doesn’t like to waste energy. I would not be surprised if there are all sorts of wavelengths that we have evolved to use, but we just don’t know about it yet. Our eyes provide our blood with a sterile irradiation chamber to catalyze such reactions. Organisms that use available energy/light to catalyze reactions will be more successful than ones that don’t.

    Chlorophyll absorbs in the UV spectrum, and all the lovely colorful phytonutrients appear to protect against sun damage. My recommendation to my patients is to use green leafy vegetables as edible sunscreen and get out in the sun. Start slow if you are pale, because you still need to work up your melanin.

    I took my own advice, and happily discovered that my pale, Northern European skin did not burn this year when I started going out in the sun like it usually does. Instead I got a lovely tan very quickly. I eat my greens three times a day along with liberal servings of organic frozen berries from Costco.




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    1. Another of his recent Vit.D video talks about the Nitric Oxide (and immediate BP-lowering) produced when we’re exposed to sunlight after eating greens. Sunshine produces hormones that make us FEEL GOOD. Sunlight has other benefits besides vitamin D, for sure. Not sure why he concluded this video at basically recommending avoiding all sun exposure…




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      1. This whole series is questionable to me as he keeps hawking supplements. Aren’t all studies done on mostly meat and dairy eaters? Am not sure that really equates to WFPB persons.




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    2. Hi Dr. Dewald,
      It’s understandable that you’d want the best of both worlds — health benefits of sun exposure while minimizing the risks using fruits/vegetables, and this makes intuitive sense. However, I’d point out that even a tan is a response of the skin to UV damage, so just because you aren’t getting burned doesn’t mean you aren’t accumulating sun damage and aging your skin prematurely. Granted the vegetables/fruits are certainly decreasing that damage to an extent, but is it enough to eliminate the increased risk of skin cancer? (I’m asking rhetorically because I don’t think anyone knows the answer)




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      1. Pigmented skin is actually the normal state of human skin. Pale skin that can adjust to UV level by tanning is a variation that developed in response to inadequate sun exposure. White people are going to have an increased risk of skin cancer, that is an evolutionary trade-off. I am not saying it can be eliminated, but it can be reduced with a better diet.

        The big issue here is that we are enamored with this concept of sunlight’s only action in people is to make vitamin D and cause skin cancer. We are being told that we should completely avoid the sun, and take vitamin D supplements. However, there is inadequate evidence that vitamin D is a complete substitute for sunlight. What we do know is that vitamin D prevents and treats rickets.

        The action of sunlight in humans has been barely researched at all, and there is a good amount of circumstantial evidence that our current paradigm of photobiology in humans is incomplete.

        Higher natural vitamin D levels (a marker of full spectrum sunlight exposure, mind you) have been linked to a reduced risk of a long list of diseases including cancer, cardiovascular disease, dementia, autoimmune diseases, and psychiatric diseases. Vitamin D supplementation has fizzled in trials to see if it could treat these diseases. So something else is at work here. Interestingly, a study done in Sweden that showed that people who smoke and sunbathe have the same risk of death as people who don’t smoke and avoid the sun. So sun avoidance would seem to be as bad as smoking from this study.




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        1. Whatever we choose to call “normal” skin pigmentation, along with a tan comes DNA damage that raises risk of skin cancer and premature aging. Is it balanced out by fruits/vegetables? Only to the extent that the carotenoids and other compounds help to block the damage, which would decrease both burning *and* tanning. If you get enough sun exposure to overcome the protection, you’ll still tan/burn but also still cause damage.

          As you note, there are other organs and organ systems to consider regarding potential benefits of the sun exposure, and I agree with what you’re saying regarding what we *don’t* know about full-spectrum sun exposure and its potential non-vitamin-D health benefits. I think Dr. Greger is keeping that in mind when trying his best to weigh the pros and cons of sun exposure. It’s hard to make firm recommendations on what we don’t know yet. While I probably wouldn’t argue with someone who wanted to sit in the sun for a few minutes a day to get some benefit while hopefully minimizing risk, I’d almost never recommend tanning.




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  11. “When we were evolving, we didn’t live long enough to have to worry about skin cancer…”

    From a standpoint of evolutionary biology, that statement does not account for the differences in skin color depending on the amount of regional sun exposure. Having more melanin had to confer an evolutionary advantage to those subjected to equatorial sun on the savannah, meaning those with lighter skin did not live long enough to pass along their genes. While during the Ice Age, for instance, lighter skin in northern regions would confer a survival benefit, not enough Vit. D and they might succumb to some disease before being able to reproduce. Darker skin does lessen UV exposure and subsequent Vit. D synthesis, compared to lighter skin, so one of sub-Saharan African descent would need more sun exposure than a lighter skin person of European descent, to reach optimal levels, without supplementation.

    “Vitamin D insufficiency is more prevalent among African Americans (blacks) than other Americans and, in North America, most young, healthy blacks do not achieve optimal 25-hydroxyvitamin D [25(OH)D] concentrations at any time of year. This is primarily due to the fact that pigmentation reduces vitamin D production in the skin.” – http://jn.nutrition.org/content/136/4/1126.full

    It is possible that climate extremes (solar events, ozone holes, etc.) beyond what we experience today were killing off young early humans, enough to produce regional evolutionary changes in melanin, one of the characteristics that we moderns define as different races of the same species, all tied to sun exposure and Vit. D and disease and death.




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  12. There are so many things that energy coming from the sun does to help us, but we have only scratched the surface. Besides the production of vitamin D, nitric oxide, and bactericidal aspects of sunlight, the infrared energy actually enters close to 4 inches into our tissues and has all kinds of effects on our cells. For example, this article explains how infrared causes apoptosis in fibroid tumor’s mitochondria.
    http://www.jidonline.org/article/S0022-202X(15)32040-6/abstract?cc=y=




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    1. Thanks John! I pointed out in some other posts that the infrared portion of sunlight penetrates sunscreen and clothing as well as tissues, so in my view it’s a win-win to get outside and enjoy nature while at the same time protecting against UV rays and taking a vitamin D supplement!




