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Skin Cancer, Sun and Vitamin DCenturies ago, when Vikings and other European seafarers took to the high seas for years at a time, they pioneered new trade routes and they mostly died of skin cancer. Native American Indians, living mostly outdoors, also mostly died of skin cancer.What? You never heard that? Right. Because it didn't happen. Here are a few things that really did happen:
Let There Be LightMankind was designed to bask in the rays of the sun.About 90 percent of the vitamin D in your body is made when your skin is exposed to sunlight. Only about 10 percent comes from food – butter, egg yolk, fish oil, and human milk. Because people have been told to fear the sun, there is a widespread vitamin D deficiency today. Boston University researcher Michael Holick estimates that approximately 1 billion people worldwide are vitamin D deficient.[2] If you've been avoiding the sun, have you been getting enough vitamin D in your daily multi-vitamin? Probably not. Just 15-20 minutes in the summer sun produces a blast of 10,000-20,000 international units. Ancient humans spent all their time outdoors and got such doses. By contrast, the U.S. government recommends a mere 200 to 600 IU a day, depending on age – what you get in two to six cups of fortified milk.
Sunlight is the most efficient way to get vitamin D. And ancestry really makes a difference here. The figure above of 10,000-20,000 units of vitamin D from being outdoors applies to fair skinned adults sunbathing in the summer. Dark-skinned people require 10 times that exposure to make an equivalent amount. And considering how important vitamin D is to a baby's brain development, what happens to pregnant women who avoid the sun? They would have to drink 200 glasses of milk or take 50 prenatal multivitamins to equal 20 minutes in the sun. An autistic boy who plays inside the house, instead of outside, would have to take several thousand units of vitamin D to make up for what his skin would have produced had he played outside that day.[3] When it comes to getting vitamin D from a pill, the most useful form is the D3 – the form found in animal foods. Beware that many vitamin D and multivitamin supplements use the D2 form which the body has a harder time assimilating. Vitamin D's Connection to Chronic DiseaseDoctors have observed that where there's less sun, there's more cancer, flu, and even autism. And, there are more of these diseases in winter, which has less sunlight. There are also more of these diseases the further you get from the equator – the further you move away, the less sunlight there is.1. The Diabetes Connection Blood sugar is closely associated with your vitamin D level. Researchers in Australia added to the growing evidence that sun avoidance may have caused the epidemic of type 2 diabetes. The Australians' findings were straightforward and powerful. The higher your vitamin D level, the lower your blood glucose.[4] 2. The Breast Cancer Connection In 2007, researchers at the Moores Cancer Center at University of California, San Diego (UCSD), published research findings that women with higher levels of Vitamin D had lower levels of breast cancer. The researchers estimated that possibly half the cases of breast cancer and two-thirds of the cases of colorectal cancer in the United States could be prevented with higher levels of Vitamin D.[5] "For the first time, we are saying that 600,000 cases of breast and colorectal cancer could be prevented each year worldwide, including nearly 150,000 in the United States alone."3. The Overall Cancer Connection  The UCSD research team also reported links between low vitamin D levels and endometrial cancer (Feb 2007), and ovarian cancer (Oct 2006), and kidney cancer (Sept 2006).[6]In 2009, the UCSD team proposed a new model of cancer development that hinges on a loss of cancer cells' ability to stick together. The model differs substantially from the current model which suggests genetic mutations are the earliest driving forces behind cancer. "The first event in cancer is loss of communication among cells due to, among other things, low vitamin D and calcium levels," said epidemiologist Cedric Garland, who led the work. "In this new model, we propose that this loss may play a key role in cancer by disrupting the communication between cells that is essential to healthy cell turnover, allowing more aggressive cancer cells to take over."[6a] A recent Norwegian study found that vitamin D levels, calculated based on sun exposure, were linked to survival rates for cancer patients. Those who lived in sunnier, southern latitudes, and had higher vitamin D levels, were less likely to die from cancer than people in northern latitudes.[7] The Creighton University School of Medicine studied 1,179 postmenopausal, cancer-free women between 2000 and 2005 who took nearly three times the Recommended Daily Amount of vitamin D 3. Participants showed a dramatic 60 percent or greater reduction in cancer risk compared with women who did not get the vitamin.