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Dr.Michael Holick is a dermatologist and the world's leading authority on Vitamin D. In this his latest book, he describes the result from more than 30 years of research into the secrets of how the human body is using UV-light to protect us from most diseases.
Since this is a blog about tanning (there are many other sources on Internet for Vitamin D), I have extracted in this post what Dr. Holick writes about using UVB from tanning-beds for boosting our Vitamin D levels when UV light from the natural sun is not available (which is most of the time for many of us). This is Step 1 in his 3-Step Strategy and Chapter 8 in the book. In Chapter 1-7, he gives all the proof needed in order to understand why we need moderate and regular exposure to UV-light all the year round.
THE VITAMIN D SOLUTION
MICHAEL F. HOLICK, Ph .D. M.D.
A 3 -Step Strategy to Cure Our Most Common Health Problem
Foreword by Andrew Weil, M.D. (www.drweill.com)
…. The message of The Vitamin D Solution is simple yet profound: just as we require a little fat and salt for survival, we need the sun in moderation, too — for sun exposure is our best source of vitamin D. It's a well-documented fact that sunlight is necessary for human survival, but we've been brainwashed into thinking that any exposure to sunlight is bad. This is both unfortunate and untrue. There is really no substantiated scientific evidence to suggest that moderate sun exposure significantly increases risks of benign cancers or, and more importantly, the most deadly form of skin cancer, melanoma. Dr. Holick shows you how to safely and sensibly take advantage of sunlight during certain times of the day and year to build and maintain your natural levels of vitamin D without increasing your risk for skin cancer.
The 3 -Step Strategy
Step 1: Let the Sunshine In – Practicing sensible sun exposure for optimal health
Step 2: Bone Up Calcium – The dynamic duo of calcium and vitamin D can sustain your life
Step 3: Supplement Safely – How to supplement as a backup plan
INTRODUCTION – From NASA to the National Zoo
By the time we reach adulthood, most of us have developed a general sense of what's good and bad for our health, Eating fresh fruits and vegetables: good, Drinking a bottle of whiskey a day: bad, Exercising a few days a week: good, Basking in the sun without sunscreen: bad.
I agree with the first three ideas but emphatically disagree with the notion that sunbathing is always bad. And I'm going to prove it to you in this book. In fact, I'm going to show you — backed by more than thirty years of science, including some astonishing discoveries in just the last few years alone — how valuable and necessary the sun is in powering up your health, enhancing your well-being, staving off typical causes of disease, and extending your life.
If I had to give you a single secret ingredient that could apply to the prevention — and treatment, in many cases — of heart disease, common cancers, stroke, infectious diseases from influenza to tuberculosis, type 1 and 2 diabetes, dementia, depression, insomnia, muscle weakness, joint pain, fibromyalgia, osteoarthritis, rheumatoid arthritis, osteoporosis, psoriasis, multiple sclerosis, and hypertension, it would be this: vitamin D.
Three out of every four Americans are deficient in vitamin D, up from one out of two twenty years ago.
You may wonder: Why is this happening and what can we do about it? How can a single vitamin be associated with so many conditions?
That's exactly why I wrote this book. One of my goals is to convey to you just how critical this vitamin (actually a hormone) is in our lives and inspire you to spring to action and welcome the rewards that a healthy vitamin D status has to offer. The list of health conditions associated with a deficiency is overwhelming (I listed just a choice few above), and the amount of research that has emerged lately on this vitamin of vitality begs for a book that shares this latest knowledge in a way anyone can understand and use to become a healthier, happier individual. Contrary to popular wisdom, vitamin D isn't just about strong bones and teeth.
And you can't get enough from foods and multivitamins alone.
Your overall well-being depends in part on developing an appropriate relationship with the sun. However, it can be a challenge to get the kind of information you need to establish such a relationship. I will provide you with a comprehensive understanding of the issues at hand. Equipped with this knowledge, you will be able to make your own decision about what your relationship to the sun should be. You, too, can learn to use sunlight for health. I know that I may have an uphill battle to climb for some readers, who, upon the mere thought of sensible sunbathing, immediately think about wrinkles, premature aging, skin cancers such as melanoma, and so forth, but I trust you'll be amazed by the lessons learned in this book.
