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Position of health organizations and agencies in Australia, Canada, New Zealand, the United Kingdom, and the United States, and the World Health Organization, on UV radiation and vitamin D

Solar ultraviolet-B radiation reduces cancer risk in Spain

A study published electronically this week in the International Journal of Cancer used a novel approach to examine the relation between solar ultraviolet-B (UVB) irradiance, vitamin D, and cancer risk reduction. In this study, mortality rates for non-melanoma skin cancer (NMSC), which is primarily due to squamous cell carcinoma, were used as the index of integrated lifetime solar UVB irradiance. NMSC mortality rates provide higher confidence regarding the population exposure to solar UVB than geographic location of residence, which has been used in such studies in the past. Thus, locations with a larger fraction of the population having outdoor occupations, such as farming, will have higher NMSC mortality rates.

In addition, lung cancer mortality rate was used as the index for the adverse health effects of smoking.

These two indices were used in a study of cancer mortality rates for 1978-1992 for the 48 continental provinces of Spain; those data were compared statistically to the mortality rates for non-melanoma skin cancer (NMSC) and lung cancer.

This UVB index was correlated with reduced risk for17 types of cancer. The cancers inversely correlated with NMSC were, for both sexes: brain, colon, pancreatic, pleural, rectal, and thyroid cancer and non-Hodgkin’s lymphoma. Those for males only were
males: buccal, esophageal, and gallbladder cancer. Those for females only were: breast, Hodgkin’s lymphoma, lung, melanoma, multiple myeloma, ovarian, and uterine corpus cancer. Mortality rates for various cancers were often 20 to 40% higher in provinces with low NMSC mortality rates than in those with high NMSC rates, with differences generally more pronounced for females than for males.

Nearly all of these cancers have been identified as UVB- or vitamin D-sensitive in other studies. However, the results for brain and pleural cancer are new and should be checked further.

According to Dr. Grant, “This is the first study since 1937 to use skin cancer rates to investigate the role of solar UVB in reducing the risk of cancer, but the role of vitamin D was not known until 1980. The results are quite consistent with results from other studies, and provide further support for the UVB/vitamin D/cancer theory. This is also the first study to investigate the role of solar UVB and vitamin D in reducing the risk of cancer mortality rates in Spain.”

“Since those living in Spain generally have their ancestral roots there, they generally have skin pigmentation appropriate for the UV doses in Spain. However, when those with Northern European ancestry live in countries nearer the equator, such as in Australia, New Zealand, and the U.S., their skin is not well suited for the UV, so their risk of melanoma can increase with increased time in the sun. Nevertheless, even there, the health benefit from solar UVB irradiance generally greatly outweighs the risks as long as one is careful not to burn or tan excessively.”

“Other studies have estimated that a daily intake or production of 1000-2000 International Units of vitamin D3 (cholecalceferol) per day could reduce the risk of many cancers by about 30% in Western Developed Countries. However, vitamin D2 (ergocalciferol), made from yeast, is much less effective and should not be considered useful in preventing cancer.”

According to Dr. Grant, “These results strongly suggest that cancer deaths in Mediterranean countries could be reduced dramatically and very easily by taking steps to see that the populations increase their vitamin D intake from supplements and fortified food and production from solar UVB irradiance.”

In addition, Dr. Grant notes “Studies in Norway, the United States, and England found that cancer survival rates are 10-50% higher for discovery of cancer in summer or fall than in winter or spring. These findings are attributed to summertime production of vitamin D. Thus, the results of those studies plus the present study strongly suggest that natural vitamin D would be useful in treating cancer as well as preventing it.”

Melanoma
Surprisingly, all of these cancers except esophageal cancer and Hodgkin’s lymphoma were correlated with melanoma mortality rates, as was prostate cancer. There is a growing body of research suggesting that long-wave UV, called UVA (315-400 nm), rather than UVB, is the more important risk factor. Occupational or chronic exposure to solar UVB for those whose skin is well suited for the normal solar UV for the location increases both vitamin D and the protective tan that helps prevent UVA radiation from penetrating deeply into the epidermis as well as helping to repair the damage caused by free radicals created by UVA.

According to Dr. Grant, “This study provides striking evidence that the risk factors for squamous cell carcinoma and melanoma are different. Thus, more research is required to sort out the differences and determine whether different recommendations are required to reduce the risk of each type of skin cancer.”

“The global epidemic of melanoma is also linked to increased travel to sunny locations and use of sunscreen that blocks UVB more effectively than UVA. In addition, dietary factors affect the risk of melanoma, with fat and alcohol associated with increased risk, and with carbohydrates, protein, antioxidant vitamins and vitamin D associated with decreased risk as reported by Dr. Amy E. Millen and colleagues in 2004.”

Grant WB. An ecologic study of cancer mortality rates in Spain with respect to indices of solar UV irradiance and smoking. Int J Cancer, Dec. 5, 2006 [Epub ahead of print]

Atlas of Cancer Mortality and Other Causes of Death in Spain 1978-1992. Fundación Científica de la Asociación Española Contra el Cáncer Madrid, 1996.
http://www2.uca.es/hospital/atlas92/www/Atlas92.html (accessed August 2, 2006).

For further information, please contact:

William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
San Francisco, CA 94109-2510, USA
wgrant@sunarc.org
www.sunarc.org

New study finds that solar ultraviolet B (UVB) radiation reduces the risk of 16 types of cancer in the U.S.

Tuesday, August 1, 2006

Contacts:
William B. Grant, Ph.D., SUNARC, San Francisco CA, USA 1-415-776-5274, wgrant@sunarc.org

Cedric F. Garland, Dr.P.H., University of California San Diego School of Medicine and Moores Cancer Center, San Diego CA, 1-619-553-9016, cgarland@ucsd.edu.

A study published this week in Anticancer Research confirms that solar UVB irradiance is associated with reduced risk of 16 sites of cancer, apparently through production of vitamin D. These cancers include 6 sites of gastrointestinal cancers, 3 cancers of female sites, 3 urogenital cancers, 2 types of lymphomas, and 2 upper aerodigestive tract cancers.

The analysis examined age-adjusted mortality rate data from 49 states plus the District of Columbia for two periods: 1950-69 and 1970-94. Other cancer risk-modifying factors were included in the analysis. A proxy indicator of smoking was associated with risk at 10 cancer sites, alcohol consumption with 9 sites, urban residence with 7, and Hispanic heritage with 6.

“This study provides important additional support for the vitamin D/cancer hypothesis” according to William Grant. This new study shows that the approach used, a statistical comparison of cancer mortality rates by state according to several cancer risk factors, is likely to be reliable since the results for known factors other than UVB agreed well with the results in the literature. In addition, the new study replicates many of the links between higher levels of vitamin D and lower risk of cancer that were identified in earlier studies that had less control for risk factors other than vitamin D or UVB deficiency.”

“The mechanisms whereby vitamin D reduces the risk of cancer are well known, and include effects on intercellular adhesion, apoptosis (programmed cellular death), the inhibition of angiogenesis around tumors, and the inhibition of metastasis.”

According to co-author Cedric Garland, Dr.P.H., “Enhancing vitamin D status appears to be the single most important single simple thing that people can do to reduce their risk of cancer, apart from avoiding tobacco and moderation in intake of alcohol. While solar ultraviolet B is not always available or convenient for synthesis of vitamin D and entails a possible small increase in risk of nonmelanoma skin cancer, vitamin D supplements are readily available and nontoxic in the preventive range of 1,000-1,500 IU/day.”

According to William Grant, Ph.D. “Other recent studies recently found that it takes 1000 to 1500 International Units (I.U.) of vitamin D per day to reduce the risk of cancer incidence and death by 30-50%. In the U.S., dietary sources provide only 250 to 300 I.U. per day. People with fair skin living in the sunnier regions of the country can make 1500 I.U. of vitamin D in about 20 minutes near solar noon with 10-20% of their body exposed, i.e., arms and back in women and back or chest in men. Those with darker skin require 2-4 times as much time or body exposed for the same vitamin D production. This may help explain why black Americans have higher cancer incidence and mortality rates than white Americans, which was described recently in the Journal of the National Medical Association.”

