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Good Books to read written by Doctors Michail F. Holick Ph.d, MD and DR. Marc Sorenson

Fact of the month

Humans make thousands of units of Vitamin D within minutes of whole-body exposure to sunlight.  From what we know of Nature. it is unlikely that such a system evolved by chance. 

Dr. John Connell Vitamin D Council.

Does tanning indoors have the same effect as tanning outdoors?

Yes. The advantage to indoor tanning is "control." You always know what you're getting from an individual tanning session. It is very precise, calculated, controlled exposure designed to give you a cosmetically pleasing tan without burning your skin. When a customer goes outdoors, he/she places himself in an uncontrolled environment. They don't know how much they are getting and frequently tanning outdoors results in sunburn.


Are there really parts of my body that can not tan?

Yes there are 6 parts of the human body that do not tan.  They are the eye lids, Lips, Nipples, palm of the hands, bottom of the feet, and the penis.
How do I prevent "raccoon eyes?"

Adjusting the protective eye-wear occasionally during a tanning session will help to minimize this condition. The adjustment can be performed by gently sliding the eye-wear to a new position. You should never lift the eyewear off of your eyes to adjust their position

Can I wear my contact lenses while tanning?

Because tanning naturally draws moisture from the body, eyes are sometimes inconvenienced with contacts that lose moisture too. Even with protective eye-wear, eyes can dry out a little. If somebody is going to tan with their contacts in, it is recommended that they use moisturizing drops prior to or just after the tanning session to prevent any temporary discomfort.

Is it okay for pregnant women to tan indoors?

One concern about pregnant women tanning is the heat. Remember that the temperature around the baby remains relatively constant at 98.6 degrees, so the baby can take a little heat, but the same amounts of heat that would cause anyone to be uncomfortable (e.g. sauna, hot tub, hot sun during the summer) will also make the baby uncomfortable. It is suggested that if pregnant, you tan during the morning hours and with a doctor's permission.

 Reprinted with permission from the Wolff System Technology FAQ booklet.

How Do We Tan?

Over a century ago it was discovered that invisible light rays in the ultraviolet region of the light spectrum caused the skin to darken. As scientists studied ultraviolet light, they divided this region into three groups, UVA (320-400 nm), UVB (280-320 nm), and UVC (200-280 nm). Nanometers, or nm for short, define the wavelength of the ultraviolet light; one nanometer is about 1/100,000 the thickness of a human hair. The primary effect of UVA light on the skin is called pigmentation, or darkening of the skin.

The primary effect of UVB on the skin is called erythema, or reddening of the skin. Erythema begins shortly after exposure to UVB, and varies depending upon the intensity and length of the exposure. How much redness is also determined by how much UVB is coming from which wavelengths; for example, UVB at 290 nm produces 100 times more erythema than UVB at 320 nm! At the same time as erythema is taking place, the UVB causes melanin to form just beneath the surface of the skin. The melanin is oxidized and turned brown by the UVA rays given off by the tanning lamps.

Thus, the tanning process involves the relatively quick reddening of the skin, followed by a slower forming, but longer lasting browning of the skin. Without some exposure to UVB rays, the tanning process cannot take place. The key is providing sufficient amounts of UVB to properly stimulate melanin, followed with effective amounts of UVA to complete the tanning process.

Get Real! Myths About UV

Myths and Misconceptions About UV and Tanning

The purveyors of sun-scare, in inexplicable blind zeal for their cause, have made some outlandish and unsupportable statements about sunshine, UV, Vitamin D and tanning. Think about this: Because sunshine is free, there is no powerful pro-sun PR lobby aggressively countering these misstatements. Think about it some more: Just imagine if a large pharmaceutical company did own the sun and was able to send you a bill for your monthly sunshine. The mass-media marketing message you got about sunshine – based on the same science that exists today – would be completely positive. The statements that follow show you that, when it comes to “sun scare” marketing is more important than science.



They Said It:

“I can remember as a youth when I was growing up I had gone to movies to see that the population was living underground because of severe solar energy and the lack of protection. In some vision as I grow older I see us moving to more shelters and perhaps underground living because of these hazards.” - Dr. Wilma Bergfeld, then-president of the American Academy of Dermatology at Derm Update, the AAD’s 1996 annual media day, Nov. 13, 1996.

Get Real!

It’s an oldie, but it’s still the misguided mantra of the AAD today. AAD still believes people do not need sunshine at all to make vitamin D and that people should turn to dietary supplements instead of Mother Nature. While underground living may be fine for the most extreme anti-sun lobbyists, the science in the decade since Bergfeld made this statement has only strengthened the case that human beings live naturally in sunlight and that we need regular sun exposure to be healthy. Anti-sun lobbyists like Bergfeld, unfortunately, have confused the good cause of fighting against sunburn and overexposure with a misguided attempt to get people out of the sun completely.

They Said It:

“People who practice proper sun protection and are concerned that they are not getting enough vitamin D should either take a multivitamin or drink a few glasses of vitamin D fortified milk every day. ..Dietary intake of vitamin D can completely and easily fulfill our needs.” – Dr. Raymond L. Cornelison Jr., then-president of the American Academy of Dermatology, in a July 3, 2003 AAD press release entitled, “Vitamin D + Sunshine = Bad Medicine.”

Get Real!

