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The problem with tanning (and the myth of the base tan)

April 12, 2017

About the Author

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio
View all posts by Robert H. Shmerling, MD


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Randy Green
May 1, 2017

Sensible sun exposure has numerous benefits besides vitamin D, a lot of them listed by Marc Sorenson, above. Even a cursory survey of scientific papers shows these benefits.

Vitamin D has been produced by animals almost since they first evolved – there are almost no natural sources of D in natural food, except for livers of some fish, seals, polar bears, etc. In edible plants, D sources are limited mainly to sun-exposed live mushrooms.

So people cannot get the necessary levels of D through their foods unless the foods are supplemented, like in milk, or through nutritional supplements. From an evolutionary biology standpoint (I’m a biologist), doesn’t this seem suspicious?

As Marc stated above, there are many other benefits to sensible sun exposure besides just vitamin D: for example lower blood pressure due to increased nitric oxide and mitigation of the renin/angiotensin pathway.

Plus, correlational data (yes, correlation is not causation) shows that certain diseases like multiple sclerosis, heart disease and many common cancers are inversely correlated with latitude: these diseases are more prevalent the higher in latitude one lives (the further you get from the equator). Many studies show that the increased risk of skin cancer from sensible sun exposure is far less than the decreased risk of other internal cancers and heart disease.

There is also the issue of some sunscreens possibly aiding in cancer formation and other illnesses. Go back and look at the last 60 years of sunscreens that were determined to have health issues that have been discontinued (remember PABA?).

While one should certainly not overdo their exposure, especially if you have certain fair skin types, some sun is absolutely necessary for decent health. Our ancestors did just fine for millions of years, otherwise we wouldn’t be here!

Should we avoid fresh air because oxygen is a component in the production of damaging free-radicals? Is it possible that other things in our diet or environment are interacting with excessive sun exposure to produce increased skin tumors?

We’ve become a generation of heliophobic troglodytes (sun-fearing cave dwellers). Time to re-examine this topic more objectively.

May 2, 2017

Thank you, Randy Green, for your great comment that lists many of the
arguments for (moderate, sensible, gradual …) sun exposure.
Dr. Shmerling’s blog reflects the still prevailing view of most dermatologists who disregard stubbornly the scientific findings of the
past ten to fifteen years that support reasonable (skin-type and location-
specific) sun exposure such as can be found in the work of Profs. Holick,
Vieth, Garland et al. Of course, much depends on the skin type: if you are
type 1 stay out of the sun and cover up. If you are skin type 2-3 take it easy
and build up a tan slowly and enjoy your sunbath (still “in moderation”).
Beyond skin type 3 the precautions and rules barely apply even though
a dark-skinned person may get skin cancer once in a blue moon.
Which leads us to another hardly ever mentioned aspect of this controversial discussion: The (IMO ill-advised) opinions and warnings
by the Dermatology establishment apply mainly/almost exclusively to
“fair”-skinned populations, it is a problem of “white” people that live in or
came from Northern latitudes. The great majority of the world population
does not experience the skin cancer problem (“epidemic”?) of Caucasians because their skin is brown or black …pre-tanned by Nature.
Skin cancer is rampant among the (white) immigrant population of
Australia, but certainly not among Aborigines. There seems to be a certain rather narrow (racially prejudiced?) view of the “tanning problem”.
Tanned skin is desirable in many but certainly not all cultures. Where I live,
in Hawaii, it is a natural result of our environment (unless you hide from the sun and heed Dr. Shmerling’s advice, which results in Vitamin D deficiency as in the majority of Hawaii residents – rather ridiculous !).
I like to blend in with the rest of the totally mixed Hawaiian population
that shows all healthy skin pigmentation shades from white to black.
Ola La (Hawaiian for “Health from the Sun”)

mike gudman
May 2, 2017

Sunburns will give you skin cancer guaranteed, and the dead from it is fast and very painful. So go and catch some sun you idiots. You will look good in your casket.

April 15, 2017

To tan or not to tan that is the question. The author obviously thinks not. Not all end up with a leather hide maybe the people that overdo it. Why not present the facts (instead of inserting your opinion) and let the reader decide how they look “best”.

June Ross
April 14, 2017

Ten years ago, I developed agonising muscle pain and myriad other symptoms. In those days, GP’s didn’t consider vitamin d deficiency. So, I did my own research, started myself and my husband on 10 k D3 daily for six weeks, at which point we got our levels checked. It was the month of June. They were just about within normal levels, so we used a maintenance dose from thereon in. What we noticed then, and every year since, is that, if we maintain our levels, and start exposing skin from the earliest possible sunshine, we never burn (my husband has fair skin, freckles and used to have ginger hair!). It seems that, if one has enough D3, it acts as a protection against burning. I also discovered this fifty years ago when I lived in Spain for a year as an 18 year old, and built up a tan gradually from the earliest sunny weather. I never burnt at the height of summer. There was no sun screen in those days!

Marc Sorenson
April 13, 2017

Do you realize that sun deprivation has been shown, in a recent study, to lead to the death of 330,000 people per year? Did you also realize that women who use sunbeds over a -year period have a 23% reduced risk of all-cause mortality? It would be wise to know all the facts before printing anti-tanning articles. Here are a few well-documented facts regarding sun exposure:
•A 20-year Swedish study shows that sun avoidance is as bad for the health as cigarette smoking.
•A Spanish study shows that women who seek the sun have one-eleventh the hip-fracture risk as those who avoid sun.
•Men who work outdoors have half the risk of melanoma as those who work indoors.
•Women who avoid the sun have 10-times the risk of breast cancer as those who embrace the sun.
•Women who sunbathe regularly have half the risk of death during a 20-year period compared to those who stay indoors.
•Sun exposure increases nitric oxide production, which leads to a decrease in heart attack risk.
•Vitamin D, the sunshine vitamin, is essential to human survival, and sun exposure is the only natural way to obtain it
•Sun exposure dramatically improves mood through the production of serotonin and endorphin.
• Sun exposure increases the production of BDNF, which is vital to human health.
Sunscreen reduces all of these healthful effects by preventing sun exposure. Think about it!
For references and articles,

May 1, 2017

Moderation, as with all things, is the keyword here. You are speaking of extremes on both sides of the issue. You need food to survive, but too much can be unhealthy and the same can be said for sunlight.

People in the tanning bed industry have a particularly big dog in this issue, so their information will be suspect from the beginning. Common sense should prevail.

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