[8] "The findings are very exciting. They confirm what a number of vitamin D proponents have suspected for some time but that, until now, have not been substantiated through clinical trial," said principal investigator Joan Lappe, Ph.D., R.N., Creighton professor of medicine. "Vitamin D is a critical tool in fighting cancer as well as many other diseases." It's known that vitamin D stimulates white blood cells to produce a powerful natural antibiotic called cathelicidin. Vitamin D has the capacity to turn on powerful antimicrobial genes. Some of these genes make proteins that halt cancer by inducing apoptosis (programmed cell death), which destroys aberrant cells before they become cancerous, like adenoma cells in the colon and rectum. Other genes rein in out-of-control growth of cancer cells like those in the prostate. Vitamin D-expressed genes inhibit angiogenesis, the formation of new blood vessels that malignant tumors need to grow, as studies on lung and breast cancers show. Other genes inhibit metastases, preventing cancer that arises in one organ from spreading its cells to other parts of the body, such as in breast and prostate cancers.[9] 4. Growing Healthy Children In 2007, the Canadian Cancer Society made big news as it announced a national program to prevent cancer using vitamin D. The society now advises all Canadians to take 1000 IU of vitamin D daily. The Canadian Pediatric Society now recommends that pregnant women take 2,000 IU of vitamin D per day (10 times more than the 200 IU/day the National Institutes of Health recommends for pregnant women in the USA). According to the Canadian press, the Canadian Pediatric Society acted "to protect babies from a litany of illnesses later in life." Others feel that even 4,000 IU/day is not enough for breast-feeding mothers to maintain adequate levels of vitamin D in their breast milk; that would take about 6,000 IU/ day.[10] 5. The Autism Connection Dr. John Jacob Cannell of the Vitamin D Council believes that falling levels of vitamin D in the last 20 years parallel the rise of the autism epidemic. "The theory that vitamin D deficiency causes autism...has a plausible mechanism of action ... The very different effects estrogen and testosterone have on vitamin D metabolism may explain why boys are much more likely to get it than girls are. Lower vitamin D levels in blacks may explain their higher rates of autism...Glutathione is the body's main detoxifing agent. It helps the liver remove chemicals that are foreign to the body, such as drugs and pollutants. Dr. Cannell makes a fascinating observation: If vitamin D levels are low, glutathione levels also may be low, thus children may not be able to detoxify the mercury, aluminum, formaldehyde and other ingredients in vaccines. 6. Keeping Our Brains Healthy Renowned UCLA researcher Bruce Ames, Ph.D., notes the wide distribution of vitamin D receptors throughout the brain, and underscores the role of the vitamin in maintaining brain health. He emphasized that vitamin D appears to affect brain proteins responsible for learning and memory, motor control, and behavior. Inadequate vitamin D levels may impair cognition and give rise to behavior problems. "We conclude there is ample biological evidence to suggest an important role for vitamin D in brain development and function," Ames said.[11a] Why the Rise in Skin Cancer?A number of researchers would point first to the imbalance of omega 3 and omega 6 fatty acids in our diet – our grandparents ate cod liver oil high in omega 3s, and we eat French fries high in omega 6s. The research is piling up that omega 3 deficiencies are a far more significant risk factor for deadly skin cancers than sun exposure.Studies, particularly a comprehensive review from the National Academy of Sciences, show that omega 3 fatty acids, including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), can reduce the risk of skin cancer whereas omega 6 fatty acids such as arachidonic acid (AA) promote risk.[12,13,14] Processed foods tend to be full of partially hydrogenated oils – trans fatty acids – which stiffen your body's cells and block the flow of nutrition coming in and toxins passing out. Dr. Johanna Budwig, a seven-time Nobel Prize nominee, demonstrated that certain wavelengths of sunlight vibrate at the same frequency as chemical bonds in trans fats. Dr. Budwig believed this leads to early mutations that can become skin cancers. After studying thousands of blood samples, she discovered a key difference was healthy people had a higher content of omega 3 oils in their blood than those who are ill.[15] Sunscreens are another factor increasingly implicated in skin cancer because they promote vitamin D deficiencies – remember, vitamin D fights cancer. The rise in skin cancers over the last 25 years parallels the rise in use of sunscreen lotions, which block vitamin D-producing UVB rays. And many sunscreens contain potentially harmful ingredients that absorbed through the skin. Working indoors where light is artificial may also account for the rise in skin cancer. A U.S. Navy study found that the most malignant melanoma was found not in people who worked in the sun, but with people who worked indoors under artificial light. They found that most of these skin cancers occur on areas of the body not even exposed to the sun. (Arch Environmental Health, 1990;45:261-267) A study published in The Lancet found that it was not sunlight that caused melanoma but rather fluorescent light that caused more than twice the melanoma risk. The study found that long exposure to sunlight actually "immunized" people from the later development of melanoma. (Lancet, 8/7/82, 290-293) Not All Skin Cancers Are the SameSkin cancer is responsible for perhaps less than two percent of all cancer deaths, accounting for about 11,000 of the 565,000 American cancer deaths recorded in 2006.Nearly all skin cancer deaths stem from relatively rare malignant melanomas, which constitute only six percent of all skin-cancer cases.  