Should we fear Vitamin D deficiency more than we fear the sun?

Crohn’s Disease: Better Results With Tanning Bed?

I have several similar reports from patients with both Crohn’s disease and ulcerative colitis. Some literature lends support for your results, but not much; several studies have found low 25(OH)D in such patients. Pappa HM, et al. Vitamin D status in children and young adults with inflammatory bowel disease. Pediatrics. 2006 Nov;118(5):1950–61. Gilman J, Shanahan F, Cashman KD. Determinants of vitamin D status in adult Crohn’s disease patients, with particular emphasis on supplemental vitamin D use. Eur J Clin Nutr. 2006 Jul;60(7):889–96.

I’m not surprised you had some results with supplements but better results with tanning beds. Some patients with bowel disease have trouble absorbing vitamin D. Here is a case report of improvement in bone pain with sunlamps. It does not mention other symptoms. Koutkia P, et al. Treatment of vitamin D deficiency due to Crohn’s disease with tanning bed ultraviolet B radiation. Gastroenterology. 2001 Dec;121(6):1485–8.

As I have said before, briefly sunbathing, with as much skin exposed as possible, at solar noon, when the sun is high enough in the sky, so your shadow is shorter than you are, is the most conservative and sure way to get vitamin D. Who knows what other good thing the sun does? Just don’t get burned and realize that summer sun makes vitamin D so fast you only have to stay out 10–30 minutes, depending on how fair you are. Also, as you will see below, washing with soap after being out in the sun, reduces the amount of vitamin D you get. Of course, the sun makes little or no vitamin D during many winter months and most people cannot get naked at solar noon. Vitamin D producing sunlamps are the next best way to get vitamin D as they come close to reproducing the sun’s rays indoors. So we looked for the best-in-class in-home UV lights and found them.

On our site’s sidebar you will find a link to three different, stand-up, full length, in-home sun lamps. A standard tanning system, the SunSplash Tanning Unit, has both UVA and UVB so you will get a tan. The second system, the D-Lite System, emits Vitamin D-producing UVB with little UVA and full-body high-intensity cosmetic light. Thus you will not tan but can burn if you stay in too long. The third, the SunSplash Renew, is the system that combines tanning with high intensity cosmetic light for the body. All the lamps are the size of a full length mirror and attach to the wall or a door. You stand up in front of them, not lay down, so it is harder to over-expose.

Many women know all about the beneficial effects of high intensity red light on collagen and photo-damage in their skin, but some scientists do not. Lam, et al demonstrated that irradiation of fibroblasts with 633 nm wavelength light increased pro-collagen synthesis four-fold from baseline. Lam TS, Abergel RP, Meeker CA, Castel JC, Dwyer RM, Uitto J. Laser stimulation of collagen synthesis in human skin fibroblast cultures. Lasers Life Sci. 1986;1:61–77.

Human studies confirm such light improves photo-aging and even reduces wrinkles. Russell BA, Kellett N, Reilly LR. A study to determine the efficacy of combination LED light therapy (633 nm and 830 nm) in facial skin rejuvenation. J Cosmet Laser Ther. 2005 Dec;7(3–4):196–200. Goldberg DJ, et al. Combined 633-nm and 830-nm led treatment of photoaging skin. J Drugs Dermatol. 2006 Sep;5(8):748–53.

Here is a PDF of the entire Goldberg article: Combined 633-nm and 830-nm LED treatment of photoaging skin.

The majority of patients in these studies reported this high intensity light improves the softness, smoothness and firmness of their skin. Electron microscopic analysis showed evidence of a post-treatment effect, with thicker collagen fibers. I use the D-Lite with full-body UVB and high-intensity longer wavelength light. It works for me; at least it seems to reduce prior photo-damage, like the studies indicate. If you don’t want to tan, the D-Lite does not tan, but lots of vitamin D producing UVB, thus it will burn. Be warned, these lights are expensive, so you may just want to go to a sun tanning parlor in the winter and enjoy the summer sun during the warmer months. If you use a sun tan parlor, be sure to ask for the low pressure beds; do not use high-pressure UVA lights. Another good thing, for every in-door UV light sold, the Vitamin D Council receives a donation of 20% of the purchase price. So you will be making a donation to a good cause.