Cedric Garland added, “Briefly exposing a large enough area of skin for adequate vitamin D synthesis is more effective than increasing the amount of time spent in the sun. Protracted exposures to the sun are counterproductive after the 20-30 minutes at most when vitamin D synthesis for the day is complete. People of all ages should wear a hat whenever spending more than a few minutes in the sun, and should spend the time walking or otherwise in motion.”

William Grant added “The public receives a steady barrage of public service messages to avoid the sun and wear sunscreens in order to reduce the risk of skin cancer and melanoma. Unfortunately, such messages do not mention that these risks are counterbalanced to a substantial degree by the advantages of producing vitamin D from solar UVB irradiance. Insufficient UVB irradiance and vitamin D costs society about 10 times what excess solar UVB does, and excess UVB irradiance is not required for optimal vitamin D production.” Cedric Garland said “vitamin D in the appropriate dose is giving society new hope in the fight to prevent cancer.”

This paper is available to journalists upon request:
Grant WB, Garland CF. The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of geographic variation in age-adjusted cancer mortality rates. Anticancer Research. 2006;26:2687-2700.

William B. Grant has a Ph.D. in physics from the University of California, Berkeley. He enjoyed a 30-year career in atmospheric sciences with an emphasis on optical and laser remote sensing of atmospheric constituents. His interest in health research began by writing the first paper identifying the primary dietary risk factors for Alzheimer’s disease in 1997. He has written a number of papers on dietary links to chronic disease. In 2002 he showed that at least 13 types of cancer were vitamin D-sensitive, up from 4 known at that time. He founded Sunlight, Nutrition, and Health Research Center (SUNARC) in 2004 to extend his health studies. More about his work can be seen at www.sunarc.org.

Cedric F. Garland, Dr.P.H., is a professor with UC San Diego's Moores Cancer Center and the Department of Family and Preventive Medicine at the UCSD School of Medicine. He, along with his brother, Frank C. Garland, Ph.D., first proposed the ultraviolet-B/vitamin D/cancer hypothesis in 1980 to explain why colon cancer mortality rates in the southwestern U.S. were about half those in the Northeast. He has published a number of papers on the role of vitamin D in reducing the risk of cancer and melanoma.

Commentary: Time for public health action on vitamin D for cancer risk reduction
William B Grant and Edward D Gorham

Int. J. Epidemiol. Advance Access published November 22, 2005

PDF Document 39.4KB

Health and economic benefits from sun exposure are much greater than risks: study

Health and economic burdens from insufficient solar UVB irradiance and vitamin D greatly outweigh all known adverse health outcomes. These are the findings from a rigorous study published this week by the journal Photochemisty and Photobiology. Scientists investigated the annual number of cases and deaths due to cancer, multiple sclerosis, and osteoporotic hip fracture that likely could have been prevented with sufficient vitamin D as well as the number of cases and deaths from skin cancer and melanoma as well as cases of cataracts that likely have been prevented by avoiding excess UV irradiance. Economic burden values were then determined for these results.

It was estimated that about 50,000-63,000 annual cancer deaths in the U.S. (10% of all cancer deaths) could be prevented if all Americans had sufficient vitamin D. These findings are based on data in the Atlas of Cancer Mortality Rates for the United States, 1950-94, (http://www3.cancer.gov/atlasplus/type.html), but are also supported by a number of recent reports that vitamin D plays a very important role in increasing survival once cancer is discovered. These deaths greatly outnumber the annual number of deaths from melanoma (8000) and skin cancer (2000).

In the UK, the preventable cancer deaths with sufficient vitamin D may be as high as 20% since oral intake is low and vitamin D produced from solar UVB is much lower than in the U.S.

In addition, UVB irradiance and vitamin D also provide important health benefits in preventing or ameliorating such conditions or diseases as bone diseases and muscle pain, multiple sclerosis, type 1 and type 2 diabetes mellitus, high blood pressure, etc. For more on these benefits, see Grant WB, Holick MF. Benefits and requirements of vitamin D for optimal health: a review. Altern Med Rev. 2005;10:94-111.
http://www.thorne.com/altmedrev/.fulltext/10/2/94.pdf

While more research is needed to check these results, there is already enough known about the health benefits of vitamin D to change public health policies now. In fact, conferences were held in the U.S. in the past couple of years to review the evidence relating to the health benefits of vitamin D and set new recommended levels. Final recommendations, however, have not been issued.

It is hoped that these results will provide further emphasis on the health benefits of UVB and vitamin D for maintaining optimal health and treating diseases and conditions. It is hoped that there will be a diminution of efforts to demonize UVB irradiance, as is being done in Australia, that additional foods such as bread be fortified with vitamin D, that guidelines for vitamin D increased, and that there be increased testing of serum vitamin D levels.

According to Cedric Garland, a coauthor of this study, and the first to link vitamin D to cancer risk reduction (in 1980), “This analysis estimates the number of cases and lives that could be saved, and the major economic savings that could result, from attempts to reduce incidence rates of several important cancers by improving vitamin D status.  More specifically, it estimates the reduction in incidence of these cancers that is likely to result from oral intake of vitamin D3, or no more than 10-15 minutes spent daily in activity outdoors in sunlight (not exceeding 0.75 MED), by persons whose skin type and personal history will allow.  It also estimates a possible, although unlikely, increase in risk of skin cancer that might theoretically result, and places the potentially competing risks in context. This comparison revealed that the vitamin D-based strategy for cancer risk reduction would have considerably greater benefits than risks.”

The title and abstract:
William B. Grant, Cedric F. Garland, and Michael F. Holick

Comparisons of estimated economic burdens due to insufficient solar ultraviolet irradiance and vitamin D and excess solar UV irradiance for the United States

Photochemistry and Photobiology, [Epub ahead of print]

Abstract
Vitamin D sufficiency is required for optimal health, and solar ultraviolet B (UVB) irradiance is an important source of vitamin D. UVB and/or vitamin D have been found in observational studies to be associated with reduced risk for over a dozen forms of cancer, multiple sclerosis, osteoporotic fractures, and several other diseases. On the other hand, excess UV irradiance is associated with adverse health outcomes such as cataracts, melanoma, and nonmelanoma skin cancer. Ecologic analyses are used to estimate the fraction of cancer mortality, multiple sclerosis prevalence, and cataract formation that can be prevented or delayed. Estimates from the literature are used for other diseases attributed to excess UV irradiation, additional cancer estimates, and osteoporotic fractures. These results are used to estimate the economic burdens of insufficient UVB irradiation and vitamin D insufficiency as well as excess UV irradiation in the United States for these diseases and conditions. We estimate that 50,000–63,000 Americans die prematurely from cancer annually due to insufficient vitamin D, and 19,000–25,000 in the United Kingdom. The U.S. economic burden due to vitamin D insufficiency from inadequate exposure to solar UVB irradiance, diet, and supplements is estimated at $40–56 billion in 2004, whereas that for excess UV irradiance is estimated at $6–7 billion. These results suggest that increased vitamin D through UVB irradiance, fortification of food and supplementation could reduce the health care burden in the U.S., U.K., and elsewhere. Further research is required to confirm these estimates.

Available from: http://phot.allenpress.com/pdfserv/10.1562%2F2005-01-24-RA-424

The authors may be contacted as follows:

William B. Grant, Ph.D.
Sunlight, Nutrition and Health Research Center (SUNARC)
San Francisco, CA
wgrant@sunarc.org
www.sunarc.org
1-415-776-5274 - voice
1-415-776-5270 - fax

Cedric F. Garland, Dr.P.H.
Professor
Department of Family and Preventive Medicine
University of California, San Diego
La Jolla CA 93093, USA
cgarland@ucsd.edu
Tel. (619) 553-9016

Michael F. Holick, Ph.D., M.D.
Vitamin D, Skin and Bone Research Laboratory
Professor
Section of Endocrinology, Diabetes, and Nutrition
Department of Medicine, Boston University Medical Center
Boston University School of Medicine
mfholick@bu.edu

Sunlight prevents cancer
Miscellaneous News
Published: Wednesday, 23-Mar-2005

The health of the public is being put at risk by recommendations to cover up and stay out of the sun in the UK. These recommendations, which are part of Cancer Research UK's SunSmart programme, increase the risk of several types of cancer, and may also increase deaths from melanoma, the most serious form of skin cancer.

