For years, the message about the sun was simple --- avoid it.
Slather on sunscreen. Wear a hat and long-sleeved shirts. Seek cover under trees. The sun was your foe --- wrinkling your skin, or worse, causing skin cancer.
The sun, we said, could kill you.
The new message emerging? Maybe we went a little too far.
As in SPF 70 too far.
While no one is suggesting we return to the days of rubbing Crisco on our bodies, many doctors now insist we need more of the sunshine vitamin --- vitamin D.
Some even suggest --- gasp! --- we get some rays naked (without sunscreen) --- although not for very long.
Very few foods are naturally rich in vitamin D, and most Americans rely on limited sun exposure and fortified foods, such as milk and cereal to get their daily dose of the sunshine vitamin. As a result, many people are falling short of what they need.
But just how many of us fall in this category is unclear because scientists and doctors disagree on what the "optimal" thresholds should be, according to Anne Looker, senior scientist at Centers for Disease Control and Prevention. So the percentage of American adults not getting enough vitamin D ranges from 32 percent to 74 percent, according to the analysis of the CDC's 2000 to 2004 nutrition examination surveys.
The levels are highest among African-Americans, in part, because their skin is less able to synthesize vitamin D from the sun, according to doctors.
A shortage of vitamin D has been linked to several cancers, bone loss and unexplained muscle pain. Vitamin D also boosts our immune system and is needed for strong bones.
"It's our modern lifestyle," said Dr. Vin Tangpricha, an Emory University endocrinologist who has been studying vitamin D deficiency for 10 years. "We go from our office to our cars and spend very little time outside."
He believes the anti-sun message needs a readjustment.
"I feel like it swung to the extreme," he said. "And common sense will tell you, if you completely avoid the sun, it's not good. A little sun is OK. It's good for you."
Tangpricha recommends about 10 minutes of sun every day --- without sunscreen. Then, apply sunscreen and enjoy the outdoors some more, he says. Still, for people who burn easily or have fair complexions, two minutes is likely more appropriate.
Whether daily sun gazing is necessary --- or worth the risk --- is open to debate.
For dermatologists seeing a rise in skin cancer every year including a continuous rise of melanoma --- the most deadly form of cancer --- the benefits of naturally producing vitamin D may not be worth the potentially long-term harmful effects of the sun.
Dr. Diamondis Papadopoulos, an Atlanta dermatologist, believes maybe we can relax --- a little.
"I am not so obsessed to think that you need to wear sunscreen every second of every day," he said. "And if you going from your car to Kroger, you wouldn't need to put on sunscreen."
But just how much sun is healthy varies from person to person --- skin type to skin type.
"We dropped everyone in a grab bag of equal risk," Papadopoulos said. "So the message is use sunscreen all the time."
And while some people may be able to tolerate a little sun without sunscreen, he said carefully avoiding sun exposure is needed for people at high risk for skin cancer.
For men and women with fair skin or a family history of skin cancer, he said they should get their vitamin D dose from supplements and vitamin D-rich foods such as salmon or tuna instead of soaking up the sun.
Many dermatologists also worry that loosening up on the sun exposure recommendations will lead to carelessness. Already, only a third of Americans regularly use sunscreen, according to the CDC.
"If people are encouraged to get a few minutes of sun without sunscreen, they may just skip the sunscreen altogether," Papadopoulos said.
He also said many people already don't follow a basic rule of applying sunscreen --- they fail to reapply every one to two hours.
Clip 'n' keep!
WHAT IS VITAMIN D?
A fat-soluble vitamin produced when ultraviolet rays strike the skin and trigger vitamin D synthesis. Vitamin D also is naturally present in a few foods, including tuna, eggs, fortified milk and cod liver oil. It is needed for strong bones and helps boost the immune system. It's also important for overall good health.
How do you get the daily allotment?
You would have to eat 10 bowls of fortified cereal to get your daily recommended allotment of vitamin D. Or four glasses of milk. Or 6 ounces of tuna. Or 16 egg yolks.
How much vitamin D is enough?
The National Academies of Sciences currently recommends 200 international units (IU) of vitamin D for children and adults up to age 50, and 400 to 600 IU for adults older than age 50. However, researchers now question whether these levels are adequate for optimal health. Most researchers agree that daily intake of 800 to 1,000 IU would benefit many people --- especially those at increased risk of vitamin D deficiency, including babies who are exclusively breast-fed, older adults, people with darker skin and people with limited sun exposure.
Don't overdo it
Although vitamin D can be toxic when taken in too large a dose from supplements, natural exposure of the sun --- or filling up on vitamin D-rich foods like salmon or tuna --- doesn't cause the same harm.
What SPF number is right for your skin?
The lighter your skin is, the higher your SPF should be. Light-to medium-skinned people should use at least a 30, but preferably 45, especially during great exposure to the sun between the peak hours of 10 a.m. to 2 p.m. Darker-skinned people should use at least SPF 15. An SPF of 15 filters at least 93 percent of the UVB Rays; 30 SPF filters 96 percent of the UVB rays; and 45 SPF filters 97 percent of the UVB rays.
UVA vs. UVB rays
They are both rays emitted by the sun, which can result in premature aging and skin cancer. UVA penetrates the ozone more easily, and can penetrate deeper into the dermis (second layer of skin). UVB is more responsible for the sunburn reaction but can also cause premature aging and skin cancer.
Sources: Dr. Craig Austin, a New York dermatologist, National Institutes of Health, CDC, Mayo clinic, columnist Chris Rosenbloom
ONE WOMAN'S TALE
For 49-year-old Cheryl Richards-Mann, the carefree attitude toward the sun eventually caught up with her.
In college, she sunbathed on rooftops, her body glistening with baby oil. She would burn, and then her skin would start to peel eventually giving way to a golden tan.
Over the next several years, she continued to bask in the sun. She was lackadaisical about wearing sunscreen. Then, last year she noticed a red patch on her skin below her lower lip, and another one on her back that just wouldn't go away.
A biopsy revealed they were basal cell carcinoma, the most common form of cancer with about 1 million new cases diagnosed yearly in the United States.
Surgery left with her almost 30 stitches on her face. She's made a full recovery but she no longer takes the sun lightly.
"During my twenties, I thought I was invincible and I did all of the bad things like lay outside on rooftops," she said. "And now that I am 49, the sun damage is starting to show. If I was independently wealthy, I would travel to college campuses across the country and tell young people 10 minutes of sun is all that you really need."
For her, it's an easy decision.
She wears SPF 30, wide-brimmed hats and lounges on a covered back porch.
But, particularly as she ages, she said she knows she needs the sunshine vitamin to keep her bones strong.
She blocks the sun, but takes a vitamin D supplement every day.
Copyright 2008 The Atlanta Journal-Constitution