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  13. I just came away from Mercola’s comment forum section. He has an article on how people on a whole food plant diet cannot get the proper amount of omega 3’s from eating chia seeds, flax seeds, walnuts, and algae. He says these short chain ALA molecules only change to long chain omega 3 molecules at a rate of only 1% to 3%. So, he is warning his readers that they better start taking krill oil. By the way, if you read the label on his krill oil it says TALAPIA on it. Anyhow, all I can say is that thousands of people following Greger, Ornish, McDougall, Fuhrman, Esselstyn, seem to live healthy lives using flax and chia seeds. There are many vegan atheletes, and body builders who look a whole bettter than he does. He just doesn’t look healthy at all. His eyes look sunken in, his skin looks leathery from being out in the sun to much. He has a kind of a malnourished look.




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    1. Fuhrman very strongly recommends taking a low dose, vegan DHA/EPA supplement, so he disagrees quite pointedly with McDougall, Esselstyn, Ornish, Campbell, and as far as I know, Barnard, on this issue. In his practice, he discovered that many older vegans have very little DHA in their blood, and worries that this could lead to serious cognitive and other neurological disorders.
      In his latest book The End of Heart Disease, he also criticizes the Ornish/Esseltstyn diets for being too low in fat (he does not discuss McDougall for some reason, but the same conclusion would apply). His concern about ultra low fat diets has to do with long term neurological health, if I recall right. I think that he recommends at least 15% of calories should come from “good fats”, but higher levels are fine if one is not overweight, and if the extra fat comes from nuts/seeds. I’d be careful about lumping everyone of these practioners together, since if one is a vegan interested in “fine tuning”, these differences can be significant. I wish they’d be discussed more.




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        1. That’s an interesting point! But still there seems to be a lot of variability in how well different people convert ALA to EPA (and from there to DHA). I’ll have to look into this more.




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            1. Me, too. I’ve copied a response to Thea below, which seems to me to support caution in this area.

              ====
              I’ve read the article, and it is encouraging. But I’d like to raise another point. You said above one only needs a little bit of DHA. I am wondering how that was determined. There is also evidence that those who have a relatively higher amount experience less brain shrinkage in older age and test better on cognitive performance metrics, on average. See e.g.

              http://www.ncbi.nlm.nih.gov/pm

              This raises the general point of what’s optimal vs what prevents obvious disease. One could be classed as cognitively normal (no MCI or AD) at an older age but still not be functioning as well as one could had one had more DHA over a long period of time. Given my age, I tend to think about these issues more than I think younger people do. But it is something to think about.




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          1. David J: That’s odd. If you wait a beat, the link should have scrolled down to my actual comment. But just to be helpful, I’m repeating the comment here:

            Here is some information/studies that I think are relevant to this issue of whether humans can get enough DHA from plant sources. I believe I got the following two sections of text from an article by Jeff Novick, RD, but the link no longer works. So, I can’t refer you to the original. I also reference below a study that moderator Stephanie pointed me to at one point.

            The main points are:
            1) The bodies of vegan people do a better job of converting ALA to DHA. So, the question is, even if the conversation rate is low, can our bodies convert enough to make us healthy? We don’t need very much:
            2) Studies of vegan people show DHA levels to be high compared to other groups. Other studies show vegan bodies to be relatively low, but in those cases there is no apparent harm from those levels. So, the problem may be in the assumption that the DHA levels are low.

            *********************
            In regards to ALA conversions, This recent study showed that the conversion rate in Vegans is 2x that of a fish-eater.

            “Comparison of the PLLC n23 PUFAs:DALA ratio between dietary-habit groups showed that it was 209% higher in vegan men and 184% higher in vegan women than in fish-eaters, was 14% higher in vegetarian men and 6% higher in vegetarian women than in fish-eaters, and was 17% and 18% higher in male and female meat-eaters, respectively, than in fish-eaters This suggests that the statistically estimated conversion may be higher in non-fish-eaters than in fish-eaters.”
            http://www.ncbi.nlm.nih.gov/pubmed/20861171

            *****************************
            In addition, another study showed that despise this “theoretical” low conversion rate, there is no evidence of any harm so, the problem may not be in the conversion rate, but in the assumption that it is low.

            Prostaglandins Leukot Essent Fatty Acids. 2009 Jun 3.

            “There is no evidence of adverse effects on health or cognitive function with lower DHA intake in vegetarians.

            In the absence of convincing evidence for the deleterious effects resulting from the lack of DHA from the diet of vegetarians, it must be concluded that needs for omega-3 fatty acids can be met by dietary ALA. ”

            They also noted the importance of limiting excess omega 6’s, especially in vegans/vegetarians.

            **************************
            American Journal of Clinical Nutrition. November 2010, Vol 92, Number 5, Pages 1040-1051. The vegans in the study actually had highest levels of DHA (which most sources say it’s harder for the body to convert ALA into DHA, than it is to convert ALA into EPA) compared to the fish eaters, non-fish-eating meat-eaters, and vegetarians. This was despite the fact that they consumed less omega 3s. (Stephanie also found an article that summarizes the study: http://www.nutraingredients-usa.com/Research/Omega-3-ALA-intakes-enough-for-EPA-DPA-levels-for-non-fish-eaters?utm_source=copyright&utm_medium=OnSite&utm_campaign=copyright




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    2. John Axsom: Here is some information/studies that I think are relevant to this issue of whether humans can get enough DHA from plant sources. I believe I got the following two sections of text from an article by Jeff Novick, RD, but the link no longer works. So, I can’t refer you to the original. I also reference below a study that moderator Stephanie pointed me to at one point.