Humans make 90 percent of their vitamin D from sun exposure. That’s the natural way. To recommend that supplements and milk replace what Nature intended is unnatural as well as impractical. You would have to drink a full quart of fortified whole milk every day to attain the current median recommendation for vitamin D. What’s more, that level is now regarded as considerably too low by Vitamin D scientists, who foresee that recommendations will eventually be increased as much as five to 10 times their current levels. There is also growing consensus that supplements and diet alone will not provide sufficient vitamin D without additional sun exposure to the skin. The American Cancer Society and the Canadian Cancer Society have both recognized that some sunlight in moderation is necessary, even though both organizations fall short of advocating tanning.Despite all the evidence to the contrary, many anti-sun lobbyists have stuck with their rhetoric that humans make sufficient vitamin D from incidental sun exposure. If this were the case, how would it be possible for 40-90 percent of the population to be Vitamin D deficient, as has been demonstrated by several studies, if, as dermatologists also say, people are getting too much sun exposure? The outcomes are divergent.

They Said It:

“Avoiding the sun at all costs, for most of us, simply doesn’t make sense.” – Dr. Len Lichtenfeld, American Cancer Society’s Chief Medical Officer, in a statement issued May 27, 2006. ACS and the Canadian Cancer Society now recognize that some sunlight in moderation is necessary.

Get Real!

Bravo. That’s a great first step toward bringing common sense and Mother Nature back into the mix. Unfortunately, the anti-sun lobby hasn’t kept pace. Prime example: When asked to speak on behalf of the dermatology community to a major conference of worldwide Vitamin D scientists in Victoria, Canada, in April 2006, Boston University Dermatology Chair Dr. Barbara Gilchrest (Who in 2004 asked Vitamin D pioneer Dr. Michael Holick to resign from his dermatology post because he dared to write a book suggesting that UV exposure had health benefits) told the group, “When you tell a 15-year-old to get 10-15 minutes of unprotected sun exposure, they just don’t get it.” That brought groans from the researchers in the audience and an unidentified reply, “If you don’t trust people to do the right thing, I think we have a problem.”

They Said It:

“This (melanoma) epidemic is so severe that in the year 2012 malignant melanoma will be the leading cancer above breast and lung and colon, and may also be the leading cause of death all over the world.” - Dr. Wilma Bergfeld, then-president of the American Academy of Dermatology, at Derm Update, the AAD’s 1996 annual media day, Nov. 13, 1996.

Get Real!

Not even close. American Cancer Society statistics on these four cancers still speak for themselves:

Estimated Cancer Death Rates By Site and Year
Year - Breast - Lung - Colon - Melanoma
1997 - 44,190 - 160,400 - 46,600 - 7,300
2006 - 41,430 - 162,460 - 55,170 - 7,910

Source: American Cancer SocietyAnti-sun lobbyists often have called melanoma an “epidemic.” In 1995, world-renowned research dermatologist and photobiologist Dr. Fred Urbach chastised his peers at an FDA open forum for this characterization saying, “I wish you would look up the meaning of the word epidemic in your Oxford English Dictionary. Epidemics happen suddenly.”In fact, melanoma incidence has been rising for nearly 80 years, primarily in older men who are still much more likely to contract this disease. Yet the anti-sun lobby has directed its screenings and marketing attention at younger women who are more likely to purchase dermatologic services (Cosmetic botox injections are the fastest growing dermatologic procedure) and cosmetic products with sunscreen.The allegation that melanoma is increasing rapidly in young people is not supported by data and has obvious confounders that the anti-sun lobby conspicuously ignores in its regular discussion. Primarily, one must consider that dermatology’s ability to detect melanoma has improved steadily in the past half century (better techniques, better equipment, more dermatologists per capita and more screenings). Because more and more young people visit dermatologists today (dermatology’s fastest growing procedures are cosmetic, with cosmetic botox injections leading the way. These procedures, of course, are marketed to younger people), it is understandable that dermatologists identify more melanomas. This also explains why – despite the allegation that more young people are getting melanoma, there is not a corresponding increase in the mortality rate from this disease in young people. In fact, in Canadian cancer registries the melanoma incidence and mortality rates are declining for women under age 50.That’s not to say people shouldn’t be vigilant about taking the right precautions. But the profit-driven anti-sun lobby has a track record of bending the numbers to overstate their case. That’s not science. That’s politics.

They Said It:

“Tans acquired at indoor tanning parlors have been studied and have a very poor ability to prevent sunburning.” - The Skin Cancer Foundation, June 2006

Get Real!

Care to get a second opinion? How about 30 million second opinions! A cornerstone of the indoor tanning industry for more than two decades has been the ability of base tans, in proper combination with sunscreen usage outdoors, to protect people from sunburns on sunny vacations. Literally millions of indoor tanners will tell you it works. And it does.Here’s what the sun-scare lobby either fails to understand or won’t admit: Sunscreen, as a product, is designed to prevent sunburn. A base tan essentially multiplies the ability of sunscreen to do its job. It’s all about protecting skin cells, one cell at a time, from overexposure and burning. Because a tan essentially enshrouds skin cells one cell at a time – much like the hard-shell coating of an M&M candy protects the chocolate – sunscreen is better able to do its job.Think about it. An average indoor tanner might begin his or her tanning regimen with a five minute session and, over the course of three to four weeks, gradually work up to 15 to 20 minute sessions under the supervision of a professionally trained tanning operator. That means – after building a base tan – he or she can be exposed to 3-4 times as much sunlight before sunburn develops.And here’s the thing the anti-sun lobby doesn’t tell you: Professional tanning facilities recommend the proper use of sunscreen outdoors in situations where sunburn is a possibility. So the base tan makes the tanner’s skin 3-4 times more resilient, which multiples the effectiveness of the sunscreen he or she applies.That’s a huge difference on a sub-tropical vacation and most likely means the difference between burning and not burning. It’s also the reason why tanning industry research suggests that a higher percentage of indoor tanning clients use sunscreen outdoors than non-tanners, and likely is part of the reason why indoor tanners sunburn outdoors less often than non-tanners.

