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TANNING BEDS: A HEALTHY SOLUTION TO SUPPLEMENT VITAMIN D?

The naked truth about the validity of health benefit claims by the tanning industry

By:  Jacqueline Konopa

On an average day, more than a million Americans patronize the nation's 50,000 tanning facilities.

(http://www.cbsnews.com/stories/2006/01/20/health/webmd/main1226618.shtml)

 

Introduction

It is estimated that over 28 million people tan indoors annually in the United States and despite the public educational efforts to increase awareness of the health risks of ultraviolet light exposure,  the use of tanning beds continues to grow in popularity.  The indoor tanning industry is rapidly growing, with over 50,000 tanning facilities nationwide generating $ 5 billion in annual revenue, up from $1 billion in 1992 (http://www.cbsnews.com/stories/2006/01/20/health/webmd/main1226618.shtml). The success of the tanning bed industry has been perpetuated by the promotion of misguided claims of the health benefits of artificial UV light exposure.  This paper will investigate health claims made by the tanning industry, particularly the use of tanning beds to supplement Vitamin D, and evaluate the risks and benefits of exposure to artificial ultraviolet radiation. 

 

A Brief History of Artificial Ultraviolet Light

The effects that wavelengths of light can have on the human body was first studied in the late 1800’s by Niels Finsen.   He researched the potential beneficial medicinal effects that light can have on the body and developed the first artificial light source.   After years of research, he introduced his theory of phototherapy and in 1903 he was awarded the Nobel Prize in medicine for his "Finsen light therapy" for infectious diseases, particularly the skin disease lupus vulgaris. (http://nobelprize.org/nobel_prizes/medicine/laureates/1903/finsen-bio.html).

During the 1920’s and 1930’s, studies showed that UVR can play a role in Vitamin D production in the body and it was suggested that it may have preventative effects on rickets, a disorder leading to weakening of the bones due to lack of Vitamin D.  Numerous other medical benefits were attributed to sunlight, increasing the popularity of tanning beds.  During the 1930s and 1940s, tanning became popular not only for medical purposes, but also for cosmetic purposes as well.  The attitudes towards a tan complexion changed during this time, rumored to be because the famous fashion icon, CoCo Chanel, came back from vacation with a deep suntan, setting the new fashion trend.  Previous to the 21st century, fair skin was valued and was a sign of prosperity.  Now, the perceptions of skin tone have reversed.  Having a dark tan complexion is now associated with health, youth, and beauty and has become a cultural symbol of status. 

This recent trend has put pressure on our society, mainly young white females, to meet the cultural standard of beautiful.  The desire to acquire a tan for cosmetic or fashion purposes have led to the increase in use of artificial light tanning beds.  Studies indicate that factors shown to be associated with indoor tanning in the United States include female sex, residence in the Midwest or South, rural school location, increasing age, use of tobacco and alcohol, and increased personal spending money (Levine).

http://i.ehow.com/images/GlobalPhoto/Articles/5157835/263974-main_Full.jpg

(http://i.ehow.com/images/GlobalPhoto/Articles/5157835/263974-main_Full.jpg)

 

How it Works: Understanding the Tanning Process

                Tanning is the process in which skin pigmentation darkens as a result of exposure to ultraviolet light.  Ultraviolet (UV) radiation is an invisible light that comes directly from the sun, and is part of the electromagnetic spectrum with a wavelength ranging from 290-400nm.  There are three types of UV light emitted from the sun, UVA, UVB, and UVC.  Both UVA and UVB reach the earth’s surface, while UVC does not, as it is filtered by the ozone layer.  

UVA rays are the most abundant, accounting for up to 95% of all rays emitted by the sun that reach the earth’s surface.  They can penetrate clouds and gas and present more or less the same intensity throughout the daylight hours of the year.  UVA rays penetrate the skin more deeply than UVB and studies show they play a major part in photoaging of the skin, or premature aging.  Recent studies have shown that UVA rays damage skin cells called keratinocytes (include basal and squamous cells) in the basal layer of the epidermis, which contributes to the development of skin cancers.