      The main points are:
      1) The bodies of vegan people do a better job of converting ALA to DHA. So, the question is, even if the conversation rate is low, can our bodies convert enough to make us healthy? We don’t need very much:
      2) Studies of vegan people show DHA levels to be high compared to other groups. Other studies show vegan bodies to be relatively low, but in those cases there is no apparent harm from those levels. So, the problem may be in the assumption that the DHA levels are low.

      *********************
      In regards to ALA conversions, This recent study showed that the conversion rate in Vegans is 2x that of a fish-eater.

      “Comparison of the PLLC n23 PUFAs:DALA ratio between dietary-habit groups showed that it was 209% higher in vegan men and 184% higher in vegan women than in fish-eaters, was 14% higher in vegetarian men and 6% higher in vegetarian women than in fish-eaters, and was 17% and 18% higher in male and female meat-eaters, respectively, than in fish-eaters This suggests that the statistically estimated conversion may be higher in non-fish-eaters than in fish-eaters.”
      http://www.ncbi.nlm.nih.gov/pubmed/20861171

      *****************************
      In addition, another study showed that despise this “theoretical” low conversion rate, there is no evidence of any harm so, the problem may not be in the conversion rate, but in the assumption that it is low.

      Prostaglandins Leukot Essent Fatty Acids. 2009 Jun 3.

      “There is no evidence of adverse effects on health or cognitive function with lower DHA intake in vegetarians.

      In the absence of convincing evidence for the deleterious effects resulting from the lack of DHA from the diet of vegetarians, it must be concluded that needs for omega-3 fatty acids can be met by dietary ALA. ”

      They also noted the importance of limiting excess omega 6’s, especially in vegans/vegetarians.

      **************************
      American Journal of Clinical Nutrition. November 2010, Vol 92, Number 5, Pages 1040-1051. The vegans in the study actually had highest levels of DHA (which most sources say it’s harder for the body to convert ALA into DHA, than it is to convert ALA into EPA) compared to the fish eaters, non-fish-eating meat-eaters, and vegetarians. This was despite the fact that they consumed less omega 3s. (Stephanie also found an article that summarizes the study: http://www.nutraingredients-usa.com/Research/Omega-3-ALA-intakes-enough-for-EPA-DPA-levels-for-non-fish-eaters?utm_source=copyright&utm_medium=OnSite&utm_campaign=copyright




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      1. I’ve read the article, and it is encouraging. But I’d like to raise another point. You said above one only needs a little bit of DHA. I am wondering how that was determined. There is also evidence that those who have a relatively higher amount experience less brain shrinkage in older age and test better on cognitive performance metrics, on average. See e.g.

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829435/

        This raises the general point of what’s optimal vs what prevents obvious disease. One could be classed as cognitively normal (no MCI or AD) at an older age but still not be functioning as well as one could had one had more DHA over a long period of time. Given my age, I tend to think about these issues more than I think younger people do. But it is something to think about.




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        1. David J: It is definitely something to think about. I wanted to take a few days to do just that (think about it) before responding. Please note: This post is just about me having a conversation with you. These are just my thoughts/opinions. I’m not saying you are right or wrong or that I know something definitive. I feel that we need a *whole* lot more science before this issue is put to bed. All we can do now is work with the information available and talk it out with each other.

          —————
          The daily recommendation for omega 3 is 1.1 grams per day for women and 1.6 for men. If I understand correctly, that’s about 1/4 teaspoon. It is a fair question to ask how they came by that amount, and I have no idea. If someone can answer that, please speak up…

          It’s also fair question whether any particular RDA is about avoiding a particular disease or about optimizing health. I looked at that study you referenced, but I did not review the study in detail. Nor do I feel qualified to do so. For what it’s worth, it is not a compelling study to me. The wording of some of what I read left me with questions about how much we can really learn/conclude from the study. And I was left feeling that this *may* be a situation like cholesterol and disease – where we have reverse causation. Certain diseases cause low cholesterol (not the other way around). So, you can find all sorts of well-sounding studies that purport to show that low cholesterol leads to higher mortality. But studies done properly going forward in time show this is not true. After looking at the study you referenced, I was left wondering how much we really learned about the relationship between the intake of fish oil and brain size. (But I just may not be understanding the study itself.)

          And then I think about that study I referenced above about vegetarians having more DHA in them. It seems unlikely to me that the study you referenced makes the distinction between how much DHA people already have in their bodies verses supplementation. And how many of them were vegetarians. And in the study I referenced, did those vegetarians supplement? (I doubt they supplemented with fish oil, because that would not be vegetarian. And while is it becoming more popular now, I doubt many of them were supplementing with algae oil.)

          Here’s another thought: Suppose the study you reference is a good reflection of reality – that if humans focus on making sure we get enough DHA in our blood, it will help make sure our brains don’t shrink. That study/idea says nothing about whether or not we can meet that goal with flaxseeds and many servings of greens a day. In other words, maybe someone taking care of their omega 3 needs by eating a whole plant food diet that includes flaxseeds and lots of servings of greens would do as well or better as the fish oil people in your study. There is nothing about the study that I can see that would indicate otherwise. Their low or no fish oil group was not eating whole plant foods…

          Having said all that, in Dr. Greger’s book How Not To Die, he does recommend that people “consider” taking an algae-based DHA pill “until we know more.” I have no inside info on what Dr. Greger thinks on this. But my interpretation of the wording in that section of the book is that Dr. Greger has reviewed the science and thinks that taking the pill is a good, cautious choice. But I don’t think it means that we have definitive science saying that taking such a pill will lower disease risk. And I do think we have some good science hinting that such a supplement may not be necessary.

          That’s all I got right now. :-)




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          1. Thanks for your reply, Thea. I always pay attention to your comments because they are so thoughtful, and I have benefited from many of them. As you said, the science is not definitive on either side, which was really the point I wanted to make. Frankly, what has bothered me and caused me to comment on this is that I have the impression that some people just assume that the science is stronger than it is, and that one can confidently assume vegans would have no problem in this area over a long period of time. Hence I follow Dr. Greger’s and Dr. Fuhrman’s recommendations on this, as this makes me more comfortable, and I am unaware of any downside (but I am more open to taking supplements than many vegans).

