9 ms·

Avoidance of sun exposure as a risk factor for major causes of death (2016)

98 points by jeremylevy 5y ago

323 5y ago
One thing I don't understand is how do animals get their Vitamin D since they are covered in fur. Surely it's not only humans for whom Vitamin D is important.
- czzr 5y ago
  Other mammals synthesize vitamin D in their fur instead of their skin. We lost this option when we lost our fur, hence we’re more prone to vitamin D deficiencies.
  - tpmx 5y ago
    Vitamin D3 supplements are commonly made from sheep wool grease (lanolin).
  - Aachen 5y ago
    Wait, in fur? Hair is dead right? Or do those animals have something flow back in from the hair? Does our hair do that? Is our hair where our vitamin D is made?
    - Someone 5y ago
      Not in(side) the hairs of their fur, on the hairs of their fur/in the entire fur. https://en.wikipedia.org/wiki/Vitamin_D#Evolution https://en.wikipedia.org/wiki/Vitamin_D#Evolution: In birds and fur-bearing mammals, fur or feathers block UV rays from reaching the skin. Instead, vitamin D is created from oily secretions of the skin deposited onto the feathers or fur, and is obtained orally during grooming. So they take vitamin D orally, producing it on their bodies.
      - Aachen 5y ago
        I see, thanks!
- beagle3 5y ago
  I don’t know the answer, but different animals are very different in these respects; for example - humans and squirrels need to eat vitamin C, but other mammals synthesize it themselves.
faeyanpiraat 5y ago
Living further away from the equator (thus getting less sunlight) increases the risk of developing MS.
mjburgess 5y ago
Or: living-longer is a predictive factor for sun exposure. Or: people who live a long time, often go outside. Or: non-sedentary lifestyles predict long-life. Or: to quote the paper 2/3rds in, "We acknowledge several major limitations of this study. First, it is not possible to differentiate between active sun exposure habits and a healthy lifestyle". This isn't doing the cultural perception of science any favours.
- egocodedinsol 5y ago
  An unsophisticated person looks at this and says golly I better get tan! A somewhat sophisticated person says something like the above. People who change the world will wonder there’s something there. especially given the sober and candid examination of possible confounding factors and mechanisms of action.
- _Microft 5y ago
  I don't have time to read the study but if you want to have a look yourself, the terms to look for are "confounder", "confounding factor", ... https://en.wikipedia.org/wiki/Confounding https://en.wikipedia.org/wiki/Confounding
- Victerius 5y ago
  You can also stay inside all the time and be physically active. And take vitamin D supplements to compensate. I hate these types of headlines. They're akin to "Coffee is a carcinogen", "Chocolate makes you live longer", "Making your child listen to Mozart 30 minutes a day boosts his IQ", etc. I.e. the results are probably either outright wrong, non-reproducible, or statistically insignificant. Avoiding the outdoors won't shorten your lifespan if you take care of your health in general. Just live your life the way you want to and all will be well.
  - csee 5y ago
    They controlled for exercise and the effect size decreased by 40 percent but was still significant. My biggest criticism is, as usual in epidemiology, there's a bunch of confounders that weren't controlled for and are very difficult to control for. Vitamin D levels, social life, psychiatric disorders for example. However I'm sceptical that vitamin D deficiency explains the entire effect given it is quite large. If sunlight itself isn't relevant I expect other confounders to be stacking on top of vitamin D deficiency.
vocram 5y ago
My mood is so positively influenced by sun exposure or just by a clear sunny sky, that I really don’t understand why you would avoid it. For me it’s one of those things where the risk is worth the benefits.
- noasaservice 5y ago
  In summer, my skin burns in 10m outside in sun (partial or full). My mother also has multiple cases of confirmed carcinomas. She obtained disability due to those. So yeah, even though you may be all shock and awe about why some of us would avoid it, its definitely genetic. And I don't need the risk of having my skin burn and eventually cancer.
  - ginja 5y ago
    Does it burn in the early morning and late afternoon too? Those are probably the only times light skinned people should get extended sun exposure during the summer.
    - hutzlibu 5y ago
      Every person should probably avoid the summer sun at noon. But if you want Vitamin-D - the morning and evening sun won't help you, as they are too filtered out. And basically the whole winter sun in the northern hemisphere is too weak, even at noon. But the beauty of the morning and evening sun helps, too.
  - ChrisMarshallNY 5y ago
    I'm of Irish/Scottish/British descent. Despite having a lineage that hates itself, it also means that I don't tan; I stroke. My mother was actually allergic to the sun. She had to be hospitalized, a few times, because of it. I live in an area with tons of folks of Mediterranean descent. Every summer, they end up looking like alligator purses, come May. I get really sick of them insisting that I "just need to do it in stages. Just go out for fifteen minutes at a time. You'll tan; I promise!" For me, it's: 15 Min. -> Nothing 15 Min. -> Nothing 15 Min. -> Nothing 15 Min. -> Bright red, peeling and screaming
Jiejeing 5y ago
Quickly skimming the article, it seems like they address the use of sunscreen or related blockers, only to say that the advice "when you put sunscreen you can stay very long in the sun" seems wrong, which I thought was well known at least among scientists in the domain. Although that provides additional sourced guidance for public health officials, for sure.
carterschonwald 5y ago
This study doesn’t seem to control for fitness or activity level of the folks they tracked. Also doesn’t seem to talk about that in the analysis of proposed mechanisms.
- csee 5y ago
  They do.
nabla9 5y ago
1. Avoid exposure to sun. 2. Ensure vitamin D levels are right (In Swedish latitude vitamin D deficiency is common in the winter) 3. Control for confounding variables.
Eddy_Viscosity2 5y ago
I actively avoid sun exposure because I burn super easily. Does this mean I'm going to die?
- mbrudd 5y ago
