National Institute of Health 



"Despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight [36] and UV radiation from tanning beds [37]. UV radiation is a carcinogen responsible for most of the estimated 1.5 million skin cancers and the 8,000 deaths due to metastatic melanoma that occur annually in the United States [36]. Lifetime cumulative UV damage to skin is also largely responsible for some age-associated dryness and other cosmetic changes. It is not known whether a desirable level of regular sun exposure exists that imposes no (or minimal) risk of skin cancer over time." http://ods.od.nih.gov/factsheets/vitamind-HealthProfessional/#h3

Vitamin D Sufficiency vs. Sun
Protection: Must We Choose?

Kavitha K. Reddy
Barbara A. Gilchrest 

Kavitha K. Reddy, MD, is a Resident,
Boston University and Tufts University School
of Medicine Dermatology Program, Boston,
MA.

Barbara A. Gilchrest, MD, is a Professor
and Chair-Emeritus, Department of
Dermatology, Boston University School of
Medicine, Boston, MA.

( Note -effective June 1, 2012  Dr Gilchrest will be the editor of the Journal of Investigative Dermatology   ttp://www.nature.com/jid/index.html )

This continuing nursing educational (CNE) activity is designed for nurses
and other health care providers who are interested in vitamin D and sun protection.
For those wishing to obtain contact hour credit, an evaluation follows. After
studying the information presented in this article, the nurse will be able to:
1. Explain how vitamin D levels are defined.
2. Identify sources of vitamin D.
3. Discuss sources of vitamin D.
4. Describe how to obtain sufficient levels of vitamin D safely.

"The same problems of inconsistent and unreliable

results from UV light seen with

sunlight apply to tanning beds.

In addition to often complex

environmental conditions and tanning

bed dynamics, which make

risk-benefit ratios in use of UVB to

obtain vitamin D quite complicated,

what UVB does reach the skin often

does not result in adequate vitamin

D synthesis.

Many people with abundant sun

exposure, even including young

Hawaiian surfers, do not achieve recommended

vitamin D levels

(Binkley et al., 2007; Harinarayan,

Ramalakshmi, & Venkataprasad,

2004; Levis et al., 2005; Webb et al.,

1988). Importantly, more dark-complexioned

or elderly individuals,

who are at highest statistical risk of

low vitamin D levels, produce vitamin

D inefficiently: melanin in dark

skin absorbs the UVB photons and

epidermal thinning in elderly skin

reduces the amount of 7-dehydro –

cholesterol, the cell membrane component

that is converted to vitamin

D. Oral sources of vitamin D avoid

these barriers to correction of low

vitamin D levels.

Importantly, people with vitamin

D deficiency from a variety of

causes have been able to increase

vitamin D to the desired level by taking

a supplement (Wolpowitz &

Gilchrest, 2006). Therefore many

consider a supplement to be the best

way to get a consistent and reliable

amount of vitamin D, while also

avoiding photodamage (AAD, 2009;

Boucher, 2001; Grant & Boucher,

2009; Moyad, 2009; Utiger, 1998).

One physician has counseled

patients that vitamin D from the sun

is more healthful than vitamin D

from oral supplements (Holick,

2009). He has also stated that any

resultant skin cancer is “easily treated

and often cured” (Holick, 2009),

and resurrected a statement from

1941 in the Journal of Cancer suggesting

increased non-melanoma skin

cancer was “one of the prices to be

paid” for decreased systemic cancers

(Holick & Jenkins, 2003). This last

point is highly arguable and appears

to be directly contradicted by recent

evidence that the risk of internal cancers

is instead increased in patients

with non-melanoma skin cancers

(Chen et al., 2008; Troyanova,

Danon, & Ivanova, 2002). Further –

more, many patients with skin cancer

may disagree that the disease is

trivial. In any case, such an argument

sadly fails to highlight that the

same form of vitamin D produced

by sunlight is easily obtained from

oral supplements costing less than

$20/year (CVS, 2009), without causing

damage to the skin. For all these

reasons, getting more sun or UV

exposure to correct a low vitamin D

level is not in the best interest of the

vast majority of people (AAD, 2009;

Boucher, 2001; Grant & Boucher,

2009; Wolpowitz & Gilchrest, 2006)."

"CMM, while the most deadly, is not the only skin cancer linked to UVR exposure. Basal cell carcinomas (BCC) and squamous cell carcinomas (SCC), classified as non-melanocytic skin cancer (NMSC), account for an estimated Canadian incidence of 227.6 per 100,000 skin cancer cases in 2009 (11).  Despite their high incidence, most of these lesions can be successfully treated at an early stage; however, metastasis persistently occurs in a small minority of such lesions, at which point cure is rare. Although the overall rate of death from SCC is low, the high incidence of this form of cancer means that it accounts for up to 25% of skin cancer-related deaths (11).  The International Agency for Research on Cancer (IARC) reported a 2.5 times greater risk for SCC and a 1.5 times increased risk for BCC associated with the use of tanning beds (38). Early life UVR exposure increases the risk of BCC, whereas chronic or total exposure is associated with increased risk for SCC (6,38)."

http:// http://www.cps.ca/English/statements/AM/AH12-01.htm

Shining light on the vitamin D

Michael F Holick

“The association of excessive exposure to solar ultraviolet B radiation and increased risk of developing non-melanoma skin cancer is well documented."

http://www.ncbi.nlm.nih.gov/pubmed/20570907

Nonmelanoma skin cancer and the risk of second primary cancers: a systematic review.