            Good health to you!




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    3. There is probably no harm in getting a little preformed DHA and EPA, but there is no need to strip mine the oceans to get it and much to recommend that you don’t. Fish and krill don’t form a lot of their own DHA or EPA because they get it from the marine algae that they eat. As such they aren’t actual a source, but rather just a transmission channel. The trouble is that DHA and EPA aren’t the only thing from their environment that they transmit. They are also quite good at gathering and concentrating environmental toxins like mercury and the like. The much better bet is to get the DHA and EPA direct from the source by taking algal based supplements. The algae are raised in tanks with controls on the water and food they are given so you get the good stuff without the toxins and environmental destruction. A very nice Win/Win.




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      1. Thanks for your reply. I was always a little suspicious of krill oil. I will try taking the algae supplements. It seems like growing algae is a very sustainable source of DHA and EPA as compared to strip mining krill. In his article, Mercola says that harvesting krill is regulated by some kind of global protection agency for the Antarctica. I doubt if they have the resources and personnel to check every ship that goes down there to troll for krill. He also states in his article that since krill is at the bottom of the food chain it does not receive all the pollution into their systems, especially since they live at the Antarctica where waters are supposedly clean. But, how can that be after we saw the radiation pollution from Fukashima, Japan travel across the Pacific Ocean to the western states of Washington, and Oregon? I imagine that a lot of ocean pollution is spread through out the entire global oceanic system by currents, winds, and other forces….and the Antarctica is not as pristine as one might think. It won’t be long and we will “really”, “really” be walking around on a junk filled planet: plastics, antibiotic resistant microrganisms, GMO plants, GMO animals, and the spread of thousands of chemicals, poisons, and all of it topped off with radiation from spent fuel rods from all of the hundreds of nuclear power plants around the planet. Something is going to “crack” in the future, because it is just not sustainable. If I were a young person, I would try to find a good safe, healthy place to live, but as things progress, I don’t think such a place will even exist anymore. There is no place to hide.




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        1. I don’t think it is quite that bad yet, but it does take action by each person. We can’t wait for somebody else to take action and make decisions for us. We each have to do all that we can do as much of the time as we can do it. And eating a plant based diet is probably the single largest thing that each person can do to really make an impact on all the problems we face. And when it seems like the impact that we can make as individuals is just a drop in the bucket next to the scale of the problems, just remember that a mighty river is just millions of raindrops all flowing in the same direction.




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    1. You’re right that in his videos and book, How Not to Die, Dr. Greger discusses how exposure to sunlight helps regenerate CoQ10, an antioxidant. However, there are also plant-based sources of CoQ10, including legumes, broccoli, spinach and cauliflower, so we aren’t entirely reliant on sun exposure.




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  14. Hi. I was wondering if you know of any studies on chicory coffee vs just plain coffee? I’ve heard chicory tea is said to have benefits, and I know you’ve said before that coffee isn’t the greatest, because of the caffeine and the fact that there are better alternatives. So does decaf chicory coffee have different health benefits? Writing from New Orleans where coffee without chicory just doesn’t taste right




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    1. Actually, Sophie, you may have just found one of those “better alternatives” Dr. Gregor suggested. I did a check on PubMed and while there were several studies listed under Chicory Coffee, this one seemed the most relevant: Phytother Res. 2011 May;25(5):744-8. doi: 10.1002/ptr.3481. Epub 2011 Mar 21. Thrombosis preventive potential of chicory coffee consumption: a clinical study. As summarized, It “offers an encouraging starting-point to delineate the antithrombotic and antiinflammatory effects of phenolic compounds found in chicory coffee.” Unfortunately I found no discussion of caffeinated chicory-blend coffee v decaffeinated, but it makes sense to go with a decaffeinated chocory blend if you can find it to eliminate the effects of caffeine if they bother you




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  15. I grew up in an era when there was a lot of propaganda on TV about the attractiveness of tan skin and the unattractiveness of my own type of complexion: the classic pasty, freckled skin of a lad whose ancestors came from Scotland (latitude 56 degrees N).




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    1. Thank you for your comment. I would like to think with the growing awareness of increasing skin cancer among young people especially the view that a “golden glow” looks good is fading. Of course, pasty white isn’t desirable, either, but fortunately we now know what we can do to avoid that–eat our veggies!




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      1. And cooked might contribute more to the glow then raw. In another video Dr. Gregor shows that it takes 17 servings of raw veggies to produce the same concentration of carotenoids in the blood as 4 servings of cooked veggies. Eat cooked carrots and beets and sweet potatoes if you want that glow. We should still eat a big raw salad, i’m just saying its going to be hard to get much of a glow with raw alone.




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          1. Yes, Ben, cooked has some great advantages. You may be interested in the book “Eating on the Wild Side” by Jo Robinson. She is a food researcher similar to Dr. Greger. And she references all her statements with science a la Greger. Anyway, lycopene, found in tomatoes in particular and also associated with lots of good things for the body (reduced prostate cancer for one) is increased in tomato sauce the longer you cook it. Lycopene has also been shown to protect the skin from burning (and I’m sorry I can’t put my finger on the research anymore, it was years ago). So the longest-cooked form of tomato product is tomato paste.
            An Italian friend of mine has an old family recipe that involves simmering greens in tomato sauce. Just add some garlic and some cannellini beans and you’ve got a great meal that protects your skin from skin cancer as well as one’s prostate. Bon appetite!




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            1. Also, making smoothies with raw vegetables/fruits would have the same (if not even better) effect as cooking. For instance, my morning smoothie has 2 cups of raw frozen kale and a handful of walnuts, so you get the breakdown of cell walls/release of nutrients from the kale in addition to enhanced absorption of carotenoids due to the fat from the walnuts!




