CONNECTIONS to HEALTH

It's that time of year to rush out and get a tan! According to Oliver Gillie, who has written a brilliant report called Sunlight robbery (there's a link to the full article below) outlining why we all need a tan and not to be shy about going out in the sun without our hats, sunscreens and 'T' shirts. According to Oliver we are literally being robbed of our ability to produce sufficient vitamin D to sustain health. I hope like us you all took advantage of the recent wonderful weather and were outside as much as you were able. It was great; we had a refreshing week in Belgium. The sun shone all week, not too hot, we still needed our fleeces but we could expose our faces and hands to the therapeutic effects of the sun and we did (was this enough?-more later!). We returned looking healthier and feeling great. I can hear a lot of you saying but you should have taken more care, worn a sunscreen, hat and been indoors at midday, but I am afraid to say this is out of date information that the government has been telling us backed by various cancer charities and other organisations. The government policy cautions the public to avoid exposure to the sun while making no concessions to the health benefits of sunlight. In fact any benefit derived by this policy in the prevention of skin cancer is greatly outweighed by the disease deficits incurred by the loss of vitamin D. People enjoy sunbathing. It is the natural, healthy way to obtain vitamin D. Sunlight costs nothing and has very great health benefits but sadly in the UK we get too little of it. Oliver's report shows sufficient vitamin D for optimum health cannot generally be obtained in the UK simply from casual exposure to the sun. Planned exposure, including sunbathing and wearing clothing that exposes the skin, is necessary in the UK and Northern Europe to provide optimum levels of vitamin D. Disease caused by vitamin D deficiency and exacerbated by present UK sunlight policy is much greater than was imagined when the policy was first devised 10 years ago. Let's take a look at vitamin D Vitamin D may be obtained in small amounts from the diet. Margarine, butter, some breakfast cereals, liver and other meats and eggs provide small amounts of vitamin D. Oily fish (including herring, mackerel, sardines, salmon, trout, fresh but not tinned tuna) provide more substantial amounts but are eaten by a minority of people. Sunlight is the most important source of vitamin D, providing around 90% of the supply for most people in the UK. It is the action of the suns UVB rays on lipids (fats) on the skin that produces the body's pre-vitamin D. It has been discovered over the last ten years that vitamin D is not only made in the kidney (from pre-vitamin D synthesised by sunlight in the skin) but in some 30 other tissues of the body and that vitamin D plays an important role in the differentiation of cells and tissues. Vitamin D is a fat-soluble vitamin which acts like a hormone, regulating the formation of bone and the absorption of calcium and phosphorus from the intestine. It helps to control the movement of calcium between bone and blood, and vice versa. Vitamin D influences differentiation and maturation of cells, triggers cell death (apoptosis), and switches genes on and off. It alters growth signals to cells, inhibits growth of blood vessels which is an important part of tumour formation, and has a modulating activity on the immune system. Accumulating evidence now suggests that vitamin D deficiency increases the risk of many chronic diseases including 16 different cancers, several nervous system diseases including schizophrenia and multiple sclerosis, diabetes types 1 and 2, as well as being a contributory cause of heart disease, raised blood pressure (hypertension), inflammatory bowel diseases, polycystic ovary disease, menstrual problems and infertility, infections and dental decay. The cancers that have an increased risk as a result of vitamin D deficiency include some of the most common types: cancers of the breast, bowel, ovary, and prostate. The cost of diseases caused by vitamin D deficiency has been estimated to be $50 billion per year in the United States and must be of the order of billions of pounds per year in the UK. According to government figures, falls and fractures alone cost some £2 billion per year in the UK. Scientific trials have shown that a substantial proportion of these falls and fractures can be prevented by vitamin D and calcium supplements. Diabetes costs £1.7 billion a year in the UK (official figures) and a substantial part of this could be saved if blood levels of vitamin D in the population were higher. The cost of other diseases such as cancer, heart disease, hypertension and schizophrenia must also run into billions per disease per year and a substantial number of people might be prevented from getting each of these diseases if vitamin D levels in the population were improved. Levels of Vitamin D Most children in the UK have less than optimum levels of vitamin D in both summer and winter. In winter, one third to a half of children have insufficient vitamin D for long term health. In summer the amounts of vitamin D increase, but not enough to provide for the autumn and winter. Elderly people in the UK have been found to have levels that are insufficient for good