- Sun and Your Health
- Rant O' the Month - Puritanical about Pain
- Monroe Street Clinic News
Sun and Your health
Section titled “Sun and Your health”In our February and March newsletters I discussed the importance of Vitamin D, which not only builds strong bones but also prevents a whole host of diseases. If you live where the sun don't shine strongly, and where you have to wear clothes, you probably are a bit low in vitamin D, especially in the winter. The average adult Puget Sounder would have to take about 4,000 IU of vitamin D a day to equal what a person at the equator gets from the sun.
The Benefits of Sunlight
Last week a patient sat on my exam table, looked at the floor, and asked me what I thought about getting out in the sun. When I replied I thought it was good for her, she looked up in pleasant surprise. She followed eagerly with "what about sunscreen?" I responded that in these latitudes, we rarely need sunscreen unless we're getting extraordinary exposure such as when we're skiing or mountain climbing. She smiled. "You know, I feel so good when I get some sun, I can't explain it. And everyone tells me to avoid the sun, and use sunscreen. It's so frustrating."
It didn't surprise me that the sun makes my patient feel good. Those who study sun exposure tell us that light treatment improves many symptoms. For example, some women with pre-menstrual syndrome improve with sunlight, perhaps related to increased production of endorphins and serotonin stimulated by light coming through the eyes.
If getting sun can make you feel better, missing it can do you harm. Shift-workers know that living a life out of synch with sunlight can lead to sleep problems and decreased energy. Scientists tell us shift workers are also at higher risk for high blood pressure, a greater incidence of colds, flu, and gastrointestinal infections, increased pregnancy complications, and numerous other problems.
My patient didn't know the research, but she knew how she felt, and that is probably more important.
Two Types of Sunlight
Sunshine contains ultraviolet light, which comes to us in wavelengths we cannot see. When we look at a rainbow, we see a spectrum of colors, starting at red, orange, yellow, green, blue, indigo, and violet. Next to the violet, we see only plain sky. If we were bees, however, we would see the color associated with the ultraviolet (UV) light in that part of the rainbow. UVA is the light closest to the violet band of the rainbow, and UVB is a bit further away.
UVA hammers the DNA in our skin cells, increasing the risk of cancer. UVB, on the other hand, produces vitamin D, protecting us from cancer. The old sun screens didn't block UVA. Modern sun screens do block UVA as well as UVB.
Sunlight and Skin Cancer
So you love being in the sun and you know about its benefits, but you still worry about the risks of sun exposure. Commercial advertising has done a good job of telling people about the risk of skin cancer and the value of sun screens in reducing that risk. Let's look behind the skin cancer scare and see what's really there.
Skin cancer comes in two major categories: melanoma and non-melanoma. Non-melanoma cancer includes the common squamous cell and basal cell cancers. These skin tumors are rarely fatal except in people with an uncommon ability to ignore obvious signs such as skin sores that ulcerate and grow rather than heal.
Melanomas, on the other hand, are less common than non-melanoma cancers, but are uniformly deadly if left untreated. About 7000 Americans die each year from these. These may be related to ultraviolet A (UVA) sun exposure. In general, melanoma is actually more common in people who get less sunlight, and more common on parts of the body that don't see the sun.
We can't ignore the non-melanoma skin cancers, which we believe are more directly related to sun exposure. No one welcomes squamous cell and basal cell cancers, but their treatment is generally inexpensive and effective, and only about 1,200 people die from these cancers in the US each year.
It's interesting to note that rates of many cancers are about twice as high in the Northeastern US as they are in the Southwest. This is apparently because there is less exposure to protective UVB light in the North than the South (Cancer 2002 Mar 15; 94(6): 1867). You can see graphs of reduced cancer incidence in the sunnier parts of the US in Michael Holick's book "The UV Advantage". When we compare the few deaths from skin cancer to an annual toll of 140,000 a year from breast and colon cancer, and remember that up to half of those breast and colon cancers may be related to inadequate vitamin D from that same sunshine, it is clear that the risks of sun exposure are usually worth the benefits it brings us.
Light Therapy
I recommend that you go outside and enjoy the sun. It's easy, inexpensive, fun, and good for your health. Another option in the winter is to use lights, making sure you get exposure to UVB, which does not pass through glass or clothing. In my previous articles, I pointed out that excessively low levels of Vitamin D are associated with high blood pressure and some cancers. Lancet published a study in 1998 comparing 18 people with mild hypertension treated with either UVB or UVA light three times a week for six weeks. They treated them with exposures so short that the skin was not even reddened. The UVB group experienced a six-point drop in both systolic and diastolic blood pressure. There was no change in the UVA group, because the UVA group didn't experience an increase in vitamin D. (Lancet Aug 29, 1998; 352:709)
If you choose to use lights, you do not need so much that you will get a suntan, and you should certainly avoid sunburn. The more skin you expose, the better. Your body will not make more vitamin D than you require. If you are a technogeek and would like to know more about getting vitamin D from artificial light, click here for details from the Sperti Company, which manufactures these lights.
Dr. Rienstra's Recommendation
My own conviction is that our emotional and physical health is improved by getting outdoors. Scientists have far to go in understanding all the benefits, but they are working on it. Some researchers looked at people recovering from surgery and tracked the number of days it took them to get out of the hospital after having surgery. The study compared patients recovering in rooms with no window with patients who were able to see greenery through the window. The latter group recovered more quickly from serious illness.
If you are over fifty, remember that vitamin D supplements help replace some of what we are not getting from the sun. Vitamin D has the benefits described in our previous newsletters. Still, since we don't know what else there is in sunshine that we can't get from a pill, we in the North also need whatever real outdoor sunlight we can get.
It's still important to be careful in the middle part of summer days. Put on some sunscreen either before or during sun exposure on those days. Otherwise, don't hide from the sun. Let it feed your health. As your mother probably told you at some point, "Go outside and play!"
Rant O' The Month - Puritanical about Pain
Section titled “Rant O' The Month - Puritanical about Pain”The US Drug Enforcement Administration got antsy last September after the FDA refused to adopt its suggested restrictions on painkillers. Two weeks after the FDA ruling assured more freedom in treating pain, the feds arrested pain specialist William E Hurwitz MD of McLean, VA for drug trafficking. Let's give the feds the benefit of the doubt. Let's assume that their arrest of this doctor was just a case of over-zealousness. Or we can credit their dressing him in prison clothing for the benefit of the television cameras as an unfortunate attempt at media theater.
Leading pain specialists in the US don't look at the arrest so benignly. They see it as part of a federal program to equate the treatment of chronic pain with substance abuse. The story of Richard Paey, a chronic pain patient in Florida, adds substance to this concern. American Medical News quotes Joel Hochman, MD, executive director of the National Foundation for the Treatment of Pain, as charging "When we give up the infantile need to demonize and punish, we will get somewhere with the problem of substance abuse."