My dermatologist's vitamin D tips are something that patients are always very interested in. Over the past few years, we've learned some important information about vitamin D that make sun protection decisions more complicated for people.
Controversies about vitamin D and sun exposure:
- vitamin D is critical for health,
- many people have dangerously low vitamin D levels,
- sun exposing your skin produces vitamin D, and
- sun exposing your skin causes skin cancer, wrinkles, age spots and thin/fragile skin.
Even physicians have been giving patients conflicting recommendations. That is starting to change.
Scientists and doctors are finally getting a better understanding of what to tell our patients about vitamin D.
Up until now, we haven’t known what to tell patients about how to safely raise their vitamin D levels. That's because a person's vitamin D level is affected by a number of complex factors.
Conditions that impact your vitamin D levels:
- your diet,
- your body's ability to actually absorb the vitamin D that you eat,
- the amount of sun your skin can absorb (which is determined by factors such as where you live in the world, the seasonal variation in sun intensity, and your skin color).
Maintaining a healthy amount of Vitamin D in your body is still an ongoing area of scientific study, but doctors are zeroing in on some more concrete recommendations to help you know what you should be doing for your health.
I've summarized my dermatologist's vitamin D tips and recommendations for your overall body health and combined them with my dermatologic experience regarding skin health.
Dermatologist Dr. Cynthia Bailey's vitamin D tips for patients:
I recommend to my patients that they get their vitamin D levels measured.
I have patients with low vitamin D levels despite of getting a lot of sun or taking a lot of vitamin D. Every body is different so you just need to get your levels measured.
- The name of the vitamin D level to test is 25-hydroxyvitamin D (25-OHD).
- Vitamin D deficiency is defined as a 25(OH) D below 20 ng/mL (which is also 50 nmol/L depending on the units that the lab is using). If your level is below this then you need more vitamin D.
- Healthy levels are somewhere between 30 and 70 ng/mL. If your vitamin D level is normal, you don’t need to make any changes in what you're doing.
If a person's vitamin D level is low a key element of my dermatologist's vitamin D tips include taking oral vitamin D supplements.
The name of the supplement you want to take is vitamin D3.
- Ask your doctor how much vitamin D3 you should take and have him/her recheck your level in a few months. Standard dosage recommendations for vitamin D3 are still up in the air and it is possible to take too much. Our old recommendation for adults was 400 IU for healthy adults, it climbed to 2000 IU and now it's 4000 IU. The dose is different for children. If you’re severely vitamin D deficient expect that your doctor will tell you to take A LOT more than that until your level normalizes.
- Taking too much vitamin D supplements can hurt you, so ask your doctor for help recommending a dose, and get retested to be sure it’s working!
- If your level doesn’t go up after taking supplements, have your doctor figure out why. It could be that you’re not absorbing it because of an intestinal condition such as celiac. I have one patient who had asymptomatic celiac that affected her ability to absorb vitamin D.
I recommend that everyone make a point of eating vitamin D rich foods.
Foods are always better than commercial vitamin pills. Palatable (in my opinion) vitamin D rich foods are:
seafood: wild sockeye salmon (sockeye is the richest in vitamin D and farmed salmon has less vitamin D that wild salmon-no surprises here) cod, steelhead, halibut, shrimp, sardines (I actually like canned sardines topped on a salad!), and some shellfish.
- vitamin D enriched dairy products including soy milk
- egg yolks
Other sources (harder to eat since they're not so palatable in my opinion) include some of the smelly fish like mackerel, herring, and sardines (I would love some good sardine recipes). Liver is also a good source of vitamin D if you can manage it. These foods supplied vitamin D during the winter to our ancestors who lived in the northern parts of the world that had very weak sun intensity in the winter.
Cod liver oil is rich in vitamin D, but like supplements, you can OD on it and hurt yourself, so ask your doctor for help if you want to use it.
For a good list of the vitamin D content in foods based on a 200 calorie serving size, visit NutritonData.com: Foods Highest in Vitamin D.
I know that sun bathing for vitamin D production is dangerous and ages the appearance of a person's skin (not to mention puts them at higher risk of skin cancer), but may be a necessary last resort to raise vitamin D.
If your oral vitamin D supplements don't raise your level adequately then you may need to use your skin as your vitamin D factory. This has big down sides however! So, use the 'right' sun ray and get just the dose of sun you need- and no more. Realize that sun exposure will permanently damage the part of your skin that you're exposing. - Dermatologist Dr. Cynthia Bailey
Dermatologist's vitamin D tips to use sun exposure of your skin to raise your vitamin D levels:
Only UVB sun rays make vitamin D.
UVB is the most cancer-causing part of sunlight; they are the mid-day (10am to 3pm), mid-summer rays that doctors normally caution people to avoid. Winter sun and morning or late afternoon sun has very little UVB and thus won't really help with your vitamin D production.
Turn your tummy skin into your vitamin D factory.
Most patients I see have very little sun damage on their tummy and as a result I rarely find skin cancer there. Plus, if you do get a cancer on your tummy, you're more likely to see it than on your back, and it's easier to treat than on your face (depressing but true).
Learn the signs of skin cancer. Do your own skin exams and see a dermatologist to screen you for skin cancer if you are getting UVB exposure for vitamin D.
Sun exposure will definitely increase your risk of skin cancer on the sun exposed skin so being able to do skin exams on your exposed skin is important. Learn the signs of melanoma, basal cell carcinoma and squamous cell carcinoma and see your dermatologist anytime a spot looks worrisome for one of these. Also remember that the sun will wrinkle and age the look of your exposed skin. I find that most people aren't as concerned about sun damage on their tummy.
Definitely don't sun expose your face, legs, hands, or other areas that have already had too much sun in your lifetime.
They are already your highest risk sites for skin cancer, and they are the parts of your skin that you show off to the world so wrinkles and age spots matter. This tummy skin vitamin D factory idea is definitely the most innovative of my dermatologist's vitamin D tips!
Get the bare minimum amount of sun necessary to raise your vitamin D level into the normal range and no more.
Knowing how much sun you will need is impossible, so get your levels rechecked. A person's sun absorption varies with their skin color, the time of day and season, where they are on the earth etc.
I've seen learned sources recommend 30 minutes of sun exposure twice a week, but most people will sunburn in that period of time. Because sunburns increase the risk of melanoma, you definitely want to avoid burning in your effort to turn your skin into a vitamin D factory.
For those who must use sun for vitamin D, I tell my patients to start at 5 minutes 3 to 5 times a week using 12 noon sun.
I need to reemphasize that this is only as a last resort if you can't get your levels up with diet and vitamin D3 supplements! 12 noon tummy sunbathing may be impractical, but it's not impossible. Again, remember, do this with your doctor's supervision, and get your level rechecked to monitor your progress; you don't want to get more sun than you need!
Practice good sun protection for the rest of your skin - unless you want a long relationship with your dermatologist!
CLICK HERE TO SEE ALL THE SUN PROTECTION PRODUCTS THAT I RECOMMEND TO MY PATIENTS AND THAT I USE MYSELF.
Photo attribution, thanks to NASA