  Eventually, yes
  - Eddy_Viscosity2 5y ago
    ouch. Can't say that truth bomb didn't hurt. As a counterpoint, if I did plan on living forever, by extrapolating all the past history of me not dying into the future, the data trend is pretty robust that I will continue to not die indefinitely.
- pc86 5y ago
  If you're a woman in the south of Sweden, I'd say yes. Otherwise you're probably fine.
- icanhackit 5y ago
  Possibly. But your risk of melanoma is reduced. It's just other shit that will kill you.
quanto 5y ago
> We acknowledge several major limitations of this study. First, it is not possible to differentiate between active sun exposure habits and a healthy lifestyle, and secondly, the results are of an observational nature; therefore, a causal link cannot be proven. A further limitation is that we did not have access to exercise data from study initiation; however, similar sHR values were obtained when including exercise for those women who answered the second questionnaire in 2000. This is the rub. We don't know sun-exposure is merely a signal of some healthy lifestyle; but evidence from the later questionnaire suggests that normalizing for exercise still leads to a reduction in risk.
nu11ptr 5y ago
I am a "sun convert". I used to avoid it like the plague because I burn so easily. However, I started reading the dangers of low vitamin D and some of the positive effects of the sun (mood, circadian rhythm, etc). I am convinced now that the sun is a net positive when exposed in moderation (I do avoid burning like the plague, however). During the summer months, I now get 20 min full body exposure daily and I supplement D3 on the days I can't (and months I can't - I live in a colder climate). As my body has built up tolerance, I've even developed a light tan and I've found my skin no longer burns as easily. Best of all, I just look healthier and my mood is better.
- GordonS 5y ago
  I've done almost exactly the same - only difference is I still don't tan and still burn really easily!
- SteveNuts 5y ago
  When you say full body do you really mean full body? If so how do you accomplish that without getting arrested?
  - sofixa 5y ago
    Depending on location, there are nudist accepting places. E.g. in Paris there's a nudist park, and there are nude beaches and places across France, Spain, Germany at the very least.
  - hutzlibu 5y ago
    Open up a window and let the sun shine in. Usually people are allowed to be naked inside .. and unless you are presenting yourself, no one will notice, if you are a bit inside. But way better is of course, a garden with surrounding bushes, or living close to wilderness, where no one bothers your privacy.
  - jandrewrogers 5y ago
    It depends on where you live. In Seattle, for example, this is expressly legal just about everywhere in the city and is evidently exercised in practice. Interestingly, this instance stems from a court ruling several decades ago that a government requirement to wear any particular article of clothing in public spaces was a violation of First Amendment rights. While the original case was about the right to be topless in public spaces, the generalized implication was that the government couldn't require you to wear anything at all.
thenerdhead 5y ago
The data is pretty fun to look through. Low alcohol consumption, excess disposable income, assumed healthier diet, presumably more time-off, etc. Although the article seems like common sense science, it does bring up the question of why there's such an opposition regarding moderate sun exposure. I think the question that makes me really curious is whether natural sun exposure is more beneficial than supplementation or vice-versa. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391331/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391331/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/
- bhk 5y ago
  The highest sun exposure group reported more alcohol consumption.
Malic 5y ago
Personally, I think Weller's line of thinking may fit here: https://www.youtube.com/watch?v=Lh9lDWPMWrM https://www.youtube.com/watch?v=Lh9lDWPMWrM (TED Talk - Richard Weller: Could the sun be good for your heart?) TL;DW - It's not just Vitamin-D generated from UV exposure but nitric oxide release in the skin, that may have a positive effect on health.
kingcharles 5y ago
calibas 5y ago
> Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking. And yes, while correlation isn't causality, it's very difficult to separate sunlight exposure from a healthy lifestyle. Since we don't know exact causality, the takeaway should be this: Get regular exercise and sun exposure if you want to live a longer, healthier life. The benefits far outweigh the risk of skin cancer.
owenversteeg 5y ago
I am confident we’re underestimating the role of sun exposure and time spent outdoors in health today. At the very least, there are multiple well-done studies connecting time spent outside with myopia, light exposure with vitamin D levels (which are then linked to everything from covid mortality rates to depression) I also have to say that I bought into the HN idea of “you can fix life indoors” because it’s an attractive idea. Air quality is far lower indoors? Just buy multiple high quality HEPA air filters and a humidifier and perhaps a dehumidifier if needed, and oh you’ll want a high quality CO2 monitor because those levels are likely high as well. Vitamin D? Just take a supplement! Except oh wait, if you’re deficient you’ll need a large amount, so take a bunch… but vitamin D is fat soluble, so now you have hypervitaminosis D which is terrible, so really you should just get your vitamin D levels checked regularly, which is not cheap. Eyesight issues? Eh, sunlight exposure can help prevent that better than anything else we know, but let’s not talk about that, let’s just let everyone ruin their vision by staying in dim rooms and focusing on close objects and then you can get LASIK, but oh wait, that often isn’t permanent and sometimes it gives people dry eyes so bad they kill themselves. Sleep issues, because you don’t get enough sun exposure to regulate your circadian rhythm? Just take an Ambien or similarly powerful drug, if you get side effects you can medicate those away. And so on, and so on, and so on… Everything can be solved through technology and medication, air sensors and supplements and the like.