UVB rays are the primary rays that cause skin reddening and are known as the ‘sunburn’ rays.  In contrast to UVA rays, UVB rays damage the superficial layer of the epidermis.  UVB rays also have a contributory role in the development of skin cancers and photoaging.  UVB rays are most intense from 10am to 4pm from April to October, with intensity ranging depending on the time of day, the season, and geographical location.  The most important feature of UVB rays is its role in the production of Vitamin D (http://www.skincancer.org/understanding-uva-and-uvb.html).

http://www.newlifetanningcenters.com/images/skin.gifuvradiation3.jpg

(http://www.newlifetanningcenters.com/images/skin.gif)

(http://www.skincancer.org/understanding-uva-and-uvb.html)

 

So, how do we tan?  Tanning is the skin’s reaction to UV radiation.  UVB rays are short and only reach the epidermal layer of the skin.  They stimulate melanocytes to produce a pigment called melanin.   UVA rays penetrate the skin more deeply and slowly than UVB rays and are absorbed by the melanin, turning it brown.  Continued UV exposure increases melanin production and darkens the cells in the epidermis.  The darkening of the skin provides a basic form of defense against further damage of the skin from UV light (http://www.tanningtraining.com/btc/ch4.html?prodid=2).

UV Rays from Artificial Lighting in Tanning Beds

                Tanning booth lights emit approximately 95% UVA rays and 5% UVB rays, similar to that of the natural sunlight.  However, the dose of UVA rays that a tanning bed emits is 12 times as strong as that of the sun.   Even though UVA radiation does not cause burning, unless exposure levels are very high, it penetrates the skin more deeply which has significant adverse effects on cells involved in the immune response, thereby increasing a person’s risk of developing malignant melanoma as well as other skin cancers.   Research shows that people who use tanning salons are 2.5 times more likely to develop squamous cell carcinoma, and are 1.5 times more likely to develop basal cell carcinoma.  According to recent research, “first exposure to tanning beds in youth increases melanoma risk by 75 percent” (http://www.skincancer.org/understanding-uva-and-uvb.html).  

 

Popular Claims: Tanning Industry’s Health Assertions

Marketing campaigns by the tanning industry claim that indoor ultraviolet radiation is safe and provides many health benefits.  They suggest that tanning indoors produces an increased psychological sense of well-being and provides treatment for dermatological conditions.  In addition, some claim that tanning prevents skin cancer.  Because a tan protects the skin from sunburn, and sunburn causes skin cancer, indoor tanning therefore prevents skin cancer.  The most widespread claim that will be investigated is that tanning beds are essential for the optimal production of Vitamin D, an essential vitamin for good health. 

 

Importance of Vitamin D

                Vitamin D plays a role in many normal body functions including regulation of cell growth, bone formation, immune function, muscle strength, hair growth, fighting infections, and reducing the risk of autoimmune diseases.  The main function of Vitamin D in the body is to maintain normal blood levels of calcium and phosphorus by helping to absorb calcium from food or supplements.  Vitamin D can be found in food sources such as cheese, fortified milk, fish, and fortified cereals.  The recommended dietary intake for Vitamin D varies depending on age, gender, and other factors (such as pregnancy).  The current recommendation for Vitamin D intake are 5 ug/d for adults, both male and female, from ages nine to 50 years and 10ug/d for adults, both male and female, ages 50 to 70 years. Vitamin D can also be produced by the body after being exposed to sunlight, which is why it is sometimes known as the “sunshine vitamin.”  The RDA recommends 10-15 minutes a day of sun exposure, 3 days a week.  For people of color, or dark complexion, longer and more frequent exposure is recommended, or 30 minutes a day.  A Vitamin D deficiency can lead to osteoporosis, rickets, and various types of cancer.  It is also important to note that too much Vitamin D can have some adverse effects as well.  Therefore it is essential to maintain optimal levels of Vitamin D in your body (http://health.nytimes.com/health/guides/nutrition/vitamin-d/overview.html), (http://www.associatedcontent.com/article/23996/vitamin_d_intake_vs_sun_exposure.html?cat=51).

 

http://www.electricbeachtan.net/images/vit_d_posterart_image_sm.jpg

(http://www.electricbeachtan.net/images/vit_d_posterart_image_sm.jpg)

 

Do Tanning Beds Provide a Sufficient Source for Vitamin D?