Full story: http://www.news-medical.net/?id=8666

Press Release (MS Word)

Statement by William B. Grant, SUNARC, in response to Press Release "WHO recommends that no person under 18 should use a sunbed" posted to Medical News Today.com

http://www.medicalnewstoday.com/medicalnews.php?newsid=21421

While melanoma and skin cancer rates are rising worldwide, it is incorrect to attribute this rise to sunbed use, even for those under the age of 18 years.  A simple look at melanoma incidence and mortality rates in a number of countries yields a few interesting results.  First, melanoma rates increase with increasing latitude for those living in their ancestral homelands [Ferlay et al., 2004].  Second, melanoma incidence and mortality rates are highly correlated with fraction of food energy (calories) derived from animal products [FAOSTAT data, 2004; Millen et al., 2004].  Thus, to protect oneself from melanoma, one should have a good tan [Kennedy et al., 2003], and have a diet high in anti-oxidants, such as fruits, vegetables, and cereals.  Vitamin D also seems to help protect against melanoma [Millen et al., 2004; Berwick et al., 2005].

The health benefits of solar ultraviolet B (UVB) irradiance, through the production of vitamin D, greatly outweigh the health risks, even for those under the age of 18 [Grant, 2002, 2004].  Indoor tanning facilities provide an alternate way to obtain the health benefits of UVB irradiance when it is impossible or inconvenient to get UVB from the sun [Tangpricha et al., 2004].  Dietary sources are simply insufficient to provide enough vitamin D to protect against soft tissue diseases such as cancer [Grant and Garland, 2004; Vieth, 2004].

For more information on the health benefits of UVB and vitamin D, please visit www.sunarc.org.

William B. Grant, Ph.D.

President, SUNARC

Berwick M, Armstrong BK, Ben-Porat L, Fine J, Kricker A, Eberle C, Barnhill R. Sun exposure and mortality from melanoma. J Natl Cancer Inst. 20052;97:195-9.

FAOSTAT data, 2004 http://faostat.fao.org/faostat/collections?subset=nutrition (accessed March 17, 2005)

Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide, Version 2.0. IARC CancerBase No. 5. Lyon, IARCPress, 2004. Limited version available from: URL: http://www-depdb.iarc.fr/globocan2002.htm (accessed March 11, 2005)

Grant WB. An estimate of premature cancer mortality in the United States due to inadequate doses of solar ultraviolet-B radiation, Cancer. 2002;94:1867-75.

Grant WB. Insufficient sunlight may kill 45,000 Americans each year from internal cancer. J Cos Dermatol. 2004;3:176-8.

Grant WB, Garland CF. A critical review of studies on vitamin D in relation to colorectal cancer. Nutrition and Cancer, 2004;48:115-23.

Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN; Leiden Skin Cancer Study. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol. 2003 Jun;120(6):1087-93.

Millen AE, Tucker MA, Hartge P, Halpern A, Elder DE, Guerry D 4th, Holly EA, Sagebiel RW, Potischman N. Diet and melanoma in a case-control study. Cancer Epidemiol Biomarkers Prev. 2004 Jun;13(6):1042-51.

Tangpricha V, Turner A, Spina C, Decastro S, Chen TC, Holick MF. Tanning is associated with optimal vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density. Am J Clin Nutr 2004;80:1645-1649.

Vieth R. Why the optimal requirement for Vitamin D3 is probably much higher than what is officially recommended for adults. J Steroid Biochem Mol Biol 2004;89-90:575-579.

Statement by William B. Grant, SUNARC, on "Risks and Benefits of Sun Exposure statement recently released by the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia, Australasian College of Dermatologists and the Cancer Council Australia."

http://www.cancer.org.au/documents/Risks_Benefits_Sun_Exposure_MAR05.pdf

William B. Grant, Ph.D.

Founding Director

SUNARC (Sunlight, Nutrition and Health Research Center)

www.sunarc.org

wgrant@sunarc.org

We at SUNARC are pleased to find that a rational statement regarding sun exposure has just been released by The Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia, Australasian College of Dermatologists, and the Cancer Council of Australia.  The Australian authorities acknowledge the importance of vitamin D for health and its role in prevention of such diseases as cancer, multiple sclerosis, and osteoporosis.  They recommend that many Australians need to obtain more vitamin D than available from food and could obtain adequate serum 25-hydroxyvitamin (25(OH)D) (>50 nmol/l) for bone health in northern Australia by the face, arms and hands or the equivalent surface area being exposed to as little as an average of 5 minutes of sunlight either side of the peak UV periods on most days of the week.  In winter, in the southern states of Australia where UV radiation levels are less intense, vitamin D levels may be maintained by approximately 2-3 hours of sunlight exposure accumulated over a week to the face, arms and hands or equivalent surface area.  This makes them one of very few of the major organizations and government agencies surveyed admitting that solar ultraviolet-B (UVB) irradiance is an important source of vitamin D and that vitamin D is essential for optimal health [Grant, 2002, 2004].  While this is an important step in the right direction, we note some problems with the statement, such as underestimating the amount of vitamin D required for optimal health and overlooking the body of literature that describes the mechanisms by which vitamin D protects against cancer and multiple sclerosis.  We hope that these deficiencies will be addressed in the near future. 

First, the level of serum 25(OH)D required for optimal health is generally acknowledged to be higher than >50 nmol/l required for bone health when one considers soft tissue diseases as well:  vitamin D deficiency is reached for serum 25(OH)D levels below 16 ng/ml (40 nmol/L), insufficiency in the range 20-32 ng/ml, and sufficiency in the range from 32 to 80 ng/ml, with normal in sunny countries (54-90 ng/ml), and excess greater than 100 ng/ml [Heaney, 2004; Hollis and Wagner, 2004a,b; Vieth, 2004; Hanley and Davison, 2005; Hollis, 2005].  Thus, the recommended exposure times are likely to be too low to achieve serum 25(OH)D levels associated with optimal health.  For a recent review on the health benefits of vitamin D, see Moskilde [2005].

Second, as one goes father from the equator, midday solar radiation becomes more important for production of vitamin D because the ratio of ultraviolet-B (UVB) (290-315 nm) to UVA (315-400 nm) is highest at the time nearest solar noon; thus more effective vitamin D production in a shorter period can be obtained near solar noon.

Third, it was stated "Recently, some studies have been published that suggest possible beneficial effects of sun exposure in the prevention or improvement in outcome of a number of diseases including breast, prostate, and colorectal cancer, non-Hodgkin’s lymphoma and multiple sclerosis.  However, the biological pathways underlying these observed observations are far from clear and it is not known how much sun exposure is necessary, and when.  Thus, there is insufficient evidence for any definitive action to be taken on these finding or make any recommendations, as more research is needed."

In the opinion of SUNARC and others who have studied the link between UVB, vitamin D and risk for these diseases, the mechanisms are very clear for cancer and multiple sclerosis.  For cancer, vitamin D metabolites increase cell differentiation, suppress growth-stimulatory signals, potentiate growth-inhibitory signals, and reduce cell proliferation and angiogenesis.  Vitamin D also reduces the effect of IGF-I on cancer progression.  The mechanisms whereby vitamin D reduces the risk of MS is thought to be related to its effect on modulating the immune system.  For over a dozen types of cancer, rates in the U.S. are highest in the northeast and lowest in the southwest [The Atlas of Cancer Mortality in the U.S., 1950-94].  These regions differ in both summertime and annual UVB irradiance.  It is estimated that 45,000 Americans die prematurely from cancer each year due to insufficient UVB/vitamin D [Grant, 2002, 2004].  For multiple sclerosis, there is a very strong latitudinal gradient, with rates increasing with increasing latitude, in Australia, Europe, and the U.S.  These results are most consistent with serum 25(OH)D levels in winter being important to strengthen the immune system to fight the neurological effects of viral diseases.  For more information on these topics, the interested reader is urged to visit www.sunarc.org as well as many of these URLs listed below.

