The Dark Side of Anti-Sun Campaigns

AHS13 has been and gone. Hideous trans-Pacific jetlag is now over. I am off Twitter and other social media, apart from our Whole9 South Pacific page as part of our Personal Growth September (Jamie calls it the Antisocial Media September). I will write a post on it another day to explain why we decided to surrender to our antisocial introverted selves. The main benefit of not spending wasting time scrolling through a Twitter feed is time to think and time to write. I have come to the conclusion that my 20 minute presentation on melanoma at AHS was grossly inadequate to explain my thoughts and conclusions regarding sunlight and melanoma.

I first became interested in sunlight when I was preparing an Honours project on Vitamin D and Multiple Sclerosis in medical school. I never published but I kept the research, as well as the overall feeling that sunlight is good, is necessary, and is sometimes healing. This is in contrast to what I can only describe is the state of fear when it comes to the UV radiation in Australia. This paranoia is incredibly pervasive*. Those of you who do not live Down Under might not appreciate its true extent. Otherwise sensible adults get a look of panic in their eyes when melanoma is mentioned. Children at school are not allowed outside into the sun at recess or lunch unless they wear a wide-brimmed hat. Those whose irresponsible parents dare to forget one, stay in the shade, unable to play. Every preschool and school excursion involves long sleeved rasher shirts, tubs of sunscreen applied liberally on each child and, again, hats.

*I am not talking about whether this is clinically justified as yet, merely describing the situation.

The public awareness campaigns are omnipresent. The iconic Slip!Slop!Slap! campaign launched in 1981 is widely touted as one of the most successful campaigns in the Australian history. From the SunSmart website:

Cancer Council believes its Slip! Slop! Slap! campaign has played a key role in the dramatic shift in sun protection attitudes and behaviour over the past two decades.

Wow! That’s fantastic. That campaign must have saved thousands of lives and stopped cancer in its tracks! From Melanoma Institute Australia website:

Melanoma rates have doubled in the 20 years from 1986–2006.

Awkward.

It is quite fascinating that most people in Australia like to talk quite expertly on the topic of melanoma. We are so well “educated” by various health campaigns that any self-respecting TV owning Aussie off the street will tell you that sunlight causes melanoma. Total strangers will point out that the visible burn on your nose from the weekend SUP adventures is practically cancer waiting to happen. And heaven forbid you mention you had blister burns in childhood. People just shake their heads and look away, as if you are not long for this world.

I like to compare that unshakeable assurance to the society’s view on saturated fat. Your Auntie Madge just KNOWS that butter on your broccoli will clog up your arteries (while she is completely safe with her low fat banana bread) and cause a heart attack. Just like she KNOWS that going out in the sun without sunscreen will result in your untimely death.

Researchers in dermatology may argue about photocarcinogenesis for another 20 years. As far as the  public goes, the sun has already been condemned.

For those of us who have come to question and ultimately reject the conventional wisdom as it relates to the diet-heart hypothesis, it is almost too easy to reject this other “undisputed truth”.

It doesn’t help the cause of the sunlight fighters that they use emotional blackmail and scare tactics to “warn” the population about the dangers of that bright orb in the sky. Let me give you an example. For those of you living in Australia this will be very familiar as you have no doubt seen these “health announcements” on TV multiple times.

The self-professed aim of these campaigns is to discourage the pro-tanning attitude of the younger generation. I don’t know about you, but I feel quite uncomfortable about the imagery used in this commercial. A healthy cell transforms into a black tentacled monster which burrows its way into a blood vessel and multiplies, seeding the body with its progeny. Children will have nightmares. I realise this is a pictorial representation but this is not what happens. Hard-hitting messages are sometimes necessary but you need to be absolutely sure that your message is 100% backed up by solid evidence.

And this is where we hit a little snag.

This particular commercial seems to imply that tanning increases the risk of melanoma. Let’s examine this assertion in a little more detail.

1. Having a tan is generally associated with chronic sun exposure. Chronic (occupational) sun exposure has been repeatedly shown to be protective against melanoma (Elwood and Jopson, 1997).

2. Tanning and sunburn are two different things. The evidence on sunburn and melanoma is not foolproof but there seems to be a slightly increased risk.