                A recent study done by Tangpricha et al was done to study the effects of artificial UV radiation on Vitamin D production.  The objective of the study was to ascertain whether subjects who regularly use a tanning bed have a higher Vitamin D concentration compared to those subjects who do not.  The second objective was to determine if a higher Vitamin D concentration correlated positively with bone mineral density. 

The study began by recruiting health subjects between the ages of 18 and 70 years to participate in the study by advertising the study in the local newspaper and online.  Subjects were classified as tanners (those who used the tanning bed more than once a week for over 6 months) and non-tanners, those who did not use the tanning bed.  Subjects were excluded from the study if they had history of osteoporosis, took vitamin D supplements other than a regular multivitamin, took medications that interfered with vitamin D metabolism, were undergoing ultraviolet radiation as medical therapy, or were pregnant.  Each subject underwent a bone mineral density test and took a test that measured his/her Vitamin D concentration. 

The results indicated that subjects who participated in regular use of tanning beds had higher 25(OH)D (Vitamin D)concentrations than those who did not.  In addition, tanners had significantly higher bone mineral density in the hip than did the non-tanners.  Further analysis of the results showed that the prevalence of vitamin D deficiency among the non-tanners was 41.5%, and that among the tanners was only 8%. 

From this study, we can conclude that the regular use of a tanning bed that emits vitamin D–producing ultraviolet radiation (UVB rays) is associated with higher Vitamin D concentrations and thus may provide many medical health benefits, such as the protection against chronic diseases including hypertension, cardiovascular disease, type I diabetes, and common cancers.   This study highlights the importance of Vitamin D production, for a lack of sunlight exposure can result in a vitamin D deficiency.   Further studies should be conducted to investigate the long term effects of chronic use of tanning beds in on Vitamin D levels and bone density (Tangpricha et al, 2004).

Furthermore, the study fails to determine whether natural or artificial tanning is more beneficial for increasing Vitamin D production. More testing should be done to compare the positive and adverse effects of both natural and artificial UV light. 

Moreover, how much is too much?  More studies should be conducted to determine the correct amount of artificial UV radiation for the production of Vitamin D.

 

More about Vitamin D

According to Johns Hopkins researchers, low levels of Vitamin D may raise a person’s chances of premature death, as it is linked to certain cancers, diabetes, and bone and immune system problems.  Erin Michos, assistant professor of cardiology at Johns Hopkins School of Medicine in Baltimore conducted a study analyzing data from 13,000 people.  In the study, people who had low vitamin D levels (17.8 ng/mL or lower) were 26% more likely to be dead at the end of the study than those with higher vitamin D levels.  Michos describes the results saying, “We took into account 30 different variables — including age, weight, diabetes, cholesterol, high blood pressure, whether they exercise, smoking — and we found that low vitamin D levels, independent of all these other risk factors for heart disease, predicted an increased risk of dying from any other cause. So we found a new risk factor for death." However, Michos also indicated that further tests must be done for the evidence to be conclusive (http://www.usatoday.com/news/health/2008-08-11-vitamin-D-death_N.htm).

 

A Double Edged Sword?

                Despite the positive benefits that artificial UV radiation may provide, including a source of Vitamin D production (which is vital for the prevention of several types of deadly cancer), tanning beds present many health consequences as well. Research by the World Health Organization suggests that tanning beds are one of the most dangerous forms of carcinogenic (cancer-causing) radiation, emitting extremely high levels of UVA, more so than the natural sunlight.  Research also shows that exposure to UV radiation, from either natural or artificial lighting, is a known risk factor for skin cancer.  One in every three cancers diagnosed worldwide is skin cancer, most of which is attributed to the overexposure of UV radiation. 

 

More about Skin Cancer

Skin cancer is a mutation in the DNA of the skin’s epidermal cells caused by ultraviolet radiation. The damage to the DNA causes the release of enzymes that try to repair the damage. However, the repair is not always successful, which leads to the continued reproduction of the DNA mutation.    It is important to note that radiation doesn’t have to cause sunburn in order to cause skin cancer (http://www.who.int/mediacentre/factsheets/fs287/en/index.html).

