Tanning beds for health?!
You may think:
"You must be freakin' insane..."
"Everyone knows tanning beds are unhealthy"
"Tanning beds are only used for superficial cosmetic reasons"
"You'll age your skin and get cancer"
Sure, I get your sentiment...
Governments and health institutions have been cracking down on tanning beds for years. So answering the question "are tanning beds safe?" is kind of easy:
"The proof is that tanning beds are unsafe is devastating."
"No need to question recommendations on tanning beds: governments surely do their research".
"Over. Done. Next topic"
But wait a sec...
There's a bit of a problem...
Should you always trust governments?
Should authority not be questioned?
Should you reject the notion that governments always knows best?
I think you do...
Government act upon incomplete data all the time - sometimes even in the absence of any data.
Governments are allowing 5G networks to be built in cities, even though the technology is untested. And air pollution reigns supreme after decades, killing millions of people yearly while the problem is not countered. And Norway admitted in 2018 they had no intelligence on Libya in 2011 while helping NATO invade the country.
So let's have a fresh look at tanning beds, answering the question: "are tanning beds safe for health?"
The goal is to maximize the health benefits of indoor tanning and minimize risks.
I'm against tanning for cosmetic purposes, which sends the wrong message. I'm not trying to turn you into an over-tanned leather skinned TV model.
Just in case, I'll repeat my words again: I do not advocate for tanning for cosmetic purposes, only for health purposes.
So here's the gist of my claim:
Ultraviolet light exposure from sunlight is the traditional means by which humans created vitamin D. When certain types of ultraviolet light hit your skin, vitamin D is created.
Animal foods are another ancestral vitamin D source.
Vitamin D pills have only been used for a few decades, and are thus not our traditional source.
Tanning beds emit ultraviolet light (UV) - just as sunlight - and can thus help you create vitamin D in the skin, attempting to replicate sunlight in the process...
Besides creating vitamin D in the skin, ultraviolet light exposure has many more benefits, such as helping your mood, increasing relaxation, boosting the energy levels in your cells, and improving circulation.
But here's a shocker:
40-60% of the world's population is vitamin D deficient. Vitamin D deficiency does not just plague higher norther latitudes (Canada, Scandinavia, Russia)--it's even a problem if you're living around the equator and cover yourself with clothing.
Vitamin D supplements are almost always recommended as a solution to that problem--not sunlight exposure or tanning beds...
By taking supplements you'll miss out on all these amazing benefits though. Indoor tanning does have a very negative reputation for its health effect today, and is often seen as a terrible solution.
Is that assessment correct?
Let's find out:
That sentiment changed in the late 1970s and early 1980s - antibiotics and vitamin D pills started to replace ultraviolet light devices.
Governments and health institutions began promoting sunscreen en masse. Sunscreen blocks ultraviolet rays from reaching the skin, and thus lowers the amount of ultraviolet light reaching your skin.
Ultraviolet light began to be seen as dangerous by health institutions.
Today, recommendations go as far as reducing ultraviolet light exposure to zero, which can be achieved by wearing sunscreen year-round and using umbrellas that prevent sunlight from touching your skin.
The modern "sunlight exposure" ideal
Skin cancer is almost completely caused by sunlight exposure and tanning bed use, according to the dominant narrative.
Any amount of ultraviolet light is also deemed to be damaging and counterproductive (as you can get your vitamin D levels up via pills).
Let me explain:
Skin cancer rates are going up, including the most dangerous form of skin cancer called a "melanoma".
And yet, many people in the developed world are wearing more and stronger sunscreen than ever. People are also exposed to less ultraviolet light than any time in history.
In 1910, most jobs were outdoors while no sunscreen was used. Today, most jobs are indoors, and people slather on sunscreen whenever they leave the house. Skin cancer rates have been going up since then.
Outdoor workers have 3-9 times as much ultraviolet light exposure than indoor workers. And yet, even today, outdoor workers have up to half the melanoma risk of indoor workers.
Another shocker: even tanning bed usage has been going down in the last decade.
And again: skin cancer rates are still going up...
In essence, I don't believe that ultraviolet light exposure is responsible for that escalation in skin cancer numbers. Ultraviolet light cannot alone explain skin cancer rates...
So what's the solution?
The best way of getting ultraviolet light exposure have a continuous exposure over the course of a year. I.e., get stable ultraviolet light exposure year-round. Of course you'll have lower exposure during the wintertime, and higher in the summer.
But: if you're never getting any ultraviolet light exposure in the late winter, and then move into the full spring sun, you're making a mistake.
Balance is key.
Tanning beds are best used when sunlight is really weak at your location. When the sun only moves low in the sky, no vitamin D will be created in your skin as a response to UV light exposure.
Keep in mind that tanning beds cannot replace sunlight. If you've got the option, always opt for sunlight exposure:
Sunlight remains king...
To be precise, more than 55,000 people die of melanoma every year on a worldwide basis. Perhaps 5,000 - 7,500 of these deaths are caused by tanning beds.
The mainstream narratives ignores the fact that hundreds of thousands if not millions of lives that can be saved by getting adequate vitamin D levels and promoting all the other sunlight exposure and tanning bed benefits.
I'll explore these numbers in excruciating detail in the full blog post.
The question "are tanning beds safe" is thus answered as: "it's unsafe NOT to use them (correctly)".
In the full blog post I'll give you all the nuance in the world to make the decision for yourself. Many important details are not laid out in this summary - hence: read the full text...
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Author: Bart Wolbers. Bart finished degrees in Physical Therapy, Philosophy (BA and MA), Philosophy of Science and Technology (MSc: Cum Laude), and Clinical Health Science (MSc).
Tanning Bed Safety Introduction:
Answering The Question: "Are Tanning Beds Safe":
3. How Tanning Beds Affect Your Health
4. Are Tanning Beds Safe? The Scientific Answer
5. Protecting Against Sunburn And Optimizing Tanning Sessions
6. Guiding Your Tanning Sessions By Vitamin D Lab Tests
To tan or not to tan...
