NEW STUDY SHOWS TANNING AND MELANOMA LINK SCIENTIFICALLY FLAWED
IARC Sunbed Review Ignored Obvious and Crucial
SAN FRANCISCO - March 15, 2010– A new study published in the peer-reviewed journal “Dermato-Endocrinology” shows that there is no statistically significant connection between sunbeds and melanoma in those who can develop suntans (skin type II-VI), with increased risk centered only on those whose skin is so fair it cannot tan (skin type I).
William B. Grant, PhD, a former NASA atmospheric research scientist and founder of SUNARC, Sunlight, Nutrition and Health Research Center (SUNARC), re-examined the same epidemiological data used by the International Agency for Research on Cancer (IARC) group from their findings in 2007 titled, “The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review”. Grant’s study strongly challenges this review and argues it is both flawed and cannot be used as the basis for U.S. health policy.
The IARC review originally claimed a 15% increased risk of melanoma for ever use of sunbeds and a 75% increased risk in melanoma for respondents who had ever used or first used a tanning bed prior to age 35. Grant’s findings show that with the removal of those with skin type I who possess the greatest genetic risk of cutaneous malignant melanoma (CMM), there fails to be any statistically significant link between ever use of indoor tanning facilities and CMM.
ACCORDING TO GRANT’S ANALYSIS:
- The reported 75% increased risk of melanoma for those ever having used a sunbed prior to age 35 drops to a 25% reduced risk of melanoma in the United States based on a scientifically-centered reanalysis of the data in the IARC report.
- When skin type I is omitted from the IARC analysis, the reported 15% increased risk in melanoma fails to remain statistically significant. This is based on a meta-analysis of the 14 studies not from the UK, where skin type I is most prevalent.
- The IARC study inappropriately combined four studies from northern Europe, one from the UK, one from Canada, and one from the U.S. in the analysis of first use of sunbeds before the age of 35 years. There are vast differences between American and European sunbed regulations and use. US regulations do not allow Skin Type I patrons to tan, European tanning beds are often used at home or are unsupervised and do not follow the regulations in the U.S. The study fails to state that its findings are not, and should not be considered “universal findings.”
“The reason this “Skin Type I” distinction is so important is that we now know that UV avoidance among people who can develop a tan has contributed to epidemic-level vitamin D deficiency in North America, with 3 out of 4 Americans being vitamin D deficient today,” said Grant. “Our public health messages about the benefits of UV radiation from any source need to recognize this.”
The IARC report was a meta-analysis of epidemiologic surveys – questionnaire surveys designed to retrospectively identify correlations, but which do not by nature identify causation. As stated in the IARC report, “Epidemiologic studies to date give no consistent evidence that use of indoor tanning facilities in general is associated with the development of melanoma or skin cancer.”
Melanoma’s connection with UV exposure is controversial, as research clearly shows it is more common in indoor workers than in outdoor workers and is more common on parts of the body that aren’t regularly exposed to sunlight, implicating sun burning rather than regular tanning.
THE IARC REVIEW ALSO NEGLECTED TO:
- Find a dose-response relation between the amount of sunbed use and risk of melanoma – which would be key to establishing a causal relationship.
- Recognize a growing body of literature that shows that non-burning UVB exposure reduces the risk of CMM, and that recreational exposure and sun burning increases risk
- Cite other potential reasons for increases in melanoma, including: geography, differing sunbed regulations in various locations, gender, increased travel to sunny places, greater levels of sunscreen use, or the nature of solar UV exposure.
IMPORTANCE OF SUNLIGHT AND VITAMIN D TO OUR SURVIVAL
Another recent study from Grant, “In Defense of the Sun,” published in Dermato-Endrocrinology, suggests that raising vitamin D blood levels to 45 ng/ml could reduce mortality rates in the United States by 15% and prevent up to 400,000 premature deaths from vitamin D deficiency-related diseases annually. Such diseases include many types of cancers, cardiovascular disease, heart failure, respiratory infections, diabetes, and falls and fractures.
Vitamin D researchers today recommend vitamin D blood levels should be maintained above 40-60 ng/ml. At least 2,000 IU of vitamin D daily in addition to dietary sources and casual solar UV irradiance are required to maintain those levels. According to peer-reviewed, published research, indoor tanners have those levels, but non-tanners do not.
Indoor tanners: 42-49 ng/ml
American average: 23-25 ng/ml
In addition, two 2009 Swedish studies of indoor tanners showed a reduced risk of endometrial cancer and thrombotic events. A recent study at Boston University School of Medicine also found that blood levels of D3 were almost twice as high in sunbed users as in non-users. Sunbed users’ bone densities at the hip were also significantly higher.