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    1. Hi Aryeh, while we still don’t know if the CoQ10/sun phenomenon is important (vs just an interesting academic phenomenon), you should be able to get this effect even with sun protective clothing and/or sunscreen, since the near-infrared rays penetrate through these (as well as through skin and tissues)




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  16. I’m fair skinned with some freckles, and yes we have a red haired son.
    Over the years I’ve gotten a few sunburns so now I get actinic keratosis and squamous cell carcinoma removal a couple times a year. We do get some sun exposure part of the year way up north in New Hampshire. We do vitamin D3 2,000 IU. Note that Vitamin D2 is of little use to the body.




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    1. Thanks for your comment, Jerry LA. It’s a good reminder that those of us who have very fair skin need to be careful with sun exposure. (Sadly, I’m writing this with a sunburn I got when I wasn’t acting on this advice. Not the way I meant to boost my Vitamin D level.)




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    1. Was there a point to this? Were you trying to say that a plant based diet is not healthy? Or were you trying to say that the worries about feeding children a plant-based diet is overblown and that it only becomes an issue when parents do a horrific job of feeding their children. The article you point is kind of all over the place and so it is hard to know what your point was when you just drop a reference without comment.




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  17. I think the impression this video leaves, is a problem. 1. It goes against Dr. Greger’s normal wisdom of getting vitamins naturally, not from supplements. and 2. Medical societies cannot be trusted since they take massive donations from industry-in this case the sunscreen industry. So when doctors advise against their interest, that’s not unusual when their society espouses it based upon THEIR collusion with industry. Doctors probably don’t go against the protocols of their peers for a variety of reasons including the increased litigation risk of diverging from the standards of care.

    The conclusion of the video-take supplements, avoid sun exposure-seems wrong headed, based upon what’s in the video and other videos of Dr. Greger’s:
    1. Chronic sun exposure is beneficial-though we don’t know if that’s from increased exercise or from the sun.
    2. Sun has other benefits than vitamin D. One video of Dr. Greger’s talks about increased ubiquinone production from sun exposure.
    3. Sun increases nitrous oxide production.

    The video doesn’t touch on the net affect of toxic substances in sunscreens and whether they affect mortality. The only mortality discussion was vitamin D cancers vs. skin cancers. It’s likely that sun exposure improves mortality and not just from vitamin D. This data is necessary to actually decide whether to sunbathe or not. We also don’t know if skin cancer’s aren’t actually in part caused by sunscreen usage. We also don’t know why European’s had improved longevity from sun exposure and the U.S. had decreased longevity. The science is so confused on this that it’s hard to say whether more, not less sun exposure isn’t better. The video leaves us thinking less is better. And it seems to say the dermatologists can be trusted because they make money on skin cancer and their advice will reduce skin cancer. This contradicts the evidence that the video presents that chronic sun exposure doesn’t increase skin cancer. Finally, this video doesn’t address a video a few days ago that suggested that the evidence for supplementation of vitamin D wasn’t as persuasive as the evidence of getting it naturally.

    So I”m confused.




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    1. Hi Richard, thanks for the thoughtful questions. Let me take a shot at hopefully helping to clear things a little. You make some good points, too. If there were a good whole-food plant-based source of vit D, I have no doubt Dr. G would be espousing it heartily! Unfortunately we have two choices — sunlight vs supplements. As he points out, since we as species (as a general rule) didn’t live long enough during our evolutionary history to get skin cancer, the main consequences of sun exposure weren’t a big problem.
      I don’t think it’s contradictory that chronic sun exposure has health benefits, and that would be due to both the vitamin D *and* the exercise. We also know for a fact, of course, that chronic sun exposure dramatically increases risk of skin cancers (I treat current and former athletes and outdoor workers, etc, all day long for skin cancers, and the areas exposed to the sun chronically such as face, forearms and lower legs are the worst. It’s amazing to look at the person’s forearm — mottled, freckled, covered in pre-cancerous lesions — and compare it to his abdomen, which often looks like the skin of a newborn babe!).
      We can get the benefits of exercise and vitamin D by exercising and taking a vitamin D supplement. Regarding the ubiquinone/ubiquinol recycling, this will happen in the sun even with sun protective clothing because it’s the near-infrared portion of the sun’s rays that are responsible for this effect, and those rays penetrate sunscreen/clothing/skin. To help regulate circadian rhythms (if one needs help), one can use a blue light, which is the portion of the spectrum responsible for melatonin suppression and doesn’t contain any skin-damaging UV radiation.
      I think the concerns about sunscreens are largely overblown, but it’s reasonable to weight them against the known risks of skin cancer. If concerned about the chemical sunscreens such as oxybenzone, I recommend a physical blocking sunscreen such as zinc/titanium (these sunscreens are more “pasty”, however). And nothing beats sun-protective clothing, such as a hat *with* a brim! (http://www.tilley.com/us_en/ are some of my favorites)
      Hope that helps!
      -David




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      1. You linked skin cancer to sun exposure which I guess is true for one kind of skin cancer. But don’t you think that the correct endpoint is all-cause mortality. A recent study showed that most standards of practice-such as telling patients to stay out of the sun- because research fails to get to the correct endpoint is refuted more often than confirmed by recent research [A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices]. The relationship between long term exposure (as compared to intermittent exposure) to the sun and skin cancer is already quite confused as it is and not at all clear, don’t you think? [Time trends in incidence of cutaneous melanoma by detailed anatomical location and patterns of ultraviolet radiation exposure: a retrospective population-based study] and [Melanoma and sun exposure: contrasts between intermittent and chronic exposure.].

        I was wondering what your basis for saying sunscreen ingredients are safe? Don’t you think with industry so involved in making science, that a conservative approach is in order to deal with signs of danger? So why do you say it’s “overblown”. I’m very suspcicious-and with good cause-of standard interventions accepted by the medical community and it turns out that studies and experts confirm this concern, such as the one i mentioned earlier and this [Why Most Published Research Findings are False] or this by the head of Lancet [http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2815%2960696-1.pdf].