Basal cell carcinoma is the most common form of cancer, with about a million new cases estimated in the U.S. each year. Basal cells line the deepest layer of the epidermis. Basal cell carcinomas are malignant growths – tumors – that arise in this layer.Basal cell carcinoma can usually be diagnosed with a simple biopsy and is fairly easy to treat when detected early. This cancer has an extremely low rate of metastasis, and although it can result in scars and disfigurement, it is not usually life threatening. Doctors have noted that basal cell carcinomas often occur behind the ears, an area not generally affected by sunlight. President Richard Nixon had an inch-long basal cell carcinoma removed from behind his left ear. Squamous cell carcinoma is the second most common form of skin cancer, with some 250,000 new cases per year estimated in the United States. It arises in the squamous cells that compose most of the upper layer of the skin. Pre-cancerous patches of rough or scaly skin known as actinic keratoses are patches of damaged skin. If not addressed, some of this can develop into squamous cell skin cancer. Squamous cell cancer appears on the skin as small lumps or sore spots that don't heal properly. This is a superficial cancer, and non-life-threatening unless allowed to advance over many years. By treating keratoses, however, you may be able to head off squamous cells before they develop. At the Arizona Center for Advanced Medicine we use glycoalkaloids, natural compounds found in an Australian botanical known as the devil's apple plant. Historically, the use of glycoalkaloid-rich plants in addressing skin conditions goes back to the second century A.D. Glycoalkaloids are thought to work by exploiting structural differences between healthy and damaged skin cells. As skin cells become damaged, the cell walls become more permeable, allowing glycoalkoloids to penetrate abnormal cells. Once inside the cell walls, glycoalkaloids release enzymes that break down the cells from the inside out. As the abnormal cells die, they're replaced by healthy skin cells, which don't absorb the glycoalkaloids, thus avoiding their destructive effects. Of far greater concern is the skin cancer called melanoma. This is a very dangerous cancer, especially when it's not diagnosed early. Melanoma cannot be reversed with glycoalkaloids. Melanoma is usually associated with moles, so if you experience any irregularity in a mole - such as changing shape, color, or size – make an appointment immediately. Genetic and nutritional factors appear to play greater roles than sun exposure. Sunscreens do not appear to prevent melanomas. Think Twice Before Slathering That SunscreenThe active ingredients of sunscreen are many times less efficient than melanin at dissipating the sun's rays into nonreactive forms of energy. Sunscreens block your skin from producing the pigment melanin. This prevents your body from employing its natural defense against overexposure to sunlight – a tan. Sunscreens primarily block UVB waves, the wavelength that stimulates the skin's vitamin D production. Sunscreen with a sun protection factor (SPF) of 8 prevents more than 95% of vitamin D production.[16]A team of researchers from the University of California-Riverside found sunscreen can do more harm than good once it soaks into the skin.[17] The research team found that three commonly used ultraviolet (UV) filters – octylmethoxycinnamate, benzophenone 3, and octocrylene – eventually soak into the deeper layers of the skin after application, leaving the top skin layers vulnerable to sun damage. UV rays absorbed by the skin can also generate harmful compounds called reactive oxygen species (ROS), which can cause skin cancer and premature aging. The researchers found that once sunscreen filters soak into the lower layers of skin, the filters react with UV light to create more damaging ROS. The UC-Riverside team's research is the first to indicate that sunscreen filters – intended to protect the skin from UV damage – apparently promote such damage. In June, 2007, the Environmental Working Group (EWG) released an in-depth analysis of the safety and effectiveness of more than 700 name-brand sunscreens. "Our review of the technical literature shows that some sunscreen ingredients absorb into the blood, and some are linked to toxic effects. Some release skin-damaging free radicals in sunlight, some act like estrogen and could disrupt hormone systems, several are strongly linked to allergic reactions, and still others may build up in the body or the environment. FDA has not established rigorous safety standards for sunscreen ingredients."[18]A March 2008 study by the U.S. Centers for Disease Control (CDC) revealed that 97% of Americans are contaminated with a widely-used sunscreen ingredient called oxybenzone that has been linked to allergies, hormone disruption, and cell damage. A companion study from the Mt. Sinai School of Medicine revealed that this chemical is linked to low birth weight in baby girls whose mothers are exposed during pregnancy.