Lown Forum

Carrie Snow said, No day is so bad it can't be xed with a nap.

T HE

2011

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LOWN CARDIOVASCULAR RESEARCH FOUNDATION

Sleeping your way to health

Vikas Saini, MD
that the lack of sleep reduces the bodys ability to heal wounds. Getting enough sleep is critical after surgery. Yet it is in the hospital that patients often suer the most from sleep deprivation. From the glare of lights through the night, to the sometimes noisy nightshift workers, to the ubiquitous midnight and 4 am wake-up to check vital signs we health care people disrupt sleep routinely. Instead we should be oering a systematic approach to improving the sleep of our patients, both in the hospital and at home.

Sleep has always been a mysterious, somewhat magical state that keeps us wondering about its purpose. We spend an enormous amount of our lives in this unconscious condition, yet we know little about its nature and role. After 50 years of research, William Dement reportedly said, "As far as I know, the only reason we need to sleep that is really, really solid is because we get sleepy."

Sleep and aging

Sleep has a particularly strong eect on body chemistry. The anabolic (body-building) hormones, growth hormone (GH), and insulin are secreted preferentially during sleep and reduced by poor sleep. Since aging aects sleep quantity and quality, and also reduces these hormones, many of the eects of aging can be aggravated by poor sleep in a vicious circle. Insulin Sleep duration has decreased in Western societies in recent years, and the increased rates of diabetes over the same period may not be a coincidence. Reductions in sleep duration over multiple nights can result in prediabetic chemistry, and recent research has found that even a single disrupted night of sleep can have profound eects on insulin response and blood sugar even in young, healthy people. Growth hormone In young men, up to 70% of daily GH is secreted during the deepest part of sleep. With aging, deep sleep decreases by up to 80% from our teenage years, and a big decrease in GH secretion occurs at the same time. Meanwhile, the stress hormone cortisol, which increases with daytime stresses, rises with aging and even more so at night with
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Sleep and memory

Why do we need sleep? There is no good answer to this question, but there are a lot of hints. While the folklore about dreaming tells us that sleep may be important for complex mental function, it does seem to be a very ancient biological process: even ies deprived of sleep have disruptions of their memory! Researchers divide sleep into stages based on the characteristic electrical waves that can be recorded through the skull. The most well-known is the Rapid Eye Movement (REM) stage, and is associated with dreaming. Yet this occupies only 25% of sleep time. Delta-wave, or slow-wave sleep, is the deepest non-REM stage, which occurs early in the night, and is very important for health. Getting enough sleep is critical to maintaining memory as we age. REM and slow-wave sleep each have distinctive eects on dierent types of memory and decision making. Disruptions of sleep can cause memory to weaken.

Sleep and healing

Sleep is also known to be a general healer. Not only does it promote the rejuvenation of the immune, skeletal, muscular, and nervous systems, but it is literally a healer in

The Lown Foundation is grateful to the Rodgers Family Foundation for their steadfast support of our work for nearly a decade. Their contributions have enabled us to advance our patient-centered model of health care here in Brookline, across the country, and around the world.

INSIDE

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Sleeping your way to health Florida friends welcome Foundation Q & A: Harvard Medical students Patient prole: Trusting heart health Can statins aect my memory?

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Meet the nurse & medical assistant team ProCor: Global heart health successes

NewsBeat
Contact us Sunlight and your health

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(continued from page 1)

Sleeping your way to health

Vikas Saini, MD
poor sleep. It makes sense that these changes of sleep, GH, cortisol, stress, and health are interrelated as we age. Importantly, young men given drugs that increase deep sleep have increases in nighttime secretion of GH. Perhaps if we could increase deep sleep in the elderly, we might enhance GH secretion in them as well, restoring a younger hormonal pattern (Hint: exercise increases deep sleep).