You may think: "Just spending 15 minutes in a tanning bed already increases my risk for skin cancer"
"People only use tanning beds for cosmetic purposes"
"You'll look great in the short term, but tanning beds eventually age your skin."
And you know what? There's truth to some these statements. Improper tanning does cause skin cancer in some people.
The other statements above are pertinently untrue - which I'll prove soon.
Tanning also makes you feel incredible and increases your vitamin D levels - additionally making you look great.
So how to minimize skin cancer risk?
Avoid tanning beds at all cost, take some vitamin D supplements, and opt for long-term health?
I argue otherwise...
Why that answer?
Well, on the one hand, there are studies stating that "melanoma risk increases by 1.8% with each additional tanning session per year".
Melanoma is the most dangerous form of skin cancer.
But there's a flip-side:
Vitamin D deficiency is more widespread than ever. Between 50-80% of the world's population does not have optimal vitamin D levels.[3; 4] 70% of Americans have low vitamin D levels.
Even people living in equatorial countries have low vitamin D levels, mostly due to wearing clothing when spending time outside.
Let's take a look at such countries. In India, between 70 and 100% of people have insufficient vitamin D levels. Turkey? Above 90%. Iran, 45-60%, and Saudi Arabia ~50%.[7; 8]
Sure, culture plays a massive role in these places.
Consider some other countries:
Norway at 56%. Israel? 78%. US adolescents: 42%. Germany 61%.
On the highway to vitamin D deficiency...
Keep in mind that these numbers do vary because of different conceptions of what vitamin D insufficiency is defined.
And yet, sunlight is by far the best source of vitamin D. Vitamin D is necessary for many bodily processes to function correctly.
Tanning beds purport to simulate that sun, at least, if they contain the right types of light, and can thus create vitamin D.
Another reason is the absence of consuming vitamin D-rich foods in the wintertime (more on that later).
You'll essentially want to avoid skin cancer but enhance health benefits.
To answer that question, I'll first take you on a tour through the history of indoor tanning products.
Stay tuned for the answers to the question above...
The tanning industry is a 3 billion dollar market today. The US alone has more than 13,000 tanning salons. The market also grows 4% per year (much faster then the US economy), and seems booming.
But nothing is further from the truth...
The use of tanning beds has decreased rather than increased, and many tanning salons have gone bankrupt in the last decade.
Now that consumer spending is slowly going up again, the industry merely looks profitable.
Let's explore why the tanning industry is not doing that well:
In roughly the same period - the late 70s and early 80s - the tanning industry also took off. Before that, tanning beds had not been used widely.
Tanning was very popular initially, until it got a bad rap. Sunscreen also started to be promoted widely, especially in the 80s and 90s - coinciding with the more negative view of indoor tanning.
That process culminated in countries such as Brazil and Australia started banning tanning beds altogether. Many countries also put age restrictions on the use of tanning beds - exemplified in signs such as "no UV exposure before the age of 18".
Today almost all countries actively discourage their citizens from visiting tanning salons. After 2010, tanning's addictive nature of tanning began to be emphasized - creating an analogy in consumers' minds between indoor tanning, cigarette smoking, and alcohol addictions.
For these aforementioned reasons tanning bed use has declined in the previous decades. Since 2010 alone, both adult and teenager tanning bed use has declined with a whopping 30%.
But there's a surprise:
Before the mid-20th century, sunlight was extensively used in treatments of rickets and tuberculosis.[152-155] Scientists even attempted to replicate that sunlight in indoor lamps, such as "Sunray lamps", solaria, and finally tanning beds.
But let's take a step back:
For millions of years, the sun was the original source of humanity's ultraviolet light exposure. Ultraviolet light is the type of light which can give you a sunburn.
Throughout recorded history, tanning has an altering reputation. Some Ancient Egyptians ascribed healing powers to the sun, while at other periods society's elites avoided sunlight exposure...
At the beginning of the 20th century many healing benefits were ascribed to the ultraviolet light. UV light sources included both sunlight and sunlight-mimicking lamps.
Tanning lamps that emit ultraviolet light became more popular in the 1920s. You can see a picture of a young Dutch man using such a lamp in the '30s below:
Around that same period, having tanned skin also became associated with health. In the 19th century and before, tans were often associated with the lower class status. Elites actively prevented being tanned to distinguish themselves from lower classes.
That practice is still present today in countries such as Thailand and China.
In a sense, the early 20th century was a golden age of sunlight exposure: sunlight and ultraviolet light were associated with a tremendous number of health benefits.
Fast forward to today:
The end results of that campaign are exemplified in statements such as "tanned skin is not healthy skin" and "a base tan is not a safe tan".
The CDC also claims that greater reductions in ultraviolet light exposure lead to progressively greater health benefits. In other words, the CDC assumes that there's a dose-response relationship between lower ultraviolet light exposure and increasing health.
Complete sun and tanning bed avoidance is the logical consequence of that advice.
Additionally, the WHO also assumes that low vitamin D levels are a consequence of ill health, not a cause.[168-170] Fixing vitamin D deficiencies is thus not a primary health priority when considering the logical implications of the WHO's own words.
(Nerd section: the reason why increasing vitamin D levels may not work in everyone is because the effects is mostly to be expected if you're already deficient.[172; 173] Raising vitamin D levels in a deficient population probably confers health benefits upon you, in combination with other health strategies. If your vitamin D levels are already sufficient, then raising vitamin D levels further can have side-effects. Measuring an averaged effect over sufficient and deficient participants can thus lead to observing no benefit to upping vitamin D levels.)
Fascinatingly, the WHO does state that:
"As yet, evidence for an association between sunbed use and increased melanoma risk is suggestive but not conclusive."
(Melanoma is the most dangerous type of skin cancer.)
The story continues:
Due to a combination of new taxes and a recessions back then, many tanning salons went bankrupt.
The Federal Trade Commission (FTC) even brought lawsuits against pro-tanning institutions such as the "Indoor Tanning Association" for preventing to communicate to customers that indoor tanning causes skin cancer and eye problems.
The FCT alleged that the Indoor Tanning Association has misled customers into believing that getting a tan was necessary for vitamin D creation in the skin.
