AAD Guidelines on Vitamin D, Sun Exposure, Sunscreen

Dermatologists Can Help Separate Fact From Fiction for Sun Exposure, Sunscreen and Vitamin D

American Academy of Dermatology Increases Minimum Sunscreen Recommendation from SPF 15 to SPF 30
NEW YORK (Nov 10, 2009) — When it comes to vitamin D, consumers are bombarded with mixed messages about the best source for this essential nutrient. While some may argue that small doses of intentional sun exposure are safe, dermatologists point out that the risk of developing skin cancer from ultraviolet (UV) radiation far outweighs the benefit of stimulating vitamin D production – particularly when enriched foods and supplements are safe and effective sources of this vitamin.

Speaking today at the American Academy of Dermatology’s SKIN academy (Academy), Washington, D.C., dermatologist Elizabeth L. Tanzi, MD, FAAD, clinical faculty in the department of dermatology at Johns Hopkins Hospital Center in Baltimore, addressed common myths about sun exposure, sunscreen and vitamin D, and announced the Academy’s increased recommendation on the minimum Sun Protection.

Factor (SPF) of sunscreen.
“Despite years of ongoing public education efforts on the dangers of UV radiation, a number of misconceptions remain as to how to best protect ourselves from this known carcinogen and whether or not we absolutely need sun exposure for vitamin D production,” said Dr. Tanzi. “The fact is these myths are harmful because sun exposure is the leading cause of skin cancer, and the consequences of this misinformation could be potentially fatal.”

Myth: Sun exposure is the best source of vitamin D.
Vitamin D is an essential nutrient that is vital for strong bones and a healthy immune system. Deficiency of vitamin D is associated with bone softening in adults, rickets in children and, more recently, with high blood pressure, arthritis, type I diabetes and certain cancers.

While UV radiation is one source of vitamin D, dermatologists argue that it is not the best source because the benefits of obtaining vitamin D through UV exposure cannot be separated from an increased risk of skin cancer. Instead, the Academy recommends that an adequate amount of vitamin D should be obtained from a healthy diet that includes foods naturally rich in vitamin D (e.g., dairy products and fish), foods/beverages fortified with vitamin D (e.g., fortified milk and fortified cereals), and/or vitamin D supplements.

“Although studies showing the benefits of increased vitamin D intake have caused some to propose ‘sensible sun exposure’ or intentional sun exposure as a cost-effective method for preventing vitamin D deficiency, increased sun exposure is not the answer,” said Dr. Tanzi. “UV radiation is the most preventable risk factor for the development of skin cancer, which is the most common form of cancer in this country. There are more than an estimated 1 million new cases of skin cancer every year. Despite this fact, there remains a tremendous amount of misinformation about UV exposure – especially in relation to vitamin D.”

Myth: All sunscreens are created equal.
While on the surface most sunscreens may look the same, they are in fact quite different. One of the things that makes sunscreens different is the level of protection from UV exposure that they provide. Dr. Tanzi explained that a common misconception is that the SPF rates the degree of protection from both UVA rays (which pass through window glass, penetrate into the deepest layer of the skin and are associated with premature aging and melanoma) and UVB rays (the sun’s burning rays, which are blocked by window glass, are the primary cause of sunburn, and also are linked with skin cancer). In fact, the SPF number on sunscreens only reflects the product’s ability to deflect the sun’s burning rays (or UVB). Sunscreens labeled broad-spectrum provide coverage against both UVA and UVB light.

“SPF may create a false sense of security about the level of protection a person is getting, because many sunscreens do not adequately protect against harmful UVA rays,” said Dr. Tanzi. “The main challenge in providing effective protection from UVA rays is that traditional chemicals used in sunscreens that absorb UVA light degrade quickly and become ineffective.”

Fortunately, there are ingredients that can be added to traditional sunscreen ingredients to keep them stable and provide broad-spectrum protection. For example, Dr. Tanzi noted that the ingredient oxybenzone can help stabilize avobenzone (one of the best absorbers of UVA rays that, while highly effective, breaks down quickly), which provides a longer duration of effective protection from UVA rays. Other effective ingredients that help provide broad-spectrum UV coverage include ecamsule, cinoxate, menthyl anthranilate, octyl methoxycinnamate, octyl salicylate, and sulisobenzone.

For those with sensitive skin, sunscreens with non-chemical ingredients work best and will prevent irritation. Dr. Tanzi said the ingredients zinc oxide and titanium dioxide provide both UVA and UVB protection.