Abstract

BACKGROUND:

Based on empirical evidence, a personal history of nonmelanoma skin cancer (NMSC) has been hypothesized to be a risk factor for other cancers. Others hypothesize that NMSC may be a marker of high cutaneous vitamin D synthesis and therefore inversely associated with risk of other malignancies. To reconcile these divergent views, we carried out a systematic review to determine the association between NMSC and subsequent risk of other cancers.

METHODS:

Bibliographic databases were searched through March 2009. Studies were included if sufficient information was presented to estimate the risk of developing other cancers following NMSC. Studies were reviewed and data were abstracted independently in duplicate with disagreements resolved by consensus.

RESULTS:

Of the 21 included studies, 15 reported the association between NMSC and risk of all other cancers combined. NMSC was significantly associated with increased risk of another malignancy among cohort studies based on cancer registries summary random-effects relative risk (SRR), 1.12; 95% confidence interval (CI), 1.07-1.17; n = 12 studies) and those with individual-level data (SRR, 1.49; 95% CI, 1.12-1.98; n = 3). In stratified analyses of registry studies, this association held true for both squamous (SRR, 1.17; 95% CI, 1.12-1.23; n = 7) and basal cell carcinoma (SRR, 1.09; 95% CI, 1.01-1.17; n = 7), and both men (SRR, 1.14; 95% CI, 1.09-1.20; n = 12) and women (SRR, 1.10; 95% CI, 1.04-1.15; n = 12).

CONCLUSIONS:

Strong, consistent evidence indicates that a personal history of NMSC is associated with increased risk of developing other malignancies.

IMPACT:

For unknown reasons, NMSC may be a risk factor for other cancers.

Dr. Joseph Mercola 's website states that the Vitamin D council recommends his  tanning beds

“Recommended by the Vitamin D Council
Scientists at the Vitamin D Council agree that both children and adults should have a Vitamin D level of 50 ng/ml all year-round. They recommend the use of any Mercola Tanning Systems as a safe and effective way to help you achieve natural levels of Vitamin D. The Vitamin D Council is a nonprofit organization whose aim is to educate the public about Vitamin D deficiency and how to prevent it.
http://tanningbeds.mercola.com/

 Dr Cannell  (of VitaminD Council fame ) co authored an Epidemic influenza and vitamin D paper ..

 J. J. CANNELL, R. VIETH, J. C. UMHAU, M. F. HOLICK, W. B. GRANT, S. MADRONICH, C. F. GARLAND and E. GIOVANNUCCI (2006). Epidemic influenza and vitamin D. Epidemiology and Infection, 134 , pp 1129-1140 doi:10.1017/S0950268806007175

"An interventional study showed that vitamin D reduces the incidence of respiratory infections in children. We conclude that vitamin D, or lack of it, may be Hope-Simpson's ‘seasonal stimulus’."http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=529704

Dr Cannell later made the following comments

“Like all theories, our theory must withstand attempts to be disproved with dispassionately conducted and well-controlled scientific experiments.” http://www.whale.to/a/cannell.html

  And said the following about a leading dermatologist's lecture ( the same year or thereabouts)
 

 “Dr. Barbara Gilchrest, who fired Dr. Michael Holick from one of his professorships several years ago after Holick wrote a book saying God knew what she was doing when she created sunlight, gave the Plenary Lecture. Wisely, Dr. Gilchrest overwhelmed the audience with graphic pictures of invasive skin cancer to support her argument that sunlight is evil. Of course, it’s harder to show pictures of invasive colon cancer, breast cancer, prostate cancer, and the 15 other internal cancers caused by sunlight deprivation.”
http://www.vitamindcouncil.org/news-archive/2006/13th-annual-vitamin-d-workshop/

   This study makes it look like the 'theory' needs more defending..

Vitamin D supplementation did not prevent influenza-like illness as diagnosed retrospectively by questionnaires in subjects participating in randomized clinical trials.

CONCLUSION:

Our results do not support the hypothesis that high doses of vitamin D supplementation will have a pronounced effect on influenza-like disease in populations not targeted for high influenza risk. http://www.ncbi.nlm.nih.gov/pubmed/22026455

A review by the Institute of Medicine

IOM Endorses Vitamin D, Calcium Only
for Bone Health, Dispels Deficiency Claims

"And in a blow to a growing number
of claims that vitaminDcan help protect
againstotherconditions—suchascancer,
cardiovascular disease, diabetes,immune
dysfunction, multiple sclerosis, and preeclampsia
in pregnancy, to name just
a few—the IOM committee flatly declared
that “the data just aren’t there”
to recommend that people consume
higheramountsof vitaminDor calcium"