Of course, these statements are logically true, as it's possible to get your vitamin D levels up by taking a pill.
Nevertheless, for millions of years the mechanisms by which our ancestors created vitamin D was skin-exposure, not pills. I'll explore the specific claim of the FTC in a later section...
The FTC even states that not only sunburns, but even "tans are signs of skin damage". In other words, tans are directly a symptom that skin damage has already occurred.
Additionally, the FTC also states that "UV radiation causes wrinkles and age spots", hinting at a direct dose-response relationship between ultraviolet light exposure and wrinkles and age spots.
In 2014, even the US surgeon general made a call to action on skin cancer.
Fortunately, the surgeon general does state that: "[a]lthough all UV exposures can affect skin cancer risk, entirely avoiding UV rays from the sun is neither realistic nor advisable for most Americans".
I agree with the assessment that avoiding UV rays is unrealistic. Nevertheless, the surgeon general does recommend to eliminate tanning bed use, stating that indoor tanning is "completely avoidable".
Sunlight is also demonized by the surgeon general. The attack on indoor tanning also continues to this day.
Let's find out...
Logical implication of the FTC's assertions:
tanned children equal child abuse.
So what's the solution?
Minimize all ultraviolet light exposure?
Avoid tanning beds like the plague?
In the next third section, I'll consider by which mechanism tanning beds affect your health. The fourth section dives deep into the question whether tanning beds are safe (and healthy).
The basic idea of using tanning beds is that you're trying to recreate the benefits that you'd otherwise get through sunlight exposure, using specifically "ultraviolet light" which I mentioned before.
I've stated that ultraviolet light helps create vitamin D, and that sunlight has many other benefits than just vitamin D creation. By analogy, the same is true for tanning beds.
I'll explore these benefits in the next section.
Observe the picture below:
That picture illustrates the light spectrum.
The complete light spectrum is made up of:
Your eyes can only see visible light--both infrared and ultraviolet light are thus invisible to the human eye.
As you can see, ultraviolet light can be sub-divided into "UVA", "UVB", and "UVC". UVC that's emitted by the sun does not reach the earth's surface in high quantities. That leaves you with mostly UVA and UVB here on earth (except in special cases).
Notice that each type of light on the light spectrum contains specific wavelengths. Observe that UVA and UVB have different wavelengths. UVA is located between 315 and 400 nanometers, for instance.
Each color of visible light falls within a certain interval of these wavelengths as well.
The shorter the wavelength, the higher the energy of the light. Ultraviolet light has a very low wavelength, and thus a very high energetic value.
(Wavelengths measure how long different types of light oscillate in space.)
Additionally, almost all tanning beds emit visible light as well.
Because the ultraviolet light emitted by tanning beds has a higher energetic value than visible and infrared light, it can cause a sunburn - just as sunlight.
In fact, UVB which has the highest energy level and most commonly causes sunburn. At very high doses, UVA can cause sunburns as well.
Melanin is the substance in your skin that causes that tanned pigment. The darker your skin, the more melanin it contains. If you've naturally got a darker skin type (independent of tanning), that's due to having more melanin in your skin.
A darker UVB tan.
So how does UV exposure get you a tan?
UVA (at higher dosages) temporarily darkens the currently present melanin in the skin, which immediately makes you look more tanned. That UVA tan does not last very long though.
UVB also causes (temporary) reddening of the skin when you're exposed to ultraviolet light. At a dosage that's high enough, UVB, increases melanin production in the skin. After a 2-3 day period you'll look darker, and that increase in melanin lasts a long period of time.
Some skin types, such as the a very white Caucasian skin type, have trouble creating new melanin in response to UVB. Not everyone can thus produce great amounts of melanin.
So let's say you want to start using UVA and UVB to your advantage.
Tanning thereby becomes a mere by-product...
I just treat the topic of tanning here because understanding how and why you tan is an important part of sunburn prevention.
So let's explore how UVA and UVB can lead to a possible health improvement:
UVA penetrates deeper into the skin than UVB and causes the blood vessels below the skin to expand. UVB creates vitamin D in the skin, while UVA does not.
Exclusively using UVA causes aging of the skin. That exclusive UVA exposure is problematic because modern windows block all UVB while letting UVA through.
Driving a truck or working beside a window for a few decades can thus really make your skin look old, because you're solely exposed to UVA.
The bottom line is this: tanning beds emit UVA (and hopefully UVB) to replicate the ultraviolet light of the sun. Through that mechanism, you can build vitamin D. Both UVA and UVB are thus necessary for the best health results.
There's a problem though: the UV light strength of most tanning beds varies:
I know I'll have some explanation to do...
New York city and the Mediterranean sea are located around that parallel. These least intensive tanning beds are generally used on the EU (mainland).
Such EU tanning beds may emit a maximum dose of 0.3 Watt per square meter - approximating the sun's strength at the 40th parallel summer I talked about earlier.
Some countries such as the UK, US, and Russia often use (much) stronger tanning beds.[158-161] Tanning beds in these countries can even surpass the 1 Watt per square meter level, leading to UV light exposure levels that are far stronger than the sunlight found at the equator.
I do not recommend using very strong tanning beds, and I think such tanning beds may lead to health risks such as skin cancer.
On another note:
The sun emits a combination of ultraviolet, visible, and infrared light that cannot be replicated with one light bulb nor with a combination of light bulbs.
Tanning beds usually completely miss the infrared spectrum, and most parts of the visible light spectrum as well.
Always opt for the sun if possible if the sun's UVB rays still reach your location. You'll need to be in the sun around noon to reap the benefits of those UVB rays.
The only time I use tanning beds here in the Netherlands is between the end of October and February. In these months there are only 45-80 sun hours in an entire month.
The sun also does not rise over a 45 degree angle during that period, which is necessary for your skin to produce vitamin D. Below a 45 degree angle (almost) no UVB from sunlight reaches the earth's surface.
Again, remember that UVB is necessary to produce vitamin D in the skin...
Sunburns are almost certainly damaging and increase your skin cancer risk.