[19] Oxybenzone is also a penetration enhancer, a chemical that helps other chemicals penetrate the skin. EWG's analysis of ingredient labels found oxybenzone in nearly 600 sunscreens and in lip balm, lipstick, moisturizers, and fragrance for women. The FDA recently proposed to disallow manufacturer claims on bottles that using sunscreens prevents cancer. This came on the heels of a 2006 class action lawsuit filed in Los Angeles alleging that five of the leading U.S. makers of sunscreen lotions – including Coppertone, Banana Boat, Hawaiian Tropic – deceptively promote their products as protection from harmful sun rays. "Sunscreen is the snake oil of the 21st century," said attorney Samuel Rudman.[20,21] Old News, New News"Up until now we looked at vitamin D the way we look at an iceberg. Eighty-five percent of its function has been hidden, and we had no idea until two or three years ago," Robert Heaney, an endocrinologist at Creighton University in Nebraska told Forbes Magazine in 2008. "The field has just exploded."[22]Current research indicates vitamin D deficiency plays a role in causing some 17 kinds of cancer as well as heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects, and periodontal disease. Vitamin D regulates cells, systems, and organs throughout the body. A 2008 study showed that adults in sunny southern Arizona are commonly deficient in vitamin D; more than a quarter of the adults tested had dangerously low blood levels of vitamin D. Those who had higher vitamin D levels developed fewer colorectal polyps.[23] In the largest study of possible links between vitamin D and respiratory infections, researchers reported in 2009 that people with the lowest blood vitamin D levels have significantly more recent colds or cases of the flu. The risks are even higher for those with chronic respiratory disorders, such as asthma and emphysema.[23a] Once you realize the many connections that vitamin D makes to keep people healthy, you'd want to patent it to make bundles of $$$. If it were a drug, it would be a mega-blockbuster outselling all others. But it's a nutrient that cannot be patented. Your body makes it for free. In February, 2008, the New York Times pointed out the lackluster response from the mainstream medical community. "The so-called sunshine vitamin is poised to become the nutrient of the decade, if a host of recent findings are to be believed. Vitamin D seems to dampen an overactive immune system. The incidence of autoimmune diseases like Type 1 diabetes and multiple sclerosis have been linked to low levels of vitamin D.As Dr. John Cannell of the vitamin D Council put it: "A child has never gotten into a vitamin D cabinet and gotten poisoned. That happened hundreds of thousands of times though with Tylenol or aspirin or other things ... This whole thing when you think about it is patently absurd. They refuse to change, they refuse to even look at the science."[25]The current RDAs for vitamin D are 400 IU for adults aged 51 to 70 and 600 IU for people over 70. And the RDA for all persons younger than 51 is a scant 200 IU. Studies show that much more than that is needed to prevent falls and fractures. In double-blind, randomized controlled trials involving 2,426 older people, daily supplemental doses of vitamin D between 700 and 1,000 IU reduced the risk of falling by 19 percent, while doses below 700 IU per day showed no benefits.[26] Researchers noted that muscle weakness is both an important risk factor for falls and a proven, prominent symptom of vitamin D deficiency.[27] Vitamin D stimulates synthesis of protein, the building material for muscle. Let the Sun ShineIn the early 1900s, most Americans lived a rural lifestyle and spent a lot of time outdoors. Today, most people simply aren't getting enough mid-day summer sun to make an adequate amount of vitamin D. Strike a balance. Remember: never get sunburned, that is key. If you have lots of antioxidants on board, you will not burn nearly as easily by the way.Sunscreen? It is certainly useful for preventing sunburn, which may be responsible for a small percentage of the relatively small number of fatal skin cancers that occur. But read up on toxic ingredients before you buy. And clothing is a time-honored way of covering up. It's free, too. Almost everyone is deficient in D3. At the Arizona Center for Advanced Medicine, we always measure vitamin D3 levels at the initial visit, and supplement appropriately, since vitamin D is so important in so many different functions in the body - kind of like the chicken soup vitamin. Michael Holick feels that we should all have levels that measure greater than 50 in order to function properly. Most of us fall in the 20-30 range - which is considered "normal." At the Clinic, we generally start people on 4000 IU per day, along with calcium and magnesium supplementation, and then monitor vitamin D and calcium levels periodically. Of course, if you want to spend hours and hours in the sun, it will turn your skin dark and leathery, and you'll wind up looking like an Arizona lizard. But in moderation, vitamin D from the sun is excellent for your health.