98 points by jeremylevy 5y ago

323 5y ago

One thing I don't understand is how do animals get their Vitamin D since they are covered in fur. Surely it's not only humans for whom Vitamin D is important.

czzr 5y ago
Other mammals synthesize vitamin D in their fur instead of their skin. We lost this option when we lost our fur, hence we’re more prone to vitamin D deficiencies.
- tpmx 5y ago
  Vitamin D3 supplements are commonly made from sheep wool grease (lanolin).
- Aachen 5y ago
  Wait, in fur? Hair is dead right? Or do those animals have something flow back in from the hair? Does our hair do that? Is our hair where our vitamin D is made?
  - Someone 5y ago
    Not in(side) the hairs of their fur, on the hairs of their fur/in the entire fur. https://en.wikipedia.org/wiki/Vitamin_D#Evolution https://en.wikipedia.org/wiki/Vitamin_D#Evolution: In birds and fur-bearing mammals, fur or feathers block UV rays from reaching the skin. Instead, vitamin D is created from oily secretions of the skin deposited onto the feathers or fur, and is obtained orally during grooming. So they take vitamin D orally, producing it on their bodies.
    - Aachen 5y ago
      I see, thanks!
beagle3 5y ago
I don’t know the answer, but different animals are very different in these respects; for example - humans and squirrels need to eat vitamin C, but other mammals synthesize it themselves.

faeyanpiraat 5y ago

Living further away from the equator (thus getting less sunlight) increases the risk of developing MS.

mjburgess 5y ago

Or: living-longer is a predictive factor for sun exposure. Or: people who live a long time, often go outside. Or: non-sedentary lifestyles predict long-life. Or: to quote the paper 2/3rds in, "We acknowledge several major limitations of this study. First, it is not possible to differentiate between active sun exposure habits and a healthy lifestyle". This isn't doing the cultural perception of science any favours.