Fourth, we would like to point out that the concern about the adverse effects of solar radiation is most keenly felt in Australia for one important reason: most of the inhabitants can trace their ancestors to the United Kingdom, at latitude 53^o N.  Their skin pigmentation is adapted for the solar UV irradiance there, not in sunny Australia.  Their skin reflectance at 425 nm is around 35% [Jablonski and Chaplin, 2000].  Those whose ancestral roots are in the 12^o-41^o latitude range have skin reflectance in the range 15-30%.  Aborigines in Australia have skin ideally suited to the open plains of Australia; those of European descent do not.  Therefore, they do have to be careful in the sun.  The same skin pigment concerns also exist in New Zealand and the U.S.  However, for those living in their ancestral homelands, they have much less concern about getting too much solar UV; in fact, due to living largely indoors, many people have to worry about getting too little solar UVB.  An interesting fact in this regard is that for those living in their ancestral homelands, the melanoma incidence rates actually increase with increasing latitude [Ferlay et al., 2004].  In addition, a number of studies have found that increased total lifetime UV exposure is associated with reduced risk of melanoma [Kennedy et al., 2003; Berwick et al., 2005].  It is not known whether this is due to vitamin D production, other defense mechanisms in the skin, or differences in overall risk for cancer due to lifestyle and diet.  Whether total lifetime irradiance is a risk or risk factor for melanoma appears to be related to skin pigmentation, and whether one can easily tan [Dubin et al., 1989].

Fifth, their statement that 99% of non-melanoma skin cancer and 95% of melanoma in Australia is caused by sun exposure is debatable.  For example, recent papers have reported that dietary factors play an important role in the etiology of melanoma [Millen et al., 2004], and smoking plays a role in squamous cell carcinoma [de Hertog et al., 2001].  So, while UV irradiance may be implicated in most melanoma and skin cancer cases, it does not act alone.  The effect of solar UV irradiance proceeds primarily through the action of free radicals produced in the skin.  To help reduce the risk of any form of skin cancer from sun exposure, it is advisable to improve one’s antioxidant status.  Both topical and ingested antioxidants such as vitamins C and E are helpful in this regard [Lin et al., 2003; Sies and Stahl, 2004], as well as a diet low in fat, high in fruits and vegetables.

Sixth, the concern regarding melanoma and other skin cancer appears to be blown out of proportion to the health benefits of UVB radiation through production of vitamin D in the U.S.  As part of an effort to extend the work reported in Grant [2002], a number of additional factors have been added to the analysis, including alcohol consumption, smoking, and urban residence.  This analysis identifies 18 cancers for which UVB/vitamin D is a risk reduction factor.  Mortality rates for these 18 cancers are much higher in the northeastern U.S. (lowest summertime UVB) than in the southwestern U.S. (highest summertime UVB).  If we compare cancer mortality rates for the period 1970-94 for states with similar alcohol consumption rates, lung cancer mortality rates, and degree of urbanization, we can see the effect of solar UV irradiance.  The comparison is given in Table 1.  As is readily apparent, there is very little variation in melanoma and other skin cancer mortality rates for this period but there is a 20% increase in vitamin D-sensitive cancer mortality rates for males and a 23% increase for females.  The differences in vitamin D-sensitive cancer rates outweigh the melanoma and other skin cancer mortality rates by a factor of 5 for males and 10 for females.  Thus, if all Americans were to receive the same UV irradiance as those living in Arizona and neighboring states, total cancer rates would be expected to decrease by about 10%.

Table 1.  July UVB doses [Leffell and Brash, 1996] and cancer mortality rates for selected states for the period 1970-94 [Devesa et al., 1999].

In conclusion, we would like to again congratulate the Australian organizations for taking this bold step, but urge them to extend their study on the topic in light of the recent work not considered in their deliberations.  We would also like to urge similar bodies elsewhere in the world to follow suit.

References

Berwick M, Armstrong BK, Ben-Porat L, Fine J, Kricker A, Eberle C, Barnhill R. Sun exposure and mortality from melanoma. J Natl Cancer Inst. 2005 Feb 2;97(3):195-9.

De Hertog SA, Wensveen CA, Bastiaens MT, Kielich CJ, Berkhout MJ, Westendorp RG, Vermeer BJ, Bouwes Bavinck JN; Leiden Skin Cancer Study. Relation between smoking and skin cancer. J Clin Oncol. 2001 Jan 1;19(1):231-8.

Devesa, S. S., D. J. Grauman, W. J. Blot, G. A. Pennello, R. N. Hoover, and J. F. Fraumeni Jr. (1999 Atlas of Cancer Mortality in the United States, 1950-94. National Institutes of Health; National Cancer Institute. NIH Pub. No. 99-4564. Washington, DC. 1999. http://www3.cancer.gov/atlasplus/type.html (accessed March 12, 2005)

Dubin N, Moseson M, Pasternack BS. Sun exposure and malignant melanoma among susceptible individuals. Environ Health Perspect. 1989 May;81:139-51.

Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide, Version 2.0. IARC CancerBase No. 5. Lyon, IARCPress, 2004. Limited version available from: URL: http://www-depdb.iarc.fr/globocan2002.htm (accessed March 11, 2005)

Grant WB. An estimate of premature cancer mortality in the United States due to inadequate doses of solar ultraviolet-B radiation, Cancer. 2002;94:1867-75.

Grant WB. Insufficient sunlight may kill 45,000 Americans each year from internal cancer. J Cos Dermatol. 2004;3:176-8.

Hanley DA, Davison KS. Disease-Specific Biomarkers of Vitamin D Sufficiency Vitamin D Insufficiency in North America.  J Nutr 2005;135:332-337.

Heaney RP. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr 2004;80:1706S-9S.

Hollis BW, Wagner CL. Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr 2004;79:717-726.

Hollis BW, Wagner CL. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr 2004;80:1752S-1758S.

Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: Implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr 2005;135:317-322.

Jablonski NG, Chaplin G. The evolution of human skin coloration. J Hum Evol. 2000;39:57-106.

Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN; Leiden Skin Cancer Study. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol. 2003 Jun;120(6):1087-93.

Leffell DJ, Brash DE. Sunlight and skin cancer. Sci  Am 1996;275:38-43. http://toms.gsfc.nasa.gov/ery_uv/dna_exp.gif (accessed March 10, 2005).

Lin JY, Selim MA, Shea CR, Grichnik JM, Omar MM, Monteiro-Riviere NA, Pinnell SR. UV photoprotection by combination topical antioxidants vitamin C and vitamin E. J Am Acad Dermatol. 2003 Jun;48(6):866-74.

Millen AE, Tucker MA, Hartge P, Halpern A, Elder DE, Guerry D 4th, Holly EA, Sagebiel RW, Potischman N. Diet and melanoma in a case-control study. Cancer Epidemiol Biomarkers Prev. 2004 Jun;13(6):1042-51.

Mosekilde L. Vitamin D and the elderly. Clin Endocrinol (Oxf). 2005 Mar;62(3):265-81. http://www.medscape.com/viewarticle/500874_1 (accessed March 15, 2005)

Sies H, Stahl W. Nutritional protection against skin damage from sunlight. Annu Rev Nutr. 2004;24:173-200.

Vieth R. Why the optimal requirement for Vitamin D3 is probably much higher than what is officially recommended for adults. J Steroid Biochem Mol Biol 2004;89-90:575-579.

