How much sun is enough?

Experts agree on sun protection and vitamin D 

New recommendations published today (31/1/16) by national peak health bodies aim to provide clearer and simpler advice to Australians on how they can balance the need for sun protection to reduce skin cancer risk with maintaining healthy vitamin D levels for optimal health.

The recommendations have been jointly published by Cancer Council Australia, the Australasian College of Dermatologists, the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia. 

Chair of Cancer Council Australia’s Public Health Committee, Craig Sinclair, said the new recommendations were based on the latest evidence and aimed to help Australians reduce their risk of skin cancer caused by overexposure to the sun’s ultraviolet (UV) rays, while maintaining adequate vitamin D levels for good health. 

He said Cancer Council’s latest National Sun Survey found that 28% of Australian adults were concerned about their vitamin D levels and a quarter had been advised by their doctor to get more vitamin D. However, experts agree that adequate vitamin D can be obtained without risk of harmful UV exposure. 

Fifteen per cent of Australian adults had adjusted their sun protection in recent summers to get more vitamin D, yet the majority of Australians (77%) aren’t vitamin D deficient.¹ 

“It is fair to say there has been mixed messaging around UV protection and vitamin D in recent years, resulting in some uncertainty in the community about how to get the balance right,” Mr Sinclair said. “During summer, most Australians have adequate vitamin D levels just from doing typical day­-to­-day activities, such as walking for a couple of minutes to the car or the shop. However, if you are going outside for more than a few minutes and the UV Index is 3 or above, you need to protect yourself ­ slip, slop, slap, seek shade and slide on sunnies.”

 Associate Professor Peter Foley, from the Australasian College of Dermatologists, said it was a misconception that prolonged sun exposure in summer increased Vitamin D levels. “Prolonged sun exposure does not cause vitamin D levels to continue to increase, but it certainly does increase the risk of skin cancer,” Associate Professor Foley said. 

“Around two in three Australians will be diagnosed with skin cancer in their lifetime and around 2000 Australians die each year as a result, so protection against excessive UV exposure remains vital, even for those with vitamin D deficiency.”

Professor Rebecca Mason, from The Australian and New Zealand Bone and Mineral Society, said Vitamin D was important for bone and muscle health and that while sun protection was needed when the UV index was 3 or above, it wasn’t required when UV levels were below 3. 

“Sun protection isn’t required when the UV Index is below 3. In winter in southern areas where the UV Index is below 3 for much of the season, such as Hobart, Melbourne, Adelaide, Perth, Canberra and Sydney, sun protection is not recommended.

“In fact, in those areas it is recommended that you spend some time outdoors, preferably being physically active, in the middle of the day. Getting physically active, by going for a brisk walk during your lunchtime or doing some gardening outdoors, will also help maintain your Vitamin D levels.” 

Professor Peter Ebeling AO, from Osteoporosis Australia and the Endocrine Society of Australia, agreed that in southern states, some Australians would need to make an extra effort to maintain Vitamin D levels during winter. 

“If you have adequate Vitamin D during summer, then your body can rely on this storage for one to two months,” Professor Ebeling said. “For most of the population, any reduction in Vitamin D levels experienced in winter can be corrected at other times of the year when UV levels are higher.” 

The recommendations contain specific guidance for people considered at higher risk of vitamin D deficiency, for example those with naturally very dark skinned; who live largely indoors; have conditions causing poor absorption of calcium and vitamin D; or who cover up for religious or cultural reasons. 

“Those at risk of Vitamin D deficiency should talk to their doctor about vitamin D supplementation, to see if that might be more appropriate than sun exposure,” Professor Ebeling said. 

A full copy of the recommendations can be found at cancer.org.au/vitamindposition 

Recommendations:

Keep an eye on local UV levels – you can get your local UV alert by downloading the SunSmart app – cancer.org.au/SunSmartApp 

When the UV Index is 3 or above (summer across Australia and in some parts of Australia with high  UV levels) ­ 

• Skin cancer prevention should remain a priority, even for those with Vitamin D deficiency - deliberate and extended unprotected sun exposure when UV levels are 3 or above is not recommended.
• Sun protection (including hats, sunscreen, clothing, shade and sunglasses) should be used when UV levels are 3 or above when heading outdoors for more than a few minutes.
• A few minutes of mid-morning or mid-afternoon sun exposure to arms and hands on most days of the week should be sufficient to maintain adequate Vitamin D. 

UV below 3 (Late Autumn and Winter in some parts of Australia)

• Sun protection is not necessary unless near snow or other reflective surfaces.
• To support Vitamin D production, spend time outdoors in the middle of the day with some skin uncovered.
• Being physically active outdoors - e.g. gardening or going for a brisk walk, will help boost vitamin D levels.

For those at risk of Vitamin D deficiency

• Talk to medical practitioner to determine whether vitamin D supplementation rather than sun exposure is appropriate.

Outdoor workers

• Outdoor workers should use sun protection throughout the year regardless of the UV Index, as they have an increased risk of skin cancer

1. The Australian Health Survey 2011-12