Alcohol Some of the important healing benets of sleep are reduced by alcohol consumption. While it causes people to fall asleep faster, alcohol increases the amount of lighter REM sleep through a rebound eect when it wears o in the middle of the night. This shortens slowwave sleep earlier in the night and reduces overall sleep time. As a result, it can cause more sleepiness during the next day. Melatonin The body creates a chemical called melatonin, which may be a helpful sleeping aid in certain situations like jet lag, shift work, and general insomnia. I sometimes recommend melatonin for my patients particularly post surgical patients when they are recovering from a hospitalization as a way to restore a more normal cycle. Although there are some who take melatonin nightly, and some on the internet who tout it as an anti-aging cure-all, I generally advise my patients to use it sparingly in specic settings since we dont really know the long term eects of daily use. For jet lag the optimal dose appears to be 5 mg, but for insomnia, a dose of less than one tenth of that (0.3 mg) appears adequate.

Am I getting enough sleep?

One key test of adequacy of sleep is daytime sleepiness. If you are not tired or sleepy during the day, it is unlikely that there is anything seriously wrong. But what is the best amount? Research involving thousands of people has shown that the amount of sleep one gets correlates with longevity and it seems that seven hours or so is the sweet spot. A lack of sleep (ve hours or less) can more than double the risk of cardiovascular death while too much sleep (eight hours or more) is associated with increased non-cardiovascular death. Too little sleep seems to be a particular risk factor for weight gain, hypertension, and type 2 diabetes.

Factors that inuence sleep

Food Although tryptophan, the amino acid in Thanksgiving turkey dinner, has become a legendary sleep inducer, there doesnt seem to be much hard evidence to support its claims. On the other hand, a very full stomach by itself will enhance sleepiness. Caeine Caeine is one of the major culprits in the sleep disruption of modern life even more so in recent years when the pace of multitasking and over-scheduling has been accelerating. Tea has far less caeine instead it has theophylline, which doesnt stimulate the brain as much. Switching from coee to tea may help reduce sleep disruption. For some people even one cup of coee in the morning is enough to cause a middle-of-the-night awakening followed by insomnia. This can be deceptive since often they have no trouble falling asleep at bedtime. Exercise Common sense tells us that plenty of exercise should help you get to sleep and stay asleep most people who exercise report improved sleep. However, it may take up to three weeks for the full eects to be noticeable, so an exercise program needs to be taken on faith for the rst month. The most benecial eect on sleep comes from aerobic endurance training and exercise that lasts for more than an hour.

Tips on sleep
If you can, aim for seven hours of sleep a night. Since you cant control when you wake up go to bed early enough to get seven hours. Exercise: While aerobic exercise is better for sleep than weight training, exhaustive, high-intensity exercise for long periods of time can disrupt sleep it decreases REM sleep and increases wakefulness. Jet Lag: Take melatonin close to the target bedtime at the destination (10pm to midnight). The optimal dose seems to be 5 mg above that doesnt seem to add much. Regular melatonin seems to work better than slow-release. Caeine: Before you discount that morning cup of coee as causing your insomnia, abstain for several days (on a weekend if you have a weekday job!) and see what happens. Alcohol: If you enjoy that glass of wine, I suggest having your drinks with lunch or in the afternoon to optimize your night time sleep cycle. Our common sense and folk traditions are good guides to understanding sleep. Now science is lling in many details. Paying attention to sleep is an important, though much-neglected part of achieving optimal health and function especially as we age. Like so many areas of life, the secret of getting proper sleep is to train ourselves into healthy, habitual routines. Sweet dreams!