There are three types of skin cancer:  basal cell carcinoma (BCC), squamous cell carcinoma (SCC) carcinomas, and melanoma.  Basal and squamous cell carcinoma are the most frequently occurring skin cancers, however melanoma  is the most serious form of skin cancer.  According to the American Cancer Society (ACS), about 62,000 new cases of melanoma were diagnosed in the U.S. in 2008 and of that there were 8,650 deaths caused by melanoma. (http://www.skincancer.org/world-health-organization-scientists-warn-against-ultraviolet-tanning-beds.html).  Research shows that “people 35 or younger who used the beds regularly had a melanoma risk eight-fold higher than people who never used tanning beds. Even occasional use among that age group almost tripled the chances of developing melanoma (http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Tanning_Beds_May_Increase_Skin_Cancer_Risk.asp). 

 

Evaluating the Dangers of Tanning Beds

                How much of an impact does UV radiation from tanning lamps have on the skin?  Currently, little epidemiologic data exists linking excessive UV exposure to skin cancers; however one study indicates that there is a relationship.  A population based control study was conducted which included 603 basal cell carcinoma (BCC) case patients, 293 squamous cell carcinoma (SCC) case patients, and 540 control subjects.  Each of the subjects were interviewed to determine their tanning bed use, sun exposure history, sun sensitivity, as well as other risk factors for skin cancer.  The data concluded that tanning beds contributed to the incidence of non-melanoma skin cancers (Karagas). 

 

http://www.tanningnews.org/tanning-bed-cancer.gif

(http://www.tanningnews.org/tanning-bed-cancer.gif)

 

Another study was conducted in Sweden which tested to see if indoor tanners were at increased risk of developing melanoma.  The results indicated that there was a positive association between tanning beds and melanoma.  In fact, there was a 55% increase in risk of melanoma after adjustment for sun sensitivity and measures of sun exposure.  Other studies show that there are many other adverse effects of tanning bed use such as acute sunburn, skin fragility and blistering, suppression of cutaneous DNA repair and immune functioning, and ocular disorders (Levine).

 

Finding a Balance:  Tanning Bed UV Exposure May be Excessive

Research shows that the standard UVB dose given during an average indoor tanning session greatly exceeds the recommended 25% of 1 minimal erythema dose (MED).  The MED is different for people of different skin types.  The recommended amount of UVB rays for people with type II skin is 12.6 minutes and people with type III skin is 17.7 minutes in a standard tanning bed.  The average time a person spends in a standard tanning bed is 20 minutes, far exceeding the recommended dosage.   Because it is recommended to get 25% of MED, the exposure time of UVB radiation in tanning beds is 4.5 to 7 times the amount needed for optimal Vitamin D production (Levine). 

More research needs to be done to see if reducing the time in tanning beds can have similar benefits to that of the natural sunlight.  However, as of now, it is suggested that regular sunlight is used as a source of Vitamin D.  Doctors advise that the exposure of only hands, arms, face, and legs to sunlight 15-20 minutes a day, three times a week is adequate exposure. 

 

Tablets to improve calcium and vitamin D. In a new study, those with low vitamin D levels  17.8 ng/mL or below  were 26% more likely to be dead at the end of the study than those with higher vitamin D levels, independent of other factors.

(http://www.usatoday.com/news/health/2008-08-11-vitamin-D-death_N.htm)

 

Alternatives to UV Radiation for Vitamin D

From recent research and studies, it is evident that Vitamin D is essential for one’s health.  Some people may struggle to reach the optimal level of Vitamin D, and in an effort to improve levels of Vitamin D, they may indulge in indoor tanning that may cause just as much, if not more, harm to one’s health.      Is it ok for people to justify their excessive use of tanning beds for optimal Vitamin D production?  Conversely, should people risk Vitamin D deficiency to avoid the risk of skin cancer?   Are there other ways to get an adequate amount of Vitamin D, without the use of tanning beds? 

