The Power of Vitamin D

Human skin needs both sun protection and sun exposure in moderation – and it can have both without incurring sun damage or nutritional deficiency.

The sun is the main source for vitamin D, an important nutrient for maintaining a healthy skeleton as it forms an integral part of the bone metabolism, calcium and phosphate homeostasis. There are indications that vitamin D may have several other health benefits, such as prevention or mitigation of cancer and autoimmune diseases, reduction in hypertension and prevention of influenza. Overall, vitamin D seems to have a positive regulatory effect on the immune system.

Anti-carcinogenic effects have been demonstrated in laboratory studies on animals at high doses, but evidence of causality has not been shown in humans. Recent research indicates that vitamin D stimulates antimicrobial activity and may mitigate certain types of infections. There are vitamin D receptors in many organs, and long-term vitamin D deficiency may induce a wide range of harmful biological effects.

How to tell if your client is vitamin D deficient
When assessing your client’s skin, these indicators suggest your client may need more vitamin D.

1. People with lots of pigment in their skin (Fitzpatrick VI) can produce six times less vitamin D than people with very little pigment (Fitzpatrick I).
2. Overweight individuals have a reduced capacity of vitamin D synthesis.
3. Elderly people have thinner skin, and as a result these skins are less capable of synthesizing vitamin D.
4. People who frequent sun beds that emit UVB radiation are likely to have higher bone mineral densities. Is this a consideration for massage modifications?
5. In cold climates, exposure to UV radiation is usually on the face only, which is not sufficient for vitamin D synthesis.

Clients at risk for COVID-19
A single-centre retrospective cohort study done in 2020 indicates that the COVID-19 risk increased among people with lots of pigment in their skin (Fitzpatrick VI) with a vitamin D level at less than 40 ng/mL. These clients need to increase their vitamin D levels. New evidence needs to be monitored as it is peer-reviewed and published, and will include results from several clinical trials on vitamin D and COVID-19 outcomes that are currently underway.

Clients at risk for melanoma
When assessing your clients with a genetic predisposition, a history of or a high risk for developing melanoma, these clients should have exposure to midday sun for approximately 20 minutes – quite to the contrary of what is being promoted today. A low vitamin D status is shown to be associated with melanoma and a worse prognosis.

Human skin makes a large amount of vitamin D naturally between 10:30am and 3pm, and evidence shows that people with thicker, or higher stage, melanomas have lower vitamin D status compared to those with thinner tumors. As salon/spa professionals, we should be recommending to this targeted group of people that they must ensure they get sufficient sun exposure during these hours in the middle of the day. This would ensure sufficient vitamin D levels for prevention.

1. People with lots of pigment in their skin (Fitzpatrick VI) produce less vitamin D, so they need to be outside for longer and more often (15-30 minutes).
2. If your client has little pigment in the skin (Fitzpatrick I), recommend 10-20 minutes outside in the midday sun with minimal clothing and no sunscreen – this should give them enough UV radiation to produce about 10,000 international units of the vitamin.
3. Elderly people produce less vitamin D, and many people do not get enough of the nutrient from dietary sources like fatty fish and fortified milk, so they need to be outside for longer and more often to get the same effect (15-30 minutes).

Clients with acne vulgaris (P. acnes bacteria)
Vitamin D deficiencies are more common in people with acne than in healthy controls. One 2016 study showed that people with acne had lower levels of vitamin D, but low vitamin D did not mean worse acne. Vitamin D affects the proliferation and differentiation of the skin, either directly or through its interaction with calcium. Many in vitro studies have shown a dose-dependent effect of vitamin D on keratinocyte proliferation and differentiation. Sebocytes have been identified as responsive target cells, indicating that vitamin D may be effective in the treatment of acne.

Low vitamin D does not cause acne, and vitamin D blocks P. acnes from affecting skin cells. People with acne should be tested for vitamin D deficiency and insufficiency. A random study indicates that supplementation with oral vitamin D produced a significant improvement in acne inflammation.

Testing for vitamin D levels is done with blood testing.
Readings from a blood test indicate:

VITAMIN D LEVELS RESULTS
-30 ng/mL Deficient (supplementation required)
30-50 ng/mL Insufficient
50-70 ng/mL Optimal
70-100 ng/mL Cancer + heart disease therapy
125+ ng/mL Excess

Sunscreens and sunblocks
Sunscreens are commonly formulated with chemicals that may not be in the best interests of our skin, nor our environment. The game currently appears to be that manufacturers are trying to outdo each other by “upping” the SPF numbers. The natural SPF that protects people with more pigment in their skin (Fitzpatrick VI) from common skin cancers is about 12-14, and we know that a product with an SPF 8 provides protection – so why apply more chemicals than necessary?

To summarize: This article provides some key skin/sun assessment questions to help determine sufficient vitamin D levels for skin health. As salon/spa professionals, we should be asking our clients about their vitamin D levels, especially people considered at high risk for a deficiency:
• With anorexia nervosa
• Who have had gastric bypass surgeries
• Who suffer from other malabsorption syndromes, like celiac disease
• Who wear total skin covering (and thus absorb less sunlight)
• Perimenopausal women
• Who have been diagnosed with osteopenia (reduced bone density, but not osteoporosis)
• With osteoporosis or other skeletal disorders
• Pregnant and lactating women