Truths and Myths about Tanning Vitamin D research may have doctors prescribing sunshine

Scientists are excited about a vitamin again. But unlike fads that sizzled and fizzled, the evidence this time is strong and keeps growing.
If it bears out, it will challenge one of medicines most fundamental beliefs: that people need to coat themselves with sunscreen whenever theyre in the sun. Doing that may actually contribute to far more cancer deaths than it prevents, some researchers think. The vitamin is D, nicknamed the "sunshine vitamin" because the skin makes it from ultraviolet rays. Sunscreen blocks its production, but dermatologists and health agencies have long preached that such lotions are needed to prevent skin cancer. Now some scientists are questioning that advice. The reason is that vitamin D increasingly seems important for preventing and even treating many types of cancer. In the last three months alone, four separate studies found it helped protect against lymphoma and cancers of the prostate, lung and, ironically, the skin. The strongest evidence is for colon cancer. Many people arent getting enough vitamin D. Its hard to do from food and fortified milk alone, and supplements are problematic. So the thinking is this: Even if too much sun leads to skin cancer, which is rarely deadly, too little sun may be worse.

No one is suggesting that people fry on a beach. But many scientists believe that "safe sun" 15 minutes or so a few times a week without sunscreen is not only possible but helpful to health. One is Dr. Edward Giovannucci, a Harvard University professor of medicine and nutrition who laid out his case in a keynote lecture at a recent American Association for Cancer Research meeting in Anaheim, Calif. His research suggests that vitamin D might help prevent 30 deaths for each one caused by skin cancer. "I would challenge anyone to find an area or nutrient or any factor that has such consistent anti-cancer benefits as vitamin D," Giovannucci told the cancer scientists. "The data are really quite remarkable." The talk so impressed the American Cancer Societys chief epidemiologist, Dr. Michael Thun, that the society is reviewing its sun protection guidelines. "There is now intriguing evidence that vitamin D may have a role in the prevention as well as treatment of certain cancers," Thun said. Even some dermatologists may be coming around. "I find the evidence to be mounting and increasingly compelling," said Dr. Allan Halpern, dermatology chief at Memorial Sloan-Kettering Cancer Center in New York, who advises several cancer groups. The dilemma, he said, is a lack of consensus on how much vitamin D is needed or the best way to get it. No source is ideal. Even if sunshine were to be recommended, the amount needed would depend on the season, time of day, where a person lives, skin color and other factors. Thun and others worry that folks might overdo it. "People tend to go overboard with even a hint of encouragement to get more sun exposure," Thun said, adding that hed prefer people get more of the nutrient from food or pills. But this is difficult. Vitamin D occurs naturally in salmon, tuna and other oily fish, and is routinely added to milk. However, diet accounts for very little of the vitamin D circulating in blood, Giovannucci said. Supplements contain the nutrient, but most use an old form D-2 that is far less potent than the more desirable D-3. Multivitamins typically contain only small amounts of D-2 and include vitamin A, which offsets many of Ds benefits. As a result, pills might not raise vitamin D levels much at all.