Many people who use tanning salons get sunburns.
Because these people use tanning beds incorrectly.
Hence a warning:
Don't be stupid: start very slowly. Start well below the sunburn threshold.
Build up your tolerance, and only then increase the intensity of the tanning session.
Let me explain why I'm so fanatical about these guidelines:
The reason is simple:
Most people don't have a daily sunlight habit. To explain that habit, let me tell you about a few patterns in most people's sunlight exposure that I observe.
The flipside is that you can reduce health risks if you're tanning beds correctly.
Avoid looking like this guy after being exposed
to sunlight or using a tanning bed.
In the next section I'll look at whether tanning beds are (inherently) safe. You'll learn whether the demonization of tanning beds is justified--or not...
Remember the statements health institutions and governments that the best level of ultraviolet light exposure was zero, or that having any tan on your skin is a sign of damage?
In this section I'll explore the validity of these claims.
Remember that contrary to tanning beds, sunlight does emit red and infrared light. You can see those parts of the light spectrum in the picture below.
The golden area signifies that red part of the spectrum:
That infrared light preconditions the skin for ultraviolet light. You normally get that infrared exposure by getting into the sun during the morning time. Once ultraviolet light levels increase around noon, your body is thus already preconditioned.
Ultraviolet light emitted from the sun increases the higher the sun moves up in the sky.
Sunlight also contains all parts of the visible light spectrum--tanning beds only contain peaks around certain wavelengths of light, but do not contain a continuous spectrum.
Tanning beds may emit lots of light around the 425 nanometer wavelength, for example, but almost no light around 410 and 440 nanometers. Sunlight light from UVB and UVA all the way to the 1,000+ wavelengths, and thus includes light between the 410 and 420 nanometer wavelengths, 420 and 430, 430 and 440, etcetera.
The fluorescent or LED bulbs in tanning beds flicker. Flickering means that a bulb is activated many times a second, such as 60 times. You cannot consciously notice that flicker, but it is irritating to both the skin and eyes and sub-optimal for health.[193; 194]
Sunlight is continuous and does not flicker, and is thus a better option.
Lastly, light from the sun is also "unpolarized", meaning it's not emitted in a single plane. Light from fluorescent bulbs or LED bulbs is polarized, which probably has a different biological effect.
Conclusion: always get sunlight if you can.
Several types of skin cancer actually exist. The most important ones are:
With a lighter skin type, you'll be more at risk for getting skin cancer. With a darker skin type, you'll have higher risk of spotting the cancer later, but lower overall skin cancer risk.
The white skin types that do not tan well at all are even more at risk for developing skin cancer. Lighter eyes, a blond or especially red hair color, previously having had skin cancers (or skin cancers in the family), and having moles are other risk factors.
That's a whopping 1 in 60-100 Americans.
9,000 of these people die as a result of melanoma.
Projections assume that eventually 1 in 5 will eventually get skin cancer - if the trend of skin cancer increases continues. Skin cancer diagnoses also keep increasing.[17-19]
55,000 people die due to melanoma yearly worldwide - the US is thus over-represented in melanoma deaths. Melanoma diagnoses and deaths are also projected to increase.
Almost half a million non-melanoma cancer diagnoses are claimed to be caused by tanning bed use alone, as well as 10,000 melanoma diagnoses. Keep in mind that not all 10,000 people with a melanoma diagnosis die, but that it's nonetheless a serious problem.
The US cost of treating all skin cancers now approximates 5-8 billion dollars a year.
So those numbers should immediately have you make a final verdict right?
You may have noticed that when sunbathing, people are putting more and stronger sunscreen on their skin than ever.
Health institutions now recommend to wear sunscreen in the wintertime, even if there's almost no UV, and use an umbrella when the sun is strong.
Again, complete avoidance of ultraviolet light exposure is recommended (and practiced by many).
And yet, skin cancer numbers still keep increasing.
If you're thinking: "this is not supposed to happen..." then you're 100% correct...
What makes such numbers possible?
Sunscreens were invented in the 1920s, but have only been marketed since the 1970s. At that time, longer-lasting water-resistant sunscreens became available, mass-marketed, and used more widely.
At or before the 1970s, sunscreen was not routinely used, and yet, skin cancer rates were far lower than today.
More sunlight exposure - and thus more ultraviolet light exposure - cannot explain why you're at an extremely higher risk for skin cancer today. The amount of ultraviolet light people are exposed to in 2010 is far, far, lower than 1970, not more...
Even tanning bed use has been declining for years. Between 2010 and 2015 alone, tanning salon use declined with 20-30%.
And skin cancer rates still went up...
Let me give you an analogy:
In the 1950s and 60s breastfeeding was deemed "old-fashioned" and "inferior". Infant formulas were pushed as a superior alternative to breast milk.
The claim was believable: health institutions such as the American Medical Association had already given infant formula a stamp of approval in 1929.
While infant formulas are still aggressively marketed, governments and health institutions are fortunately no longer supporting the practice like they did in the mid-previous century.
The practice of using infant formula over breastfeeding is nevertheless continued today, resulting in up to 800,000 yearly infant deaths on a worldwide scale.[23; 210; 211]
(Those are the WHO's numbers.)
So what's my point with this analogy?
That conclusion is problematic.
Let me explain...
If you think of previous generations being "unenlightened", the 1950s and 60s can be cast aside as "when our grandparents sprayed DDT pesticides on crops and fed our children infant formula".
The true historical lesson, however, is that not only were our grandparents unenlightened, but we are as well.
The reason for the analogy is that blindly acceptance that tanning bed use is unhealthy is dangerous from a historical perspective...
Let's continue the analogy with baby formula:
The same company that was boycotted for aggressively selling infant formula, Nestlé, also lay at the foundation of the sunscreen mass marketing in the 1970s. Nestlé had a stake in L'Oreal (and still does), a company which pushes sunscreen and "sponsors" dermatology institutions.
So what could you be missing by exclusively focusing on the relationship between ultraviolet radiation and skin cancer?
All cause mortality is the most general risk of death measured used in medicine.