"In evaluating vitamin D’s “purported”
role in preventing numerous diseases,
the IOM committee said the paucity
of randomized clinical trials and
conflicting evidence from observational
studies led it to conclude that the
nutrient’s links to outcomes other than
bone health is “best described as hypotheses
of emerging interest.” Added Ross,
“We describe the biological plausibility
that vitaminDmay have an effect on certain
cancers, for example, and we know
that in animal models there are some
good data. But we were not able to take
the currently available clinical data and
use that information to define DRIs"

http://www.sstans.com/wp-content/uploads/2011/02/12-IOM-JAMA+editorial+1-111.pdf

Vitamin D on Trial

IF WIDESPREAD DEFICIENCY OF VITAmin D is a “silent epidemic” plaguing North America, as some researchers have warned, then a recent Institute of Medicine (IOM) report has just restored us to good health. The majority of persons in the United States and Canada are getting enough vitamin D and calcium to maintain bonehealth, concluded a committee of 14 scientists charged by the US and Canadian governments with updating theDietary Reference Intakes (DRIs) for the 2 interrelated nutrients.And in a blow to a growing number of claims that vitamin D can help protect against other conditions—such as cancer, cardiovascular disease, diabetes, immune dysfunction, multiple sclerosis, and preeclampsia in pregnancy, to name just a few—the IOM committee flatly declared that “the data just aren’t there” to recommend that people consume higher amounts ofvitamin D or calcium.

In  evaluating  vitamin D’s  “purported” role in preventing numerous diseases, the IOM committee said the paucity of randomized clinical trials and conflicting evidence from observational studies led it to conclude that the nutrient’s links to outcomes other than bone health is “best described as hypotheses of emerging interest.” Added Ross, “We describe the biological plausibility that vitamin D may have an effect on certain cancers, for example, and we know that in animal models there are some good data. But we were not able to take the currently available clinical data and use that information to define DRIs.”

Enticing observations

In 2008, epidemiologist JoAnn Manson at Harvard Medical School in Boston received NIH funding to lead the largest vitamin D intervention trial yet. In observational studies, Vitamin D had shown promise for lowering the risk of a wide range of diseases, but Manson felt the field would benefit from a large clinical trial that more rigorously tested the vitamin’s power. This sentiment only grew when she analyzed about 1,000 reports on vitamin D metabolism, intake, and impact on human health as a member of a panel convened by the Institute of Medicine (IOM) in 2009. The panel decided that while the benefit of the nutrient for bones is real, helping to promote bone strength while staving off diseases such as rickets, osteomalacia, and osteoporosis, the evidence of nonskeletal benefits was inconclusive¹—an uncertainty that continues to linger.²

The decision infuriated many scientists—some of whom had documented the correlation between high blood levels of vitamin D and lower rates of colorectal cancer, diabetes, asthma, influenza, multiple sclerosis, and an array of other ailments. And in many cases, researchers can point to ways the vitamin might bring about benefits. The hormone derived from vitamin D, called 1,25-dihydroxyvitamin D3, or calcitriol, can turn on or off hundreds of genes in the body, thereby participating in processes ranging from cell proliferation to immune system regulation. But the IOM panel concluded that without large-scale prevention trials confirming the ultimate result of high levels of vitamin D, it could not say for certain whether insufficiency contributes to cancer or any other nonskeletal disease.

Others argue that the correlational studies provide enough evidence to recommend that people maintain a higher concentration of vitamin D in their blood, and that difficult, expensive, and often inconclusive prevention trials, particularly those for relatively rare or unpredictable diseases, are a waste of time. “The success of the RCT [randomized controlled trial] in evaluating medical treatments has, perhaps, blinded nutritionists, regulators, and editors to the fact that it is a method ill-suited for the evaluation of nutrient effects,” Robert Heaney, an endocrinologist at Creighton University School of Medicine wrote in a 2008 commentary published in The Journal of Nutrition.³

And it seems the public isn’t waiting for clinical trial data. Spurred by headlines about its potential benefits, US consumer sales of vitamin D supplements rocketed from $50 million in 2005 to $550 million in 2010, according to estimates from the Nutrition Business Journal. Enthusiasm for the vitamin echoes among doctors and natural-food advocates, who are pushing for doses higher than the 400 to 600 International Units (IU) that the government currently recommends for maintaining healthy bones.

However, Manson, a refined woman of measured words, is acutely aware of the disappointment that has trailed the hyping of vitamins over the decades. Vitamin E, a fat-soluble antioxidant, gained a reputation for fighting cancer in the 1990s, when observational studies found that people who took supplements had lower rates of the disease.  But the buzz died out in 2008 when a 35,000-person clinical trial on vitamin E and selenium was terminated prematurely after people taking the supplements showed a slightly higher risk of developing prostate cancer than the control group. Similarly, in 1996 two large clinical trials dumbfounded fans of beta-carotene, a substance that humans convert into vitamin A after consuming it in fruits and vegetables. One trial found that it raised the risk of lung cancer and heart disease, and the other ended anticlimactically after 12 years with the conclusion that beta-carotene supplements performed no differently than placebo. “You have to look at these previous randomized trials as cautionary tales,” Manson says, “because they show that time and time again, everyone jumped on the bandwagon and then the randomized trials did not have favorable results, and in fact, the risks outweighed the benefits.”