They Said It:

“Speculative at best.” - Dr. James Spencer, one of the American Academy of Dermatology’s most-quoted anti-sun pundits, in the June 2006 issue of Dermatology Times on research connecting health benefits with sunlight-derived Vitamin D.

Get Real!

One can only speculate how Spencer defines the word speculative. Researchers have known for more than 60 years that many forms of cancer were much less prevalent in sunny parts of the world. Since then, the connection to sunlight and vitamin D has been established, and in the past decade the causative mechanism by which vitamin D plays an important part in cell growth regulation has been well documented. The studies are there, and while further research is needed, calling the connection “speculative” is conspicuously unscientific.Instead of supporting the logical continuation of research on sunlight-induced vitamin D – which has massive positive public health ramifications — the dermatology industry’s lobbying groups have simply denied that the science existed. That’s not science – it’s politics.

They Said It:

“Many sunscreen companies have just teeter-tottered staying in business. It’s not easy getting rich in the sunscreen business.” – Boston University Dermatology Chair Barbara Gilchrest, in a guest lecture at the 13th Workshop on Vitamin D, April 8, 2006 in Victoria, Canada. Gilchrest was refuting the suggestion that sunscreen companies profit from preaching all-out fear of the sun.

Get Real!

Sunscreen companies are enjoying record profits right now. Gilchrest apparently doesn’t read sunscreen companies’ financial statements very closely. For instance:

  • $9 billion pharmaceutical giant Schering-Plough (Coppertone) reported sun-care related sales of $204 million in 2005, up 16 percent from 2004 and up 40 percent from 2003, making the division one of Schering-Plough’s best performers by percentage growth.
  • $50 billion Johnson & Johnson’s consumer products unit – which markets sun care products like Neutrogena and Aveeno, is one of the pharmaceutical giant’s most profitable divisions, with increased sales of $2.36 billion in the first quarter of 2006 alone. Neutrogena’s marketing uses some of the most aggressive sun-scare tactics of any sunscreen company.

Gilchrest and her peers apparently have an antiquated definition of what a sunscreen company is. It isn’t just a beach product anymore. Most women’s cosmetics today include sunscreen in their products – marketing usage and need of the product based on over-hyping fear of the sun. Because of this, most women wear sunscreen 365 days a year in any climate – even when sunburn isn’t a possibility – because the American Academy of Dermatology and sunscreen manufacturers have scared them into over-use of sunscreen. “Sun scare” – teaching total fear of the sun instead of sunburn prevention – is a huge multibillion-dollar business run by even larger multibillion-dollar cosmeceutical corporations.


How Your Skin Tanning

101: How Your Skin Tans and Why It’s Natural

Tanning is the human body’s natural and intended response to ultraviolet light exposure. Throughout human evolution a tan has served as the body’s natural acquired protection against sunburn and overexposure. Today we know that a suntan achieved in a non-burning fashion, combined with proper use of sunscreen outdoors when sunburn is a possibility, is the best way to maximize the potential benefits of regular sun exposure while minimizing the risks that are associated with overexposure.

This section will explain how your skin develops a tan by first introducing ultraviolet light, introducing parts of the skin and then showing how UV light works with the skin to develop a tan.

Part 1: Understanding UV Light

Natural light actually is composed of energy waves that are transmitted 93 million miles from the sun to the Earth. Each energy wave (or light ray) occurs in a different part of a complex light spectrum based on its length in nanometers (nm), which is one-billionth of a meter.

  • Light is energy.
  • Light travels in waves.
  • Different forms of light are differentiated by the length of the waves – the wavelength.

That means that no two types of light are the same. For example, ultraviolet light used in tanning salons cannot possibly be the same as an X-ray because of the difference in the length of their energy waves. Therefore, these two waves will behave and affect the human body in completely different ways.

For our purposes, let’s divide light into three categories: infrared, visible and ultraviolet. Not all light waves reach Earth, however. Many are filtered out by the atmosphere, which protects us from harmful rays. The light waves that tan people are invisible, but let’s briefly look at all three categories for comparison.

Tanning101: Light Rays

Infrared Light: Infrared waves (above 700nm) include electric waves, radio waves, infrared and shortwave infrared, but only this last type reaches the Earth. Shortwave infrared waves, which give us heat, make up about 49 percent of the solar radiation we receive on Earth.

Visible Light: Visible rays (400nm to 700nm) cause illumination we can see as colors, including red, yellow, green, blue and violet. These account for about 46 percent of the Earth’s solar radiation.

Ultraviolet Light: Ultraviolet rays (200 nm to 400 nm) comprise the remaining 4 or 5 percent radiation we receive on Earth. Of all invisible rays—including cosmic rays, gamma rays, X-rays and three forms of ultraviolet light—only two of the ultraviolet light rays actually penetrate the Earth’s atmosphere. These are the same two invisible light rays used in tanning equipment.