You may also come to this thinking, I get plenty of vitamin D because I drink a lot of milk, am exposed to casual sunlight during the day just walking around, and take a multivitamin and a calcium supplement with added D. Unfortunately, you are still likely to be woefully deficient.
Today there is evidence to link sun exposure and vitamin D to every facet of medicine and health.
Adequate levels of vitamin D can improve fertility, safeguard pregnancy, reduce inflammation, help with weight control, protect against infectious diseases like the flu and tuberculosis, prevent strokes and dementia, bolster the immune system, boost memory, and support muscle strength. What all of this really means is that vitamin D may be the most underappreciated and misunderstood antiaging secret. And unlike so many other antiaging “secrets,” this one is absolutely free.
No doubt you will be surprised by some of the findings I present, and you may even feel uncomfortable once I dive into the facts about sun exposure and why it's so important to let a little sunshine into your life despite what most of the dermatology community would have you believe. If the noise from the sunphobic dermatology corner has you curious about my scientific rationale for endorsing sensible sun exposure without sunblock, then I encourage you to flip to chapter 8 and first read the truth about skin cancer and the risk of melanoma.
C H A P T E R 8
Step 1: Let the Sunshine In – Practicing sensible sun exposure for optimal health
….. it's not easy to boost your vitamin D status into the healthy range of at least 30 nanograms per milliliter through supplementation alone.
….. if the body could say which method it prefers to get its daily dose of vitamin D, it would give a standing ovation to sunlight sources of vitamin D rather than a bottle. After all, why else would it spend so many millions of years perfecting this clever and self-regulating process? There's something to be said for the fact that the body can in no way overdose on vitamin D created through sunlight, as it can through supplementation.
….. vitamin D made in the skin lasts at least twice as long in the blood as vitamin D ingested from the diet. When you are exposed to sunlight, you make not only vitamin D but also at least five and up to ten additional photoproducts that you would never get from dietary sources or from a supplement.
I do not advocate tanning, and I recommend you get only enough sun exposure to establish and maintain healthy 25-vitamin D levels and to improve your psychological health as Mother Nature intended. At the same time, if you have decided that the feeling of well-being you get from UVB exposure far outweighs the dangers, I would not discourage you from UVB exposure in excess of that which is needed for good health, as long as you know and accept the risks and never burn.
Clearly, just because “some is good” doesn’t mean that “a lot is better.” Undesirable consequences can result if you get too much sun, just as if you eat or exercise too much.
If you work during the day, an indoor-tanning facility can provide the same benefits.
Sunscreens almost completely prevent the body from making vitamin D from the sun.
UVB radiation from sunlight does not penetrate glass, so you cannot make vitamin D from sunshine that warms your skin through a window. UVA, on the other hand, can penetrate glass.
One of the most important jobs of the epidermis—especially in light-skinned people—is to adapt quickly to protect skin cells from the sun’s radiation. The defence mechanism the skin uses against sunburn is what we call tanning, which is an ingenious process. In response to sun exposure, the melanocytes produce melanin that makes the skin darker. The production of more melanin is triggered through an increase in the activity of an enzyme called tyrosinase. Melanin protects the skin by absorbing UV radiation.
Sunburn is quite different from a suntan. When you get a sunburn, your skin turns red and can sometimes blister and peel.
Fear of skin cancer is one of the main reasons for the hysteria over sun exposure. As is the case with so many health axioms, the relationship between sunshine and cancer isn't as straightforward as most people think. There are a number of myths associated with what causes skin cancer.
Many myths are associated with skin cancer, thanks to the barrage of public misinformation on this topic. Here are some of them.
Myth 1: Any and all sun exposure causes skin cancer.