At the same time, however, this is exactly why large-scale trials are necessary, she says. Though they aren’t perfect, such trials are the only way to discover whether vitamin D causes better health, or simply indicates it. “For example, people who are physically active tend to spend more time outdoors walking, hiking, or playing tennis. They get more sun exposure”—and thus more vitamin D—“but the real benefit might be physical activity,” says Manson. “There are so many potential confounders, and this is just one we know about.”

http://the-scientist.com/2012/03/01/vitamin-d-on-trial/

 National Institute of Health 



"Despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight [36] and UV radiation from tanning beds [37]. UV radiation is a carcinogen responsible for most of the estimated 1.5 million skin cancers and the 8,000 deaths due to metastatic melanoma that occur annually in the United States [36]. Lifetime cumulative UV damage to skin is also largely responsible for some age-associated dryness and other cosmetic changes. It is not known whether a desirable level of regular sun exposure exists that imposes no (or minimal) risk of skin cancer over time." http://ods.od.nih.gov/factsheets/vitamind-HealthProfessional/#h3

Vitamin D Sufficiency vs. Sun
Protection: Must We Choose?

Kavitha K. Reddy
Barbara A. Gilchrest 

Kavitha K. Reddy, MD, is a Resident,
Boston University and Tufts University School
of Medicine Dermatology Program, Boston,
MA.

Barbara A. Gilchrest, MD, is a Professor
and Chair-Emeritus, Department of
Dermatology, Boston University School of
Medicine, Boston, MA.

( Note -effective June 1, 2012  Dr Gilchrest will be the editor of the Journal of Investigative Dermatology   ttp://www.nature.com/jid/index.html )

This continuing nursing educational (CNE) activity is designed for nurses
and other health care providers who are interested in vitamin D and sun protection.
For those wishing to obtain contact hour credit, an evaluation follows. After
studying the information presented in this article, the nurse will be able to:
1. Explain how vitamin D levels are defined.
2. Identify sources of vitamin D.
3. Discuss sources of vitamin D.
4. Describe how to obtain sufficient levels of vitamin D safely.

"The same problems of inconsistent and unreliable

results from UV light seen with

sunlight apply to tanning beds.

In addition to often complex

environmental conditions and tanning

bed dynamics, which make

risk-benefit ratios in use of UVB to

obtain vitamin D quite complicated,

what UVB does reach the skin often

does not result in adequate vitamin

D synthesis.

Many people with abundant sun

exposure, even including young

Hawaiian surfers, do not achieve recommended

vitamin D levels

(Binkley et al., 2007; Harinarayan,

Ramalakshmi, & Venkataprasad,

2004; Levis et al., 2005; Webb et al.,

1988). Importantly, more dark-complexioned

or elderly individuals,

who are at highest statistical risk of

low vitamin D levels, produce vitamin

D inefficiently: melanin in dark

skin absorbs the UVB photons and

epidermal thinning in elderly skin

reduces the amount of 7-dehydro –

cholesterol, the cell membrane component

that is converted to vitamin

D. Oral sources of vitamin D avoid

these barriers to correction of low

vitamin D levels.

Importantly, people with vitamin

D deficiency from a variety of

causes have been able to increase

vitamin D to the desired level by taking

a supplement (Wolpowitz &

Gilchrest, 2006). Therefore many

consider a supplement to be the best

way to get a consistent and reliable

amount of vitamin D, while also

avoiding photodamage (AAD, 2009;

Boucher, 2001; Grant & Boucher,

2009; Moyad, 2009; Utiger, 1998).

One physician has counseled

patients that vitamin D from the sun

is more healthful than vitamin D

from oral supplements (Holick,

2009). He has also stated that any

resultant skin cancer is “easily treated

and often cured” (Holick, 2009),

and resurrected a statement from

1941 in the Journal of Cancer suggesting

increased non-melanoma skin

cancer was “one of the prices to be

paid” for decreased systemic cancers

(Holick & Jenkins, 2003). This last

point is highly arguable and appears

to be directly contradicted by recent

evidence that the risk of internal cancers

is instead increased in patients

with non-melanoma skin cancers

(Chen et al., 2008; Troyanova,

Danon, & Ivanova, 2002). Further –

more, many patients with skin cancer

may disagree that the disease is

trivial. In any case, such an argument

sadly fails to highlight that the

same form of vitamin D produced

by sunlight is easily obtained from

oral supplements costing less than

$20/year (CVS, 2009), without causing

damage to the skin. For all these

reasons, getting more sun or UV

exposure to correct a low vitamin D

level is not in the best interest of the

vast majority of people (AAD, 2009;

Boucher, 2001; Grant & Boucher,

2009; Wolpowitz & Gilchrest, 2006)."