Ultraviolet light rays are energy waves that are shorter in length than visible light rays. Because of this, the human eye cannot see ultraviolet light. However, we can see the effects of ultraviolet light, such as tan skin, on the human body. Three categories of ultraviolet light exist:

  • Ultraviolet A. UVA rays are the longest (320nm to 400nm).
  • Ultraviolet B. UVB rays are shorter than UVA rays (290nm to 320nm).
  • Ultraviolet C. UVC rays are the shortest (200nm to 290nm).

Of these three categories of UV rays, only UVA and UVB pass through the Earth’s atmospheric filter. More UVA hits Earth than UVB because the filter prevents the passage of shorter wavelengths of UVB that resemble UVC. If UVC light also passed through, it would have devastating effects on this planet, which is why the depletion of the ozone layer in the atmosphere is of great concern.

UVA and UVB light waves cause skin to tan. As previously mentioned, these same light rays can be replicated in special lamps used in tanning equipment. How they work together to create a suntan is a process we’ll discuss after we introduce the parts of the skin.

Tanning101: Ozone

UV Concentration in Sunlight

The ultraviolet portion of outdoor sunlight is approximately 95 percent UVA and 5 percent UVB, although atmospheric, seasonal and geographic variables change that ratio each time you step outside.

So although UVA is the predominant ultraviolet light ray in sunshine that hits Earth, there is still an important percentage of UVB in sunshine.

Today’s indoor tanning units utilize a carefully controlled mix of both rays to help prevent indoor tanners from burning as easily or as quickly as they could by tanning outside, and also to create cosmetic tans in a controlled environment that minimize the risk of sunburn.

Note that we said that outdoor light is approximately 95 percent UVA and 5 percent UVB. The problem with stating this exactly is that the percentage of UVA and UVB outdoors is always changing. Here is why:

The earth’s ozone layer is an invisible barrier that protects us from many forms of radiation from the sun that would otherwise harm us. The ozone layer is just that – a layer. And, depending upon the angle in which sunlight hits the ozone layer, the ozone can block more or less UVB light.

At noontime, when the sun is highest in the sky, sunlight is hitting the ozone layer at a straight “up and down” angle. If you think of the light waves from the sun as arrows, it is easiest for those arrows to pierce the ozone layer when they are shot from a straight “up and down” angle. So at noontime, the ozone layer is least efficient at stopping the most intense rays, so more UVB light gets through near noon.

In contrast, in the late afternoon, when the sunlight is hitting the ozone layer on an angle, the ozone layer is thicker in relationship to the sun’s angle to your position. Because the layer is thicker, more UVB gets filtered out, so very little UVB hits your location late in the day. In fact, when the sun is on the horizon, virtually no UVB light is getting through the ozone to you at all.

  • At noon, more UVB gets through the ozone layer.
  • At dawn and dusk, virtually no UVB gets through the ozone, and all you receive is UVA light.

The other factor that affects the angle in which sunlight hits the ozone layer above your position is the time of year. In June, for example, the sun is higher in the sky in the Northern Hemisphere than it is in December, when the sun is very low in the sky in the Northern Hemisphere.

  • In December, very little UVB light penetrates the ozone layer in the Northern hemisphere because sunlight is hitting the ozone layer at a low angle, making the ozone more efficient.
  • In June, when the sun is high in the sky, the ozone is less efficient, which means more UVB light penetrates through to your position.

Very few people realize that UVA emissions outdoors are virtually unchanged throughout the year. That is because the ozone layer does not block UVA rays at all.

Why is the ratio of UVA to UVB important? While UVB is the portion of sunlight responsible for natural Vitamin D production in the body, it is also more intense than UVA light. Being more intense, UVB is significantly more effective at causing a sunburn than UVA, which is why noontime sunshine is more intense than sunshine at dawn or dusk.

Tanning101: Skin Layers

Part 2: Understanding Your Skin

Skin is the largest organ in the human body. Weighing roughly nine pounds on the average adult, it protects the body from harmful pollutants found in air, water and other things people come in contact with every day. Skin performs many other functions, too. It helps regulate body temperature, houses sensory receptors that help you feel things and synthesizes various body chemicals necessary for life. That’s why the condition of the skin is so important to good health.

Skin has many sections, but it basically is divided into three layers:

  • The top layer, or epidermis, is the one that produces a tan.
  • The middle layer, or dermis, contains collagen and other elastic materials important to the skin’s strength, and to its ability to fight off infection and repair itself. Blood vessels, nerve fibers and other structures are embedded in this layer.
  • The bottom layer, or subcutaneous tissue, primarily is composed of fat that binds the skin to the body. Subcutaneous tissue serves as the body’s food reserve, insulation and shock absorber.

Skin cells in the epidermis are constantly reproducing and pushing older cells upward to the surface of your skin – an outer mantle of dead skin cells (sometimes called the horny layer) where they are sloughed off in about one month. There are three main types of cells in the epidermis:

  1. Basal cells — the oblong cells that line the base of the germinative layer — are parent cells, giving “birth” to keratinocytes.
  2. Keratinocytes are the “daughter” cells that serve as your skin’s sealant, making up most of your epidermis.
  3. About 5 percent of the skin cells in the epidermis are special cells called melanocytes, which lie on the bottom of the epidermis. Melanocytes are pigment cells that help the skin tan.