egocodedinsol 5y ago
An unsophisticated person looks at this and says golly I better get tan! A somewhat sophisticated person says something like the above. People who change the world will wonder there’s something there. especially given the sober and candid examination of possible confounding factors and mechanisms of action.
_Microft 5y ago
I don't have time to read the study but if you want to have a look yourself, the terms to look for are "confounder", "confounding factor", ... https://en.wikipedia.org/wiki/Confounding https://en.wikipedia.org/wiki/Confounding
Victerius 5y ago
You can also stay inside all the time and be physically active. And take vitamin D supplements to compensate. I hate these types of headlines. They're akin to "Coffee is a carcinogen", "Chocolate makes you live longer", "Making your child listen to Mozart 30 minutes a day boosts his IQ", etc. I.e. the results are probably either outright wrong, non-reproducible, or statistically insignificant. Avoiding the outdoors won't shorten your lifespan if you take care of your health in general. Just live your life the way you want to and all will be well.
- csee 5y ago
  They controlled for exercise and the effect size decreased by 40 percent but was still significant. My biggest criticism is, as usual in epidemiology, there's a bunch of confounders that weren't controlled for and are very difficult to control for. Vitamin D levels, social life, psychiatric disorders for example. However I'm sceptical that vitamin D deficiency explains the entire effect given it is quite large. If sunlight itself isn't relevant I expect other confounders to be stacking on top of vitamin D deficiency.

vocram 5y ago

My mood is so positively influenced by sun exposure or just by a clear sunny sky, that I really don’t understand why you would avoid it. For me it’s one of those things where the risk is worth the benefits.

noasaservice 5y ago
In summer, my skin burns in 10m outside in sun (partial or full). My mother also has multiple cases of confirmed carcinomas. She obtained disability due to those. So yeah, even though you may be all shock and awe about why some of us would avoid it, its definitely genetic. And I don't need the risk of having my skin burn and eventually cancer.
- ginja 5y ago
  Does it burn in the early morning and late afternoon too? Those are probably the only times light skinned people should get extended sun exposure during the summer.
  - hutzlibu 5y ago
    Every person should probably avoid the summer sun at noon. But if you want Vitamin-D - the morning and evening sun won't help you, as they are too filtered out. And basically the whole winter sun in the northern hemisphere is too weak, even at noon. But the beauty of the morning and evening sun helps, too.
- ChrisMarshallNY 5y ago
  I'm of Irish/Scottish/British descent. Despite having a lineage that hates itself, it also means that I don't tan; I stroke. My mother was actually allergic to the sun. She had to be hospitalized, a few times, because of it. I live in an area with tons of folks of Mediterranean descent. Every summer, they end up looking like alligator purses, come May. I get really sick of them insisting that I "just need to do it in stages. Just go out for fifteen minutes at a time. You'll tan; I promise!" For me, it's: 15 Min. -> Nothing 15 Min. -> Nothing 15 Min. -> Nothing 15 Min. -> Bright red, peeling and screaming

Jiejeing 5y ago

Quickly skimming the article, it seems like they address the use of sunscreen or related blockers, only to say that the advice "when you put sunscreen you can stay very long in the sun" seems wrong, which I thought was well known at least among scientists in the domain. Although that provides additional sourced guidance for public health officials, for sure.

carterschonwald 5y ago

This study doesn’t seem to control for fitness or activity level of the folks they tracked. Also doesn’t seem to talk about that in the analysis of proposed mechanisms.

csee 5y ago
They do.

nabla9 5y ago

1. Avoid exposure to sun. 2. Ensure vitamin D levels are right (In Swedish latitude vitamin D deficiency is common in the winter) 3. Control for confounding variables.

Eddy_Viscosity2 5y ago

I actively avoid sun exposure because I burn super easily. Does this mean I'm going to die?

mbrudd 5y ago
Eventually, yes
- Eddy_Viscosity2 5y ago
  ouch. Can't say that truth bomb didn't hurt. As a counterpoint, if I did plan on living forever, by extrapolating all the past history of me not dying into the future, the data trend is pretty robust that I will continue to not die indefinitely.
pc86 5y ago
If you're a woman in the south of Sweden, I'd say yes. Otherwise you're probably fine.
icanhackit 5y ago
Possibly. But your risk of melanoma is reduced. It's just other shit that will kill you.

quanto 5y ago

> We acknowledge several major limitations of this study. First, it is not possible to differentiate between active sun exposure habits and a healthy lifestyle, and secondly, the results are of an observational nature; therefore, a causal link cannot be proven. A further limitation is that we did not have access to exercise data from study initiation; however, similar sHR values were obtained when including exercise for those women who answered the second questionnaire in 2000. This is the rub. We don't know sun-exposure is merely a signal of some healthy lifestyle; but evidence from the later questionnaire suggests that normalizing for exercise still leads to a reduction in risk.