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DEVELOPMENT

Traveling to Florida to promote the Foundations heart health message

The week of March 7th was a sunny one for the Lown Foundation. Florida friends of the Foundation welcomed Dr. Vikas Saini, Dr. Charles Blatt, and Andi Brown into their communities for updates on heart health and the work of the Foundation. The Naples home of Judy Hale, a longtime Lown Foundation friend, was the setting for a talk by Dr. Saini, who noted that foods and activities that prevent cardiovascular disease are also anti-aging. He reminded guests that the Foundation is continuing to advance Dr. Lowns work in advocating for a more patient-centered way of delivering health care. Two days later, Ira and Judy Rosenberg also dear friends of the Foundation welcomed guests to their home in Boca Raton. Dr. Blatt spoke on avoiding unnecessary care such as surgeries, while Andi Brown reminded attendees of the value of their contributions by supporting activities that include a national conference on overtreatment in health care; the expansion of our Second Opinion Program; spreading the word about the Lown model and heart health best practices through social media; reducing the global burden of cardiovascular disease through ProCor; and giving the Louise Lown Heart Hero Award. You can help advance better health care with a generous donation to the Lown Foundation. You can mail a check to Lown Foundation, 21 Longwood Avenue, Brookline, MA 02446, or give online by clicking the Donate Now button on our homepage at www.lownfoundation.org. For more information about how you can help, please contact Andi Brown, arbrown1@partners.org, 617-7321318, ext. 3350.
Boca Raton guests Melvin and Beverly Shapiro Naples host Judy Hale with Dr. Saini

Boca Raton hosts, Judy and Ira Rosenberg, with Dr. Blatt

Boca Raton guests Dr. Norton Klotz, and Joan and Richard Carroll

Boca Raton guests Paula and Allan Landau

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FO RUM the Lown Center, the doctors work with the patient to develop a treatment plan and trust that the patient will follow through on their own. AC: The philosophy is dierent. The focus is on noninterventional procedures. If I didnt do this training, I would have left medical school with a much more invasive model of care. When theres no clear clinical guideline to follow, the philosophy takes over. Also, people talk about patients more here. Andrew and Dr. Blatt JW: The atmosphere and attitude of patient care is fundamentally dierent from other clinical experiences. The patient/physician relationship is based on mutual respect patients are viewed as more than just a series of laboratory data or exam ndings. There is a thoughtful approach to management plans that incorporates many aspects of a patient's story and past, and as a result each plan is dierent and individually tailored. What have you learned here that you didnt learn in the classroom or at other oces? EA: A good relationship with a patient can dictate their course of care. We get to see how the doctor talks to their patient and how they respond to the patient to develop good rapport. This program stands out because of the doctors willingness to wait, and to give the patient a shot. JW: I learned just how important it is to get to know your patient. Jerey and Dr. Bilchik Building relationships is critical to the Lown Center philosophy, and something I hope to always take with me in a future career. Would you recommend this training course? EA: Yes, my experience here has proven to me this style of management works. You can see how individual physicians practice and how patients respond to that. You see how the decisions were made; you read notes in the hospital, but you get to make the notes here. AC: Yes, especially because of the way the Lown Center approaches the patient/physician relationship. Because the emphasis is on behavior change, the patients become more involved in their own care. What are your interests/future plans? JW: I plan to apply to a medicine residency followed by a cardiology fellowship. The Lown Center has helped secure my belief that cardiology oers a satisfying clinical career with rich patient relationships and the ability to add value to the health of our community.

QuESTION & ANSWER

Harvard Medical students

The Lown Center provides two dierent training opportunities to Harvard Medical School students throughout the year: a year-long Primary Care Clerkship and a month-long Clinical Cardiology in the Outpatient Setting course, which is directed by Dr. Blatt. We recently caught up with three Harvard Medical School students who are currently training at the Lown Center. Jerey Wessler, a 3rd year student with Dr. Bilchik, grew up in Massachusetts, and after studying Chemistry at Williams College, he found himself pursuing an MPH at the university of Cambridge in England. During college, Jerey also spent six months in South Africa working on the prevention of child-to-mother transmission of HIV. Andrew Chao, originally from Florida, is a 4th year medical student with Dr. Blatt. Andrew is hoping his interest in global health will take him outside of the uS once he is done with medical school. If he has anytime left over from school and work, Andrew enjoys cooking. Edmund Anstey, a 3rd year student with Dr. Saini, is planning on working in some of the more remote regions of Guyana, where much of his family is from. Edmund enjoys volunteering with peer mentorship programs and he considers himself a cookie connoisseur. Why did you choose a career in medicine? JW: As a science nerd with an interest in epidemiology, a career in medicine oered a means to use science to reduce suering and improve population health.