Useful URLs

The Vitamin D Council
http://www.cholecalciferol-council.com

SunlightD Organization
http://sunlightD.org/

Vitamin D
UC-Riverside, About vitamin D
http://vitaminD.ucr.edu/about.html

The Miracle of Vitamin D by Krispin Sullivan, CN
http://www.westonaprice.org/nutrition_guidelines/nutrition_vitaminD.html

Vitamin D deficiency -- An emerging health crisis?
http://www.mult-sclerosis.org/news/Nov2003/VitaminDDeficiency.html

Sunlight Robbery: Health benefits of sunlight are denied by current public health policy in the UK by Oliver Gillie, Ph.D.
http://www.healthresearchforum.org.uk/reports/sunlightrobbery.pdf

Medical journal information
PubMed: 16 million journal paper titles, authors, and, in most cases, abstracts:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

The Atlas of Cancer Mortality in the U.S., 1950-94
http://www3.cancer.gov/atlasplus/

Two Studies Find Evidence That Sunlight May Have Beneficial Influence on Cancer

Journal of the National Cancer Institute, Vol. 97, No. 3, 157, February 2, 2005 DOI: 10.1093/jnci/97.3.157-b

MEMO TO THE MEDIA
Press Release
Sarah L. Zielinski
jncimedia@oupjournals.org
301-841-1287
Journal of the National Cancer Institute

Two new studies in the February 2 issue of the Journal of the National Cancer Institute have found that sun exposure may have a beneficial influence on some types of cancer. One study found an association between sun exposure and increased survival from melanoma, a potentially deadly form of skin cancer for which sun exposure is a risk factor, while the other found an association between sun exposure and a reduced risk of non-Hodgkin lymphoma.

Solar radiation is a major risk factor for melanoma. The incidence of and mortality from melanoma have been increasing over the last 50 years in all developed countries with large Caucasian populations. But as the incidence of melanoma increases, so does survival, suggesting the possibility that increasing sun exposure increases melanoma survival in addition to melanoma incidence. However, increased early detection of melanoma might also explain the increased survival.

To examine the relationship between sun exposure, early detection, and melanoma survival, Marianne Berwick, Ph.D., M.P.H., of the University of New Mexico in Albuquerque, and colleagues conducted a population-based, case-control study of more than 500 patients from the Connecticut Tumor Registry who had been diagnosed with melanoma in the late 1980s.

Three measures of sun exposure - sunburn, high intermittent sun exposure, and solar elastosis (an indicator of the skin's sun damage) - and a personal history of skin awareness (a measure of early detection) were all inversely associated with death from melanoma. Melanoma patients with higher levels of sun exposure or skin awareness were less likely to die. In addition, both solar elastosis and skin awareness were independently associated with increased survival from melanoma, even after adjusting for certain melanoma characteristics, such as lesion thickness and location. The authors conclude that sun exposure is associated with increased survival from melanoma.

"It would be reasonable to speculate... that the apparently beneficial relationship between sun exposure and survival from melanoma could be mediated by vitamin D," Berwick and colleagues write. "However, an alternative hypothesis is that sun exposure induces less aggressive melanomas by inducing melanization and increasing DNA repair capacity, both of which might reduce further mutational changes in a melanoma. Which, if either, hypothesis is more plausible remains to be determined."

Non-Hodgkin lymphoma has also been on the rise worldwide, and it has been suggested that increasing ultraviolet (UV) radiation and sun exposure may be partly responsible. To investigate this hypothesis, Karin Ekström Smedby, of the Karolinska Institute in Stockholm, and colleagues conducted a population-based, case-control study in Denmark and Sweden in which they obtained detailed information on history of UV exposure and other risk factors for lymphoma from more than 3,000 lymphoma patients and a similar number of control subjects.

They found that increased exposure to UV radiation through sunbathing and sunburns was associated with a decrease, rather than an increase, in the risk of non-Hodgkin lymphoma. Increased UV exposure was also associated, although more weakly, with a decreased risk of Hodgkin lymphoma.

"[These] results suggest an inverse association between UV light exposure and non-Hodgkin lymphoma risk," Smedby and colleagues write. "However, before this association can be considered causal we need further confirmatory data from other epidemiologic studies and, ideally, a better understanding of possible biologic mechanisms," including UV-induced systemic immune modulation and the photo-initiation of vitamin D production.

In an editorial, William J. Blot, Ph.D., of the International Epidemiology Institute in Rockville, Md., and colleagues discuss how the results of these two studies provide new evidence that sunlight may have a beneficial influence on both cancer incidence and outcome and hypothesize that vitamin D may be a critical mediator in the relationship between sunlight and cancer. "In view of the major potential public health consequence of these results, further studies of sunlight and the vitamin D connection to cancer are certainly warranted," they conclude.

Contacts:

* Berwick article: Harriet Bull, UNM Cancer Research & Treatment Center, 505-272-6794, hbull@salud.unm.edu
* Smedby article: Karin Ekström Smedby, Karolinska Institutet, +591-2-277 15, ekstrom@meb.ki.se
* Editorial: Cynthia Manley, Vanderbilt-Ingram Cancer Center, 615-936-5711, cynthia.manley@vanderbilt.edu Citations:
* Article: Berwick M, Armstrong BK, Ben-Porat L, Fine J, Kricker A, Eberle C, et al. Sun Exposure and Mortality From Melanoma. J Natl Cancer Inst 2005;97:195-99.
* Article: Smedby KE, Hjalgrim H, Melbye M, Torrång A, Rostgaard K, Munksgaard L, et al. Ultraviolet Radiation Exposure and Risk of Malignant Lymphomas. J Natl Cancer Inst 2005;97:199-209.
* Editorial: Egan KM, Sosman JA, Blot WJ. Sunlight and Reduced Risk of Cancer: Is The Real Story Vitamin D? J Natl Cancer Inst 2005;97:161-63.

Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at http://jncicancerspectrum.oupjournals.org/.

Sunlight may have benefits as well as cancer dangers
By RANDOLPH E. SCHMID
Associated Press
Published on: 02/01/05

WASHINGTON — Sunlight exposure, a major risk factor for the potentially deadly skin cancer melanoma, may also help victims survive that disease, new research indicates.

Full article at:
http://www.ajc.com/health/content/health/0205/02suncancer.html

Sun Can Show a Cancer Benefit
By Amanda Gardner
HealthDay Reporter

TUESDAY, Feb. 1 (HealthDayNews) -- In a perplexing finding, a new study suggests that exposure to sunlight may help people with melanoma live longer.

And a second study found sunshine confers yet another cancer benefit: It may reduce the risk of developing non-Hodgkins lymphoma.

Full article at:
http://www.forbes.com/lifestyle/health/feeds/hscout/2005/02/01/hscout523738.html

New Findings by a Physicist/Atmospheric Scientist Regarding Diet and Solar Ultraviolet Radiation for Maintaining Optimal Health

How does one determine the dietary and lifestyle choices associated with optimal health? Well, one can read the popular books, ask an MD, or search the web. However, noting that recommendations and fad diets change, and that the profit motive seems to color many recommendations, I sought a better way: I decided to study the literature and interpret the appropriate data. However, since I'm neither trained in the study of nutrition and health nor funded for my research, I had to find an approach that is relatively simple and inexpensive, yet reliable. The approach I stumbled upon while investigating the role of acid rain and ozone on eastern oak and hickory forest decline is called the ecologic approach.

Published on the Society for Amateur Scientist web site
Full article at:
http://www.sas.org/tcs/weeklyIssues_2005/2005-01-07/feature2/index.html

Academic Rebuttal to Jannetti, Inc. Dec. 16th, 2004 article "Vitamin D Myths Revealed" in Rednova.com's "Skin Cancer Update".

http://www.sunarc.org/rednovarebut.pdf

Note: The following was submitted to the Archives of Dermatology for publication and rejected

Sun protection guidelines should include information regarding vitamin D

Letter in response to:
Benjes LS, Brooks DR, Zhang Z, et al. Changing patterns of sun protection between the first and second summers for very young children. Arch Dermatol. 2004;140:925-930.