nu11ptr 5y ago

I am a "sun convert". I used to avoid it like the plague because I burn so easily. However, I started reading the dangers of low vitamin D and some of the positive effects of the sun (mood, circadian rhythm, etc). I am convinced now that the sun is a net positive when exposed in moderation (I do avoid burning like the plague, however). During the summer months, I now get 20 min full body exposure daily and I supplement D3 on the days I can't (and months I can't - I live in a colder climate). As my body has built up tolerance, I've even developed a light tan and I've found my skin no longer burns as easily. Best of all, I just look healthier and my mood is better.

GordonS 5y ago
I've done almost exactly the same - only difference is I still don't tan and still burn really easily!
SteveNuts 5y ago
When you say full body do you really mean full body? If so how do you accomplish that without getting arrested?
- sofixa 5y ago
  Depending on location, there are nudist accepting places. E.g. in Paris there's a nudist park, and there are nude beaches and places across France, Spain, Germany at the very least.
- hutzlibu 5y ago
  Open up a window and let the sun shine in. Usually people are allowed to be naked inside .. and unless you are presenting yourself, no one will notice, if you are a bit inside. But way better is of course, a garden with surrounding bushes, or living close to wilderness, where no one bothers your privacy.
- jandrewrogers 5y ago
  It depends on where you live. In Seattle, for example, this is expressly legal just about everywhere in the city and is evidently exercised in practice. Interestingly, this instance stems from a court ruling several decades ago that a government requirement to wear any particular article of clothing in public spaces was a violation of First Amendment rights. While the original case was about the right to be topless in public spaces, the generalized implication was that the government couldn't require you to wear anything at all.

thenerdhead 5y ago

The data is pretty fun to look through. Low alcohol consumption, excess disposable income, assumed healthier diet, presumably more time-off, etc. Although the article seems like common sense science, it does bring up the question of why there's such an opposition regarding moderate sun exposure. I think the question that makes me really curious is whether natural sun exposure is more beneficial than supplementation or vice-versa. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391331/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391331/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/

bhk 5y ago
The highest sun exposure group reported more alcohol consumption.

Malic 5y ago

Personally, I think Weller's line of thinking may fit here: https://www.youtube.com/watch?v=Lh9lDWPMWrM https://www.youtube.com/watch?v=Lh9lDWPMWrM (TED Talk - Richard Weller: Could the sun be good for your heart?) TL;DW - It's not just Vitamin-D generated from UV exposure but nitric oxide release in the skin, that may have a positive effect on health.

kingcharles 5y ago

calibas 5y ago

> Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking. And yes, while correlation isn't causality, it's very difficult to separate sunlight exposure from a healthy lifestyle. Since we don't know exact causality, the takeaway should be this: Get regular exercise and sun exposure if you want to live a longer, healthier life. The benefits far outweigh the risk of skin cancer.

owenversteeg 5y ago

I am confident we’re underestimating the role of sun exposure and time spent outdoors in health today. At the very least, there are multiple well-done studies connecting time spent outside with myopia, light exposure with vitamin D levels (which are then linked to everything from covid mortality rates to depression) I also have to say that I bought into the HN idea of “you can fix life indoors” because it’s an attractive idea. Air quality is far lower indoors? Just buy multiple high quality HEPA air filters and a humidifier and perhaps a dehumidifier if needed, and oh you’ll want a high quality CO2 monitor because those levels are likely high as well. Vitamin D? Just take a supplement! Except oh wait, if you’re deficient you’ll need a large amount, so take a bunch… but vitamin D is fat soluble, so now you have hypervitaminosis D which is terrible, so really you should just get your vitamin D levels checked regularly, which is not cheap. Eyesight issues? Eh, sunlight exposure can help prevent that better than anything else we know, but let’s not talk about that, let’s just let everyone ruin their vision by staying in dim rooms and focusing on close objects and then you can get LASIK, but oh wait, that often isn’t permanent and sometimes it gives people dry eyes so bad they kill themselves. Sleep issues, because you don’t get enough sun exposure to regulate your circadian rhythm? Just take an Ambien or similarly powerful drug, if you get side effects you can medicate those away. And so on, and so on, and so on… Everything can be solved through technology and medication, air sensors and supplements and the like.