        My guess, that in spite of most doctors recommending sunscreen, there’s a very high chance that it’s not safe and that the doctors aren’t doing adequate research to find out if it is. In 1960, 1/2 of all doctors smoked and 2/3 refused to accept that cigarettes cause cancer. No offense, but “avoid the sun” could be another one of those falsities. 1. Evidence of chronic sun exposure NOT causing cancer is there. 2. Studies show increased longevity from sun exposure. 3. Vitamin D, nitrous oxide, upiquinone, and cheerfulness all derive from the sun. 4. Sunscreens have proven toxicities, and unexplored long term toxicities.

        I personally don’t have the skills to find out what’s real, but it appears that nor does the medical community. Millions of white middle aged Americans have experience a declining longevity for 15-20 years now [Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century]

        I tend to think if there’s a warning of danger, that it’s better to play it safe. Personally, I’ve made some serious errors by listening to medical advice. I was put on an Atkins diet for 10 years-high meat consumptions, basically. Then I was put on statins to deal with cholestrol. Then I got diabetes. At that point, I told my doctor-I am not going to take statin, but I’m going on a vegan diet. The chief of endocrinology at a major medical school then told me “you have to get on insulin”. “And you should stop eating spinach-it has nitrates”. I’m not kidding. My diabetes went away from the diet and I stopped taking drugs. Since that time, I’ve avoided doctor recommendations like the plague. 35 drugs have been withdrawn from the market. Before they were withdrawn, doctors assumed that they were safe and routinely used them. So I am not as sanguine about titanium dioxide as you are. It’s a group 2B carcinogen.




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  18. My problem with D3 supplements is that they give me terrible hot flashes – every hour all night long so that I can’t get proper sleep. I had to discontinue them.




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    1. Hi Dani,
      That’s a really strange and seemingly improbable side effect of vitamin D supplements. How many times did you try stopping/starting it?




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      1. “really strange and seemingly improbable side effect ” I really dislike comments like that because everyone is individual as how their body reacts to additives of any kind. Also vitamin D is a hormone not vitamin. So little is really known about it.




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  19. One vitamin D issue that I don’t think was addressed is the current thinking about storage; if you spend an adequate amount of time in the sun in the warm months, for how long will that carry over Vitamin D sufficiency in the cold months (recognizing that it will differ based on a scad of variables)?




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  20. I just have to take issue with the phrase that “chronic excessive” exposure to sunlight is the primary cause of skin cancers. In the case of melanoma, it is “Intermittent” excessive sun exposure that carries a higher relative risk.




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  21. Your coverage of this issue is frustrating me. It strikes me as ignoring fundamental questions and falling into the reductionist trap.

    You’ve acknowledged other benefits of sunlight (coQ10, NO). Now, if we think about sunshine the way we do food, recognizing that it’s better to eat whole foods with their numerous, complementary substances than to take isolated nutrients in pill form, could the same not be said about sunshine? That it’s better for us to get the full complements of sunlight’s numerous effects, than to isolate one component and take it in a completely unnatural way (orally, as opposed to our skin making it, bypassing our body’s checks and balances regulating its creation and absorption, etc.)?

    Regarding the data on sunlight, and UV lamps, being associated with disease: again, these seem to be associated with overuse of these things (aiming for a “tan” and burning, as opposed to therapeutic use for vitamin D production, etc. that results in only a small difference in skin tone being produced), as well as other bad habits (sun-tanners have higher rates of smoking, junk food consumption, etc.). We’re talking correlation, in other words, not necessarily causation, or at least, not necessarily a mechanism of causation that affects all of us equally.

    It’s kind of like exercise. You’ve covered that exercise causes oxidative damage, and as such, a person eating a horrible diet and beating their body up through training could expect to have a very high level of DNA damage, etc. perhaps in some cases more than a sedentary person eating the same diet (?). If this is the case, it doesn’t mean exercise is bad – it means we should be exercising AND eating a healthy, antioxidant packed diet that boosts the benefits of exercises while helping us recover from the “negative” ones (I use negative in quotations because these are normal effects in this context and, considering the complexity of exercise recovery, etc. are probably, in the end, good effects when managed properly). In the same way, perhaps we should be getting low to moderate sun exposure, while consuming that same healthy diet, to help us maximize benefit and minimize harm (or “harm”?). This means most of the data we have on sun exposure and disease rates may effectively not tell us much of use, because most of the people with higher disease rates due to sun exposure are also eating like crap, smoking, etc. If we health-conscious folk assume sunlight to be mostly bad because of this data, we may in fact be shunning something that’s necessary for the very best health, and doing ourselves more harm than good.




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    1. Thank you for this well-reasoned comment, with which I largely agree. You are postulating that moderate sun exposure — i.e. enough to produce sufficient vitamin D but not enough to tan/burn to the extent that you significantly increase risk of skin cancer — is good for you.

      Dr. Greger is presenting results from all the available published research on sun exposure and vitamin D, and how these relate to risks of disease and death. The problem with the available research is that it consists mainly of population studies that look at correlations between one variable such as “sun exposure” and another such as “life expectancy”. This means that lots of things get lumped together, and there can be many confounding variables. That’s why you can’t draw conclusions about causation from cross-sectional population studies.

      You point out that exposure to sunlight has several benefits, including boosting production of Co Q-10 and of nitric oxide. (You didn’t mention other known beneficial effects of sunlight — e.g. on the pineal gland, to set our circadian rhythms and help prevent seasonal affective disorder).

      You point out the “reductionist trap”, about which Dr. G. has spoken, and which is present in most scientific research, because researchers always want to try to isolate out one variable to study, keeping all the others constant. The alternative to the reductionist approach is to adhere to general principles such as: Whole plant based foods are likely to be better for you than isolated components; Exercise is good for you overall; Eating organic produce will reduce risk of various diseases. We arrive at these general principles by the process of inductive reasoning, looking at many different studies and then inferring a general conclusion.