Government advisers cant even agree on an RDA, or recommended daily allowance for vitamin D. Instead, they say "adequate intake" is 200 international units a day up to age 50, 400 IUs for ages 50 to 70, and 600 IUs for people over 70. Many scientists think adults need 1,000 IUs a day. Giovannuccis research suggests 1,500 IUs might be needed to significantly curb cancer. How vitamin D may do this is still under study, but there are lots of reasons to think it can: _Several studies observing large groups of people found that those with higher vitamin D levels also had lower rates of cancer. For some of these studies, doctors had blood samples to measure vitamin D, making the findings particularly strong. Even so, these studies arent the gold standard of medical research a comparison over many years of a large group of people who were given the vitamin with a large group who didnt take it. In the past, the best research has deflated health claims involving other nutrients, including vitamin E and beta carotene. _Lab and animal studies show that vitamin D stifles abnormal cell growth, helps cells die when they are supposed to, and curbs formation of blood vessels that feed tumors. _Cancer is more common in the elderly, and the skin makes less vitamin D as people age. _Blacks have higher rates of cancer than whites and more pigment in their skin, which prevents them from making much vitamin D. _Vitamin D gets trapped in fat, so obese people have lower blood levels of D. They also have higher rates of cancer. _Diabetics, too, are prone to cancer, and their damaged kidneys have trouble converting vitamin D into a form the body can use. _People in the northeastern United States and northerly regions of the globe like Scandinavia have higher cancer rates than those who get more sunshine year-round. During short winter days, the suns rays come in at too oblique an angle to spur the skin to make vitamin D. That is why nutrition experts think vitamin D-3 supplements may be especially helpful during winter, and for dark-skinned people all the time. But too much of the pill variety can cause a dangerous buildup of calcium in the body. The government says 2,000 IUs is the upper daily limit for anyone over a year old. On the other hand, D from sunshine has no such limit. Its almost impossible to overdose when getting it this way. However, it is possible to get skin cancer. And this is where the dermatology establishment and Dr. Michael Holick part company.

Thirty years ago, Holick helped make the landmark discovery of how vitamin D works. Until last year, he was chief of endocrinology, nutrition and diabetes and a professor of dermatology at Boston University. Then he published a book, "The UV Advantage," urging people to get enough sunlight to make vitamin D. "I am advocating common sense," not prolonged sunbathing or tanning salons, Holick said. Skin cancer is rarely fatal, he notes. The most deadly form, melanoma, accounts for only 7,770 of the 570,280 cancer deaths expected to occur in the United States this year. More than 1 million milder forms of skin cancer will occur, and these are the ones tied to chronic or prolonged suntanning. Repeated sunburns especially in childhood and among redheads and very fair-skinned people have been linked to melanoma, but there is no credible scientific evidence that moderate sun exposure causes it, Holick contends. "The problem has been that the American Academy of Dermatology has been unchallenged for 20 years," he says. "They have brainwashed the public at every level." The head of Holicks department, Dr. Barbara Gilchrest, called his book an embarrassment and stripped him of his dermatology professorship, although he kept his other posts. She also faulted his industry ties. Holick said the school has received $150,000 in grants from the Indoor Tanning Association for his research, far less than the consulting deals and grants that other scientists routinely take from drug companies. In fact, industry has spent money attacking him. One such statement from the Sun Safety Alliance, funded in part by Coppertone and drug store chains, declared that "sunning to prevent vitamin D deficiency is like smoking to combat anxiety." Earlier this month, the dermatology academy launched a "Dont Seek the Sun" campaign calling any advice to get sun "irresponsible." It quoted Dr. Vincent DeLeo, a Columbia University dermatologist, as saying: "Under no circumstances should anyone be misled into thinking that natural sunlight or tanning beds are better sources of vitamin D than foods or nutritional supplements." That opinion is hardly unanimous, though, even among dermatologists. "The statement that no sun exposure is good I dont think is correct anymore," said Dr. Henry Lim, chairman of dermatology at Henry Ford Health System in Detroit and an academy vice president.

Some wonder if vitamin D may turn out to be like another vitamin, folate. High intake of it was once thought to be important mostly for pregnant women, to prevent birth defects. However, since food makers began adding extra folate to flour in 1998, heart disease, stroke, blood pressure, colon cancer and osteoporosis have all fallen, suggesting the general public may have been folate-deficient after all. With vitamin D, "some people believe that it is a partial deficiency that increases the cancer risk," said Hector DeLuca, a University of Wisconsin-Madison biochemist who did landmark studies on the nutrient. About a dozen major studies are under way to test vitamin Ds ability to ward off cancer, said Dr. Peter Greenwald, chief of cancer prevention for the National Cancer Institute. Several others are testing its potential to treat the disease. Two recent studies reported encouraging signs in prostate and lung cancer. As for sunshine, experts recommend moderation until more evidence is in hand. "The skin can handle it, just like the liver can handle alcohol," said Dr. James Leyden, professor emeritus of dermatology at the University of Pennsylvania, who has consulted for sunscreen makers. "I like to have wine with dinner, but I dont think I should drink four bottles a day." Written By Steven Senne, AP