health in winter and summer and are associated with osteomalacia (softening of the bones), muscle weakness, and a tendency to fall which inevitably causes bone fractures. In summary these figures show that most people in the UK have inadequate levels of vitamin D all year round. The average summer levels are in the 'hypovitaminosis D range' which means that the level is not high enough to ensure an adequate level during the following winter. This is borne out by the winter figures which show that the majority of people of all ages in Europe, and particularly in the UK, are at risk of serious vitamin D deficiency in winter. Deficiency of vitamin D may be prevented in the population at large by taking supplements, especially in winter. However absorption of vitamin D, which is fat soluble, is not always efficient. In particular, old people and people who suffer from inflammatory bowel disease, which itself is caused in part by vitamin D deficiency, may have trouble absorbing D supplements. Sunlight, on the other hand, is free, enjoyable and widely available. Even though the sun cannot always be relied upon in the UK climate it is the natural source of vitamin D. Vitamin D has a half life in the body of about six weeks and so high levels must be achieved in summer to provide levels in the body which remain sufficient at the end of winter. How much exposure is healthy? Excessive exposure to the sun may cause sunburn, skin aging, and skin cancer. Melanoma skin cancer causes some 1,750 deaths a year in the UK but the cause of melanoma is not clear and it is possible that less than half of these deaths may be attributed to sun exposure. Regular exposure to the sun seems to protect against melanoma while irregular exposure increases risk. It is more prevalent among city and office workers than among people who work out-of-doors and is thought to be linked to brief, intense periods of sun exposure such as one might get on annual holidays on sunny beaches and a history of severe sunburn in childhood or adolescence. This is probably because vitamin D protects against melanoma while excessive exposure to the sun causing sunburn may induce melanoma. A reduction in exposure to sunlight in the UK, as recommended by the government, might actually increase the incidence of melanoma rather than reduce it. Melanoma may occur on parts of the body such as the soles of the feet that are seldom exposed to the sun. Other types of skin cancer which are directly caused by excessive exposure to sunlight are very common. However they can generally be treated relatively easily and cause a few hundred deaths a year. UK sunlight policy has been largely determined by dermatologists who bear the onerous task of treating skin cancer. Doctors concerned with the problems of osteoporosis and other bone disease do not appear to have been consulted despite an obvious interest. Now that vitamin D deficiency is known to be associated with a wide spectrum of disease there is a need for a new national sunlight policy that recognises the positive aspects of sunlight. The UK's skin cancer awareness campaign, SunSmart, originated in Australia which has a much sunnier and hotter climate and an incidence of skin cancer about six times that of the UK. SunSmart advises the public to cover up, seek the shade, and wear sunscreen. It fails to provide any advice suggesting that people should sunbathe in order to obtain vitamin D. Anyone following the SunSmart advice in the UK risks becoming deficient in vitamin D. The SunSmart programme has made extensive use of the slogan: 'There is no such thing as a healthy tan'. In fact there is no scientific basis for condemning tanning which is a natural side effect of sun exposure. Scientific evidence suggests that a deep tan actually protects against melanoma, although very rapid tanning on holiday in fierce sun conditions may not be wise because of the risk of burning. Nevertheless the public recognition of a tan as a sign of good health is almost certainly well founded. How much of the body needs to be exposed to the sun and for how long in the British Isles to obtain optimum levels of vitamin D? Occasional exposure of the hands and face to sunlight is widely believed to provide sufficient vitamin D for good health. This view is repeated in the UK National Radiological Protection Board's report on Health Effects of Ultra-violet Radiation which says, in its executive summary, that: "short periods outdoors, as normally occur in everyday life [in the UK], will produce sufficient vitamin D, and additional or intensive exposures will not confer further benefit." The NRPB's conclusion is based primarily on observations of nine elderly patients aged 70-94 who lived in a hospital ward near Nottingham where they had access to a sunny terrace. The patients were monitored over three months from 26 April to 26 July. This experiment on just 10 patients exposed to the sun for three months during an uncertain English summer is hardly a sound basis for a national policy on sunlight. Yet it seems to have achieved that status. The NRPB quote one further study of elderly people in Boston, Massachusetts, to support their assertion that normal exposure of hands and face will provide sufficient vitamin D. Boston is located at latitude 42º, the same as Rome, and so has a climate substantially