August 31, 2004

Any public health message should, in my opinion, be directed toward improving optimal overall health, not merely related to reducing the risk of a particular condition or disease. In addition, it should benefit all those involved, not just the direct target audience. Thus, the recent papers on sun protection for very young children in Massachusetts1 and 9-18 year old children in Connecticut,2 while well meaning, do not meet this expectation since they ignore the very important role of solar ultraviolet-B (UVB) radiation in the production of vitamin D; UVB is the most important source of vitamin D for most Americans, both children and their parents.3

Adequate levels of vitamin D are required for optimal health,4-6 yet many Americans have inadequate levels of serum 25-hydroxyvitamin D (25(OH)D), especially in winter.7 Reports of rickets have increased in the U.S. in the past few years, a situation that is attributed to vitamin D deficiency even in sunny regions.8 Some important additional health benefits of vitamin D to infants and children include proper bone development, and reduced risk of type 1 diabetes9 and multiple sclerosis.10 As noted, exposure to UVB early in life may be more important than exposure in adulthood for both beneficial and deleterious health effects.11

Writing papers from the perspective of New England is also problematic since the northeastern states receive the lowest doses of UVB in the contiguous states. The July 2002 UVB doses for the U.S.12 have been linked to protection against 18 types of cancer,4 and seem to explain much of the reason why mortality rates for breast, colon, ovarian, rectal and several other types of cancer are approximately twice as high in the northeast as in the southwest U.S.13 It is also likely that half of the multiple sclerosis cases in the U.S. would not have occurred had all Americans had the same UVB doses and serum 25(OH)D as in the southern states, which historically had prevalence rates 1/3 to ¼ that of the northern states.14

If the goal is to reduce the risk of skin cancer and aging, while maintaining optimal health, genetic variations in risk of skin cancer should be considered in designing guidelines.15,16 Also, antioxidants, which fight the free radicals involved in skin aging and cancer, can be delivered both topically17 and through diet.18 Developing a tan gradually is a very good way to protect the skin from damage and reduce the risk of melanoma.19 Regular, modest amounts of UVB exposure, well below the minimum erythemal dose, are sufficient to produce adequate vitamin D during 8-9 months of the year in Boston,3 so supplements should be used as required to augment solar UVB radiation to maintain adequate 25(OH)D levels throughout the year.

William B. Grant, Ph.D.
Founding Director Sunlight, Nutrition and Health Research Center SUNARC
2107 Van Ness Avenue, Suite 403B
San Francisco, CA 94109-2529
USA
1-415-776-5274 - voice

References
1. Benjes LS, Brooks DR, Zhang Z, et al. Changing patterns of sun protection between the first and second summers for very young children. Arch Dermatol. 2004;140:925-930.
2. Coogan PF, Geller A, Adams M, Benjes LS, Koh HK. Sun protection practices in preadolescents and adolescents: a school-based survey of almost 25,000 Connecticut schoolchildren. J Am Acad Dermatol. 2001;44:512-519.
3. Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr. 1995;61:638S-6345S.
4. Grant WB. An estimate of premature cancer mortality in the United States due to inadequate doses of solar ultraviolet-B radiation. Cancer 2002;94:1867-1875.
5. Heaney RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr 2003;78:912-919.
6. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004;79:362-371. Erratum in: Am J Clin Nutr. 2004 May;79(5):890.
7. Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young adults. Am J Med. 2002;112:659-662.
8. Shaikh U, Alpert PT. Practices of vitamin D recommendation in Las Vegas, Nevada. J Hum Lact. 2004;20:56-61.
9. Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358:1500-1503.
10. van der Mei IA, Ponsonby AL, Dwyer T, et al. Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ. 2003;327:316.
11. Lucas RM, Ponsonby AL. Ultraviolet radiation and health: friend and foe. Med J Aust. 2002;177:594-598.
12. Herman JR, Krotkov N, Celarier E, Larko D, Labow G. Distribution of UV radiation at the Earth's surface from TOMS-measured UV-backscattered radiances. J Geophys Res-Atmos 1999;104:12 059-12 076. http://toms.gsfc.nasa.gov/ery_uv/dna_exp.gif (accessed August 18, 2004).
13. Devesa SS, Grauman DJ, Blot WJ, Pennello GA, Hoover RN, Fraumeni JF Jr. Atlas of Cancer Mortality in the United States, 1950-1994. NIH Publication No. 99-4564, 1999. http://cancer.gov/atlasplus/new.html (accessed August 18, 2004)
14. Wallin MT, Page WF, Kurtzke JF. Multiple sclerosis in US veterans of the Vietnam era and later military service: Race, sex, and geography. Ann Neurol. 2004;55:65-71.
15. Sturm RA. Skin colour and skin cancer - MC1R, the genetic link. Melanoma Res. 2002;12:405-416.
16. Fuller KE. Health disparities: reframing the problem. Med Sci Monit. 2003;9:SR9-SR15.
17. Chiu A, Kimball AB. Topical vitamins, minerals and botanical ingredients as modulators of environmental and chronological skin damage. Br J Dermatol. 2003;149:681-691.
18. Cesarini JP, Michel L, Maurette JM, Adhoute H, Bejot M. Immediate effects of UV radiation on the skin: modification by an antioxidant complex containing carotenoids. Photodermatol Photoimmunol Photomed. 2003;19:182-189.
19. Kennedy C, Bajdik CD, Willemze R, et al. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol. 2003;120:1087-1093.

NIH Conference On Cancer and Vitamin D

The upcoming National Cancer Institute and National Institutes of Health conference on cancer and vitamin D promises to be an interesting match. Two very different groups of scientists will be slugging it out. In one corner will be the scientists who are trying to develop potentially profitable analogues of vitamin D to treat cancer. In the other corner will be vitamin D experts and other scientists who increasingly are saying plain old cheap vitamin D may be just as good (or even better) than the analogues to help fight cancer.

full story:
http://www.medicalnewstoday.com/medicalnews.php?newsid=14781

Vitamin D Is Good for Your Gums?

The Agriculture Research Service, the research arm of the US Department of Agriculture has recently reported that getting enough vitamin D, either through the diet or from sunlight, could be important for oral health.

full story:
http://www.medicalnewstoday.com/medicalnews.php?newsid=13771

Sunlight still associated with beauty in the U.S.
September 19, 2004
by William Grant Ph.D.

Watching the Miss America Beauty Pageant in Atlantic City last night, I was struck by how many of the final 10 contestants were from the South. Also, how tan the contestants appeared. When they showed a number of winners from 1943 to 2003, I noticed that the winners in the 1970s and early 1980s were quite tan during the pageants, but were now very pale.

Being a scientist, I decided to do an analysis of the latitude of the final ten. The final 10 were from AL, AR, CA, GA, KS, LA, NC, NY, OK, NY; the final 5 from AL, AR, CA, LA, NC; the final 2 from AL and LA, and the winner, Ms. Deidre Downs, was from AR. The findings compared to the U.S. population are given in Table 1. As can be seen, the finalists lived, on average, far south of the U.S. population as a whole. One degree is about 70 miles, so the difference of 4-5 degrees represents about 280-350 miles.

Thus, from both the fact that many former Miss America Pageant winners and many of the 2004 contestants had nice tans, and that the 10 finalists came primarily from the South, one can conclude that sunlight is associated with beauty in the U.S.

Table 1. Description of latitude medians and means for the 10 finalists compared to those for the U.S. population.

Sun Scare We’ve been told sunlight can kill us. But is our risk of skin cancer all it’s played up to be?
by Amy Brouillette

Going against decades of warnings by health officials and education campaigns linking exposure to ultraviolet rays with skin cancer, Americans continue to worship the sun in record numbers, according to the American Cancer Society.

Meanwhile, some researchers are beginning to think the public is on to something. A controversial pro-sun backlash has surfaced within the scientific community, generating a wave of new researchers who claim the sun’s harmful effects have been overplayed by conventional dermatologists, health practitioners and the media.

full story:
http://www.boulderweekly.com/hygeia.html

Ultraviolet light: Bane, boon or some of each? From MD Consult, August 27, 2004 by Doug Kaufman

ST. LOUIS (MD Consult) - Exposure to sunlight has long been considered both boon and bane among doctors.

