Illustration: Colleen Smith
August 2004 | Feature
Burning To Be Beautiful
Despite warnings about skin cancer, Californians are flocking to tanning salons. Should the risks outweigh our golden-skinned aesthetic and other health benefits of the sun?
by Karen Deger McChesney
It’s four o’clock in the afternoon and Dr. Anita Pakula reaches for a tube of sunscreen. Her 19-month-old daughter knows exactly what comes next—within seconds, toddler Sydney has donned a big white floppy hat and a pair of sunglasses. Pakula slathers her own skin and Sydney’s with sunscreen, then takes Sydney’s hand and leads her outside.
“We’re not going to the beach,” laughs Pakula. “We’re just walking to the mailbox.”
The daily ritual comes naturally to Pakula who spends her days working as a dermatologist and teaching student dermatologists. Pakula subscribes to the message health officials have long been trying to get the public to listen to about sun exposure.
“Sydney and I may be outside for only five minutes, but sometimes that’s all it takes for the sun to damage your skin,” explains the doctor.
Many experts say Pakula and the American Academy of Dermatologists (AAD) are blowing sunshine out of proportion and not tuning in to the latest research. No ifs, ands or buts in Pakula’s mind. “There is no such thing as a healthy tan or sitting in the sun to feel good,” she insists.
Not necessarily, counters Dr. Michael Holick author of the controversial, hot-off-the-press book, The UV Advantage (Ibooks, 2004), who has come under tremendous scrutiny from the medical community for saying that it is beneficial for everyone to spend a few minutes in the sun a couple days a week without sunscreen.
Holick, director of the Bone Healthcare Clinic at Boston Medical Center, told NBC recently, “Sunlight is necessary for human survival,” referring to 30 years of research and the publication of articles in such prestigious journals as The Lancet and The New England Journal of Medicine that demonstrate sunlight plays a critical role in our bodies’ vitamin D production. According to Holick, vitamin D deficiency is a major unrecognized health problem in our country, affecting at least 25 percent of adolescents and adults.
In the first chapter of his book, Holick gives a historical perspective on sunlight. He writes: “Medical practitioners reported the benefits of sun exposure on heart health 6,000 years [ago]. Humans have depended on sunlight to sustain life and health since our ancestors slithered out of the primordial ooze.”
Sunshine equals vitamin D
The debate over how much sunshine we need is complicated by the many uncertainties about vitamin D. Public health officials from the National Institutes of Health met last fall to review evidence suggesting that certain groups of Americans don’t get enough vitamin D in their diets and to review health strategies to remedy the problem. Experts recommended brief exposure to sunlight, because radiation helps the body manufacture vitamin D.
Holick takes this further: “Suffice it to say that in some respected medical circles, sunlight is being described as a ‘wonder drug.’ It can provide ‘immunity’ against the most devastating diseases around, including heart attack, stroke, osteoporosis and certain of the most deadly internal cancers.”
In the past, dermatologists referred to the sun’s two types of UV rays as UVA, long and for aging, and UVB, short and for burning. But, the more scientists study UVA and B, the more complex the findings.
The precise wavelengths of UV that contribute to the formation of skin cancer still need to be sorted out. Add location, and the sun’s rays can penetrate even more intensely. The Skin Cancer Foundation cautions that water, sand, snow and even concrete can reflect up to 90 percent of the sun’s rays at upwards and sideways angles, adding to the total exposure.
“You need to be more careful in an environment where there is reflective sun as well as direct, such as water and snow,” cautions Dr. Tara Levy, naturopathic doctor and chair of public affairs for the California Association of Naturopathic Physicians. “Also, people should be careful about their ‘winter vacation’ when they suddenly increase their sun exposure dramatically.”
Burned baby boomer looks back
She was a blond-haired, blue-eyed, fair-skinned teenager with a lot of moles on her body. Like most baby boomers, she poured on baby oil and baked her body in the sun, never knowing what could happen 20 years later.