      I myself believe all of the above 3 general principles. But we need to keep on “putting it to the test”, as Dr. G. says. This website is great, in large part, because Dr. G. keeps on presenting new studies which put things to the test. If we stop looking at new data, that’s just falling into the same trap as people who blindly believe in the Paleo diet, thinking that eating lots of meat is good for you, and refusing to consider alternative data.

      I think Dr. G. is trying to get at The Truth. I’m sure he realizes that our understanding of The Truth will continue to evolve. He’s not asking you to blindly accept everything he says. I salute you for questioning what he says, and for reminding us about reductionism.




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      1. I agree with much of what you say here, and don’t question Dr. Greger’s intentions or desire to get at the truth of the matter. I’m sure if and when studies come out showing any harms associated with vitamin D supplementation, or the inferiority of these pills compared to sun exposure, he’ll be the first to share these with us. However, I’m still not seeing how he gets from the evidence he covers to the recommendation he ends up making. He’s critical of reductionism, recognizes that there are confounding factors at work in the research linking sun exposure to disease, recognizes that sunlight has countless benefits (you mentioned a few I didn’t and undoubtedly there are others yet to be discovered), yet he still arrives at the conclusion to supplement. I’m not convinced, not based on the “case” he’s made so far, which if anything I’d personally interpret more as a case for responsible sunshine exposure being the better option.

        His advice strikes me more as being on par with the way most health guidelines are devised; it seems, to me anyway, almost as though he assumes people aren’t responsible enough to moderate their sun exposure, and therefore is hesitant to give guidelines about how much sun is enough vs. too much, thinking it much safer to just advise supplement use instead. How much sun we need is going to vary with each person, prior exposure/time of year, etc.

        I can see how this might make sense from a public policy perspective – if people aren’t responsible enough to moderate their sun exposure, telling them to get sunshine for meeting their vitamin D levels will result in more cases of skin cancer. It’s problematic, though, and somewhat on par with telling meat eaters to reduce their meat consumption, etc. because you think this is an easier guideline to follow. Why not just tell them that the science seems to show that zero meat consumption is best, and let them decide how to live their own lives with that information? In the same way, I think we should be honest that right now, sunlight looks better than popping a pill based on common sense and lessons we’ve learned in the past about reductionism, etc., but that we don’t really know 100% what constitutes the most responsible level of exposure to sunlight that maximizes benefits while minimizing harm.

        For the time being, I’m sticking with sunshine. Will keep checking back for more videos/blog posts on this subject in the future.




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        1. Sounds like a very reasonable plan. I take a vegan Vitamin D supplement during times when I don’t get enough sun exposure; as a doctor, that unfortunately happens fairly often. I will also follow with interest further developments on this topic! Thanks again for your comments.




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        2. Sounds like a very reasonable plan. I take a vegan Vitamin D supplement during times when I don’t get enough sun exposure; as a doctor, that unfortunately happens fairly often. I will also follow with interest further developments on this topic! Thanks again for your comments.




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  22. Speaking of frustration, I’m going to be in the sun for work and play for the rest of my life. What I’d really really like to see is some indications of WHICH TOPICAL SUNSCREENS are more/less dangerous. I use them almost daily, but cannot find good information (independent of the industry) in order to make an informed decision as to which ones I should use.

    Yes I wear hats and sleeves when I can, but sleeves are often inappropriate. I always wear a wide hat, every season. I’m concerned about the forearms, neck, and backs of my hands-these are where I apply sunscreen regularly to reduce the UV damage. When I’m not on the clock, or on the water, I naturally seek shade and work the garden/yard early and late. I’m no complete dummy.

    Do any of the good folks around here have some believable studies on the various concoctions we find in commercial sunscreens indicating one or more are less toxic than the others? thanks!




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  23. I generally agree with nearly everything Dr. Greger says, but on this I have to say that I am still doubtfull about taking Vitamin D supplements as the first option rather than the last. It sounds like the amount of sun required to produce sufficient vitamin D is much less than that which would result in the lightest of sunburns, and so it seems possible to get sufficient UVB rays from the sun to produce all the Vitamin D without getting so much as to increase your risk of cancer appreciably. And it looks like the major issue with skin aging and cancer is that the sunlight isn’t just the narrow band of UVB frequencies that supply the energy to create the vitamin D in your skin. So if you can’t get enough UVB without getting too much UVA and other frequencies, then maybe the answer is to either filter the sunlight to only allow UVB to be absorbed (maybe a sunblock that just filters UVA and just still limit full sun exposure so as to not get too much UVB), or to get the required UVB from an artificial source where exposure can be carefully controlled.

    And then if you can’t get correct amount of sun or artificial UVB light, then resort to a supplement.




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  24. Hey Dr. Greger – regarding sunscreen though if I do go out a lot — what should I use on my skin? Are there actual studies supporting one sunscreen method/material over another? I am so confused on this topic. I was considering simply using coconut oil on my skin but then I read somewhere that even that is a myth.
    Your help is appreciated! Thankyou




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  25. Not all sun is created equal, especially with regard to its ability to damage skin and cause cancer. Obviously, the 11 am sun in Malaysia on a July day is not the same as 11 am sun in the northeastern U.S. say in April. So what becomes important isn’t the time of day or length of exposure, but what is the UV index at the time of exposure. I used to be severely vitamin D deficient. However, in recent years I have found that taking a moderate amount of vegan D supplement with a moderate amount of sunlight seems to have a synergistic effect, and gives me a good level of D without even coming close to tanning, much less burning. What is a moderate amount? My understanding is that the ideal is about 20 minutes with 2/3 of your body exposed when the UV index is in the 7 or so range. 11 a.m. sun in Malaysia on a July day is probably closer to 12 or 13 if it is a perfectly clear day, and probably too intense for good skin health. It’s claimed that vitamin D functions in the body more like a hormone than a vitamin, and the process that takes place when it is absorbed and converted by the skin may have some importance for health that is not identical to D absorbed through the digestive tract in the form of supplements. Anyway, my 25-OH D levels are now around 55 ng/mL from the combo of both moderate sun and supplements, and seems to work for me.