Tanning Facts and Myths

Q: Why do I have to go tanning every day? A: At Sun Solution, our policy is to change each tanning beds bulbs every 400 hours to insure peak performance at all levels of tanning. The truth is, you shouldnt have to tan every day. Some of the larger chain salons use their bulbs for 850-1300 hours. This causes up to a 70% loss in effective tanning power for that bed, which forces you to go tanning every day. It does not matter what type of bed you use if the bulbs are old. Some chains maximize their profits by running their lamps far beyond their normal life cycle, but you wont find that at Sun Solution. Truth: The smartest way to maximize the potential benefits of sun exposure while minimizing the potential risks associated with either too much or to little sunlight is moderate tanning.

Facts:

The professional tanning industry promotes and teaches the smart tanning rule: Dont ever sunburn. The professional tanning industry is more effective in teaching sunburn prevention. Non-tanners sunburn more often than indoor tanners. Having a base tan, combined with proper use of sunscreen outdoors, will help prevent sunburn. 30 million North American indoor tanners successfully develop base Tans before enjoying their sunny vacation locations. The bodys natural protection against the sun is a tan. Your skin is designed to tan as a natural body function, and the body is designed to repair sun damage as a natural process.

Truth: The public debate on indoor tanning has completely lost its perspective. Sun light gives the body needed Vitamin D, and helps promote mental well-being. Myth: Showering after tanning will remove your tan. Fact: It takes 24-48 hours for the natural melanin to be produced, which causes the tan. Showering immediately after tanning will not affect your tan. After the melanin travels to the surface of the skin, it naturally flakes off. That is why a tan fades with time. Myth:Ive heard that indoor tanning is more harmful than tanning outdoors because the UV light exposure is more intense. Fact: People tanning indoors are exposed to a scientifically calibrated amount of UV light. When used according to the U.S. Food and Drug Administrations exposure guidelines (posted on each machine), tanning beds are designed to maximize tanning and minimize burning. Conversely, tanning outdoors is an unregulated environment. There are many factors that have to be considered when you tan outdoors: geography, time of day, weather conditions, the seasons, and the ozone layer. Remember the best way to safeguard yourself from sun damage is to wear appropriate levels of SPF sunscreens outdoors even if you already have a tan. You should also know that, even with sunscreen protection, UV exposure can still lead to skin cancer and premature aging, even if you dont burn. Myth: My friend said she heard that tanning bakes your internal organs. Sometimes I notice a strange smell after I tan. Could this be my organs baking? Fact: The UV light from a sun bed is similar to UV light from the sun, and cannot penetrate deeper than the skin to harm internal organs. The odor you may notice is whats commonly known as the after tan odor, a common occurrence when tanning indoors or outdoors, which is caused by harmless bacteria. California Tan lotions contain the Biosaccharide Complex, which helps prevent after tan odor.

Myth: I have been told from several of my friends that showering directly after tanning will wash your tan away. They say its best to wait about 3 hours after tanning to shower. Fact: Taking a shower after tanning will not wash your tan away. A natural tan takes 2448 hours to develop. The tanning process occurs within the epidermis when melanocyte cells are stimulated by ultraviolet light that causes them to produce the pigment melanin. Melanin production results in the tanned appearance of the skin and is the skins natural defense against the sun and over-exposure, i.e. sun-burning. Melanin travels to the surface, where it eventually flakes off. This process allows us to develop new skin every four to eight weeks. Keeping your skin hydrated and exfoliated will help maintain a more radiant and healthy-looking tan. ** If you are tanning with a bronzer we recommend waiting 4 hours before showering to allow the DHA or self tanner to set.