"CMM, while the most deadly, is not the only skin cancer linked to UVR exposure. Basal cell carcinomas (BCC) and squamous cell carcinomas (SCC), classified as non-melanocytic skin cancer (NMSC), account for an estimated Canadian incidence of 227.6 per 100,000 skin cancer cases in 2009 (11).  Despite their high incidence, most of these lesions can be successfully treated at an early stage; however, metastasis persistently occurs in a small minority of such lesions, at which point cure is rare. Although the overall rate of death from SCC is low, the high incidence of this form of cancer means that it accounts for up to 25% of skin cancer-related deaths (11).  The International Agency for Research on Cancer (IARC) reported a 2.5 times greater risk for SCC and a 1.5 times increased risk for BCC associated with the use of tanning beds (38). Early life UVR exposure increases the risk of BCC, whereas chronic or total exposure is associated with increased risk for SCC (6,38)."

http:// http://www.cps.ca/English/statements/AM/AH12-01.htm

Shining light on the vitamin D

Michael F Holick

“The association of excessive exposure to solar ultraviolet B radiation and increased risk of developing non-melanoma skin cancer is well documented."

http://www.ncbi.nlm.nih.gov/pubmed/20570907

Nonmelanoma skin cancer and the risk of second primary cancers: a systematic review.

Abstract

BACKGROUND:

Based on empirical evidence, a personal history of nonmelanoma skin cancer (NMSC) has been hypothesized to be a risk factor for other cancers. Others hypothesize that NMSC may be a marker of high cutaneous vitamin D synthesis and therefore inversely associated with risk of other malignancies. To reconcile these divergent views, we carried out a systematic review to determine the association between NMSC and subsequent risk of other cancers.

METHODS:

Bibliographic databases were searched through March 2009. Studies were included if sufficient information was presented to estimate the risk of developing other cancers following NMSC. Studies were reviewed and data were abstracted independently in duplicate with disagreements resolved by consensus.

RESULTS:

Of the 21 included studies, 15 reported the association between NMSC and risk of all other cancers combined. NMSC was significantly associated with increased risk of another malignancy among cohort studies based on cancer registries summary random-effects relative risk (SRR), 1.12; 95% confidence interval (CI), 1.07-1.17; n = 12 studies) and those with individual-level data (SRR, 1.49; 95% CI, 1.12-1.98; n = 3). In stratified analyses of registry studies, this association held true for both squamous (SRR, 1.17; 95% CI, 1.12-1.23; n = 7) and basal cell carcinoma (SRR, 1.09; 95% CI, 1.01-1.17; n = 7), and both men (SRR, 1.14; 95% CI, 1.09-1.20; n = 12) and women (SRR, 1.10; 95% CI, 1.04-1.15; n = 12).

CONCLUSIONS:

Strong, consistent evidence indicates that a personal history of NMSC is associated with increased risk of developing other malignancies.

IMPACT:

For unknown reasons, NMSC may be a risk factor for other cancers.

Dr. Joseph Mercola 's website states that the Vitamin D council recommends his  tanning beds

“Recommended by the Vitamin D Council
Scientists at the Vitamin D Council agree that both children and adults should have a Vitamin D level of 50 ng/ml all year-round. They recommend the use of any Mercola Tanning Systems as a safe and effective way to help you achieve natural levels of Vitamin D. The Vitamin D Council is a nonprofit organization whose aim is to educate the public about Vitamin D deficiency and how to prevent it.
http://tanningbeds.mercola.com/

 Dr Cannell  (of VitaminD Council fame ) co authored an Epidemic influenza and vitamin D paper ..

 J. J. CANNELL, R. VIETH, J. C. UMHAU, M. F. HOLICK, W. B. GRANT, S. MADRONICH, C. F. GARLAND and E. GIOVANNUCCI (2006). Epidemic influenza and vitamin D. Epidemiology and Infection, 134 , pp 1129-1140 doi:10.1017/S0950268806007175

"An interventional study showed that vitamin D reduces the incidence of respiratory infections in children. We conclude that vitamin D, or lack of it, may be Hope-Simpson's ‘seasonal stimulus’."http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=529704

Dr Cannell later made the following comments

“Like all theories, our theory must withstand attempts to be disproved with dispassionately conducted and well-controlled scientific experiments.” http://www.whale.to/a/cannell.html

  And said the following about a leading dermatologist's lecture ( the same year or thereabouts)
 

 “Dr. Barbara Gilchrest, who fired Dr. Michael Holick from one of his professorships several years ago after Holick wrote a book saying God knew what she was doing when she created sunlight, gave the Plenary Lecture. Wisely, Dr. Gilchrest overwhelmed the audience with graphic pictures of invasive skin cancer to support her argument that sunlight is evil. Of course, it’s harder to show pictures of invasive colon cancer, breast cancer, prostate cancer, and the 15 other internal cancers caused by sunlight deprivation.”
http://www.vitamindcouncil.org/news-archive/2006/13th-annual-vitamin-d-workshop/

   This study makes it look like the 'theory' needs more defending..

Vitamin D supplementation did not prevent influenza-like illness as diagnosed retrospectively by questionnaires in subjects participating in randomized clinical trials.