Too little sun can lead to ricketts caused by a lack of vitamin D. Too much sun can lead to premature aging of the skin and skin cancer. This can be confusing to people, who may wonder what to believe.

full story:
http://www.barnesjewish.org/groups/default.asp?NavID=1838 page 1
http://www.barnesjewish.org/groups/default.asp?NavID=1840 page 2

Millions Deficient in Vital Vitamin D, Experts Warn By John von Radowitz, Science Correspondent, PA News

Millions of Britons are deficient in a vitamin that protects against a host of diseases including rickets, diabetes and cancer, it was claimed today.

Experts called for urgent action to raise vitamin D levels, particularly among pregnant women, young children, and people with dark skin.

full story:
http://news.scotsman.com/latest.cfm?id=3506655

Sun-starved Britons face increased risk of cancer By Jeremy Laurance, Health Editor, Independent.co.uk

Pale-faced Britons who do not get enough sun during the winter months are left with insufficient levels of vitamin D, increasing their risk of cancer, diabetes and bone diseases, experts said yesterday.

Grey skies and short days from October to March mean 60 per cent of the population are deficient in the vitamin by the end of the winter, a government survey has shown. Experts have called for urgent consideration to be given to fortifying staple foods such as bread and milk, or boosting levels of the vitamin in supplements.

Vitamin D, produced by the action of sunlight on the skin, is the only vitamin that humans make themselves and is essential for the health of the skin and bones. Graham Bentham, professor of environmental sciences at the University of East Anglia, said vitamin D was important in preventing a wider range of diseases than had previously been thought.

"We know its role in preventing rickets in children and osteomalcia in adults [which causes weak bones]. But there is accumulating evidence that it is also protective against some cancers - of the colon, breast, prostate and ovary - and against autoimmune diseases such as multiple sclerosis and Type 1 diabetes. It may also reduce blood pressure, which would help prevent heart attacks and strokes."

Recommended levels of the vitamin have not been set because it has been assumed that casual exposure to sunlight would produce sufficient amounts. But that assumption had never been scientifically studied and was now being challenged, Professor Bentham said. "The survey showed that a substantial proportion of the population have levels of vitamin D by the end of the winter that are insufficient. They are not low enough to cause osteomalcia but they may be bad for the bones and increase the risk of other diseases."

The simplest way of creating vitamin D is to go out in the sun but Professor Bentham, speaking after a briefing on vitamin D organised by the Science Media Centre, said that was a "very damaging idea".

"We know there has been a rise in skin cancer because many people are going out in the sun too much. We need to work very carefully with the cancer charities to get a balanced message across. It is a bit odd to ask people to binge on the sun in the summer to get them through the winter," he said.

Another option was to eat more oily fish - such as salmon, trout and sardines - which is the richest natural source of the vitamin. Margarine and breakfast cereals are fortified with vitamin D in the UK but there could be a case for fortifying milk, as in the US, and bread, Professor Bentham said. However, some people were sensitive to the vitamin and could be at risk.

Professor Brian Wharton, of the Institute of Child Health in London, said there were reports of rickets making a comeback, especially among Asian and African-Caribbean children.

He said an overreaction to "cover-up" campaigns against skin cancer was partly responsible for the lack of vitamin D. "There's no doubt that if you wear sunscreen, vitamin D conversion goes down," he said. "I'm certainly not promoting sun 'bingeing' but we do need some sensible use of the sun, and we've been swinging too strongly against it."

http://news.independent.co.uk/uk/health_medical/story.jsp?story=562658

You Need Vitamin D Dangerously low vitamin D levels may be the next national epidemic--increasing the risk of heart disease, colon cancer, and prostate cancer. The solution? Catch some rays
by Tom McGrath

full story:
http://www.menshealth.com/cda/article/0,2823,s1-3-68-0-1690-1-3-2,00.html

Men’s Health, the world’s largest men’s magazine, has a feature article in the September 2004 issue on the health benefits of solar ultraviolet-B (UVB) radiation through the production of vitamin D. The story is all the more remarkable since the 40-year old author developed basal cell carcinoma three years ago. The article quotes Professor Robert Heaney, M.D., of Creighton University as saying “I estimate that as many as 80 percent of people in the United States don’t get enough vitamin D.”Also, Michael Holick, M.D., Ph.D., of Boston University, formerly with the Dermatology Department, comments “I think this is a major unrecognized epidemic in the United States.”

The epidemiologic findings of William Grant, Ph.D., of SUNARC (www.sunarc.org) are featured prominently in the article, including his estimates of 23,000 premature cancer deaths per year in the U.S. and 200,000 preventable cases of multiple sclerosis due to insufficient UVB/vitamin D. These results are evaluated as circumstantial evidence – compelling, but not enough to convict.

Other diseases and conditions affected by vitamin D, such as bone health and heart health, are also mentioned.

James Spencer, M.D., director of dermatologic surgery at the Mount Sinai Medical Center and Co-Chair of the National Council on Skin Cancer Prevention, compares Michael Holick to Linus Pauling “Dr. Holick got religion on vitamin D the same way Dr. Pauling got it on vitamin C.” Considering that Pauling’s opinions on vitamin C have been found to be largely correct, this is a remarkable admission from Dr. Spencer. Dr. Heaney responded that “The dermatologists have looked at the rise in melanoma and panicked. But they aren’t looking at the whole human being.” Bruce Hollis, Ph.D., a vitamin D researcher at the Medical University of South Carolina, stated “I tell my students that if I were going to have cancer, I’d rather have basal-cell carcinoma than breast cancer, colon cancer, or one of the cancers linked to vitamin D deficiency.”

As pointed out in the side bar, milk is not an adequate source of vitamin D, since most brands do not contain the advertised amount. In addition, given that about 1000 I.U. of vitamin D/day seems to be required for optimal health, it is impossible to get adequate vitamin D from milk. (A recent review by William Grant and Cedric Garland concluded that dietary sources are inadequate to reduce the risk of colon cancer, but total vitamin D including diet, supplements, and UVB radiation, is.)

As mentioned in the article, Dr. Grant has submitted a manuscript extending his ecologic study of UVB and cancer in the U.S., adding alcohol, smoking, urban residence, etc., to the analysis. The finding is that UVB/vitamin D reduces the risk of 18 types of cancer, and that over 40,000 Americans die prematurely each year due to insufficient UVB/vitamin D.

(in print only)

In response to: What should I eat to reduce my risk of cancer? - posted 6 Sept. 2004 http://www.medicalnewstoday.com/medicalnews.php?newsid=12949

Recent dietary guidelines for reducing the risk of cancer posted by William Grant Ph.D. on 06 September 2004 at 3:27 am

While this press release correctly identifies diet as contributing to 30-40% of all cancers in Western Developed Countries, some of the recommendations are incorrect or incomplete.

In the U.S., complying with the Food Guide Pyramid or dietary guidelines published by the U.S. Department of Agriculture, similar to those recommended in this press release, was found not to be associated with significant reduced risk of breast cancer.

Part of the reason is that animal products of all types can increase the amount of insulin-like growth factor-I (IGF-I), which stimulates tumors to grow.

As far as vegetables go, much recent research has shown that allium family vegetables (garlic, leeks, onions, scallions) are very good at reducing the risk of many types of cancer, so could be consumed daily as insurance against cancer.

Finally, many studies have shown that solar ultraviolet-B (UVB) radiation, through the production of vitamin D, and vitamin D supplements, is associated with significant reduction in the risk of over a dozen types of cancer, but that dietary sources are generally inadequate since they do not contain enough vitamin D.

The interested reader will be able to find papers supporting these statements at PubMed, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi and at Sunlight, Nutrition, and Health Research Center, www.sunarc.org

Top tips for a healthier lunchbox - Medical News Today, 02 Sep 2004

UK - The Food Standards Agency's survey has revealed that three out of four children's lunchboxes fail to meet the Government's nutritional standards for school meals. So to help parents give their children varied and balanced lunchboxes, the Agency has put together some practical tips and suggestions.

