Fertility and Sunshine

 On my annual summer vacation, I’m down in Southern California. I look out at the pool which is inhabited by tons of future fertility patients under the age of 8. I watch in horror, as moms of all ethnicities hose their sons and daughters down with toxic sunscreen spray. It is almost like a religious ceremony the way they compulsively apply layers upon layers of creams, sprays and ointments to their children’s skin with the hopes of preventing skin cancer. Little do they know that not only are they giving me tremendous job security, they also aren’t really preventing the development of skin cancer. The real fact is that surprisingly despite all the false advertising, sunscreens are mainly good at preventing sunburns and that is all. In fact, little is known about the safety and efficacy of these ubiquitous creams and sprays. The Environmental Working Group (EWG) has done a review of the latest research and has unearthed troubling facts that might get you to consider giving up on sunscreens use altogether. Although public health agencies still recommend using sunscreens, from a fertility specialist perspective wearing protective clothing and avoiding the noontime sun are more attractive options to consider prior to smearing on the cream. Here are some interesting and surprising facts straight from the EWG website:

“It turns out that a wide range of public health agencies – including the FDA – have found very little evidence that sunscreen prevents most types of skin cancer. In reviewing the evidence, the FDA said that the available clinical studies “do not demonstrate that even [broad spectrum products with SPF greater than 15] alone reduce the risk of skin cancer and early skin aging.” The agency also said that it is “not aware of any studies examining the effect of sunscreen use on the development of melanoma.” The International Agency for Research on Cancer recommends clothing, hats and shade as primary barriers to UV radiation. It says that “sunscreens should not be the first choice for skin cancer prevention and should not be used as the sole agent for protection against the sun” (IARC 2001a).

Some researchers have detected an increased risk of melanoma among sunscreen users. No one knows the cause, but scientists speculate that sunscreen users stay out in the sun longer and absorb more radiation overall, or that free radicals released as sunscreen chemicals break down in sunlight may play a role. Rather than using chemicals, it is more important to think about the importance of shade, clothing and timing.

The FDA has proposed prohibiting the sale of sunscreens with SPF values higher than “50+.” The agency has written that values higher than 50 would be “misleading to the consumer,” given that there is an “absence of data demonstrating additional clinical benefit” (FDA 2011a), and that scientists are also worried that high-SPF products may tempt people to stay in the sun too long, suppressing sunburns (a late, key warning of overexposure) while upping the risks of other kinds of skin damage.

Flouting the FDA’s proposed regulation, companies continue to sell high-SPF offerings in 2012. More than 1 in 7 products now lists SPF values higher than 50+, compared to only 1 in 8 in 2009, according to EWG’s analysis of more than 800 beach and sport sunscreens. Among the worst offenders are Walgreens and Aveeno brands. These manufacturers boast SPF values greater than 50+ on more than 40 percent of their sunscreens

Sunshine serves a critical function in the body that sunscreen appears to inhibit — producing vitamin D. The main source of vitamin D in the body is sunshine, and the compound is enormously important to health – it strengthens bones and the immune system, reduces the risk of various cancers (including breast, colon, kidney and ovarian cancers) and regulates at least a thousand different genes governing virtually every tissue in the body (Mead 2008). About one-fourth of Americans have borderline low levels of vitamin D, and 8 percent have a serious deficiency (CDC 2012). Particular groups are at the highest risk – breast-fed infants, people with darker skin and people who have limited sun exposure (NIH 2012).

Some people can make enough vitamin D from 10 to 15 minutes of unprotected sun exposure several times a week. But many others cannot. The right amount depends on the individual’s age, skin tone, the intensity of sunlight, time outdoors and skin cancer risk.

Recently available data from an FDA study indicate that a form of vitamin A, retinyl palmitate, may speed the development of skin tumors and lesions when applied to skin in the presence of sunlight (NTP 2009). This evidence is troubling, because the sunscreen industry adds vitamin A to 25 percent of all sunscreens.

Scientists have known for some time that vitamin A can spur excess skin growth (hyperplasia) and that in sunlight it can form free radicals that damage DNA.

In the FDA’s one-year study, tumors and lesions developed sooner in lab animals coated in a vitamin A-laced cream than animals treated with a vitamin-free cream. Both groups were exposed to the equivalent of just nine minutes of maximum intensity sunlight each day. EWG recommends that consumers avoid sunscreens with vitamin A (look for “retinyl palmitate” or “retinol” on the label).

Both UV radiation and many common sunscreen ingredients generate free radicals that damage DNA and skin cells, accelerate skin aging and cause skin cancer. An effective sunscreen prevents more damage than it causes, but sunscreens are far better at preventing sunburn than at limiting free radical damage. While typical SPF ratings for sunburn protection range from 15 to 50, equivalent “free radical protection factors” come in at about 2. When consumers apply too little sunscreen or reapply it infrequently – and that’s more common than not – sunscreens can cause more free radical damage than UV rays on bare skin. The FDA could improve sunscreens’ ability to reduce free radical skin damage by strengthening standards for UVA protection.

The ideal sunscreen would completely block the UV rays that cause sunburn, immune suppression and damaging free radicals. It would remain effective on the skin for several hours and not form harmful ingredients when degraded by UV light. It would smell and feel pleasant so that people use it in the right amount and frequency.

Unsurprisingly, there is currently no sunscreen that satisfies all these criteria. The major choice in the U.S. is between “chemical” sunscreens, which have inferior stability, penetrate the skin and may disrupt the body’s hormone systems, and “mineral” sunscreens (zinc and titanium), which often contain micronized- or nanoscale particles of those minerals.

After reviewing the evidence, EWG determined that mineral sunscreens have the best safety profile of today’s choices. They are stable in sunlight and do not appear to penetrate the skin. They offer UVA protection, which is sorely lacking in most of today’s sunscreen products. Meroxyl SX (ecamsule) is another good option, but it’s available in very few formulations. Tinosorb S and M could be great solutions but are not yet available in the United States. For consumers who don’t like mineral products, we recommend sunscreens with avobenzone (3 percent for the best UVA protection) and without the notorious hormone disrupter oxybenzone. Scientists have urged parents to avoid using oxybenzone on children due to penetration and toxicity concerns. Sunscreen makers and users in Europe have more options than in the United States. Companies selling in Europe can add any of seven UVA filters to their product, but they have only three available for products marketed in the U.S. Sunscreen chemicals approved in Europe but not by the FDA provide up to five times more UVA protection; U.S. companies have been waiting five years for FDA approval to use the same compounds. “

As a concerned fertility specialist, I find it very alarming to discover that the FDA has not yet evaluated the efficacy and safety of new sunscreen ingredients or ingredient combinations and that it has no plans to consider evidence of hormone disruption for sunscreen chemicals. As a result of this lack of regulation by the US Government, companies have not felt obligated to provide sunscreens with safe formulations for consumers to use. I have personally gone into stores such as Walgreens, Target, Whole Foods, and others and have not been impressed with the selection of sunscreen ingredients that are available. More regulation, enforcement and consumer awareness needs to start happening as far as this and soon, or else, my specialty will unfortunately be one of the most secure jobs to have in America.

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