Tanning101: Skin Layers 2Melanocytes produce melanin – a protein pigment which performs the very specific body function of protecting skin from overexposure to ultraviolet light. Thus, the presence of melanin in the skin colors it and protects it.

Everyone has roughly the same number of melanocytes in the body—about five million. Your body’s melanocytes naturally will produce a certain amount of melanin based on your heredity, which is why people have different skin colors. For example, the skin of African-Americans contains more melanin, creating a black or brown color, while the skin of Caucasians has less melanin and is pale.

UVA, UVB and the Tanning Process

Melanocytes are prompted to produce additional melanin whenever ultraviolet light waves touch them, thereby making the skin darker to protect the body from additional exposure. This produces a tan—literally, a browning of the skin. The color of the tan ultimately depends on heredity and previous exposure to ultraviolet light, two factors which predetermine the amount of melanin your skin will contain. This explains why some fair-skinned people can get dark tans and others cannot.

Of course, ultraviolet light can affect the skin in other ways. In excessive doses, it can cause sunburn – a reddening caused by the swelling or bursting of tiny blood vessels in the skin. Repeated burning is believed to be the greatest risk factor for long-term skin damage, which is why it is so important to prevent sunburn.

UVA and UVB waves have specific roles in the tanning process which are determined by their effects on skin. Although all ultraviolet light is capable of tanning skin, UVA is more efficient at certain functions in the tanning process and UVB is more efficient at certain parts of tanning. For instance, melanin produced when your skin is exposed to UV light is naturally pinkish in tone. But ultraviolet light also oxidizes the melanin, turning it brown.

  • UVB is more efficient at signaling melanocytes in your skin to begin producing more melanin.
  • UVA is more efficient at oxidizing the melanin your skin has already produced, turning it brown.

Tanning101: Tanning

What Is Skin Damage?

You need to understand that technically, on the micro-level, any ultraviolet light exposure causes “skin damage.” But you also need to know that, on the macro-level, UV exposure is natural and necessary to lead a healthy life and simply calling UV exposure “damage” to your skin is more misleading than it is true.

What is sometimes called “damage” to the skin from non-burning UV exposure is actually just the skin’s way of protecting itself from sunburn. If your body can develop a tan, doing so is natural. It is what your body is designed to do. It is one of the ways your body protects itself.

  • Saying that UV light damages the skin, and therefore you should avoid UV light, is like saying that water causes drowning, and therefore you should avoid water. Just like water, we need UV light to live. So calling UV exposure “damage” is an oversimplification that misrepresents what your body as a whole is designed to do.
  • The sum of research conducted to date indicates that repeated overexposure and sunburning are the primary sun-related factors responsible for an increased risk of permanent skin damage. That’s why the prevention of sunburn and overexposure are so important.

Vitamin D: The Sunshine Vitamin

Vitamin D: One Big Reason We Need Sun Exposure

The ‘Sunshine Vitamin’ is linked to lowering your risk of several forms of cancer and many other diseases.

Exposure to UVB present in sunshine and in most tanning beds is the body’s natural way to produce vitamin D, accounting for 90 percent of vitamin D production.1 Dietary “supplements” are just that: Supplemental ways to produce vitamin D.

What’s more, research has shown that people who utilize indoor tanning equipment that emits UVB – which most tanning equipment does – also produce vitamin D. And studies have also shown that indoor tanning patrons have higher vitamin D blood levels than non-tanners.2

While the North American indoor tanning industry promotes itself as a cosmetic service, one undeniable side-effect of that cosmetic service is vitamin D production. Even though it may not be necessary to develop a tan to produce vitamin D, this should also be considered: There is growing consensus that humans may not be able to get enough vitamin D through dietary supplements alone (especially if recommended vitamin D levels are raised, as is widely anticipated, from 200-600 IU daily to 1,000-2,000 IU) and growing acceptance of moderate sun exposure as the best, cheapest, most widely available and most natural source. (In comparison, an 8-ounce glass of whole milk is fortified with just 100 IU of Vitamin D). Further, because research suggests that the risks associated with sun exposure are most likely related to intermittent sunburns, it is credible to believe that the benefits of regular, moderate non-burning exposure outweigh the easily manageable risks associated with overexposure.

New research has shown that vitamin D deficiency is epidemic in American adults today, suggesting that up to 90 percent of North Americans are vitamin D deficient and that vitamin D deficiency has significant implications on human health.3 Indeed, two world-wide conferences on Vitamin D were convened in 2006 in North America, with universal consensus that Vitamin D deficiency is a real problem. As a result of those conferences, the American Cancer Society and the Canadian Cancer Society – which had both preached sun abstinence for years – both recognized for the first time in May 2006 that some sunlight is necessary for human health.

It is likely that over-usage of sunscreen in climates and seasons when sunburn is not a possibility — sunscreen almost completely prevents vitamin D production — has contributed to this problem. This is especially significant because:

  • A 2006 systematic review of 63 studies on vitamin D status in relation to cancer risk has shown that vitamin D sufficiency may reduce one’s risk of colon, breast and ovarian cancers by up to 50 percent.4
  • Additionally, vitamin D deficiency is a leading cause of osteoporosis, a disease affecting 25 million Americans which leads to 1 million hip and bone fractures every year.3 In elderly individuals, such fractures are often deadly. Encouraging everyone to wear sunscreen all year long in any climate undoubtedly is contributing to this problem, as vitamin D is necessary for the body to properly process calcium.
  • Vitamin D deficiency most likely plays a role in the development of muscular sclerosis, according to the Calgary based charity Direct-MS. (You can learn more about this by visiting www.direct-ms.org.
  • Vitamin D deficiency is also believed to be linked to an increased risk of prostate cancer and even heart disease.