There is no data to suggest that sensible sun exposure increases the risk of nonmelanoma skin cancer
Myth 2: Sun exposure is the main cause of melanoma
There is no scientific evidence that regular, moderate sun exposure causes melanoma.
Myth 3: We are in the midst of a skin cancer “epidemic.”
It is inaccurate to call the increasing incidence of skin cancer an epidemic. If you get regular, moderate sun exposure, you have less chance of developing malignant melanoma.
Myth 4: There's no such thing as a safe tan.
Tanned skin protects you against sunburn, thought to be the main cause of melanoma. Also, it's more dangerous to avoid sun exposure completely than it is to get regular, moderate sun exposure. If you avoid getting sunburned, the benefits of sun exposure will far outweigh the possible dangers.
People who get regular, moderate sun exposure are less likely to get a malignant melanoma than those who don't.
Myth 5: Tanning is like smoking to your skin.
Wrong. Tanning is natural. It is your body’s natural defence against sunburn. Smoking is an unnatural habit that your body rejects by becoming ill.
Are Tanning Beds Right for You?
In a perfect world, all of us would have the time and opportunity to strip off our clothes and step outside for several minutes a day for the amount of sun we need to make enough vitamin D to be healthy, especially between spring and fall, when we can stock up for the winter. Regrettably, that’s not the case, and real life (not to mention office dress codes) tends to interfere with this goal.
Every day, approximately one million Americans frequent an indoor-tanning facility to look and feel better. Although I am not an advocate of tanning per se, I do believe in the importance of UVB exposure for making the vitamin D you need to be healthy and feel invigorated. If you don’t have the opportunity to go out in the sun or prefer a more private and controlled environment, indoor-tanning facilities are a viable alternative to natural sunshine.
Am I crazy? Don't I know that tanning beds were officially listed as a carcinogen last year by the World Health Organization? And that the International Agency for Research on Cancer elevated sun beds to its highest cancer risk category? What kind of a doctor am I to be touting the benefits of sun beds when the powers that be have practically declared war on tanning salons?
I am a realist. I know that many of you will continue to frequent indoor-tanning facilities because of the way you look and feel afterward.
I do understand the concern, though; tanning beds can be abused by people who don't know how to use them safely, especially the young, who are at high risk of damaging their skin for a lifetime. I also believe that if you have all the facts, you have the right to make the choice to enjoy UVB exposure indoors or outside. It's ludicrous and, frankly, irresponsible for these institutions to say that tanning beds are on par with arsenic and mustard gas. Could the same be said about saturated fat and sodium? Certainly not. We need those for survival, just as we need UVB in moderation. And that's the message: moderation—a point I've been driving home since the first page of this book. So with all this in mind, if you choose to tan indoors, make sure you use this technology responsibly.
Thankfully, the indoor-tanning industry, through the efforts of the Indoor Tanning Association, is doing its part by introducing quality-control measures and offering education and certification for its personnel. Keep in mind that there’s no such thing as artificial UV radiation. A UVB photon (packet of energy) is a photon whether it is produced by the sun or by a tanning bed with fluorescent lamps. The fact that the radiation you are exposed to in indoor-tanning facilities is the same as what you get from the sun means you need to take the same precautions you would if you were in the natural sunlight. As with natural sunlight, when using indoor tanning equipment there is the potential for the kind of overexposure that is associated with nonmelanoma skin cancer and prematurely aged skin.
Above all, make sure the indoor-tanning facility you use features appropriate equipment. At one time, indoor-tanning facilities used equipment that emitted high-intensity UVB radiation. When UVB radiation was linked to basal-cell and squamous cell skin cancer, the industry switched to UVA-only “high-pressure” lamps, which were considered safe because they didn't cause burning. Then it was discovered that UVA radiation may contribute to melanoma and wrinkles, as well as increase the risk of nonmelanoma skin cancer. Therefore, the trend in recent times has been toward low-pressure and medium-pressure lamps that emit a balance of UVA and UVB radiation (94 percent to 97.5 percent UVA and 2.5 percent to 6 percent UVB) that replicates natural sunshine. Before using an indoor-tanning facility, make sure it features low-pressure lamps (look for fluorescent tubes, not round lamps). Facilities that use high-pressure lamps should be avoided not only because of those lamps' potential for causing skin damage and certain types of cancers but also because they do not provide any sort of vitamin D benefit.