“When you grow up near the beach in Southern California, you just don’t use sunscreen,” reveals the 51-year-old melanoma survivor who asked that her name not be used. “When I was a teenager, there was still a perception that a little sunburn was a good thing.”
“I wish I knew then that the sun would have an adverse effect on my moles,” she says. Instead, she found out by accident when she was “a very busy mother” in her late 30s. “I took my daughter to a dermatologist for acne, and he asked me if I’d ever had my skin checked. In the back of mind, I had always thought about it because of my moles and fair skin… but he stopped me in my tracks.”
She was diagnosed as having basal cell skin cancer, the most common type of skin cancer, which first appears as a hard, raised or red lesion most often on the head or the neck. She began having skin checks every three months, and over the next 10 years, she had “tons of moles removed.”
A breaking study published in the journal Cancer Research showed that individual risk of melanoma is associated with the intensity of sunlight that a person receives over a lifetime and is greatest for people who develop little or no tan. In this study, the authors learned that where people live as both kids and adults and the amount of UVB exposure in those places are important factors, regardless of tanning ability.
Indoor vs. outdoor sun
It’s a Friday night and Jeff Nedelman is talking to customers at an indoor tanning salon. He is the spokesperson for the Indoor Tanning Association (ITA), and part of his job is surveying customers to find out why they go to salons.
Salons provide a controlled environment where people can monitor the dose of UV light in which they are exposed. ITA promotes the use of indoor salons for getting a “base tan,” according to Nedelman.
Indoor tanning is big business in sun-worshipping California. The state serves an estimated 1.5 million customers each year, according to ITA.
“I am not a fan of indoor tanning,” rejoins Dr. Levy. “I believe that there may be other rays emitted from the tubes besides the full-spectrum light, which may be harmful.” She continues, “If you absolutely have to have a base tan, then do it outside.”
Sunshine was the main reason that Levy ended up in California. “After five years in Seattle, I was seriously craving sunlight,” explains the mother of two.
“Also, living in a state with natural sunshine most of the year, I find that being outdoors is the best way to get the benefits of sun. Besides the sunlight, there is nature to interact with and fresh air to breathe!”
She prescribes sunshine to patients and makes sure her children get outside daily. “My youngest son goes to a preschool where they go outside every day, no matter the weather,” she says.
When taking her children to the beach this summer, Levy has been experimenting with a “UV material” that her children wear. “I recently bought my son an SPF 50 sunsuit for sunny days at the beach so I don’t have to slather him with sunscreen every hour,” Levy says. “I don’t have any experience with this fabric yet, but I am excited about an alternative to sunscreen for those longs days in the sun.”
Levy tells her patients to use natural sunscreens with an active ingredient such as titanium dioxide or zinc oxide. “Other chemicals in sunscreen are absorbed into the body and have unknown effects systemically, so I prefer not to use them,” she explains.
Recent research shows that green tea, a featured ingredient in many natural sun-protection products, is also an effective sunscreen. Lab results confirm that green tea’s ingredients actually protect the skin from sun damage and skin cancer.
Don’t bake or burn
As sun research unfolds, so does a simple new message: “Don’t bake or burn,” said Neil Walker, M.D., chair of Britain’s Skin Cancer Prevention Coalition, in the British journal Medical News.
The sun will always be up there waiting for you—and so will all the news reports. The key to sun exposure is finding a middle ground, says The Harvard Health Letter, “between being a ‘solar phobic’ person and a ‘sun-worshiper.’”
Still confused? Perhaps this quote will shed some light on sun exposure: “Indians and animals know better how to live than white man; nobody can be in good health if he does not have all the time fresh air, sunshine and good water.” (Flying Hawk, Oglala Sioux, 19th-20th Century)
Karen Deger McChesney is a freelance writer who specializes in writing about health, medical and lifestyle issues. She now sports a big white floppy hat every time she goes outside.
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