Four additional resources for more information and research on vitamin D are:

Additionally, a new Canadian Group, the Vitamin D Society, has been launched in 2006 to educate Canadians about Vitamin D deficiency and fund new Vitamin D research. Its web site is www.vitaminDsociety.org.

“Current research indicates vitamin D deficiency plays a role in causing 17 varieties of cancer, heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects and periodontal disease,” the Vitamin D Council writes on its web site. “This does not mean that vitamin D is the only cause of these diseases, or that you will not get them if you take vitamin D. What it does mean is that vitamin D, and the many ways in which it affects a person’s health, can no longer be overlooked by the healthcare industry nor by individuals striving to maintain, or achieve, a greater state of health.”

While public health officials have floundered at how to craft a message that recognizes the both the benefits of sunlight and the risks of overexposure, the professional indoor tanning industry has for more than a decade promoted a balanced message about sunlight. The tanning industry’s core belief: Moderate tanning, for individuals who can develop a tan, is the smartest way to maximize the potential benefits of sun exposure while minimizing the potential risks associated with either too much or too little sunlight.

Sunburn prevention — not sun avoidance — is the key.

1Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers and cardiovascular disease. Am J Clin Nutr. 2004: 80(6 Suppl); 1678S-1688S
2Vin Tangpricha, Adrian Turner, Catherine Spina, Sheila Decastro, Tai C Chen and Michael F Holick. Tanning is associated with optimal Vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density. Am J Clin Nutr 2004; 80:1645-9.
3Holick MF. High Prevalence of Vitamin D Inadequacy and Implications for Health. Mayo Clinic Proceedings. March 2006; 81(3): 353-373.
4Garland CF, Garland FC, Gorham ED, Lipkin M, Newmark H, Mohr SB, Holick MF. The Role of Vitamin D in Cancer Prevention. Am J Pub Health. 2006, Vol. 96 No. 2; 9-18.

Hundreds of additional research references can be found in these four papers.


The Skin Cancer Cover-up

Every summer we're warned that the sun can kill. In fact, most sun-provoked lesions are benign, and not really cancers

at all. A clinical scientist writes.

by Professor Sam Shuster

Mankind and the sun have successfully maintained their unequal partnership for some considerable time.

We owe our existence to it, and Darwinian genetic and social evolution long ago taught us how to cope

with the quiddities of that existence and turn them to our advantage. For example, our bodies have

developed the ability to use the sun for the production of vitamin D essential for our bones, and certain

immune functions. That ability is passed on by the safe hand of genetic evolution, which is not subject to

the vagaries of its social counterpart.

Unfortunately our attitude to sun and ultra-violet (UV) light is subject to much perverse and dubious

technical 'advice', which society has passively accepted without questioning its provenance. Whatever the

subject, there is always a guru: there must be experts on the best way to tie shoelaces. To test this assertion

I asked Google, and found 16,500 sites purporting to give the best way to tie shoelaces! The problem is that

there are now so many gurus on the dangers of sunshine that their shadow is obliterating the sun and our

long-learnt understanding of how to live with it.

What is skin cancer?

We are told that we must severely limit our exposure to the sun and suntan lamps. If we must take a holiday

where there is an opportunity to savour the delights of sunshine we should avoid it as much as possible.

The middle of the day should be considered dead time to be spent in the shade outdoors or indoors reading

improving books. We should wear wide-brimmed hats, long-sleeved shirts or blouses, and cover legs, and

we must not forget to cover ourselves with expensive, properly ranked, sun-protective creams and lotions.

As for the children: on the few precious occasions when the clouds of a British summer evaporate, we must

not allow them out of doors before slapping on sticky sunscreens, bullying them into sweaty hats and

clothes made with high sun-protective fabrics. The reasons given for this punitive catalogue of 'don'ts' is

that sun exposure ages the skin, and causes cancer. Yet most things we do have risks: what matters is the

consequence of that risk, which depends upon the frequency and duration of exposure. Both have been

grossly exaggerated for UV and its effect on the skin.

The rejuvenation of ageing skin is a money-spinner. There is no doubt whatsoever that exposure to UV

irradiation, particularly by UVB (the shorter wavelength that causes sunburn, but doesn't travel through

window glass), gives skin a weather-beaten look, as does smoking. How long this takes and its severity

depends on the dose of sun (or smoking) and your genetically determined response to it. The causal damage

is to skin collagen, but this is only partly understood. We know that UV promotes molecular cross-links

between collagen fibres, making them less elastic, but we do not really know the consequences of this

process. While many believe that the weather-beaten 'Marlborough Man' look justifies giving up smoking,

sun exposure is different because, as we shall see later, there are trade-off benefits with other bodily

functions. However, this particular sun and smoking effect has nothing to do with the ageing process.

