Tannning and Vitamin D

This is the first of a series of articles that will discuss the what, where, when, how and why reasons that vitamin D is so important to the health and welfare of Americans. When we first became interested in the benefits of vitamin D 10 years ago, there was only a small trickle of related articles being published in scientific journals and virtually none in the mainstream media. But what started as small stream of articles about this nutrient five or six years ago, became a torrent of information in the last couple of years. If what we have seen in the past year is any indication of the future, scientific and mainstream articles pointing out the incontrovertible benefits of maintaining optimal blood levels of vitamin D will become a flood of biblical proportions that will “wash away” individuals and organizations standing in the way of the truth.

At some point in the near future, it will become obvious to everyone that the American public needs more sensible, moderate and responsible exposure to UVR (ultraviolet radiation) in order to safely attain and maintain optimal blood levels of vitamin D, and that indoor tanning salons constitute a controlled, consistent, convenient and cost-effective source of vitamin D-effective photons.

Thus, salon owners must become knowledgeable about UVR-induced vitamin D so that they can play a leading educational role in the vitamin D revolution that is just ahead. This series of articles will give salon owners the needed educational tools.

“The elephant sitting in the living room” phrase is an allegory used to describe a situation whereby something important is happening that should be perfectly obvious but for inexplicable reasons is blindly ignored. Ignoring something as evident as an elephant sitting in a living room aptly parallels the way vitamin D experts, the media, regulatory agencies and the American public have ignored the importance of safe and effective UVR-induced vitamin D. It is the responsibility of the indoor tanning industry to educate and inform the American public, the media and regulatory agencies so they will remove their blinders and recognize that UVR-induced vitamin D is the elephant sitting in the living room.

Some of the questions addressed in the new series will include:

• Why is vitamin D is so important for optimal health?
• Why has the public been kept from learning the truth about UVR-induced vitamin D?
• How much vitamin D is necessary for optimal health?
• What are the sources of vitamin D?
• How and why did the mistaken belief originate that five to 10 minutes of sunlight exposure is satisfactory to stimulate optimal vitamin D blood levels?
• How does a tanning device compare to sunlight as a source of UVR-induced vitamin D?
• When will indoor tanning salons be considered part of the solution to help resolve the epidemic of vitamin D mediated diseases instead of part of the problem regarding skin cancer?
• How can indoor tanning salons inform their clients about the importance of vitamin D without running afoul of FDA and FTC?

Not too long ago, vitamin D was only thought to be a beneficial nutrient in bone-related conditions such as rickets and osteoporosis. It’s now known that diverse diseases including cancer, diabetes, multiple sclerosis and coronary heart disease are also vitamin D-mediated. In addition, we know that for every one individual who dies prematurely each year from the adverse effects of overexposure to UVR, there are 100 to 250 individuals who die prematurely each year from the adverse effects of underexposure to UVR. Therefore, it is increasingly clear that the odds favor more, not less, sensible, moderate and responsible exposure to UVR.

Thus, the bottom line is that advocating anything that causes the American public to shun sensible, moderate and responsible UVR exposure, including sun avoidance, inappropriate sunscreen use, banning teenagers from tanning, regulatory inhibitions, etc., is, de facto, advocating increasing the death rate from cancer, diabetes, multiple sclerosis and coronary heart disease. The position advocated by the indoor tanning industry on the other hand is that both overexposure and underexposure to UVR should be avoided. This is the only rational and scientifically valid approach.

There are three primary reasons why UVR-induced vitamin D is the “elephant sitting in the living room”. The first reason (as one speaker at the Toronto Vitamin D Symposium commented) is that if a researcher tried to use UVR to stimulate the production of vitamin D in a study he or she would “bring down the wrath of the dermatology community” upon themselves and their institution. The second reason is that pharmaceutical companies are spending millions and millions of dollars trying to find a vitamin D “analog” that is as safe and effective as UVR-induced vitamin D because the first to do so will make a fortune. The third reason is that the indoor tanning industry is specifically prohibited by the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) from promoting the fact that tanning devices deliver UVR photons that stimulate the production of vitamin D. Since we are prohibited by FDA and FTC from telling the truth about this important subject, the American public is only hearing one side of this important issue.

So why is the dermatology community so adamantly against any and all UVR exposure? The answer to this question brings to mind another “elephant-related” analogy, such as the story about how the six blind men described an elephant. As you will recall, the first blind man felt the side of the elephant and decided it was like a wall; the second felt the tusk and thought it was like a spear; the third felt the trunk and thought it was like a snake; the fourth felt the leg and thought it was like the tree trunk; the fifth felt the ear and thought it was like a fan; and the sixth felt the tail and thought it was like a rope. Obviously, the mistaken descriptions came about because none of the blind men could see the entire elephant.

The primary reason that dermatologists advocate sun avoidance and slathering on of sunscreen every day regardless of the season or time of day, is because they view their patients almost exclusively in terms of skin diseases, especially skin cancer, rather than considering their total health status. [Note: This view brings to mind the medical joke that the more a specialist knows about a specific area of the body, the less they understand about the total health status of the patient.] This “medical myopia” and the fact that dermatologists and sunscreen companies have made a lot of money over the past two decades by scaring the American public about skin cancer are, we believe, the primary reasons why an estimated 40 percent to 50 percent of the American public has sub-optimal blood levels of vitamin D.