3. The ability to tan is first and foremost influenced by your skin phenotype which is genetically predetermined. When it comes to melanoma, your skin phenotype is one of the recognised risk factors. In other words, those who are able to tan are at less risk than those (unfortunate redheads) whose skin seems to go from “pale blue” to “scorched red” to “ginger peel” with not a hint of a healthy glow. So the very fact that you are turning a nice chocolatey brown the minute you expose an inch of flesh may indicate that you have a favourable phenotype. But, of course, not everyone with skin type I develops melanoma either!

4. All tan is not the same. Although they look identical, skin tans induced by different UV wavelengths have different mechanisms. UVB-induced tan causes dramatic increases in melanin synthesis. In contrast, UVA has no effect on melanin content. The tan produced by UVA is due to the distribution and oxidation of pre-existing melanin precursors. (Miyamura et al (2011) The deceptive nature of UVA-tanning versus the modest protective effects of UVB-tanning on human skin, Pigment Cell Melanoma Res). Melanin = photoprotection. Hence UVA and UVB have totally different protective qualities.

Maybe to be on the safe side we should stay indoors and avoid the sun altogether. But it seems that those who work indoors and bask under the cool office lights are, in fact, at higher risk of melanoma.

Godar et al (2009) Increased UVA exposures and decreased cutaneous Vitamin D3 levels may be responsible for the increasing incidence of melanoma. Medical Hypotheses 72:434-443

“Paradoxically, although outdoor workers get much higher outdoor solar UV doses than indoor workers get, only the indoor workers’ incidence of cutaneous malignant melanoma (CMM) has been increasing at a steady exponential rate since before 1940.”

“In fact, outdoor workers have a lower incidence of CMM compared to indoor workers”

In diagnosed melanoma cases, previous exposure, intermittent or chronic, is associated with lower mortality. Which seems to make no sense at all if you subscribe fully to “sunlight causes melanoma” argument.

Rosso et al (2008) Sun exposure prior to diagnosis is associated with improved survival in melanoma patients: results from a long term follow up study of Italian patients. European Journal of Cancer 1275-1281

“Time spend on the beach during adulthood (on average 3 weeks/years for 19 years) was inversely associated with the risk of death…”

There are plenty of grey areas in the UV-melanoma story but tanning is certainly not one of them. I would love sending a public message to the organisation who sponsored the ad, requesting to show a single study linking suntan with melanoma.

Here is my new anti-Sun campaign suggestion. I think we are not far off that.

 

AHS 13 – moving forward.

I am not sure that I am at all able to sit down and write something remotely coherent about the Ancestral Health Symposium 2013. I feel like my jetlagged brain will struggle to sort through the blur of those 3 days but I shall do my best.

 

Physicians in evolutionary medicine panel

Physicians in evolutionary medicine panel

THE TALKS

I was really impressed with the talks this year. Overall I felt that the spread was really even between more popularised topics and hard-hitting science. AHS12 seemed a bit hit and miss, as if the presenters haven’t quite decided whether they were delivering content to laypersons or presenting at a scientific gathering. This year we struck a really good balance. The quality of the talks was also more even, unlike last year when I actually walked out on a couple of talks with a WTF expression on my face. For those of you watching the action at home here are the ones I found interesting:

1. Nassim Taleb – if you haven’t read the book “Antifragile” (and you absolutely must) you are going to think that his presentation is wordy, baffling and incoherent. If you are a fan you will nod fervently at every sentence. A few of us had a quick conversation with Nassim just before his talk. That is to say, Nassim was talking and I was trying (and failing) to look as intelligent as possible. One for the fans, for sure.

2. Gad Saad (“The Consuming Instinct: What Juicy Burgers, Ferraris, Pornography and Gift Giving Reveal About Human Nature”) had a really relaxed engaging style. He presented great arguments for why our penchant for symmetrical face, big booty, junk food and red sports cars may be evolutionarily driven. I was quite befuddled to hear that evolutionary psychology is still considered a bit “woo” in academic circles. But then I had a recent conversation with a paediatrician about evolutionary medicine and she shocked me by asking innocently: “Isn’t evolutionary biology a bit alternative and unscientific?”

3. Esther Gokhale (“Walk the Talk”)- I was determined not to miss this talk like I did last year. Esther share more of her insights on what constitutes a good posture and why the traditional view of S-shaped spine is not it. She managed to conjure up a real-life baby to assist with her demonstration of traditional baby-carrying style. The baby cried when she handed him back to the parent. I enjoyed browsing through her very well-illustrated book.