[1] Linda B. White, M.D., Vitamin D: Sunshine and So Much More, Mother Earth News, February/March 2008
[2] Michael Holick, Vitamin D Deficiency, New England Journal of Medicine, July 19, 2007 [3] Autism and Vitamin D, The Role of Sunshine; The Vitamin D Council [4] Need AG, O'Loughlin PD, Horowitz M, Nordin BE.; Relationship between fasting serum glucose, age, body mass index and serum 25 hydroxyvitamin D in postmenopausal women. Clin Endocrinol (Oxf). 2005 Jun;62(6):738-41. [5] Garland, Cedric; Gorham, Edward; et all; Vitamin D and prevention of breast cancer: pooled analysis. The Journal of steroid biochemistry and molecular biology, 103 (3-5), p.708-711, Mar 2007 [6] November 14, 2007; News Release from University of California, San Diego, Medical Center [6a] http://www.eurekalert.org/pub_releases/2009-05/uoc--nms052009.php [7] Johan Moan, Alina C Porojnicu, et al; Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure; Proceedings of the National Academy of Sciences, January 7, 2008. [8] American Journal of Clinical Nutrition, June 8, 2007 [9] Dr. Donald Miller, Jr.; Vitamin D in a New Light, September 10, 2007, accessed January 2008 at www.donaldmiller.com [10] Basile LA, et al. The effect of high-dose vitamin D supplementation on serum vitamin D levels and milk calcium concentration in lactating women and their infants. Breastfeed Med. 2006 Spring;1(1):27-35. [11] John Jacob Cannell, MD, What is Autism? accessed at http://www.vitamindcouncil.org/health/autism/what-is-autism.shtml [11a] Joyce C. McCann, Bruce N. Ames; Is there convincing biological or behavioral evidence linking vitamin D deficiency to brain dysfunction? The FASEB Journal. 2008;22:982-1001 [12] Guangming Liu, Douglas M. Bibus, et al, Omega 3 but not omega 6 fatty acids inhibit AP-1 activity and cell transformation in JB6 cells, Proceedings of the National Academy of Sciences, June 19, 2001, vol. 98, no. 13, 7510-7515 [13] Anthony P. Albino, Gloria Juan, et al; Cell Cycle Arrest and Apoptosis of Melanoma Cells by Docosahexaenoic Acid: Association with Decreased pRb Phosphorylation, Cancer Research, 60, 4139-4145, August 1, 2000 [14] ibid [15] Johanna Budwig, Flax Oil as a True Aid Against Arthritis, Heart Infarction, Cancer and Other Diseases, Apple Tree Pub Co Ltd, Vancouver, British Columbia, Canada, 1994 [16] Linda B. White, M.D., Vitamin D: Sunshine and So Much More, Mother Earth News, February/March 2008 [17] Sunscreens Can Damage Skin, Researchers find filters in sunscreens that keep out ultraviolet radiation can generate compounds that attack skin cells, UC-R Press Release of August 26, 2006, accessed at http://www.newsroom.ucr.edu/cgi-bin/display.cgi?id=1399 [18] Environmental Working Group, Which Sunscreens are Safest? First-ever online database rates sunscreen safety and effectiveness, June 19, 2007 [19] Antonia M. Calafat, Lee-Yang Wong, et al; Concentrations of the Sunscreen Agent, Benzophenone-3, in Residents of the United States: National Health and Nutrition Examination Survey 2003–2004, Environmental Health Perspectives, Volume 116, Number 3, March 2008, accessed at http://www.ehponline.org/docs/2008/11269/abstract.html [20] Elizabeth Olson, The Rub On Sunscreens, New York Times, June 19, 2006 [21] http://www.csgrr.com/csgrr-cgi-bin/mil?templ=cases/sunscreen/signup.html [22] Robert Langreth, D is For Debate, Forbes Magazine, March 10, 2008 [23] Elizabeth T Jacobs, David S Alberts, et al; Vitamin D insufficiency in southern Arizona, American Journal of Clinical Nutrition, Vol. 87, No. 3, 608-613, March 2008 [23a] Ginde AA, Liu MC, Camargo CA Jr., Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009 Mar 23;169(6):626-32. [24] Jane Brody, An Oldie Vies for Nutrient of the Decade, New York Times, February 19, 2008 [25] Gailon Totheroh, What's the Real Story on Vitamin D? Canadian Broadcasting Network, November 17, 2007, accessed March 2008 at http://www.cbn.com/CBNnews/269033.aspx [26] HA Bischoff-Ferrari, B Dawson-Hughes, et al; Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials, British Medical Journal, 2009 Oct 1;339:b3692. doi: 10.1136/bmj.b3692. [27] Ceglia L. Vitamin D and its role in skeletal muscle. Curr Opin Clin Nutr Metab Care. 2009 Nov;12(6):628-33.
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