Edmund and Dr. Saini

AC: Im interested in medicine because its a eld where I can interact with people and help guide them through some dicult decisions and times in their lives. EA: What most appealed to me about practicing medicine is that at its core, I believe it to be a service profession. Physicians are asked to use their knowledge and experience to help patients physically and emotionally, a calling that I believe to still be noble in its ends. Why did you choose to come to the Lown Center? AC: During my inpatient rotation at a hospital I didnt get to see what happens to patients before or after their visits. So much care has shifted to the outpatient setting, but so much of our training is inpatient. I heard good reviews about the Lown course from my classmates during my hospital rotation. What is unique about working at the Lown Center? EA: There is an emphasis on trust when treating a patient. In hospital settings the doctors are very hands-on, but at

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PATIENT PROFILE

than youve ever been. I trusted him implicitly. Dr. Bilchik explained exactly what happened to Brians heart. He also told Brian he didnt need all those medications. He began to eliminate some and reduce the dosages of others.

Trusting in your heart health

When he was only 28, Brian Bishop suered a heart attack. His doctor inserted a stent and sent him o with a cardiac cocktail of 11 pills to take for the rest of his life. But Brian wanted answers. Why the heart attack? Why the stent? And why so many pills? His doctor seemed to lack the time or interest to answer of any his questions. Brian (who was 511 and 288 pounds) had seen his much older roommates in the intensive care Brian before training unit and told himself, Im 28, I dont belong here. He vowed to change his life and, returning home, emptied his pantry. He started walking just a block at rst, but soon he was walking as much as a mile. And he found Dr. Bilchik and the Lown Center. Ill never forget Dr. Bilchiks opening statement: Our job is based on trust. You have to trust that what Im telling you will make you better, and I have to trust that youll do what I say. Together, well make you healthier

Brian nishing a triathlon

Brians walking turned into a ve-mile jog. He started to bike, and then took up swimming. A friend suggested he try a triathlon. This was just a year after his heart attack and by then he had already lost 112 pounds. Initially Brian was afraid he might die during the triathlon, but Dr. Bilchik encouraged him on, Try it. I dont want to hold you back. Its been six years since Brian came to the Lown Center, and seven years since his heart attack. He now participates in the Iron Man Triathlon 146 miles of swimming, biking, and running a full marathon. And hes down to two pills a day a low dose statin and an aspirin. If it wasnt for Dr. Bilchik and how he approached me as an individual, I wouldnt be doing Iron Man events today. He gave me the condence to try anything.

QuESTION FROM A PATIENT

Can statins aect my memory?

Fred Mamuya, MD, PhD
In February of 2008, a headline from the Wall Street Journal read: Can a drug that helps hearts be harmful to the brain? Since then, we have continued to respond to numerous questions from patients regarding this headline. I want to begin by emphasizing that in properly selected patients across all ages, statins have been shown to reduce overall mortality, heart attacks, and minor strokes by a signicant margin. Statins have many biological eects other than lowering total and LDL cholesterol. These include lowering inammation, improving the function of cells that line blood vessels, and lowering the risk of blood clots.

confounder is that memory problems aict an estimated 10% of the population older than 65 years. Patients in this age group are also more likely to be taking other drugs that alone or in combination may aect memory. A literature review in 2003 found 60 cases of statinassociated patient reported memory loss. The changes usually occurred within the rst two months after the initiation of therapy, and about half the patients noted an improvement when the statin was discontinued. However, a recent large randomized trial of over 20,000 patients conducted over ve years showed a similar rate of cognitive impairment in patients taking simvastatin (23.7%) and a placebo (24.2%). The major criticisms of this study were that it did not set out to test the hypothesis of whether statins aect memory, and that the rigor of the memory tests was questionable.