Scientific research does not support the use of indoor tanning beds to receive the proper amount of Vitamin D.  Only in special circumstances may it be necessary to use UV radiation for the correction of Vitamin D deficiency.  For example, patients with severe intestinal fat-malabsorption syndrome, who can’t absorb Vitamin D in the digestive system, may benefit from tanning beds for Vitamin D production.  In addition, researchers suggest Vitamin D supplements and Vitamin D fortified foods as an alternative method to increasing levels of Vitamin D.  800 to 1000 IU of oral vitamin D can provide an adequate supply of the nutrient.  Even so, it is extremely important not to overdose on Vitamin D, which can have deadly effects (Levine). 

 

Risky Behavior: Why is Indoor Tanning so Rampant Despite the Warnings?

                In 2002, a study was conducted to determine if perceived risks and benefits associated with UV exposure and knowledge of skin cancer influenced behavior of college students.  Participants included students who visited the health center on campus, who were then administered a survey.  The results show that 47% of the students surveyed had used a tanning bed in the past 12 months, while 39% of the students had never used a tanning bed.  Females were more common users of tanning beds than their male counterparts.  Interestingly, more that 90% of tanning bed users admitted that they were aware of the risks of premature aging and skin cancer (Knight).  Despite the known risks of UV exposure, people still engage in tanning bed use.  Can we change this behavior?  Maybe more information about the severity of the risks should be provided to the public in order to deter them from participating in unhealthy activity.  Or, maybe it requires a change in the society beliefs that tans are attractive and healthy. 

 

Why Does the Tanning Industry Present these Misleading Claims?

The tanning industry is a multibillion dollar industry. The reason for these misguided claims is to encouraging people to frequent tanning salons to increase economic profit.  The claims that the tanning industry is making about the production of Vitamin D with the use of indoor tanning facilities may be founded in studies, however they fail to note the negative effects that tanning beds can have on one’s health and also fail to mention that they are healthier alternatives.

http://www.realself.com/files/Image/tanning-promotion.jpg

(http://www.realself.com/files/Image/tanning-promotion.jpg)

Conclusion and Recommendation

                The use of indoor commercial tanning facilities has recently gained widespread popularity.  It is suggested that this increase is due to misguided perception of the health benefits of artificial UV light exposure as well as the societal perception that a tan increases a person’s attractiveness.   Studies indicate that tanning in beds with artificial lighting is a dangerous practice and has many adverse effects.  It seems as though many people believe they are knowledgeable about the dangers of UV exposure, yet their behaviors do not show that they are concerned.  I think it is important to increase public awareness of the risks of UV exposure, both indoor and outdoor and education youth on the effects.  It is also important to consider that while excessive sun exposure is a risk factor for developing cancer, some sun exposure in moderation is beneficial.  But it is essential that people understand the limits of exposure.  Based on research, tanning beds are not a health way to increase Vitamin D production, as there are other alternatives to receive a healthy recommended dosage of Vitamin D.   From the studies and research that have been done so far, I would not recommend the use of indoor tanning beds, even in moderation.  More research needs to be done to study the potential benefits (if any) of indoor tanning and the long term effects. 

 

References

Knight, M.,  Kirincich, A., Farmer, E., and Hood, A.(2002). Awareness of the Risks of Tanning Lamps Does

                Not Influence Behavior Among College Students.  Archives of Dermatolog,  138, 1311-1315.

 

Karagas, M., Stannard, V., Mott, L., Slattery, M., Spencer, S., and Weinstock, M. (2002).  Use of Tanning

                Devices and Risk of Basal Cell and Squamous Cell Skin Cancers.  Journal of the National Cancer

                Institute, 94, 224-226.

 

Levine, J., Sorace, M.,  Spencer, J., and Siegel, D. (2005). The indoor UV tanning industry: A review of skin

                cancer risk, health benefit claims, and regulation.  Journal of the American Academy of

                Dermatolog, 53, 1038-1044.

 

Tangpricha, V., Turner, A., Spina, C., Decastro, S., Chen, T., and Holick, M. (2004).  Tanning is associated

                with optimal vitamin D status(serum 25-hydroxyvitamin D concentration) and higher bone

                mineral density1–3.   American Journal of Clinical Nutrition, 80, 1645-1649.

 

 

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