Myth: Using a higher SPF will ensure you don’t burn.
Dr. Tanzi explained that those who use sunscreen with a higher SPF may think they will not burn when exposed to UV light, but she said that is not true. In fact, actual sunscreen protection depends on many other factors – including skin type, the amount and frequency of sunscreen application, and the impact of activities (such as swimming and sweating). As a result, sunburn can occur even when wearing a higher SPF sunscreen.

Another important factor Dr. Tanzi emphasized is that UVB protection does not increase proportionately with a designated SPF number. For example, an SPF of 30 screens 97 percent of UVB rays, while an SPF of 15 screens 93 percent of UVB rays and an SPF of 2 screens out 50 percent of UVB rays. However, not applying enough sunscreen or not covering all exposed areas may result in a lower SPF than the product contains.

“For adequate protection, sunscreens are best applied 15-30 minutes prior to going outside, approximately every two hours or immediately after swimming or sweating,” said Dr. Tanzi. “Research demonstrates that most people only apply 25 to 50 percent of the recommended amount of sunscreen, which is one ounce for the entire body or enough to fill a shot glass. Therefore, if only half the proper amount of SPF 15 is applied, the SPF has been reduced to an SPF of approximately 5, which is then inadequate protection. ”

To address the issue of people not using enough sunscreen or reapplying improperly, the Academy recently increased its recommended SPF to a minimum of 30 for proper sun protection. Dr. Tanzi said that while sunscreen is important to protect against skin cancer, it is only one part of what should be an overall sun-protection program. To minimize your risk of skin cancer, the Academy recommends that everyone Be Sun SmartSM :

• Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days, and after swimming or sweating.

• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.

• Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.
Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.

• Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.

• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.

• Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

Check the Academy’s Web site for the latest list of sun protective products that meet the stringent, evidence-based criteria of the AAD SEAL OF RECOGNITION®.

For more information about skin cancer, please visit the “SkinCancerNet”, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.

Take a Break: Play Moon, Fish, Ocean

Play the Zen version of Rock, Paper Scissors , called Moon, Fish, Ocean

The author of this site, Craig Conley, has another site called Follow Your Bliss Compass Those three little words by the great mythologist Joseph Campbell teach a profound lesson in tapping the energy that makes you tick. But how to begin? Start using the Follow Your Bliss Compass to put yourself on the right track. You'll soon start becoming mindful of the blissful energy within you and will begin using it to make empowering changes in your life. Following your bliss is always a real adventure—a journey into the uncharted center of yourself.

You’re in Charge/Shared Decision Making

The health care system is shifting to “patient centered care,” which puts the patient and those closest to them, at the head of the health care team. Depending on your situation, this can be a complicated maze, which seems to have no end. Fortunately, hospitals and medical centers are recognizing the need to provide patients with tools to help them. One such program is the University of Minnesota’s Center for Spirituality and Healing’s “Taking Charge of Your Health" Within the site are excellent resources including: “Navigate the Healthcare System.”

Dr. Carolyn Clancy, a director for the Agency for Healthcare Research and Quality, has an advice column, with brief and easy to understand responses to many issues, such as Open enrollment-what to consider when choosing a health plan.

There are a variety of other on-line resources, including
• Bravewell Collaborative Navigating the Healthcare System

• Revolution Health Navigating the Healthcare System

• Excerpts from our Bodies, Ourselves: Navigating the Health Care System

Shared Decision Making
In most fairy tales, there generally comes a point where the hero has to make a very important decision. Do I take a right or left at the fork in the road? Is it a toad or a prince disguised as one? Frequently, the hero or heroine has a trusty fairy godmother, or a special device to help them make that decision.

When it comes to managing our health, there are many decisions that must be made. Should I try a particular type of treatment? Is surgery my best option? Maybe it’s time to stop treatment? So where’s your fairy godmother when you need her?

Pioneered at the Dartmouth Hitchcock Medical Center, hospitals are now starting to offer “Shared Decision” programs. Working with a staff member of the program, and/or using some simple tools, decision making becomes a lot easier. Check with your doctor, case manager, or social worker to see if one is offered where you receive care. There are also a number of excellent websites on-line to help as well.

• The Ottawa Decision Guide make decisions, plan next steps and monitor their progress. The tool can be used for making any type of decision.

• Decision Aids by Health Topic

• Decision Aid Library

• Informed Medical Decisions

Take an Art Break: Make a 3-D Snowflake

There is snow in the mountains where I live, so this is as good a day as any to learn how to make 3-D snowflakes. Go to http://www.wikihow.com/Make-a-3D-Paper-Snowflake for step-by -step instructions. I’ve been making them for years and have taught first graders as well as grandmothers how to do it. The final result can be enhanced with spray glitter and be the star on a Christmas tree.