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  26. How about sun-dried fruits ? Do they contain more Vitamin D ? I search online and it seems sun-dried mushrooms contain lots of vitamin D but another web site said that they don’t. I was just curious because it makes some sense that if you expose fruits, vegetables to sun, they also make vitamin D, but I am not in medical field.




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    1. Thanks for your question Ray.

      As explained in this article by Dr Greger:

      “Years ago, it was shown that vitamin D isn’t just the sunshine vitamin for us, but for mushrooms as well. You take some mushrooms, put them under a sun lamp for an hour, and they’ll make vitamin D just like we do lounging at the pool. Unfortunately most mushrooms you buy at the store don’t have any vitamin D because they’re grown in the dark, but now there are sun-bathed varieties on the market that boast significant levels. Some mushrooms grown out in the wild have vitamin D as well, but only about 12% of one’s recommended daily allowance per cup.”

      On other hand, I am not aware of any sun dried food containing vitamin D as per the National Institute of Health vitamin D fact sheet:

      “Very few foods in nature contain vitamin D. The flesh of fatty fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3 and its metabolite 25(OH)D3. Some mushrooms provide vitamin D2 in variable amounts. Mushrooms with enhanced levels of vitamin D2 from being exposed to ultraviolet light under controlled conditions are also available.”

      Hope this answer helps.




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  27. Dr. Greger

    Would you be able to advise a recommended sunscreen? I really can’t seem to find any recommended on your site or in your book. I have been asked by my Dermatologist to wear a SPF 70 on my face daily due to Melasma. I am concerned that I may be doing more harm than good by applying this prescribed sunscreen daily.

    Thank you

    Tammy




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    1. Not a doctor, but just going by what I’ve read, I would suggest looking for a natural sunscreen that uses traditional zinc oxide for constant protection. The chemical sunscreens (where they create chemicals trying to mimic antioxidants, not only cause damage to the skin and get in the blood stream, but get used up quickly so you constantly need to reapply).




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  28. Oh yeah, let’s trust the American Academy of Dermatology because it’s not like there’s any money to be made off of sun scaring people. It would be hard to find a dermatologist office that didn’t have pamphlets on UPF clothing along with entire lines of SPF lotions, and not even just one convenient bottle either, you can even sell separate ones for the eyes, lips, face, body… I’ve even seen spray for hair SPF. There are even dermatologists now coming out with their own line of “sun protection,” many of whom have entire websites dedicated to telling people why they should wear spf even indoors with long sleeves and wide brim hats and sunglasses even in winter and on yeah, to buy their products.

    We literally evolved millions of years in the light. I do not believe a 21st century conclusion that suddenly, sun is bad for us and our biggest ager among other things. But here’s the thing, we’ve never been so overloaded with toxins due mostly to our diets. We’ve evolved millions of years to live in and with the sun while eating a plant based diet with lots of greens and fruits. No surprise that antioxidants work so incredibly well at working with the sun (and for a long time before even being used up!). Someone explained this process incredibly well under another video, a process they called “physical quenching.” It was incredibly interesting and very well written.

    Excess sun leading to redness is different. Every single animal (except maybe for some reptiles and perhaps even them… I’m not an expert on reptilians) instinctually balances sun with periods of shade. If we give our bodies what they need, not only are we SAFE in the sun, but we get more benefits than just vitamin D (things not even understood yet and many will probably never be (Dr. Greger has some interesting videos explaining this with how greens and sun work to produce CoQ10) because we are meant to not just live with one part of nature’s incredible design, but with the full spectrum (no pun intended… cause you know, light and all its colors) which includes greens, fruits, oxygen, water, and natural LIGHT.
    BUT, it is much more profitable to all but omit the sun and bank in on “protecting” ourselves from it with products and substituting it with more products… pure insanity. And man has long tried to deny nature and “do it better” so why isn’t anyone realizing that this extreme new view on the thing our world literally revolves around, is no different than many saying not to eat broccoli but instead take their vitamins? Although some actually are realizing it.

    Just like we can’t live off of something so great as broccoli alone, we can’t just expect to work properly with the sun alone, it’s a whole system and plants are required.

    This isn’t to say that hanging out on a boat all day shouldn’t be paired with some natural form of spf, but it is to say that despite the purposefully terrifying articles and tidbit warnings strategically placed all over, it’s ok to go outside without a coating of zinc oxide, and also essential. But like damage occurs in other regard when we don’t eat our plants, so can it from the sun when we don’t eat properly.

    I don’t mean to sound preachy but I have been in a state of terror for some time over the extremist position on sun exposure bursting through the seams of western society, and I’ve lived miserably from it and did obsessive research over it and alas, this is my conclusion. Common sense and nature are two wonderful things.




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    1. And I do not believe the Dermatology Academy is arguing against financial interest. For one, skin cancer has actually been linked to chemical sun screens. Then you have the fact that dermatologists themselves are vastly tied into the sunscreen industry. And what would be their alternative? To tell people to get excessive sun in hopes of increasing skin cancer rates? I think people would more easily catch onto that for one thing, plus I don’t think they’d be that blatantly evil.




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        1. A quote from the above article which reveals a bit about The American Dermatology Association: “sunscreen companies can’t actually advertise that their product prevents skin cancer because research doesn’t support that claim. So companies fork over millions of dollars in “pay for play” endorsements to groups like The American Academy of Dermatology and The Skin Cancer Foundation to make that claim for them. Indeed, most people are surprised to learn that the Skin Cancer Foundation is mainly funded by the very pharmaceutical companies who profit from its anti-sun message.”




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  29. I had a melanoma in-situ on my nose 2 years ago. Since then I’ve avoided the sun like the plague and my D levels are low. Are MY risks of cancer and sun exposure greater or the same as someone who doesn’t/didn’t have skin cancer?




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