CONCLUSION:

Our results do not support the hypothesis that high doses of vitamin D supplementation will have a pronounced effect on influenza-like disease in populations not targeted for high influenza risk. http://www.ncbi.nlm.nih.gov/pubmed/22026455

A review by the Institute of Medicine

IOM Endorses Vitamin D, Calcium Only
for Bone Health, Dispels Deficiency Claims

"And in a blow to a growing number
of claims that vitaminDcan help protect
againstotherconditions—suchascancer,
cardiovascular disease, diabetes,immune
dysfunction, multiple sclerosis, and preeclampsia
in pregnancy, to name just
a few—the IOM committee flatly declared
that “the data just aren’t there”
to recommend that people consume
higheramountsof vitaminDor calcium"

"In evaluating vitamin D’s “purported”
role in preventing numerous diseases,
the IOM committee said the paucity
of randomized clinical trials and
conflicting evidence from observational
studies led it to conclude that the
nutrient’s links to outcomes other than
bone health is “best described as hypotheses
of emerging interest.” Added Ross,
“We describe the biological plausibility
that vitaminDmay have an effect on certain
cancers, for example, and we know
that in animal models there are some
good data. But we were not able to take
the currently available clinical data and
use that information to define DRIs"

http://www.sstans.com/wp-content/uploads/2011/02/12-IOM-JAMA+editorial+1-111.pdf

Vitamin D on Trial

IF WIDESPREAD DEFICIENCY OF VITAmin D is a “silent epidemic” plaguing North America, as some researchers have warned, then a recent Institute of Medicine (IOM) report has just restored us to good health. The majority of persons in the United States and Canada are getting enough vitamin D and calcium to maintain bonehealth, concluded a committee of 14 scientists charged by the US and Canadian governments with updating theDietary Reference Intakes (DRIs) for the 2 interrelated nutrients.And in a blow to a growing number of claims that vitamin D can help protect against other conditions—such as cancer, cardiovascular disease, diabetes, immune dysfunction, multiple sclerosis, and preeclampsia in pregnancy, to name just a few—the IOM committee flatly declared that “the data just aren’t there” to recommend that people consume higher amounts ofvitamin D or calcium.

In  evaluating  vitamin D’s  “purported” role in preventing numerous diseases, the IOM committee said the paucity of randomized clinical trials and conflicting evidence from observational studies led it to conclude that the nutrient’s links to outcomes other than bone health is “best described as hypotheses of emerging interest.” Added Ross, “We describe the biological plausibility that vitamin D may have an effect on certain cancers, for example, and we know that in animal models there are some good data. But we were not able to take the currently available clinical data and use that information to define DRIs.”

Enticing observations

In 2008, epidemiologist JoAnn Manson at Harvard Medical School in Boston received NIH funding to lead the largest vitamin D intervention trial yet. In observational studies, Vitamin D had shown promise for lowering the risk of a wide range of diseases, but Manson felt the field would benefit from a large clinical trial that more rigorously tested the vitamin’s power. This sentiment only grew when she analyzed about 1,000 reports on vitamin D metabolism, intake, and impact on human health as a member of a panel convened by the Institute of Medicine (IOM) in 2009. The panel decided that while the benefit of the nutrient for bones is real, helping to promote bone strength while staving off diseases such as rickets, osteomalacia, and osteoporosis, the evidence of nonskeletal benefits was inconclusive¹—an uncertainty that continues to linger.²

The decision infuriated many scientists—some of whom had documented the correlation between high blood levels of vitamin D and lower rates of colorectal cancer, diabetes, asthma, influenza, multiple sclerosis, and an array of other ailments. And in many cases, researchers can point to ways the vitamin might bring about benefits. The hormone derived from vitamin D, called 1,25-dihydroxyvitamin D3, or calcitriol, can turn on or off hundreds of genes in the body, thereby participating in processes ranging from cell proliferation to immune system regulation. But the IOM panel concluded that without large-scale prevention trials confirming the ultimate result of high levels of vitamin D, it could not say for certain whether insufficiency contributes to cancer or any other nonskeletal disease.

Others argue that the correlational studies provide enough evidence to recommend that people maintain a higher concentration of vitamin D in their blood, and that difficult, expensive, and often inconclusive prevention trials, particularly those for relatively rare or unpredictable diseases, are a waste of time. “The success of the RCT [randomized controlled trial] in evaluating medical treatments has, perhaps, blinded nutritionists, regulators, and editors to the fact that it is a method ill-suited for the evaluation of nutrient effects,” Robert Heaney, an endocrinologist at Creighton University School of Medicine wrote in a 2008 commentary published in The Journal of Nutrition.³

And it seems the public isn’t waiting for clinical trial data. Spurred by headlines about its potential benefits, US consumer sales of vitamin D supplements rocketed from $50 million in 2005 to $550 million in 2010, according to estimates from the Nutrition Business Journal. Enthusiasm for the vitamin echoes among doctors and natural-food advocates, who are pushing for doses higher than the 400 to 600 International Units (IU) that the government currently recommends for maintaining healthy bones.