Avoiding the sun thus increases your overall risk of death independent of cause: whether you die because of skin cancer, a car crash, pneumonia, a drug overdose, or a heart attack.
(yes, that list is morbid, but I had to make my point.)
In other words, higher ultraviolet light exposure is thus protective against dying.
To understand this problem, let me give you an analogy. What if:
Spotting the logical error?
"No exercise for me human, as I can fall of the stairs.
Cannot take any risk..."
So even though:
The same is true with exposing yourself to ultraviolet light - that light exposure has both risks and benefits.
Focusing on risks only is myopic. Context is key...
Take vitamin D for example. Measuring vitamin D levels is a great proxy for how much time people spend in the sun.
Having higher vitamin D levels decreases your risk for several other types of cancers, such as prostate, ovarian, breast, and colon cancer.[34-39] Any calculation that only takes skin cancer into account is thus short-sighted.
Higher vitamin D levels also decrease your risk for almost all diseases, a topic I'll get back to later.
The low vitamin D epidemic is almost never taken into account by the opponents of tanning bed use.
Why is there a "melanoma awareness month" when 9,000 people die on a yearly basis, but no air pollution awareness month, that kills tens if not hundreds of thousands of people every year in developed nations (let alone the developing world)?
I've written an extensive guide on air pollution before, in which you can read that even a single air pollutant such as nitrogen dioxide kills 6,000 people each year in Germany and 20,000+ in the UK.
Translated to the US, that number approximates 50,000 - 100,000 deaths. With more than 10 different air pollutants that you can be routinely exposed to in the city, the damage that is leveled upon your health is far greater than the risk of dying of melanoma.
Sure, dying of melanoma is terrible. Every person who dies of the consequences of melanoma or is even suffers because of it is a tragic case - I wish those consequences upon no-one. Every death is one too many.
But given the scare that health institutions and governments put out about indoor tanning and sunlight exposure, you'd expect a lot more melanoma deaths than 9,000.
Heck, even radon, a simple indoor pollutant kills 20,000 people each year due to lung cancer. Why don't you hear commercials about radon on the radio and television every day?
Why only a UV light scare but no radon scare?
Common statistic: using tanning beds, your risk of melanoma is often stated to increase by a whopping 70%.
But 70% compared to what number?
Let me explain...
If you're already at a high statistical risk for getting dangerous forms of skin cancer, then a 70% increases is quite damaging. If the risk is very small, on the contrary, you'll have to worry less.
So what's the risk?
Well, in a study in Norway and Sweden in which 100,000+ people were followed for 8 years, 187 of these people developed melanoma over the course of that period. Yes, tanning bed use increased that risk, but so do sunburns, having less pigmented skin, blue eyes, and other factors.
Let's break those numbers down further:
Of 65,239 women who never or rarely visited a tanning salon, 111 developed a melanoma. In the group of 14,377 women who used tanning beds once a month or more, 34 developed a melanoma. That's a 55% (instead of a 70%) increase--but a 55% increase on a risk that's very low nevertheless.
Phrased differently, the women who never visit a tanning salon have a 0.17% risk of developing melanoma over 8 years, while women who do use a tanning bed have a 0.23% risk.
To put that number in perspective, having more than two sunburns each year increases your risk with 80%.
From a statistical point of view, sunburns are thus much worse than using tanning beds (80% versus 55%).
But there's a shocker from the same study: alcohol consumption increases the melanoma risk with a whopping 65% - why does the melanoma scare focus on sunlight and tanning beds in relation to melanoma risk, not alcohol?
Meat consumption is also strongly associated with melanoma risk--but they key word is associated.  I've written about how associations in medical studies are not always predictive of disease in my blog post about the carnivore diet.
Association does not equal causation.
To explain that principle: there's a very strong association between rainfall and wet streets. But if the streets are wet on a hot summer day, that does not mean it has rained 10 minutes ago, the better causal explanatory reason is probably that children set up a plastic pool in the garden and played with the hose.
In the same way, tanning use and meat being associated with higher risks of melanoma don't immediately mean anything. It might be that because many people associate tanning with an unhealthy practice, so that healthy people (who avoid alcohol, watch their diet, sleep well, and exercise) may avoid tanning beds.
The same is true for alcohol use...
The 55% increase in melanomas is thus not as scary as it originally sounded...
Let me continue with my argument:
30 million people tan every year in the US. Assume for the sake of argument that the US has population of 300 million. In that case, 10% of the US population tans in a salon every year.
Let's also assume for the ease of calculation that 10,000 people die each year of melanoma (the real number is 9,000), and that indoor tanners have a 66% increased risk of melanoma (real number: 55%).
(notice that all my assumptions are biased against tanning bed use).
If I'd used the same distribution of risk as in the Norway study, in the US that would lead to to 8450 deaths of melanoma in the non-tanners group (of 270 million) and 1550 in the indoor tanners group (of 30 million people.)
Next, to paint the bigger picture correctly, I have to adjust for the fact that some of the tanners who die of melanoma would have also died if they wouldn't have indoor tanned.
The risk of death of the non-tanners needs to be subtracted from the tanners group.
938 people die per 30 million people in the non-tanners group each year due to melanoma. So 1550 - 938 = ~650 people die from melanoma due to using tanning salons in the US each year.
By extrapolation, there are about 6,500 tanning bed related melanoma diagnosis each year.
(Nerd section: for the full proof of the calculation above: 8450/9=938. 938*1,66=1558 deaths in the tanners group. For the sake of argument, I've also assumed that the population groups of tanners and non-tanners have equal population characteristics, which they are not in reality. In reality, the tanners are probably less healthy people, as indoor tanning is associated with being an unhealthy practice.)
So 650 melanoma deaths, is that a lot?
Remember: radon killed 20,000 per year, and other air pollutants far more...
So let me ask yet another question:
Heart disease kills over 600,000 people each year in the US. Cancer around 600,000. Lung disease over 150,000.
Indoor tanning 650, while not taking the far greater lives that are saved by this practice into the equation.