Full story:
http://www.medicalnewstoday.com/medicalnews.php?newsid=12799#

REPOST: Sunshine 'prevents cancer' originally posted Friday, 15 February, 2002, 20:53 GMT

A small amount of sunshine can help reduce the risk of breast, colon and prostate cancers, according to US scientists.

full story:
http://news.bbc.co.uk/1/hi/in_depth/sci_tech/2002/boston_2002/1823457.stm

An Unpleasant Blast from the Past - Rickets, a disorder characterized by bowlegs and stunted growth, is an entirely preventable disease that most of us connect with the hard life of bygone days. But the disease is making a troubling comeback.

North American health organizations report a number of alarming cases of rickets in both the United States and Canada.

The cause? Vitamin D deficiency — and children aren’t the only ones at risk.

“Vitamin D is important not only for bone health, but also for a number of other conditions and diseases including muscle well being and prevention of 16 types of internal cancer, multiple sclerosis and type 1 diabetes among infants,” says Dr. William Grant, of Norfolk News, Virginia, a prominent medical researcher in the fields of nutrition and ultraviolet radiation and the director of Sunlight Nutrition and Health Research Center (www.sunarc.org).

Vitamin D is also useful in the treatment of muscle pain, psoriasis and multiple sclerosis. Excess amounts can be problematic, however, causing bleeding, kidney stones and weakened bones and muscles.

The importance of vitamin D, which helps the body absorb calcium and phosphorous, is evident in the way that skin pigmentation adapts over periods of millennia to local UV conditions, says Dr. Grant, so that it’s “… light enough for production of vitamin D yet dark enough for reduced risk from free radicals from penetration of UV radiation.”

Dr. Grant, along with many leading vitamin D researchers, is concerned that by successfully demonizing sunlight, the most important source of vitamin D, we run the risk of widespread and potentially devastating health problems.

“There is an epidemic of vitamin D insufficiency in the United States and Canada. As is readily apparent from the Atlas of Cancer Mortality, mortality rates for breast, colon, ovarian and rectal cancers are about twice as high in the northeastern states as they are in the southwestern states. I’ve shown that this is directly related to July UVB doses as well as differences in degree of urbanization,” says Dr. Grant.

For most people, solar UVB radiation provides the majority of vitamin D. It’s also available in some foods, including cheese, butter and margarine, cream, fortified milk, fish, oysters and fortified cereals.

“Food does not generally contain enough vitamin D to do much good. (Researcher) Cedric Garland and I recently reviewed the literature on vitamin D and colorectal cancer. Dietary sources were almost always found to be inadequate to reduce the risk of colorectal cancer in a statistically significant manner…” says Dr. Grant.

The views of vitamin D researchers such as Dr. Grant fly in the face of warnings by dermatologists who caution against any unprotected sun exposure. “The dermatologists are like highway patrolmen who, seeing that many people die from accidents due to speeding, urge everyone to drive slowly and not during peak commute hours,” he says.

Sunshine State:

Elderly people, breast-fed babies and African-Americans are especially vulnerable to vitamin D deficiencies. The American Academy of Pediatrics recommends that children get 200 IU/day beginning at 2 months — a dosage that should carry into adolescence. Dr. Grant suggests the following ways to make sure you get adequate daily amounts of vitamin D:

• Go into sunlight and soak up the beneficial rays.
• Consider taking supplements or using artificial UV lamps, especially in winter or if lifestyle prevents adequate UVB exposure.
• If you take more than 1,000 IU/day of vitamin D or combine UVB exposure with more than 600 IU/day, have a blood test to make sure proper D levels are maintained.

“Excess D can lead to problems such as reduced calcium in bones and increased risk of prostate cancer,” says Dr. Grant. “Dermatologists have made those living in the United States, Canada and Australia afraid of their shadows. Sunscreen blocks UVB and some UVA, thereby reducing the production of vitamin D. Sunscreen doesn’t reduce the risk of melanoma. Canadians and Americans have skin pigmentation appropriate for their latitudes so really don’t need artificial sunscreen,” says Dr. Grant. “The main thing regarding solar UV exposure is to avoid burning or reddening or excessive tanning.”

Essential Nutrient
Why vitamin D deficiency may be a hidden epidemic. By Amanda Schaffer Posted Tuesday, Aug. 24, 2004, at 12:34 PM PT on Slate.com

What exactly are the health benefits of vitamin D? How much does a person need? And why is the issue so often framed in terms of sun exposure—can't you just drink fortified milk or take a multivitamin?

Full story:
http://slate.msn.com/id/2105560/

Hot topic - Vitamin D, sunlight and cancer Updated 23 March 2004. First published: 26 November 2003 - written by BUPA's Health Information Team

A letter was published in the 22 November 2003 British Medical Journal by Professor Cedric Garland that argues that a lack of sunlight may be responsible for increasing the risk of developing certain cancers.

The idea that vitamin D may play a useful role in helping to prevent breast cancer was given a boost by UK research presented in March 2004. The researchers announced at a British Endocrine Societies meeting that they had found an enzyme in breast tissue that converts vitamin D into a cancer-fighting compound called calcitriol. Until now, it had been thought that this enzyme was only present in the kidneys.

Full Story:
http://www.bupa.co.uk/health_information/html/health_news/261103vitd.html

In response to "10,000th liver transplant performed in the UK" posted 12 Aug 2004 on Medical News Today.com

"Liver transplants can be avoided using alpha lipoic acid" posted by William B. Grant on 12 August 2004

There is a much cheaper option for treating liver disease including hepatitis C and mushroom poisoning: treatment with alpha lipoic acid, silymarin, and selenium. Here is a paper reporting such for hepatitis C. I am also aware of similar treatments in the U.S. for mushroom poisoning.

Med Klin (Munich). 1999 Oct 15;94 Suppl 3:84-9.

A conservative triple antioxidant approach to the treatment of hepatitis C. Combination of alpha lipoic acid (thioctic acid), silymarin, and selenium: three case histories.

Berkson BM.

Integrative Medical Center of New Mexico,
New Mexico State University, Las Cruces, USA.
burt@zianet.com

BACKGROUND: There has been an increase in the number of adults seeking liver transplantation for hepatitis C in the last few years and the count is going up rapidly. There is no reliable and effective therapy for chronic hepatitis C since interferon and antivirals work no more than 30% of the time, and liver transplant surgery is uncertain and tentative over the long run. This is because, ultimately, residual hepatitis C viremia infects the new liver. Furthermore, liver transplantation can be painful, disabling and extremely costly.

TREATMENT PROGRAM: The author describes a low cost and efficacious treatment program in 3 patients with cirrhosis, portal hypertension and esophageal varices secondary to chronic hepatitis C infection. This effective and conservative regimen combines 3 potent antioxidants (alpha-lipoic acid [thioctic acid], silymarin, and selenium) that possess antiviral, free radical quenching and immune boosting qualities.

CONCLUSION: There are no remarkably effective treatments for chronic hepatitis C in general use. Interferon and antivirals have less than a 30% response rate and because of the residual viremia, a newly transplanted liver usually becomes infected again. The triple antioxidant combination of alpha-lipoic acid, silymarin and selenium was chosen for a conservative treatment of hepatitis C because these substances protect the liver from free radical damage, increase the levels of other fundamental antioxidants, and interfere with viral proliferation. The 3 patients presented in this paper followed the triple antioxidant program and recovered quickly and their laboratory values remarkably improved. Furthermore, liver transplantation was avoided and the patients are back at work, carrying out their normal activities, and feeling healthy. The author offers a more conservative approach to the treatment of hepatitis C, that is exceedingly less expensive. One year of the triple antioxidant therapy described in this paper costs less than $2,000, as compared to mor than $300,000 a year for liver transplant surgery. It appears reasonable, that prior to liver transplant surgery evaluation, or during the transplant evaluation process, the conservative triple antioxidant treatment approach should be considered. If these is a significant betterment in the patient's condition, liver transplant surgery may be avoided.