However, Manson, a refined woman of measured words, is acutely aware of the disappointment that has trailed the hyping of vitamins over the decades. Vitamin E, a fat-soluble antioxidant, gained a reputation for fighting cancer in the 1990s, when observational studies found that people who took supplements had lower rates of the disease.  But the buzz died out in 2008 when a 35,000-person clinical trial on vitamin E and selenium was terminated prematurely after people taking the supplements showed a slightly higher risk of developing prostate cancer than the control group. Similarly, in 1996 two large clinical trials dumbfounded fans of beta-carotene, a substance that humans convert into vitamin A after consuming it in fruits and vegetables. One trial found that it raised the risk of lung cancer and heart disease, and the other ended anticlimactically after 12 years with the conclusion that beta-carotene supplements performed no differently than placebo. “You have to look at these previous randomized trials as cautionary tales,” Manson says, “because they show that time and time again, everyone jumped on the bandwagon and then the randomized trials did not have favorable results, and in fact, the risks outweighed the benefits.”

At the same time, however, this is exactly why large-scale trials are necessary, she says. Though they aren’t perfect, such trials are the only way to discover whether vitamin D causes better health, or simply indicates it. “For example, people who are physically active tend to spend more time outdoors walking, hiking, or playing tennis. They get more sun exposure”—and thus more vitamin D—“but the real benefit might be physical activity,” says Manson. “There are so many potential confounders, and this is just one we know about.”

http://the-scientist.com/2012/03/01/vitamin-d-on-trial/

 National Institute of Health 



"Despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight [36] and UV radiation from tanning beds [37]. UV radiation is a carcinogen responsible for most of the estimated 1.5 million skin cancers and the 8,000 deaths due to metastatic melanoma that occur annually in the United States [36]. Lifetime cumulative UV damage to skin is also largely responsible for some age-associated dryness and other cosmetic changes. It is not known whether a desirable level of regular sun exposure exists that imposes no (or minimal) risk of skin cancer over time." http://ods.od.nih.gov/factsheets/vitamind-HealthProfessional/#h3

Vitamin D Sufficiency vs. Sun
Protection: Must We Choose?

Kavitha K. Reddy
Barbara A. Gilchrest 

Kavitha K. Reddy, MD, is a Resident,
Boston University and Tufts University School
of Medicine Dermatology Program, Boston,
MA.

Barbara A. Gilchrest, MD, is a Professor
and Chair-Emeritus, Department of
Dermatology, Boston University School of
Medicine, Boston, MA.

( Note -effective June 1, 2012  Dr Gilchrest will be the editor of the Journal of Investigative Dermatology   ttp://www.nature.com/jid/index.html )

This continuing nursing educational (CNE) activity is designed for nurses
and other health care providers who are interested in vitamin D and sun protection.
For those wishing to obtain contact hour credit, an evaluation follows. After
studying the information presented in this article, the nurse will be able to:
1. Explain how vitamin D levels are defined.
2. Identify sources of vitamin D.
3. Discuss sources of vitamin D.
4. Describe how to obtain sufficient levels of vitamin D safely.

"The same problems of inconsistent and unreliable

results from UV light seen with

sunlight apply to tanning beds.

In addition to often complex

environmental conditions and tanning

bed dynamics, which make

risk-benefit ratios in use of UVB to

obtain vitamin D quite complicated,

what UVB does reach the skin often

does not result in adequate vitamin

D synthesis.

Many people with abundant sun

exposure, even including young

Hawaiian surfers, do not achieve recommended

vitamin D levels

(Binkley et al., 2007; Harinarayan,

Ramalakshmi, & Venkataprasad,

2004; Levis et al., 2005; Webb et al.,

1988). Importantly, more dark-complexioned

or elderly individuals,

who are at highest statistical risk of

low vitamin D levels, produce vitamin

D inefficiently: melanin in dark

skin absorbs the UVB photons and

epidermal thinning in elderly skin

reduces the amount of 7-dehydro –

cholesterol, the cell membrane component

that is converted to vitamin

D. Oral sources of vitamin D avoid

these barriers to correction of low

vitamin D levels.

Importantly, people with vitamin

D deficiency from a variety of

causes have been able to increase

vitamin D to the desired level by taking

a supplement (Wolpowitz &

Gilchrest, 2006). Therefore many

consider a supplement to be the best

way to get a consistent and reliable

amount of vitamin D, while also

avoiding photodamage (AAD, 2009;

Boucher, 2001; Grant & Boucher,

2009; Moyad, 2009; Utiger, 1998).

One physician has counseled

patients that vitamin D from the sun

is more healthful than vitamin D

from oral supplements (Holick,

2009). He has also stated that any

resultant skin cancer is “easily treated

and often cured” (Holick, 2009),

and resurrected a statement from

1941 in the Journal of Cancer suggesting

increased non-melanoma skin

cancer was “one of the prices to be

paid” for decreased systemic cancers

(Holick & Jenkins, 2003). This last

point is highly arguable and appears

to be directly contradicted by recent

evidence that the risk of internal cancers

is instead increased in patients

with non-melanoma skin cancers

(Chen et al., 2008; Troyanova,

Danon, & Ivanova, 2002). Further –

more, many patients with skin cancer

may disagree that the disease is

trivial. In any case, such an argument

sadly fails to highlight that the

same form of vitamin D produced

by sunlight is easily obtained from

oral supplements costing less than

$20/year (CVS, 2009), without causing

damage to the skin. For all these

reasons, getting more sun or UV

exposure to correct a low vitamin D

level is not in the best interest of the

vast majority of people (AAD, 2009;

Boucher, 2001; Grant & Boucher,

2009; Wolpowitz & Gilchrest, 2006)."