If you require assistance, find a facility where the staff has been certified by an industry association such as the International Smart Tan Network. A qualified staff member should do the following:
• Discuss your skin type and exposure-time charts carefully with you and ensure that you have access to this information at all times.
• Recommend an exposure schedule that will tan you moderately and avoid any pinkness and especially sunburn.
• Discuss with you anything that may cause you to react adversely to UV exposure (certain medicines, birth control pills, cosmetics, or soaps may increase your risk of a sun-sensitive reaction).
• Provide you with FDA-approved eyewear with usage instructions.
• Guide you through your first tanning experience.
Follow staff guidelines and those of the equipment manufacturers.
Wear sun protection on your face. Do not exceed the recommended exposure time. Be aware that areas not usually exposed to sunlight can still get pink—another reason to consider spending less time than is recommended, which is supposed to be 0.75 MED. Indoor tanning exposure times are based on FDA and Federal Trade Commission guidelines, which allow a per-session UV exposure equivalent to 75percent of 1 MED. This is quite liberal because you require only 25 percent to 50 percent of 1 MED (again, the time it would take you to get pink) to get enough vitamin D (equivalent to taking about 4,000 to 10,000 IU of vitamin D orally).
If you are concerned about the potential harm of UVB radiation and are not interested in a tan, you can get all the medical benefits of UVB exposure from just 25 percent of 1 MED (about 4,000 IU of vitamin D).
One of the most popular reasons for using indoor-tanning facilities is to build a “base tan” in anticipation of a winter visit to a tropical destination such as the Caribbean. I think that's smart, and I'll explain why.
As I've made clear, I'm not a proponent of tanning, but I do believe in the importance of skin health and of protecting skin against strong sunshine. Increasing the melanin content in your skin by going to an indoor-tanning facility will provide you with a certain amount of natural protection against a burn. Start increasing the melanin content in your skin by visiting an indoor-tanning facility at least one month before you leave, and have three sessions a week. When you arrive at your tropical or subtropical destination, take the appropriate measures to protect yourself against a burn. Depending on your skin type, the protection you get from pre-vacation tanning salon exposure is equivalent to using a sunscreen with a sun protection factor of two or three (SPF2 or SPF3), which means you can stay outside two or three times longer than you could if you didn't have the “base tan.”
Some people choose to purchase tanning equipment for use in their homes. I am in favor of doing this if your primary goal is to make vitamin D and improve your psychological health. Follow the same guidelines and precautions you would observe in commercial facilities or in natural sunshine. It is especially important to avoid overexposure, which can be a temptation because of your easy access to the equipment. Again, be sure your equipment uses low- or medium-pressure lamps—those that emit a balance of UVA and UVB radiation that most closely replicates natural sunlight.
Remember: Tanning beds that only emit UVA radiation will not produce any vitamin D in the skin.
Most people use tanning facilities for cosmetic reasons—in other words, to look and feel better. I use this kind of equipment extensively to test the effects of UV radiation on health. In one of the most dramatic examples of how indoor-tanning equipment can be used therapeutically, I managed to relieve excruciating bone pain in a woman with severe Crohn's disease who was vitamin D deficient because 90 percent of her intestines had been removed in surgery and no amount of oral vitamin D could enable her intestines to absorb enough vitamin D to keep her bones healthy. Her bone pain, caused by the condition known as osteomalacia (see chapter 3), was relieved in a month thanks to three-times-weekly sessions on a tanning bed, observing the manufacturer's exposure guidelines.