The fundamental defect of skin ageing is loss of collagen, the skin's main constituent, which is why ageing

skin thins. The loss is one per cent a year throughout adult life and is equal in men and women. The reason

female skin appears to age faster than male is that women have less skin collagen. This unfair difference is

equivalent to 15 years of ageing! The loss of collagen with age is genetic; it has absolutely nothing to do

with UV irradiation and occurs equally in skin that has spent its life covered or exposed. And, contrary to

the advertising blurb for anti-ageing creams - which simply irritate the skin producing inflammation that

swells the skin and conceals the wrinkles - nothing is known that reverses this loss of collagen. Ageing of

the skin is not due to UV and it cannot be overcome by the products of the cosmetic industry.

Skin cancer is the big scare; it is the main plank of the warnings that have come from government bodies.

The case that is made is that skin cancer is the commonest of all cancers and its increasing incidence is

casually associated with solar irradiation. These facts are correct but they have been mischievously

interpreted to scare us into self-inspection, attendance at special skin clinics and a masochistic, oppressive

and totally unnecessary, regimen of prophylaxis. Indeed, the very word 'cancer' is being deliberately used to

create fear and coerce a public acceptance of these measures. Yet the key fact is that about 95 per cent of

skin cancers are basal or squamous cell epitheliomas (in a ratio of about five to one) and although they are

called 'cancers' they are functionally benign; they do not spread from the skin and kill. Most are just a

centimetre in size; local excision is 95-99 per cent successful; residual microscopic pieces of tumour

disappear by themselves and the few recurrences are easily removed. The exceptions are rare and often the

consequence of some other diseases.

So while 'skin cancer' is certainly the commonest cancer, the more honest statistic is that skin cancer is the

least dangerous cancer; it lies at the very bottom of the mortality table.

So the problem of 'skin cancer' shrivels as soon as you start to examine it, because the vast majority of

these lesions are benign. The problem is technical: these benign epitheliomas are classified as cancers from

a particular appearance under the microscope, not from their behaviour. The public, for whom the word

cancer creates fear, does not understand this. While it may be technically correct to say that skin 'cancer' is

related to sun exposure, this is meaningless, because these sun-provoked lesions are not really cancers: they

are just small, local, slow-growing and above all benign. These trivial benign lesions cannot possibly

justify the aggressive hue and cry about avoidance of UV exposure.

The misunderstanding has been inappropriately talked up by the Australian experience. The high incidence

of skin cancer in Australia is the product of a high UV exposure in a population whose ancestors included

many with pale, freckled skin and red hair. It should not be extrapolated to different populations living in

sun-deprived climates.

But if 'skin cancer' is the bait, melanoma is the hook. Melanoma is the least common of the three skin

cancers. There is an alleged increase in its incidence and this is blamed on UV. People have been terrified

into inspecting their skin regularly, even though it is of doubtful value. Most of us have simple moles and

even more have seborrhoeic warts, which enlarge, get darker, itch and bleed in the same way as

melanomas. Dermatological clinics are overfilled with patients worried about these totally innocent spots.

Malignant melanomas are not found often enough to justify the hoo-ha about early screening and there is

no good evidence that screening saves lives.

Changing diagnosis

We need to have definite answers to two questions: is the increase in melanoma real, and what is its

relationship to UV? Sadly, the answer to both questions is uncertain.

Certainly, there has been a big increase in reports of melanoma; the problem is that what is now being

called melanoma may be nothing of the sort: it seems to be due to a reclassification of what constitutes

malignancy. The diagnosis of malignancy in a melanoma is subjective; it's in the eye of the histopathologist

looking down a microscope. In the past it was commonplace for histologists to report borderline, minimal

or dubiously suspicious histological appearances of moles. Experience of outcome of these cases taught us

that it was not alarming; we did nothing and nothing untoward happened to the patients.

Later, as compensation claims began to dictate a more defensive practice, this led to the very same lesions

being labelled suspicious, without the qualification of dubious. The process moved on, and it didn't take

long before brown spots previously labelled benign acquired a new label indicating the possibility of early

malignant change. In time this moved on again to probability and finally to certainty. The moles have not

changed but the diagnosis has.

Having seen the process evolve, I have no doubt that the re-labelling of benign lesions as malignant is a

major, if not the main cause of the increased incidence of reported malignant melanoma. I had confirmation

of this from well-known clinicians who had observed the same development in other countries. But an idea

is nothing without testing, and to put it to the test I proposed to send copies of the histology slides of moles

that were labelled benign years ago, from patients found by follow-up not to have had a malignant

melanoma, to a panel of histopathologists for their diagnosis by today's criteria. No laboratory would agree

to take part in the study; although they agreed with its design they appeared fearful of its outcome.

Support for this thesis comes from a variety of sources. The most important is that while the incidence of

melanoma has increased it has not been accompanied by a corresponding change in mortality. In the UK

the annual number of melanomas in women increased by 250 per cent between 1980 and 2002, but

mortality increased by just under 30 per cent and is decreasing. The reason for the apparent improvement is

not that we have more effective therapy, but that the number of cancers has been swollen by the new wave

melanomas. These have a cure rate of 100 per cent because they were never malignant in the first place;

they are paper malignancies, benign moles reclassified!