Sunbeds, Sunscreens, and Malignant Melanoma

Most studies indicate they do, as do sunburns and intermittent sun exposure. However, not all studies show such a relationship, in fact, one of the largest studies showed sunbed use had a small protective effect against melanoma. Individual factors, such as numbers of moles and skin type were the strongest risk indicators for melanoma, not UV exposure. Bataille V. A. et al. Multicentre epidemiological study on sunbed use and cutaneous melanoma in Europe. Eur J Cancer. 2005 Sep;41(14):2141–9.

Others believe the risk is unclear. de Winter S, Pavel S. Tanning beds: effect on skin cancer risk unclear. Ned Tijdschr Geneeskd. 2000 Mar 4;144(10):467–70.

In fact, the risk of melanoma from UV light appears small compared to risk factors such as skin type and nevus counts. Bataille V. et al. Exposure to the sun and sunbeds and the risk of cutaneous melanoma in the UK: a case-control study. Eur J Cancer. 2004 Feb;40(3):429–35.

Ironically, sunscreens may increase the risk of melanoma. Westerdahl J. et al. Sunscreen use and malignant melanoma. Int J Cancer. 2000 Jul 1;87(1):145–50. Gorham ED et al. Do sunscreens increase risk of melanoma in populations residing at higher latitudes? Ann Epidemiol. 2007 Dec;17(12):956–63.

In one of the best studies, the factor most associated with increased melanoma risk was the use of sunscreens. Subjects who often used sunscreens had triple the melanoma risk compared with subjects who never used sunscreens. Skin color and higher numbers of sunbaths were significant protective factors. Subjects who took more than 30 sunbaths per year were ten (10) times less (less) likely to have melanoma, compared with subjects who took less than 20 sunbaths per year. However, sunbaths had no protective value when they were associated with sunburns. Wolf P, et al. Phenotypic markers, sunlight-related factors and sunscreen use in patients with cutaneous melanoma: an Austrian case-control study. Melanoma Res. 1998 Aug;8(4):370–8.

Other studies show the risk is increased only with intermittent UV exposure, and not with chronic exposure. Walter SD, King WD, Marrett LD. Association of cutaneous malignant melanoma with intermittent exposure to ultraviolet radiation: results of a case-control study in Ontario, Canada. Int J Epidemiol. 1999 Jun;28(3):418–27.

This month, Dr. Dianne Godar, of the United States Food and Drug Administration, published a fascinating paper indicating UVA light, even through window glass, is responsible for the melanoma epidemic. She points out the melanoma epidemic began long before sunbeds; the dramatic increase is only in indoor workers, not outdoor workers; low 25(OH)D levels predict melanoma; all-year tans protect against melanoma; and melanoma patients who expose themselves to the sun live longer than those who don’t. Of the 14 published studies, she reported only two found a positive association between solar UV exposure and melanoma; seven found no association; and five studies found an inverse association, that is, the more sun-exposure the less melanoma. Godar DE, Landry RJ, Lucas AD. Increased UVA exposures and decreased cutaneous Vitamin D(3) levels may be responsible for the increasing incidence of melanoma. Med Hypotheses. 2009 Apr;72(4):434–43.

Ironically, sunscreens appear to dramatically increase the risk of melanoma, probably by increasing the amount of time one spends in the sun. Until recently, sunscreens only blocked vitamin D-producing UVB and let UVA through. That is, the sunscreen-promoting dermatologists many be partially responsible for melanoma epidemic.

I use an in-home UVB light, the D-Lite mentioned above, that emits little UVA. However, I limit myself to short exposures and I do sunbathe in the summer, but briefly. I also keep my 25(OH)D level at 70 ng/mL. My advice is to read about the issue before you buy an in-door UV light. UV lights and natural sunlight will age the skin and increase the risk for squamous cell carcinoma of the skin. If you worry about it—at all—stick to vitamin D supplements and stay away from indoor UV lights. Remember, some people who use indoor UV lights will get melanoma; some people who never use them will get melanoma; and many people who avoid sunlight will get melanoma. If you do use indoor UV lights, use them sensibly, avoid sunburn, and respect them as you respect the sun.

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