different from the British Isles with much longer and hotter summers. Furthermore the research was conducted in 1990 when much lower levels of vitamin D were accepted as optimal. Even in Boston, where the hours of sunlight are so much better and the summer is substantially longer, exposure of only hands and face did not produce a sufficiently high level of vitamin D for optimum health. The assertion made in the NRPB report that we obtain enough vitamin D from everyday exposure of hands and face to the sun is not securely founded in scientific evidence. Reinhold Vieth, an internationally recognised expert on vitamin D, has calculated that short exposures of hands and face to the sun provides as little as 200-400iu of vitamin D per day during summer months and will only do that if enough sunlight is available. But he calculates that such limited exposure would leave more than half the population with insufficient vitamin D. Maximum synthesis of pre-vitamin D in the skin occurs after exposure to the sun for about 10 minutes in the Tropics. Since one side of the body is always in the shade, it takes at least 20 minutes to expose the whole body to the sun and obtain the maximum synthesis of pre-vitamin D in the skin leading to maximal production of vitamin D in the body. Vitamin D synthesis in skin reaches this maximum after 10 minutes because the reaction comes to a chemical equilibrium when pre-vitamin D begins to be converted into other compounds as quickly as it is synthesised. Holick, a well-recognised world authority on vitamin D states: "Sunlight itself seems to be the most important factor in regulating the total cutaneous production of cholecalciferol [vitamin D]. This is the likely explanation for why there are no reported cases of vitamin D intoxication from chronic excessive exposure to sunlight." Outside the Tropics this process will certainly take longer to reach equilibrium. Holick has shown that there is a substantial difference in the amount of vitamin D synthesised at midday in Boston, Mass, and Edmonton, Canada. Boston (42°N) is on a latitude similar to Rome while Edmonton (52°N) is on a latitude similar to southern England. In Boston some 50% more pre-vitamin D can be synthesised in a given time around midday compared with in Edmonton. A pale skin exposed to the sun makes vitamin D six times faster than a dark skin. So, in England in midsummer a white person may obtain all the vitamin D he needs in three 20 minute sessions of sunbathing on three separate days around midday over the period of a week. But a person with dark skin would have to spend up to six one hour sessions over a week to achieve the same result. It is not easy to obtain this amount of clear sunlight in the British Isles, even in midsummer. In April and September, at the beginning and end of the English summer, longer exposures are needed to obtain an optimum level of vitamin D. In Scotland longer exposures are likely to be needed in early May and late August as well to obtain the same levels as in England. For most efficient results sunbathing sessions should be conducted in the two hours around solar noon - that is between 11.00am and 3.00pm. At other times of day the ultra-violet component of sunlight is weaker and so a longer period must be spent in the sun. In Denmark the value of the midday sun is recognised by the public who do not hesitate to sunbathe naked in parks around midday. Apart from nudity being unacceptable to many in the UK there are other practical difficulties in obtaining 20 to 60 minutes in the sun (depending on skin colour) in the middle of the working day. Many people cannot get into the open air at this time and if they can the weather may not be suitable. So the best advice that can be given to people living in the British Isles is to be opportunistic in obtaining sun exposure and not miss any opportunity to remove clothes and expose as large an area of skin as possible to the sun while taking care not to bake or burn. At midday in midsummer when the sky is clear a white skinned person will obtain maximum vitamin D from an exposure of about 20 minutes while a person with dark skin will require up to an hour and a half. If exposure to the sun begins in spring when the sun is weak such times may be well tolerated by most people except those with the most sensitive skin type. If sunbathing begins in midsummer, or on holiday abroad, then exposures should be shorter at first and special care must be taken not to burn. Children and the sun. If like me you have a young child you want the best for them. For me this meant that I didn't allow Nathan to be in the sun from 11 to 3 during the spring and summer in his first 2 years, he didn't develop a tan at all and I thought I had done a great job. He has red hair and the fair complexion to go with it. But after reading the research about sun and suntans and vitamin D I realised that I was in fact depriving Nathan of his right to experience the natural environment that he is genetically designed to live in; i.e. a northern latitude with limited sunlight and cloudy a lot of the time. Now I allow him to be outside as much as possible during spring so that he can build up a base line tan that prepares for the summer months, during the summer we avoid the heat of midday and use sunscreen if necessary. He is