If you have trouble absorbing vitamin D from your diet, speak to your doctor about whether indoor tanning sessions would help correct your vitamin D deficiency. Three of the most common conditions associated with difficulty absorbing vitamin D through the small intestine are Crohn's disease, inflammatory bowel disease, and cystic fibrosis.
……. With the new information that vitamin D is so important for good health, I hope you will start to regard indoor-tanning facilities as places not to bronze yourself but rather to undergo therapy to stimulate your production of vitamin D. When my colleagues and I compared two groups of Bostonians—one a group of tanners and another who didn't tan, matched up in terms of age and sex, we showed that the tanners boasted a blood level of about 45 nanograms per milliliter, which, again, is thought to markedly reduce the risk of myriad health problems. Their counterparts who never visited a tanning facility, however, had 25-vitamin D levels in the 18-nanogram-per-milliliter range, far below the level required for maximum health protection.
Guidelines for Indoor Tanning
• Educate yourself. Know the pros and cons of UV exposure and how to use it and protect yourself.
• Use low-pressure or medium-pressure lamps. Look for beds that have fluorescent tubes, as opposed to round lamps. Ask the attendant working at the facility whether he or she knows for sure that the lamps at that facility are low pressure (those that emit a balance of UVA and UVB). High-pressure lamps emit only UVA, which penetrates deep into the skin and may cause skin cancer and wrinkles and alter your immune system. By definition, fluorescent tubes emit UVB, whereas round, high-pressure lamps emit UVA.
• Use common sense and practice moderation. Refer to the guidelines in this chapter for how much UV exposure you need.
Keep in mind that indoor-tanning facilities emit UV radiation equivalent to the sunshine at tropical latitudes. Restrict your exposure to 50 percent of the manufacturer's recommended time of exposure, or the time defined by my guidelines— whichever is less. Protect your face and wear lip sunscreen.
• Know the consequences of using oil. Rubbing oil into your skin flattens the very top layer of skin (the stratum corneum, which acts like a field of little mirrors reflecting the UVA and UVB) and increases the penetration of much of the UVA and UVB radiation that would otherwise be reflected off the skin. If you use such products, cut your UV exposure time by at least 30 percent.
• Wear goggles or peepers. Make sure the facility provides eyewear that fits snugly. If the facility offers goggles, make sure the goggles are sterilized after each use to prevent the spread of eye infections. If they are not, purchase your own pair of goggles.
• Consider your medical history. If you are being treated for lupus or tend to get cold sores, these conditions can be activated through exposure to UV radiation from indoor-tanning lamps, just as they are by natural sunlight. For example, if you carry the herpes virus, UV exposure to the areas affected, such as lips and the genital region, can induce activity of the virus and thus cold sores. Your skin may also be more sensitive to UV radiation if you take certain medications, such as antibiotics, antihistamines, tranquilizers, water pills, diuretics, or birth control pills. A well-run indoor tanning facility will keep a file with information about your medical history, medications, and treatments. Make sure you help the staff keep the file up to date.
Michael Holick, Ph.D., M.D., is the Professor of Medicine of Physiology and Biophysics at Boston University School of Medicine. Dr. Holick specializes in vitamin D, calcium, bone metabolism, photobiology of vitamin, and osteoporosis. He is the recipient of the American Skin Associations Psoriasis Research Achievement Award, the American College of Nutrition Award, the Robert H. Herman Memorial Award in Clinical Nutrition from the American Society for Clinical Nutrition.
In 2006, Dr. Holick received the 18th Annual Award for Excellence in Clinical Research for his pioneering contributions in the basic science of vitamin D. In 2007 he received the Linus Pauling Functional Medicine Award, given for research that is changing the thinking about a biomedical problem. On 15 May 2009 Dr. Holick received the Linus Pauling Institute Prize for Health Research. In October 2009 Dr. Holick received the 2009 NAMS/Upsher-Smith Laboratories, Inc. Vitamin D Research Award from the North American Menopause Society (NAMS) for research that has advanced the understanding of the role of vitamin D for peri- and postmenopausal women.