And that's just a small short-list of vitamin D benefits. Other benefits may for example include helping your immune system, preventing obesity and diabetes, plus reversing gut problems.[89; 90; 132; 133]
How many lives would getting your vitamin D levels up save every year? 50,000? 100,000? 200,000?
I'm pretty sure the number is much higher than 650...
Please keep in mind I've also ignored the additional UV exposure benefits in this calculation, a topic I'll get back to in a moment...
Cat superpowers: never sunburned before...
And if you learn to tan safely, the risk you're among these 650 people becomes much lower.
Sure, tanning beds are associated with a higher risk for getting melanoma, but lots of people use tanning beds stupidly. The 650 number can thus also be dramatically reduced by promoting safe indoor tanning.
Some studies show an increase in skin cancer while others no association.[112-119] One study even argue that tanning bed usage may prevent non-melanoma skin cancers types, such as "basal cell carcinoma" and " squamous cell carcinoma".
Another important fact is that mostly older people die from these non-melanoma cancers, and the yearly number approximates 2,000. Other skin cancers not reated in this blog post lead to roughly 4,000 deaths...
And there's more:
Up to 30 false positive "melanoma" tissues are cut away for every true one.
There are good reasons for that high rate of false positives, as an early detection and removal is essential to melanoma survival. I thus do think the number of 30 false positives for every true melanoma can be justified.
Fortunately, the number of people dying yearly due to melanoma has also been stable--not increasing.
More people may thus simply be diagnosed with melanoma, even though such diagnosis are more often than not incorrect. That over-diagnosis is thus another explanation of the "skin cancer epidemic".
I need to consider one counterargument though:
If you do get a melanoma removed based on a false positive diagnosis you'll also have to deal with the psychological trauma of having had cancer - even though you did not really have a melanoma.
Overall, the "cancer epidemic" may exist, but it's certainly not a melanoma epidemic caused by tanning beds.
Again, more melanomas are being diagnosed than before while ultraviolet light exposure of most people is going down.
So let's continue:
Examples are the backs of outdoor workers or tights of women. The head, neck, hands, and forearms, which would be expected to the main melanoma locations, are not always.
And then there's yet another devastating angle to my argument....
The 30,000 foot view:
The average American now spends 90% of their time indoors.
Most people only spend time in the sun in the spring or summer, once the temperatures have increased. Staying indoors and getting sunlight on summer weekends or holidays is called "recreational" sunlight exposure.
Regarding skin cancer risk, recreational sunlight exposure is far more dangerous than having an outdoor job. And yet, realize that if you do work outside all day you've got far greater UV light exposure than if you're tanning recreationally.
Ultraviolet light exposure is thus not the problem per se.
Let that number sink in...
Why is that number mind-boggling?
Indoor workers have three to nine times lower exposure levels to ultraviolet light than outdoor workers.
Moreover, even heavy occupational sunlight exposure reduces you risk for getting melanoma. Non-sun-burning ultraviolet light exposure is also associated with lower melanoma risks.
The assumption of many health institutions and governments that ultraviolet light exposure directly caused skin damage and cancer can thus not be true.
Farmers: three to nine times the ultraviolet light exposure of
indoor workers, and yet, a lower melanoma risk.
From 1910 to 2000, farmers and farm laborers, as percentage of the US labor population, declined from both 16% to less than 1%.
Indoor job numbers have expanded massively since then, either doubling or tripling in number. Most people are thus exposed to less ultraviolet light compared to what they were in 1910.
In 1910, most jobs were outdoor jobs. Most jobs are indoors today. The only time you can get good sunlight exposure during an indoor job is during breaks.
A 9-5 job will prevent your body from being exposed to UVB because UVB does not penetrate through windows. About 25% of the sun's UVA rays can still end up indoors.
That exposure possibly leads to an unbalanced exposure pattern, with too much UVA with an absence of UVB.
Why have melanoma incidences increased with 800% for younger women, and 400% for their male counterparts, from 1970?
Given the data I've just presented, have humans increased or decreased their UV exposure during that time?
Can ultraviolet light alone explain why melanoma rates have gone up?
I'll let you answer these questions...
With that data, let's return to the question "are tanning beds safe?"
You may think: "why not use vitamin D supplements instead?"
"With vitamin D pills I don't have to risk ultraviolet light exposure at all?"
Let me explain my response:
The ultraviolet light in tanning beds and sunlight:
Humans and humans ancestors have not relied on vitamin D supplements for millions of years.
In fact, supplementation has only been possible for 50 years.
The recommendation to avoid tanning beds reeks of reductionist thinking. Let me give you some examples of that thinking style:
All these examples exemplify human overconfidence in reductionist thinking - humans often assume they know better than nature.
Are you really in a position to state that all ultraviolet light exposure is bad?
That style of thinking always has a cost. The assumption that human beings can do without ultraviolet light, after our ancestors have lived in high UV environments for most of the time, is mind boggling.
Sure, your ancestors moved into the shade after they were exposed enough sunlight.
A counterargument against my position is that tanning beds also try to replicate sunlight. I can debunk that counterargument by claiming that I've never advocated for replacing sunlight exposure by tanning bed use anyway - sunlight is superior.
Let me give another example of the anti ultraviolet light exposure position:
What if I told you that you could simply take a pill that affects your body cells (such as a PPQ supplement) so that you'd no longer have to exercise? Would most people believe the pill works equally good as the the real thing?
If not, then why assume that vitamin D pills are equally as healthy as ultraviolet exposure?
I'll let you answer the question again...
There's another option though:
To get most of your vitamin D through foods, you would need to consume a high amount of animal products.
Seafood and egg yolks are the best vitamin D3 sources, specifically salmon, herring, mackerel, egg yolks, shrimp, and shellfish. Wild fish is much better than farmed fish in terms of vitamin D content.
Tuna is a great vitamin D source too, but I do not recommend that fish source as it's often contaminated by heavy metals.
Two to three hundred grams (6-9 ounces) of these foods per day will supply you 2,000 - 5,000 international units. You'll need at least 1,000 international units a day to maintain proper levels in the wintertime at high latitudes - if you don't get tanning bed exposure.