“There is conclusive evidence that indoor tanning in a non-burning fashion offers a tremendous source of vitamin D,” Grant says. “The benefit of regular UV exposure as the body’s only true natural source of sufficient vitamin D production easily outweighs the manageable risks associated with overexposure to sunlight,” Grant says. “We know now through more than 2,000 papers published in 2009 that smart UV exposure and increased vitamin D levels will not only save lives, but also extend and increase our quality of life."
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.”
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
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
William B. Grant, Ph.D., SUNARC, San Francisco CA, USA 1-415-776-5274, firstname.lastname@example.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, email@example.com.
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.
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]
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
1-415-776-5274 - voice
1-415-776-5270 - fax
Cedric F. Garland, Dr.P.H.
Department of Family and Preventive Medicine
University of California, San Diego
La Jolla CA 93093, USA
Tel. (619) 553-9016
Michael F. Holick, Ph.D., M.D.
Vitamin D, Skin and Bone Research Laboratory
Section of Endocrinology, Diabetes, and Nutrition
Department of Medicine, Boston University Medical Center
Boston University School of Medicine
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
Full story: http://www.news-medical.net/?id=8666
Release (MS Word)
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
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;
For more information on the
health benefits of UVB and vitamin D, please visit www.sunarc.org.
B. Grant, Ph.D.
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.
data, 2004 http://faostat.fao.org/faostat/collections?subset=nutrition
(accessed March 17, 2005)
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.
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.
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.
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.
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.
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
B. Grant, Ph.D.
(Sunlight, Nutrition and Health Research Center)
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 .
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."
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 53o 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 12o-41o 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.,
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
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 , 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].
Melanoma Mortality Rates Male/Female
Other Skin Cancer Rates Male/Female
Vitamin D-Sensitive Cancer Rates Male/Female
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.
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.
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.
(accessed March 12, 2005)
Dubin N, Moseson M, Pasternack BS. Sun exposure
and malignant melanoma among susceptible individuals. Environ Health Perspect.
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.
Hanley DA, Davison KS. Disease-Specific Biomarkers of Vitamin
D Sufficiency Vitamin D Insufficiency in North America. J Nutr 2005;135:332-337.
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.
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.
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.
The Vitamin D Council
UC-Riverside, About vitamin D
The Miracle of Vitamin D by Krispin Sullivan, CN
D deficiency -- An emerging health crisis?
Robbery: Health benefits of sunlight are denied by current public health policy
in the UK by Oliver Gillie, Ph.D.
PubMed: 16 million journal paper titles, authors,
and, in most cases, abstracts:
Atlas of Cancer Mortality in the U.S., 1950-94
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
MEMO TO THE MEDIA
Sarah L. Zielinski
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
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
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.
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
"[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.
article: Harriet Bull, UNM Cancer Research & Treatment Center, 505-272-6794, firstname.lastname@example.org
* Smedby article: Karin Ekström Smedby, Karolinska Institutet, +591-2-277 15,
* Editorial: Cynthia Manley, Vanderbilt-Ingram Cancer Center,
615-936-5711, email@example.com 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.
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
* 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/.
may have benefits as well as cancer dangers
By RANDOLPH E. SCHMID
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:
Can Show a Cancer Benefit
By Amanda Gardner
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
Full article at:
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
Full article at:
The following was submitted to the Archives of Dermatology for publication
Sun protection guidelines should include information regarding
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
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
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
2107 Van Ness Avenue, Suite 403B
San Francisco, CA 94109-2529
1-415-776-5274 - voice
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.
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.
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.
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.
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
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
still associated with beauty in the U.S.
September 19, 2004
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
Table 1. Description of latitude medians and means
for the 10 finalists compared to those for the U.S. population.
Number of Finalists
Mean (degrees N)
Median U.S.(degrees N)
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.
Deficient in Vital Vitamin D, Experts Warn By John von Radowitz, Science Correspondent,
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.
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
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
"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.
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
Originally posted 08/25/2004
Starved by Tom McGrath, Men’s Health, September 2004, pp. 138-142, 203. (in
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.
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.
response to: What should I eat to reduce my risk of cancer? - posted 6 Sept.
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.
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.
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.
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.
interested reader will be able to find papers supporting these statements at PubMed,
and at Sunlight, Nutrition, and Health Research Center, www.sunarc.org
tips for a healthier lunchbox - Medical News Today, 02 Sep 2004
- 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.
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.”
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.
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.
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.”
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
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?
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.
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
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.
Medical Center of New Mexico,
New Mexico State University, Las Cruces, USA.
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.
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.