No causal link between statins and memory loss has been conclusively demonstrated.
However, if you feel that your memory has changed after the initiation of a statin, please discuss the issue with your doctor. Statins that are water-soluble, such as pravastatin and to a lesser extent rosuvastatin, are less likely to cross the blood-brain barrier and may be an option worth trying. It is reasonable to discuss trying to lower the dose of your current medication, or consider other alternative approaches to lowering your LDL.

Unfortunately, we do not yet have a clear understanding of the interaction between statins and memory.
Over 25 million patients use statins worldwide. Major patient concerns include muscle inammation and memory loss. As of 2008, there were over 5000 reported cases of memory problems in the literature. The biggest

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FO RUM Sharon Cullinane is a Medical Assistant who has been with the Lown Center for ten years. She earned a BS in Environmental Sciences and a degree in Medical Assisting from Framingham State College. Originally from Brookline, she is now raising her two boys (ages 13 and 17) here as well. In her spare time, Sharon enjoys jogging, walking, riding her bike, and reading. Christina Fowler is a Medical Assistant who joined the Lown Center in 2008. Born in Massachusetts, Christina was raised in Jamaica until age ve and then moved to Malden, MA with her family. She received her associates degree from Laboure College, and is currently enrolled in their nursing program. Christina enjoys the familyoriented environment created by the Lown Center sta. Outside of work and school Christina enjoys Zumba classes and spending time with family and friends. Elena Popkova is a Medical Assistant who has been with the Lown Center for ve years. She enjoys the friendly and supportive work environment created by the sta and physicians. Originally from Siberia, she moved to the united States 14 years ago, but returns home every summer to visit her family. Elena enjoys spending time with friends and taking hot yoga classes. Her favorite winter activity includes a visit to the sauna immediately followed by a jump in the snow!

MEET THE LOWN CENTER STAFF

Nurse and Medical Assistant Team

When visiting the Lown Center, the rst part of your appointment will likely be conducted by a member of our Nurse and Medical Assistant team. This team is an essential part of the Lown Center and our commitment to patient care. Their range of duties includes: preparing charts, bringing patients to exam rooms, reviewing medications, checking vital signs, performing blood draws, checking pacemakers, helping with prescriptions, and answering urgent patient calls. Meet the team: Helene Glaser, RN is a cardiac nurse and oversees the Medical Assistants at the Lown Center. She earned her degree in nursing from Boston City Hospital School of Nursing in 1966. In 1976 Dr. Tom Graboys persuaded Helene to join the Lown Group to work in the arrhythmia clinic. Now in her 36th year with the Group, she loves working at the Lown Center because of the high level of care provided to patients. She greatly appreciates that the Lown physicians are foremost interested in patient care and treating their patients as people and not just a heart problem. Helenes favorite activity is taking day trips with her husband on their Harley motorcycles.

PROCOR

Recognizing heart health success in the developing world

Brian Bilchik, MD
Heart disease is the leading cause of death worldwide it is responsible for one in three deaths globally each year. Nearly 82% of CVD-related deaths occur in developing countries. Recognizing this burden, the Louise Lown Heart Hero Award was created in 2007 to honor innovative, preventive approaches to cardiovascular health in developing countries and other low-resource settings.