But again, if you choose to get your vitamin D through foods, you won't get all ultraviolet light benefits I've described above.
Foods do have a preference over vitamin D supplements, however, because they contain many co-factors such as vitamin A and K2.
Nature's original vitamin D supplement.
Returning to the topic of governments and institutions about the use of tanning beds, not all of them are bad:
Yes, I rarely compliment governments but now I do...
In 2009 the Health Council of my Dutch government rejected the WHO's classification of tanning beds as a "class 1 carcinogen" (a known carcinogenic to humans), stating that:
"As yet, there is no justification for making a distinction between sunbathing and the use of sunbeds"
The Health Council also favors sensible sunlight exposure, so that complete avoidance is not recommended. People in that Health Council had to think independently, ignoring the pressure to conform to the WHO's standard to envision tanning beds as inherently carcinogenic, to arrive at that conclusion.
A loving thanks...
I don't see the Federal Trading Commission attacking television or (LED) light bulb companies because these ruin people's sleep and damage their eyes.
Light bulb that exposes you to lots of blue light for 16 hours a day can legally be sold to customers. And yet, the amount of proof of blue light toxicity, especially at night, is already devastating for human health.
As a consequence, it's only fair that if tanning beds are accompanied with a warning sign, that the same should be true for any television, LED or fluorescent light bulb, billboard, or computer: all of these devices put out unprecedented amounts of blue light.
40 million US inhabitants have chronic sleep problems. 20 million have occasional sleep issues.
Blue light affects those sleep issues. Artificial light emits that blue light. Many sleep issues are created by not respecting the 24-hour cycle in your body, called the "circadian rhythm". The circadian rhythm underlies almost every process in your body.
The LED bulbs that are sold without warning signs, such as "cancer causing" or "causes insomnia", are thus unregulated right now...
Even if a very conservative 10% of sleep issues are caused by blue light toxicity, that's 6 million sleep problems. How much disease is caused by 6 million sleep problems, as opposed to 650 melanoma deaths?
And of course, the melanoma deaths due to indoor tanning are tragic, but the problem needs to be seen in perspective.
Why do the CDC and FTC not act against blue light? The reason is probably that these unhealthy light bulbs are so omnipresent in modern society that the trend is hard to reverse...
Should LED bulbs come with a warning sign in the
same way tanning beds do? The sleep problem statistics say "damn yes".
So let's explore the relationship between blue light and health a little further:
So is just ultraviolet light solely responsible for skin aging? Or is an environment that's completely detached from the light exposure you used to have during evolution the culprit, which has been transformed in purely visible light (read: blue light) environment?
Why does indoor artificial light, which often contains almost no ultraviolet, possibly cause melanoma as well?
Why are autoimmune diseases such as multiple sclerosis far less likely to occur around the equator compared to at northern latitudes (e.g. Russia, Scandinavia, Canada), if ultraviolet light is the devil?
In fact, taking vitamin D supplements may not be sufficient to counter autoimmune disease, precisely because of ultraviolet light's effect on the immune system. In autoimmune disease your immune system turns against your own body.
Why is "melanoma awareness month" still promoted as a solution?
Might some ultraviolet light be essential for you instead?[183-185]
I've done just that in this section.
Tanning beds are not the demon they are made out to be.
Keep in mind that having the right perspective is useless without taking proper action. As Aristotle says: "[w]ith regard to excellence, it is not enough to know, but we must try to have and use it."
Knowing is not enough, you should apply.
Many people know they shouldn't smoke, and yet, still do - the same is true for proper tanning.
In the next section I'll give you several strategies that protect against sunburn and help optimize your tanning sessions.
In this section I'll tell you how to make tanning beds as safe as possible if you choose to use them.
I've listed several practical tips below:
2sources are pastured animal products such as meats, butter, dairy, and especially organ meats. Organ meats from fish are a great vitamin K2 source too.
Many other nutrients that influence ultraviolet light tolerance exist.
Getting sunburns is merely delayed when you have a better nutritional status...
Again, yet another question:
Seeing a pattern in the nutrients I've described above?
Many people don't consume the protective nutrients described above anymore. How many people do you know who consume organ meats for vitamin A on a regular basis, or people who include shellfish (astaxanthin) regularly?
I know very few...
Might food quality partially explain why so many people get immediate sunburns once they're out in the sun for 20 minutes?
I think nutrients do explain part of that dynamic - the Standard American Diet creates lots of deficiencies...
Where I live, EU legislation has put a maximum on the amount of UVB that may be emitted by tanning lamps. The strength of the lamps, as measured in wattage, is also restricted.
The very strong tanning beds of the UK, US, and Russia can thus not be found in my country.
The EU has also limited the strength of the UV exposure to 0.3 w/m2. That 0.3 w/m2 approximates the sun's UV index in Greece or Spain in the summertime. Greece and Spain have roughly the same latitude as the northern US.
Again, remember that tanning beds exposing you to more than 1 w/m2, may be dangerous. Don't use extremely intense tanning beds.
Inquire with employees at tanning salons about the strength of the bulbs. Alternatively, use my strategy: just look at which bulbs are set up in a tanning bed, and Google them online.
Also remember the light spectrum below:
In the EU, many tanning bulbs contain a maximum amount of UVB of 0.8% or 1%, so that 99% of ultraviolet light ends up being UVA.
That light spectrum is far from perfect.
In other countries tanning bed lamps often contain 5-10% UVB, which is way better.
Around 5%, simulates the amount of UVB around the equator and maximizes vitamin D production. Most people with a fairer skin type do best on 2.5% - to be prevent burning.
I've written a long guide on the unique benefits of red light therapy in the past. Red light therapy improves mood, enhances your energy levels (at a cellular level), and even helps in building muscle and losing fat.
Some tanning lamps contain red light as part of their light spectrum.
Also opt for fluorescent lights instead of round ones. Round lamps are often pressure lamps and almost always only emit UVA - you're not getting any vitamin D from them.
The more balanced the UV light exposure is, the less of a concern aging of the skin should be. Nutrition helps to prevent that aging process in the skin.