So how can the indoor tanning industry help bring about a paradigm change regarding the attitude of the media, regulatory agencies and the American public toward UVR-induced vitamin D? In summary, how do we get them all to notice the elephant sitting in the living room?

Future articles in this series will help salon owners find answers to these important questions and provide information to help them educate and inform their clients about the rationale for viewing sun-beds as a controlled, consistent, convenient and cost-effective source of vitamin D-effective photons.

This is the third in a series of articles that discuss the what, where, when, how and why reasons that vitamin D is so important to the health and welfare of Americans. Please check out the first two installments of the series in the June and July issues, respectively, or view them online at www.lookingfit.com. 

This third installment shows 1) why augmenting a balanced diet and taking a daily 1,000 IU-2,000 IU vitamin supplement with a regimen of sensible, moderate and responsible UVR exposure in the controlled, consistent and convenient environment of an indoor tanning salon is the ideal way to safely attain and maintain an optimal blood level (i.e., 150 nmol/L) of vitamin D year-round, and 2) why UVR does not induce cutaneous malignant melanoma (CMM).

It takes approximately one hour (30 minutes per side) of whole-body sunlight exposure and approximately double this time for face and hand exposure at noon on a typical Midwestern summer day to accumulate the minimum dose of vitamin D-effective photons required by the average person (a skin subtype 3A) in the United States.

Compare these times with the fact that it takes only an average of 10 minutes (six to 14) for a 360-degree tanning device to deliver the same whole-body dose of vitamin Deffective photons and it becomes evident why tanning devices are a controlled, consistent and convenient way to maintain an optimal (150 nmol/L) vitamin D level. Sunlight is uncontrolled and varies by time of day, season and environmental conditions; therefore, it can be seen that tanning devices are ideal because they can deliver the same dose of UVR photons at 8 a.m., noon and 8 p.m. year-round.

Because the “elephant sitting in the living room” is being ignored, it means that the American public is not being told that 1) sensible, moderate and responsible UVR exposure is required to safely attain and maintain optimal blood levels of vitamin D, and 2) indoor tanning salons in the United States constitute a controlled, consistent and convenient source of the vitamin D-effective photons required for our health and well-being. Therefore, it’s time to take a look at the primary tool used by the sun-scare coalition to demonize any and all UVR exposure.

The first tool used by the sun-scare coalition to demonize any and all UVR exposure was to promote the fear of nonmelanoma skin cancer (NMSC). However, after the American public realized that only 400 to 600 deaths each year can be attributed to basal cell and squamous cell carcinomas, it became necessary to “promote” the concept that cutaneous malignant melanoma (CMM) with an estimated 6,000 deaths each year also was induced by UVR. The sunscare coalition used very weak and unsubstantiated epidemiological data to “link” UVR to CMM and quickly changed from saying “UVR may be linked to CMM” to “UVR is known to be linked to CMM” to “UVR is known to cause CMM” in scientific articles.

Two new studies published in the last year utilizing specific molecular data refute the notion that there is a link between UVR and CMM.

• 1. The Wang Study. A paper published in the Journal of the National Cancer Institute (Vol. 97, No. 24, 1822-1831, 12/21/05) by Wang, et al, titled “In Vitro Sensitivity to Ultraviolet B Light and Skin Cancer Risk: A Case-Control Analysis” showed that although there was a link between UVR and basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), there was no link between UVR and CMM when the sensitive and specific “chomatid break” assay was used. Wang, et al, concluded that “UVB-induced mutagen sensitivity may play a role in susceptibility to NMSC but not to CMM.”
• 2. The DeFabo Study. A paper published in the journal Cancer Research (Vol. 64, 6372-6376, 9/15/04) by DeFabo, et al, titled “Ultraviolet B but not Ultraviolet A Radiation Initiates Melanoma” showed that UVA (UVA1 and UVA2) wavelengths do not induce CMM in a mouse specifically bred to develop a “human-like” CMM (even at very high doses) and that UVB only was able to induce CMM when mice three days old or less (i.e., still an embryo) were subjected to UVR doses much higher than would be experienced in either sunlight or in a tanning device.

Taken together, these two studies show that UVR does not induce CMM ; therefore, the UVR-avoidance message by the sun-scare coalition should be discounted by the American public.

As the citations above show, there is now sensitive and specific molecular evidence showing that UVR does not induce CMM and since NMSC is not likely to cause death, the scare tactics used by the sun-scare coalition are false, deceptive and misleading and, therefore, should be viewed skeptically by the American public.

Therefore, since sensible, moderate and responsible exposure to UVR—especially in the controlled, consistent and convenient environment of an indoor tanning salon—is the most efficient and safest way to attain and maintain an optimal blood level (150 nmol/L) of vitamin D, the public message should be to encourage more UVR exposure, not less.

Moreover, it is totally unacceptable for any individual or entity to recommend sun avoidance given the fact that there are at least 150 to 250 premature deaths each year due to underexposure to UVR for every one premature death due to overexposure to UVR—especially since $100 is spent each year on underexposure to UVR for every $1 spent on overexposure to UVR.

The bottom line is that everyone in the indoor tanning industry can take justifiable pride in our dual message that 1) the benefits of sensible, moderate and responsible exposure to UVR outweigh the minimal and manageable risks involved, and 2) don’t ever sunburn turns out to be exactly what is best for the health and welfare of the American public.

Part IV of the series continues next month and will show how to reduce the incidence of NMSC by 60 percent. In October, Part V will provide scientific data showing what really induces CMM.