much happier outside and thrives when the weather is good; he even grows taller before my very eyes. Each child is different and you would have to decide for yourself what is best for your child/children. Here is the advice from Oliver Gillie- Children can safely be allowed to run about in strong sun wearing brief clothing without sun creams for limited periods of time, so long as care is taken to avoid burning. This will enable children to benefit from vitamin D production in the skin. Burning is best avoided by encouraging children to seek the shade after a suitable time in the sun. Time that may safely be spent in the sun depends upon skin type, previous exposure to the sun, time of day, season (early, middle or late summer), latitude, and whether or not the sky is at all overcast. Sun creams/screens can be used when extended exposure cannot easily be avoided e.g. when playing sports. Sun creams As far as vitamin D production, advice for the British Isles may be to expose the body to full sun (so long as there is no baking or burning) for up to half an hour before applying any sun screen, preferably a physical sunscreen. In the British Isles the sun often comes and goes behind fast moving clouds and under these circumstances a person may need to be fully exposed to the sun without sunscreen for an hour or more to get optimum vitamin D synthesis. If exposure is to continue then a sunscreen could be applied. However the benefits of sunscreens are not scientifically established. The medical establishment in Queensland has vigorously promoted the use of sunscreens for many years - and today, Queensland has more cases of melanoma per capita than any other place in the world. This is a trend seen worldwide. While sunscreens protect against burning, they do not adequately protect against the whole of the UV spectrum and may encourage people to spend longer in the sun and so increase the risk of skin cancer. Also sunscreens that are chemically based contain powerful chemicals to absorb the suns rays, mainly UVB, and do little to stop the UVA rays penetrating the skin which have been linked to skin cancers. Whereas physical sunscreens containing inert minerals such as titanium dioxide, zinc oxide, or talc work by reflecting the ultraviolet (UVA and UVB) rays away from the skin. This is the type seen as white or coloured bands on the lips and faces of sportsmen. So sunscreens should not be endorsed for everyday use by all people in Britain. Furthermore, sunscreens block synthesis of vitamin D with the result that chronic users have lower levels of vitamin D in blood which the majority of people in the UK can ill afford. People who use sunscreens regularly have been found to have half as much vitamin D in their blood as people who do not use sunscreens. Sunscreens are now included in many cosmetic preparations used on the face further blocking the possibility of casual vitamin D synthesis. Sunscreens do protect against burning and so are useful when excessive exposure cannot be avoided and a suitable hat is not entirely effective or cannot be used, for example, when involved in sports such as skiing, sailing, tennis etc. But covering up or seeking shade is generally preferable to sunscreen. To summarise:- DO build up a tan slowly over, say, a week. Aim for no more than a slight pinkness each day. You should never tan so much that your skin peels off. DO remember that sunlight is strongly reflected from sand, snow, ice, and concrete and can increase your direct sunlight exposure by 10 to 50%. DO see your doctor if you spot any unusual moles or growth on your skin -- particularly if they are irregular in shape, bleed, itch, or appear to be changing. Most skin cancers can be cured if caught in time. Do use a sunscreen if exposure is to be extended, preferably a physical sunscreen. DO NOT shower in the morning before going out to sunbathe. The oils naturally produced by your body during the night are a good protection. DO NOT shower for at least an hour after you have sunbathed. Vitamin D formed by the action of the sun on oils on the skin need time to be absorbed. Special offer on a sunscreen and after-sun from the Ishta Centre- Sunscreen This is a sunblock which reflects both UVA and UVB rays. It has an SPF of 40. It is also water resistant but not waterproof. It is fragrance free. (The Sunscreen is also PABA free.  PABA has been widely used as a UV filter in sunscreen formulations. However, it has been determined that it increases the formation of a particular DNA defect in human cells, thus increasing the risk of skin cancer in people who lack the mechanisms to repair these cellular defects.) Normal retail price for 125ml, (which goes a long way) £10.00, for May and June £8.50. After-sun cream This is a super rich cream providing essential moisturising properties. Contains a full range of natural ingredients, including aloe vera, rose hips oil, spirulina, and cassia beta-glucan. Contains, wheat, dairy, soya and yeast extracts. Normal retail price for 125ml, £19.50, for May and June £16.50. Buy 1 Sunscreen and 1 after-sun and get a lip balm free.     Here is a link to the full report by Oliver Gillie, well worth a read. For an excellent book on the subject try "The Healing Sun" by Richard Hobday.  Buy from Amazon

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