them how to grow vegetables for their daily meals; Be Alive with Your Heart, a grassroots eort in uganda that promotes heart health from childhood through old age; and Olavarra: Tobacco Free City, a city-run, communityfocused tobacco advocacy, education, and support program in Argentina. The 2008 award recipient, Dr. Toakase Fakakovikaetau, the sole pediatrician in the South Pacic island nation of Tonga, was recognized for initiating a program to screen primary school children for rheumatic heart disease (RHD) and provide early, eective treatment. As a result of the Award publicity, The Lancet, a leading international medical journal, published a feature article about her work. The article was discovered by the World Heart Federation, leading to new partnerships and placing RHD on the global health agenda. Every year we receive many applications from all over the world that deserve the global visibility and opportunities for development that the Award brings. The Lown Cardiovascular Foundation Board of Directors and ProCor leadership engage in a dynamic process of narrowing the eld of many deserving programs down to one Award winner. We are currently reviewing applications for the 2011 Louise Lown Heart Hero Award, which will be awarded in early summer. For more information, or to help support the Award, please visit the ProCor website at: www.procor.org.

The Award is given annually in recognition of the role that Louise Lown, Dr. Lowns wife, had on his career in health promotion.
The Louise Lown Heart Hero Award aims to identify innovators who have an impact, are able to mobilize people, and educate their communities to make a change. Previous winners include: the Childrens Program of the Heart and Stroke Foundation of South Africa, which helps young children develop heart healthy habits by teaching

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Thank you for your support

The Lown Cardiovascular Research Foundation promotes cardiac care that advocates prevention over costly, invasive treatments and restores the relationship between doctor and patient. Your financial support allows us to continue our work and carry our heart health message to local, national, and global audiences. We greatly appreciate any donation you are able to make. You can donate online at our website (www.lownfoundation.org) or mail your donation to 21 Longwood Avenue, Brookline, MA 02446. Please make checks payable to the Lown Cardiovascular Research Foundation. For more information about supporting the Foundation, please contact Andi Brown, Director of Development at arbrown1@partners.org or 617-732-1318 (x3350).

Meet the Sta (left to right): Helene, Sharon, Elena, and Christina

New patient appointments available

New patient appointments are currently available. If you would like to make an appointment with one of the Lown Group cardiologists, please call 617-732-1318 and select option 1.

Educational opportunities
Interested in hosting a lecture on a heart health topic by one of our physicians at your worksite or community organization? Please contact Jessica Gottsegen at jgottsegen@partners.org or 617-7321318 (x3805).

LOWN CARDIOVASCuLAR CENTER

NewsBeat
On March 1, 2011 Dr. Tom Graboys participated in Brigham and Womens Hospital Center for Faculty Development & Diversity Lets Prepare Forum for Caregivers of Older Adults. Dr. Graboys discussed his memoir Life in the Balance on April 6, 2011 at the Atrium at Drum Hill, an assisted living facility in North Chelmsford, MA. ProCor and Lown Foundation sta attended the conference: The long tail of global health equity: Tackling the endemic NCDs of the bottom billion at Harvard Medical School on March 2-3, 2011. The conference was hosted by the Harvard School of Public Health, Partners in Health, the NCD Alliance, and the Department of Global Health and Social Medicine at Harvard Medical School. Please visit www.procor.org to learn more. Dr. Fred Mamuya was a guest speaker at Linden Ponds Retirement Living in Hingham, MA on March 7, 2011. More than 50 people attended this lecture where he discussed the topic of Second Opinions. Dr. Brian Bilchik has been nominated to serve another two years on the Brigham and Womens Hospital Physician Council. Mychal Voorhees, a graduate communications consultant working with the Lown Foundation, gave a presentation on the outreach and marketing campaign she developed for ProCor at Emerson College on April 26, 2011. The campaign seeks to engage African medical school students and professors in ProCors global network.

Receiving the Forum

If you would prefer to receive the Lown Forum by email, send your full name and email address to info@lownfoundation.org.