In the winter, I work at the local ski resort’s First Aid room. One of the first activities we do is make the snowflakes and decorate the room for patients. Not only do we receive many compliments all winter long, but we’ve taught more than one injured skier how to make them as they recuperate.

Chronically Ill May Be Happier If They Give Up Hope

ScienceDaily (Nov. 2, 2009) — Holding on to hope may not make patients happier as they deal with chronic illness or diseases, according to a new study by University of Michigan Health System researchers.

"Hope is an important part of happiness," said Peter A. Ubel, M.D., director of the U-M Center for Behavioral and Decision Sciences in Medicine and one of the authors of the happily hopeless study, "but there's a dark side of hope. Sometimes, if hope makes people put off getting on with their life, it can get in the way of happiness."

The results showed that people do not adapt well to situations if they are believed to be short-term. Ubel and his co-authors -- both from U-M and Carnegie Mellon University -- studied patients who had new colostomies: their colons were removed and they had to have bowel movements in a pouch that lies outside their body.

At the time they received their colostomy, some patients were told that the colostomy was reversible -- that they would undergo a second operation to reconnect their bowels after several months. Others were told that the colostomy was permanent and that they would never have normal bowel function again. The second group -- the one without hope -- reported being happier over the next six months than those with reversible colostomies.

"We think they were happier because they got on with their lives. They realized the cards they were dealt, and recognized that they had no choice but to play with those cards," says Ubel, who is also a professor in the Department of Internal Medicine.
"The other group was waiting for their colostomy to be reversed," he added. "They contrasted their current life with the life they hoped to lead, and didn't make the best of their current situation."

The research was published in this month's edition of Health Psychology.

Ubel was joined in the research by Dylan M. Smith, Ph.D., a research specialist at the Ann Arbor VA Health Services Research and Development Center and a U-M psychologist; Aleksandra Jankovic, of U-M's Center for Behavioral and Decision Sciences in Medicine and George Loewenstein, professor in the Department of Social and Decision Sciences at Carnegie Mellon University.

Loewenstein said these results also may explain why people who lose a spouse to death often recover better emotionally over time than those who get divorced.

"If your husband or wife dies, you have closure. There aren't any lingering possibilities for reconciliation," Loewenstein said.
Ubel said health professionals find it easier to deliver optimistic news to patients even when they believe the prognosis is unfavorable, justifying it by assuming that holding on to hope was better for the patient.

Said Loewenstein: "It may be easier for a doctor to deliver a hopeful message to a patient, even when there isn't much objective reason for hope, but it may not be best for the patient."

"Hopeful messages may not be in the best interests of the patient and may interfere with the patient's emotional adaptation," Ubel says. "I don't think we should take hope away. But I think we have to be careful about building up people's hope so much that they put off living their lives."

The research was funded by the National Institute on Child Health and Human Development. Smith was supported by a career development award from the Department of Veterans Affairs.

University of Michigan Health System (2009, November 2). Chronically Ill May Be Happier If They Give Up Hope. ScienceDaily. Retrieved November 3, 2009, from http://www.sciencedaily.com_ /releases/2009/11/091102085827.htm

New Approaches to Chronic Disease Website

Beth Israel Medical Center’s Continuum Center for Health and Healing has launched a new website New Approaches to Treating Chronic Disease, focusing on heart disease, diabetes and chronic pain. The site provides in-depth information on healthcare approaches that can improve your health, complement your regular medical care, expand your options, and enhance your quality of life. Information is based on the best research available and the most up-to-date and tested knowledge on managing heart disease.

The website provides integrative approaches to care. Under the heart disease page, there is information on nutrition, mind-body therapy, manual medicine, psychological approaches, East Asian medicine, movement therapy and spirituality.

Learn Something New

Learning something new, whether it’s a new craft or history of the women in Henry VIII’s life, is a wonderful way to exercise the brain. Just as important as physical exercise, much as aerobics leads to a better cardiovascular system, learning keeps the brain healthy. As Leonardo da Vinci wrote “Iron rusts from disuse; stagnant water loses its purity and in cold weather becomes frozen; even so does inaction soften the vigor of the brain.”

The list of what to learn is endless and depends on your interests. Some ideas:
• learn a foreign language
• how to knit or crochet
• where birds in your region go for the winter
• how to draw cartoons
• play an instrument
• become an indie rock expert
• read about the life of a famous person.

A fun approach to learning lots of different, and unusual things, can be found at the following sites:

• Zidbits:  Exploring Life’s Little Mysteries 

• Top 40 Useful Sites to Learn NewSkills