There are other explanations for the diagnostic confusion: for example, it is possible that UV, which is

known to increase the number of moles, also induces changes that lead to them being classified as atypical,

the jargon name for the features on which the histological diagnosis of malignancy may be based. It has

been found that death from melanoma is lower in the higher social classes. Does this mean that the genetic

defect that causes the cancer is class-related? This is obvious nonsense; the more likely reason is that the

middle classes always turn up first and flock to the clinics with their benign moles which they have been

frightened into having removed, and some of these are labelled malignant when in practice they are really

benign. Until we have better diagnostic criteria it is impossible to determine if the reported increase of

malignant melanoma is genuine. The case for an increase in the prevalence of truly malignant melanoma

remains unproven.

The role of UV

Even more doubtful is the role of UV as a causal agent. The evidence is fragile and certainly does not

justify the present anti-solar terror campaign. What we might expect if UV really caused melanomas is

illustrated by the skin epitheliomas. These cancers are caused by UV. They can be easily induced by UV in

laboratory animals, and in the case of epitheliomas there is an excellent correlation between their

prevalence in patients, the latitude at which they live and between the site at which they occur and areas of

the body exposed to UV.

None of this is true of melanomas. Melanomas are difficult to produce experimentally, the correlation with

the latitude at which the patients live is marginal, and their site of occurrence does not correspond to the

intensity of its UV exposure. They are commonest on the trunk of men, the legs of women, and the soles of

the feet of Africans, a phenomenon not to be explained by exposure to the sun's rays. Their reported

increase has been much less than the UV-related skin cancers and, unlike epitheliomas, there is no evidence

that sun screens prevent them from occurring.

The problem with melanoma, as with many other branches of contemporary clinical research, is that it is

based on circumstantial evidence obtained from epidemiological studies rather than an understanding of the

pathology. Melanoma is an illustration of the muddle introduced by uncritical acceptance of epidemiology

with its almost random generation of unhelpful numbers. A preoccupation with epidemiology has distracted

us from the essential biology. For example, we still need to establish the melanoma's cell of origin. Many

think it starts in the pigment cell, the melanocyte, but it may start in the 'naevus' cell of the ordinary 'mole'.

Establishing this is vital to our understanding because we know the distribution of moles but not naevus

cells over the skin surface, let alone what makes them go malignant. It is well established that UV damage

to DNA can produce cancer; but the only sensible conclusion from all the studies to date has to be that

while this effect plays a major role in producing epitheliomas, at worst it can only be marginal for


The evidence on the effect of UV on the skin is surprisingly clear: it has no effect on skin ageing, which is

due to thinning of the skin and loss of collagen, although UV does give the same weather-beaten

appearance that is caused by smoking. While UV is the main cause of epitheliomatous skin cancers, which

are functionally benign, there is no hard evidence that UV is the principal cause of malignant melanomas.

Nature's own sunblock

What then should we do about UV exposure and sunscreens? The short answer is that in moderate climates

like the UK, apart from avoiding sunburn and staring at the sun, it doesn't matter what we do, because the

risk of exposure is trivial. Of course, children have to learn how much sun they can take without burning,

and their parents need to ensure they get a gradual UV exposure in order to achieve a protective tan (that is

more important in children with ginger hair and freckles, most of whom will need to take care not to burn

throughout adult life). In the UK, there is no point in trying to minimise sun exposure to avoid skin cancer

because our sun is usually too weak to be a danger. Although sunscreens will reduce epithelioma formation

they have not been shown to prevent melanomas. The use of a sun blocker in countries such as the UK

could be harmful, by impairing Vitamin D synthesis in the skin, causing a risk of osteoporosis.

We still have a lot to learn about what may be the silent benefits of sun exposure. We do not know the

significance and purpose of the profound changes in immune mechanisms, the extraordinary improvement

in mood and the alleged decreased risk in bowel and prostatic cancer experienced after sun exposure. We

may do more harm avoiding these advantages than anything we might gain from the uncertain benefits of

sun avoidance.

But not all of the sun's benefits are uncertain, particularly the protective effect of a suntan. Since there is

some epidemiological evidence to suggest that sunburn in children may be more harmful later in life,

parents have been told that sun exposure must be avoided in childhood. However, if you take a close look

at people who were sunburnt as children, you will see areas of white skin that doesn't tan because the

pigment cells have been lost by the sunburning. Such skin will always be oversensitive to sun. It is evident

that the original sunburn, and subsequent damage, would have been less had there already been a protective


Excessive avoidance and UV screening is a danger because it does not allow a tan, nature's own sun block,

to develop and as a result exposure is likely to cause sun-burn. The dogma, now fossilised in print, is that

any tan is a sign of skin damage. Tell that to Darwin. Pigmented melanocytes in the skin are a system that

protects it from excessive UV, which evolved long before the advent of sunscreens. Even if there was hard

evidence that melanoma was UV-induced it would be all the more important to keep a protective tan.

It must now be evident that the effect of the sun on the skin is in desperate need of illumination, and that

the prophylactic message, particularly on melanoma, is unreliable. By presenting the fragility of the case

against the dangers of UV I hope I will provoke consideration of real cause of melanoma.

Sam Shuster is Emeritus Professor of Dermatology at the University of Newcastle Upon Tyne, and

Honorary Consultant to the Department of Dermatology, Norfolk and Norwich University Hospital. This is

an edited version of a chapter in “Panic Nation? Unpicking the myths we're told about food and health”

edited by Stanley Feldman and Vincent Marks. This excerpt appears on www.spiked-online.com. Buy this

book from www.amazon.com.