Board of Directors
Nassib Chamoun Chairman of the Board Vikas Saini, MD President Bernard Lown, MD Chairman Emeritus Thomas B. Graboys, MD President Emeritus Patricia Aslanis Charles M. Blatt, MD Joseph Brain, SD Janet Johnson Bullard J. Breckenridge Eagle Carole Anne McLeod C. Bruce Metzler Barbara H. Roberts, MD Ronald Shaich Robert F. Weis

CONTACT US
Lown Cardiovascular Research Foundation
21 Longwood Avenue Brookline, MA 02446 uSA (617) 732-1318 info@lownfoundation.org www.lownfoundation.org www.lowncenter.org www.procor.org

Lown Cardiovascular Group

Brian Z. Bilchik, MD Charles M. Blatt, MD Wilfred Mamuya, MD, PhD Shmuel Ravid, MD, MPH Vikas Saini, MD

Lown Forum Editorial Sta

Andi Brown Jessica Gottsegen Benn Grover Claudia Kenney

Advisory Board
Martha Crowninshield Herbert Engelhardt Edward Finkelstein William E. Ford Renee Gelman, MD Barbara Greenberg Milton Lown John R. Monsky Jerey I. Sussman David L. Weltman

2011 Lown Foundation Printed on recycled paper with soybased ink.

Lown Cardiovascular Research Foundation 21 Longwood Avenue Brookline, Massachusetts 02446-5239

NON-PROFIT ORG. US POSTAGE

PAID
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vitamin D from foods such as fortied milk, grains, and ocean sh. However, experts disagree on what constitutes adequate vitamin D blood levels and whether vitamin D supplements should be prescribed routinely. Bright, full-spectrum light exposure is also shown to improve mood and alleviate symptoms of depression another benet of moderate exposure to sunlight. Prolonged sun exposure can result in sunburns, premature skin aging, and higher risk for skin cancers. Cumulative sun exposure can cause skin cancers such as basal cell and squamous cell cancer in areas of the body typically exposed to the sun. Intense, intermittent sun exposure can cause melanoma, the most serious skin cancer, in areas of the body less frequently exposed to the sun. Childhood exposure is particularly hazardous.

Sunlight and your health

Shmuel Ravid, MD, MPH
For centuries the sun has been worshipped, yearned after, and sung to. It has inspired everything from poetry to rituals to spray-on tanning. You are my sunshine, my only sunshine wrote Louisiana governor Jimmie Davis in 1939, coining the state's ocial tune (and hummed by countless toddlers and smitten lovers since). There's no question about it: The sun is one important star. It is our primary source of energy, it supports life on this planet, and it drives the Earth's climate and weather. It is only natural that as the crocuses begin to poke out of the stern winter ground, we anticipate a sunny summer ahead. And so we should review the potential health implications of sun exposure. While moderate sunlight exposure is benecial, excessive and unprotected exposure may result in serious long-term health implications. ultraviolet (uV) light, a component of sunlight, is invisible electromagnetic radiation that has both benecial and damaging eects on health. During sunlight exposure, uV light penetrates the skin and generates pre-vitamin D, which is then metabolized by the liver and kidneys into active vitamin D. Adequate levels of vitamin D are needed to maintain bone health. The human body cannot produce vitamin D and so we depend on outside sources. Vitamin D is nicknamed the sunshine vitamin because we receive most of our vitamin D from the sun. Moderate sun exposure (e.g. 10 minutes in the sun with exposed hands, arms, and face, several days a week) will get you plenty of vitamin D. You can also get

Staying healthy in the sun

Although getting some sun is important to your health, you want to make sure you dont get too much. 1) Avoid excessive sun exposure is the key, especially in children and people with fair skin. 2) Minimize exposure when the sun is at its strongest, stay in shaded areas, and use protective clothing (such as large brimmed hats, long sleeved shirts, and pants). 3) Sunscreen is mandatory, with SPF of at least 30. Generously apply sunscreen to all exposed skin and reapply after swimming, sweating, or drying o. 4) Tanning beds are not recommended. Have fun but remember to be safe in the sun.