4. Victoria Prince (“Fatty Liver – Is It the Fat’s Fault?”) presented a great talk on non-alcoholic fatty liver disease. Alcoholic liver disease was the topic of her PhD thesis so this girl knows a lot about liver (and I hear she likes eating it too!) She went through the evidence on dietary fat as a contributor to NAFLD and most of the readers here will not be surprised to hear that all fat ain’t the same. I think we all walked away giving ourselves a firm permission to drink piña coladas.

Keith Norris certainly looks interested

Keith Norris certainly looks interested

5. Jamie Scott (“Are Your Sprint Intervals HIITing You in the ANS?”) – ok, ok, I am biased. But it was a great presentation even though Jamie was accosted by a whole group of Crossfitters at the end, and I had to be on standby to prevent any possible bloodshed. Everyone knows, Crossfitters go nuts when told that maybe smashing yourself to the ground 6 days a week is not a great idea. (Just kidding, they were very polite and inquisitive).

6. Whole9 Seasonal Model Workshop – I have watched this idea develop between the brains of Dallas Hartwig and Jamie for over 1.5 years now. Dallas presented the much under appreciated Seasonal Model poster at last year’s AHS but this year they decided to make it into a 2 hour workshop. I think we need presentations like this at AHS: new untested ideas, untapped frameworks (after all, Paleo is a framework too!) which encourage people to look beyond rigid programming for each of their 3 meals a day from now to the day they kick the bucket. I also like the idea of seasonal approach because it brings us, humans, back into the fold of natural environment. We need a reminder that we are a part of the natural world. I cringe whenever I hear anthropocentric ideas still thrown around even in the ancestral community (“Humans are the only animals with a capacity to play” – WTF?). Anyone who is interested in moving beyond the dietary principles should watch this talk.

photo 4I was very pleased that the conference has moved away from pure focus on diet and weight loss. The diversity of topics is very very welcome because after all, people need to realise that while it starts with food, it certainly doesn’t end there. Sleep was the topic du jour with many post-conferences tweeps confessing they have been guilted into getting their zzzzz.

THE PEOPLE

photo 1While we tried to attend the talks we were interested in we certainly did not travel halfway around the world just for those. We feel very privileged to be able to present our topics at the conference but our primary aim is always to catch up with “our people”. Living on the bottom of the planet is awesome when it comes to good food availability (sorry, US food just doesn’t cut it) but it sucks when it comes to Socialisation. We cherish the opportunity to talk in person with like-minded people and this trip was totally worth the big bucks it cost us for that fact alone.

I was going to say thank you to a few people but I don’t want to leave anyone out. Many have become close personal friends and goodbyes were really heartbreaking. I cannot wait to see them all again, either in the US, or Down Under. You know who you are, and you have an open invitation at our place.

GENERAL IMPRESSIONS

I thought there was some really good vibe this year. There was no nit-picking, no whispers in the corner, no petty arguments. It was just a bunch of people who came together to talk about their passion to make a difference. The academic disagreements were polite and civil, and there was (to me) a general feeling of mutual respect. The word “community” kept coming to the front of my mind. “Community” does not mean “cult”. I think “community” means “a tribe”. It is still totally amazing to me that a misanthropic introvert like myself can mingle, and socialise, and chat for hours to total strangers. That’s how you know that you are among “your people”.

When you have a case of warm’n’fuzzies about where we are as a movement it is really disheartening to see the usual characters come out of the woodworks to trash Paleo from the safety of their computer keyboards. It was entirely laughable to read a few tweets commenting on body shapes of the participants or the interpretation of the scientific merit of the conference based of 140 characters. My diagnosis for these keyboard warriors is the severe case of the sulks on the background of desperate attention-seeking. I have no time for that.

Once again, warm thank you to the Ancestry Foundation, to Katherine Morrison for looking her radiant cheerful self while dealing with all kinds of shitstorms, which seem to be a part and parcel of a huge event like this, and to Aaron Blaisdell for his superb organising skills and for being so gracious and welcoming.

RESOURCES

Some of the presentations are already up on slide share. Here is my presentation. I have been told it was quite good.

Here is Jamie’s.

The videos are still forthcoming. Of course I am not going to watch mine as I will undoubtedly feel dejected about its imperfections.

AHS14, we will be there.