Combining ultraviolet light with red and infrared light may have tremendous benefits to prevent skin aging. Red light therapy is commonly used as a form of skin therapy, and probably prevents the skin degrading effects of ultraviolet light which most people fear.
The inclusion of many types of red and infrared light is yet another reason why sunlight may be far superior than using tanning beds. Tanning beds usually only contain a few wavelengths of red and infrared light, as opposed to a continuous spectrum of many wavelengths in sunlight.
Red and infrared light's effects on skin health is yet another reason you should get morning sunlight. Most people don't get any morning sunlight exposure, and therefore get an overexposure of UV relative to red and infrared. That overexposure may also explain why some people think ultraviolet light "damages the skin".
You may know that melanoma not only occurs in the skin, but also in the eye. Medicine commonly assumes that ultraviolet light is the cause of "ocular melanoma", or melanoma in the eye.
But ultraviolet light is the cause, why are the incidences of ocular melanoma growing today, while the disease was mostly non-existent at the beginning of the previous century?
Another question: why does blue light increase the risk of melanoma in animal studies?[186-188] And if blue light is a culprit, why are health institutions not banning LED bulbs and television screens that contain lots of blue light?
And if people are spending 3-9 times as little time outside than 100 years ago, how can ultraviolet light exposure be the cause of increasing melanoma diagnoses in the eye?
I'll let you answer those questions yet again...
Another part of the equation is that you've literally got receptors (organs that can respond to an input) in your eye that are sensitive to ultraviolet light. Ultraviolet light entering your eye gives information to your brain about the time of the day and possibly even the seasons.[189-191]
Some ultraviolet light exposure in the eye is thus necessary.
Am I comfortable recommending that people not wear protective glasses under tanning beds? No, because I know tanning beds are mis-used. Nevertheless, I don't wear these glasses when indoor tanning, as I think there are many reasons why ultraviolet light exposure is important to both the skin and eyes.
To me, the most important instance to use tanning beds is if there's no natural sunlight in your environment, or if the UVB of the sun does not yet reach the earth's surface.
UVB only reaches the earth's surface when the sun is either 45 or 50 degrees up in the sky (depending on the source you refer to). The consequences of that necessary sun angle is that at northern latitudes, you cannot produce any vitamin D in your skin for most of the time of the year.
Get the D minder app for Android or Iphone to remove the guesswork from the equation. That app tells you whether you can create vitamin D through sunshine at your location.
How do you know for certain whether your tanning sessions are paying off?
Just one way to find out: take lab tests....
Taking vitamin D lab tests in the wintertime can be a great way to see whether you're getting enough exposure.
Again, the vitamin D test is valid because it acts as a proxy for your ultraviolet light exposure. Of course, that relationship is no longer valid once you're taking vitamin D supplements.
Nevertheless, lab tests are not just great to make sure you're doing enough--they're also great for preventing too many tanning bed sessions.
"Lab tests? Don't bore me to death human. Please talk
about high-vitamin D foods such as milk and cheese..."
For example, you can see your vitamin D levels drop from very high to deficient in a period of 6 weeks, if you're not getting any vitamin D.
The best way to keep your vitamin D levels up is thus to give your body a steady supply.
Le'ts find out...
The "storage" form of vitamin D, called "25(OH)D", or the or the "25-hydroxy vitamin D" blood test, is the most frequently used lab test. On that test 40 - 60ng/dl (100-150 nmol/l) is generally considered adequate.
The vitamin D levels of traditional hunter-gatherer societies accord to that level. The Maasai and Hadzabe - found in Africa - have levels around 50ng/dl (125 nmol/l).
If you're a lifeguard at a beach you'll have levels of 50-80 ng/dl (125-200 nmol/l).
If you're supplementing, then I do recommend not to raise your vitamin D level over 40ng/dl (100 nmol/l), due to possible side-effects. When using sunlight exposure or tanning beds, there's less of a risk because the skin prevents an excess of vitamin D form being created.
To be sure, I know people who have pushed their vitamin D levels to 70ng/dl (175 nmol/l) through sunlight exposure and tanning bed use, and I don't think that method is dangerous as it more or less reflects the vitamin D you'd get around equatorial environments.
Testing is thus highly recommended.
Now, to be 100% honest, there's no one-size-fits-all approach to optimizing vitamin D levels. Vitamin D levels have racial differences, as well as differences pertaining to individuals. Caucasians also generally have higher vitamin D levels, independent of where they live, for example.
A second vitamin D test can also be taken, the "1,25-dihydroxyvitamin D" 'test. That lab test is specialized towards shorter-term vitamin D status, which is the active hormone. Remember that on the contrary, the "25(OH)D" is the stored version. That "25(OH)D" needs to be activated through the kidneys and liver to become "1,25-dihydroxyvitamin D".
The "1,25-dihydroxyvitamin" D lab test is mainly recommended in cases of disease, such as calcium problems (e.g. bone loss), or kidney pathology.
In almost all cases the "25(OH)D" is the best test to take.
All you need to know about tanning bed use...
So let's conclude....
"Huh? Humans need to lab test their vitamin D levels
because they're indoors all day long?"
In a few decades of time, the current time you and I live in will probably be seen as a "Dark Age" of indoor tanning.
The hammer has struck down.
The verdict is in...
You judge, not me. You have to judge. Consider the following six facts:
Many health institutions and governments, however, claim that ultraviolet radiation directly causes skin aging, damage, and cancer.
Given the five facts I've described above, what's your verdict?
To tan or not to tan...
Beginning and ending the blog post with the thinker...
Don't believe me on my word, but don't believe others on their word either.
Health is far too important for your life than to relegate it's management to authority.
You can do it yourself. You can take charge. I know you can. Millions of people do.
Make a choice: to tan or not to tan...
My advice? Avoid excesses in either direction. Don't be stupid: avoid sunburns, but avoid ultraviolet light avoidance as well...
Author: Bart Wolbers. Bart finished degrees in Physical Therapy, Philosophy (BA and MA), Philosophy of Science and Technology (MSc: Cum Laude), and Clinical Health Science (MSc).
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