Vitamin D and UV – How to navigate conflicting health priorities

The higher the UV rating, the more Vitamin D we get.

The higher the UV rating, the quicker the skin damage.


Many Aussies have these two contrasting health priorities: 1. Getting enough Vitamin D and 2. Avoiding skin damage in the harsh Australian sun. In Winter, Vitamin D levels are most at risk of being depleted in individuals due to lowered UV levels. In Summer, there is a higher chance of skin damage, while more Vitamin D can be produced in a shorter amount of time. This can be especially difficult for those who have had skin cancer or have a strong family history with a concurrent Vitamin D deficiency.

Let’s start with a bit more information about Vitamin D.


Vitamin D levels: When should you get tested?

Always get tested when it is recommended by your GP or health practitioner, but also consider the following instances:

  • Low sun exposure

  • Cancer diagnosis

  • Diabetes

  • Obesity

  • During Perimenopause and Menopause

  • Poor bone density

  • Menstrual disorders

  • Pregnancy and Breastfeeding

  • Autoimmune disease

  • Allergies

  • Depressive symptoms during Winter

You get tested and find out you have low Vitamin D…..now what?


Recommendations regarding sun exposure to address your deficiency will most likely vary between health practitioners. For example, a clinician’s focus on Melanoma risk versus extensive education regarding Vitamin D deficiency will change the advice you are given by a Doctor. This has been confirmed by studies completed in NZ and Australia involving over 2000 General Practitioners.

The appropriate recommendations for addressing Vitamin D deficiency with sun exposure should depend on:

  • Instances where the requirement is increased

  • Family history of skin cancer

  • Personal history of skin cancer

  • Skin Type – as per the Fitzpatrick scale which indicates sun sensitivity.

  • Where you are located – distance from equator (affects UV ratings)

  • Vitamin D deficiency levels

  • Gender & Age

Government guidelines do not dictate exact amounts of time required in the sun to get appropriate Vitamin D. Nor has an algorithm or coherent calculation tool been created to assist health practitioners to address deficiencies. Despite this not being clear-cut, some Doctors do provide sun exposure times based on skin type, please see the table below:

Applying standard sun exposure times for skin type can be problematic because it overlooks instances where exposure should be adjusted. For example, Vitamin D deficiency, advanced age, obesity, menopause, autoimmune disease and allergies indicates more complex Vitamin D requirements while also considering skin type and cancer risks. Achieving these exposure goals will not guarantee adequate Vitamin D intake.


See a more complex take on this assessment below:

Figure 1: Sun Exposure Guide. More than skin type needs to be considered.


Considerations when addressing a deficiency via sun exposure:


1. Know your skin type

The quiz at the link below will allow you to answer some questions to obtain your skin type. The higher the number between I & IV, the higher the tolerance to sun exposure and the more sun exposure one needs to get enough Vitamin D. Note that darker skin does not eliminate the risk of skin cancer.


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--------> Find out your skin type:

FitzpatrickSkinType.pdf (arpansa.gov.au)


2. Know the current UV rating


Visit the BOM website or get the Cancer Council SunSmart app:

cancer.org.au/preventing-cancer/ sun-protection/uv-alert/sunsmart-app


From there, you will know when sun exposure is safe. Where it is below 3, no sun protection is recommended. More sensitive skin types (I & II) may find that they still need to be careful of their exposure during these times so not to burn. Based on Sun Smart Guidelines, peak UV times should be avoided by all skin types. Where this is unavoidable, apply Slip Slop Slap techniques to minimise skin damage.


3. Consider other sources

Sun is best source of Vitamin D. To put it in perspective, the Australian sun can give us as much as 10,000 IU of Vitamin D with full body exposure (UV rating not specified), which is 10 times the required dose for most people. Supplementation and dietary approaches are an excellent adjunct therapy when levels are low. Vitamin D food sources include: oily fish, fortified foods (where it has been added), sprouted seeds and egg yolks.


Final thoughts

It can be concluded that addressing deficiency is not a simple process and must be addressed via many different angles. Working with a health practitioner can assist with working out your best course of action. Thankfully, research on Vitamin D continues to attempt to answer this question with upcoming trials being developed in facilities in Brisbane.


For more targeted advice suited to you, including assistance with Nutrition, Immunity and Vitamin Deficiencies, please get in touch via my website, via phone or email at enquiries@purpletreetherapies.com.au

Purple Tree Therapies is located in New Farm but I can also do video consultations via Zoom. My clinic is open during lockdown periods as it is considered an essential service.


References:

Bordelon, P., Ghetu, M.V. Langan, R.C. (2009). Recognition and management of vitamin D deficiency. Am Fam Physician, 80(8), 841-6


Bonevski, B., Girgis, A., Magin. P., Horton, G., Brozek, I., & Armstrong, B. (2012). Prescribing sunshine: a cross-sectional survey of 500 Australian general practitioners'

practices and attitudes about vitamin D. Int J Cancer, 130(9): 2138–2145.


Cancer Council Australia. (n.d). https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/vitamin-d


Francis, H. M., et al. (2019). A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial. Plos One. doi: https://doi.org/10.1371/journal.pone.0222768


Holick, M.F. (2006). Resurrection of vitamin D deficiency and rickets. J Clin Invest, 116(8), 2062-2072


Jorde, R., et al. (2008). Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intern Med, 264(6): 599-609


Kerr, Zava, Piper, Saturn Frei & Gombart, (2015). Associations between vitamin levels and depressive symptoms in healthy young adult women. Psychiatry Research, 227(46-51)


Khoraminya, N., et al. (2013). Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder. Aust N Z J Psychiatry, 47(3), 271-5


Ong, J. et al. (2021). A comprehensive re-assessment of the association between vitamin D and cancer susceptibility using Mendelian randomization. Nat Commun, 12(1):246. doi: 10.1038/s41467-020-20368-w


Reeder, A. I., Jopson, J. A. & Gray, A. R. (2012). Prescribing sunshine: a national, cross-sectional survey of 1,089 New Zealand general practitioners regarding their sun exposure and vitamin D perceptions, and advice provided to patients. BMC Family Practice, 13:85. doi: http://www.biomedcentral.com/1471-2296/13/85


Vaziri, F., et al. (2016) A randomized controlled trial of vitamin D supplementation on perinatal depression: in Iranian pregnant mothers. BMC Pregnancy and Childbirth. 16(1), 239