"CMM, while the most deadly, is not the only skin cancer linked to UVR exposure. Basal cell carcinomas (BCC) and squamous cell carcinomas (SCC), classified as non-melanocytic skin cancer (NMSC), account for an estimated Canadian incidence of 227.6 per 100,000 skin cancer cases in 2009 (11).  Despite their high incidence, most of these lesions can be successfully treated at an early stage; however, metastasis persistently occurs in a small minority of such lesions, at which point cure is rare. Although the overall rate of death from SCC is low, the high incidence of this form of cancer means that it accounts for up to 25% of skin cancer-related deaths (11).  The International Agency for Research on Cancer (IARC) reported a 2.5 times greater risk for SCC and a 1.5 times increased risk for BCC associated with the use of tanning beds (38). Early life UVR exposure increases the risk of BCC, whereas chronic or total exposure is associated with increased risk for SCC (6,38)."

http:// http://www.cps.ca/English/statements/AM/AH12-01.htm

Shining light on the vitamin D

Michael F Holick

“The association of excessive exposure to solar ultraviolet B radiation and increased risk of developing non-melanoma skin cancer is well documented."

http://www.ncbi.nlm.nih.gov/pubmed/20570907

Nonmelanoma skin cancer and the risk of second primary cancers: a systematic review.

Abstract

BACKGROUND:

Based on empirical evidence, a personal history of nonmelanoma skin cancer (NMSC) has been hypothesized to be a risk factor for other cancers. Others hypothesize that NMSC may be a marker of high cutaneous vitamin D synthesis and therefore inversely associated with risk of other malignancies. To reconcile these divergent views, we carried out a systematic review to determine the association between NMSC and subsequent risk of other cancers.

METHODS:

Bibliographic databases were searched through March 2009. Studies were included if sufficient information was presented to estimate the risk of developing other cancers following NMSC. Studies were reviewed and data were abstracted independently in duplicate with disagreements resolved by consensus.

RESULTS:

Of the 21 included studies, 15 reported the association between NMSC and risk of all other cancers combined. NMSC was significantly associated with increased risk of another malignancy among cohort studies based on cancer registries summary random-effects relative risk (SRR), 1.12; 95% confidence interval (CI), 1.07-1.17; n = 12 studies) and those with individual-level data (SRR, 1.49; 95% CI, 1.12-1.98; n = 3). In stratified analyses of registry studies, this association held true for both squamous (SRR, 1.17; 95% CI, 1.12-1.23; n = 7) and basal cell carcinoma (SRR, 1.09; 95% CI, 1.01-1.17; n = 7), and both men (SRR, 1.14; 95% CI, 1.09-1.20; n = 12) and women (SRR, 1.10; 95% CI, 1.04-1.15; n = 12).

CONCLUSIONS:

Strong, consistent evidence indicates that a personal history of NMSC is associated with increased risk of developing other malignancies.

IMPACT:

For unknown reasons, NMSC may be a risk factor for other cancers.

Dr. Joseph Mercola 's website states that the Vitamin D council recommends his  tanning beds

“Recommended by the Vitamin D Council
Scientists at the Vitamin D Council agree that both children and adults should have a Vitamin D level of 50 ng/ml all year-round. They recommend the use of any Mercola Tanning Systems as a safe and effective way to help you achieve natural levels of Vitamin D. The Vitamin D Council is a nonprofit organization whose aim is to educate the public about Vitamin D deficiency and how to prevent it.
http://tanningbeds.mercola.com/

 Dr Cannell  (of VitaminD Council fame ) co authored an Epidemic influenza and vitamin D paper ..

 J. J. CANNELL, R. VIETH, J. C. UMHAU, M. F. HOLICK, W. B. GRANT, S. MADRONICH, C. F. GARLAND and E. GIOVANNUCCI (2006). Epidemic influenza and vitamin D. Epidemiology and Infection, 134 , pp 1129-1140 doi:10.1017/S0950268806007175

"An interventional study showed that vitamin D reduces the incidence of respiratory infections in children. We conclude that vitamin D, or lack of it, may be Hope-Simpson's ‘seasonal stimulus’."http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=529704

Dr Cannell later made the following comments

“Like all theories, our theory must withstand attempts to be disproved with dispassionately conducted and well-controlled scientific experiments.” http://www.whale.to/a/cannell.html

  And said the following about a leading dermatologist's lecture ( the same year or thereabouts)
 

 “Dr. Barbara Gilchrest, who fired Dr. Michael Holick from one of his professorships several years ago after Holick wrote a book saying God knew what she was doing when she created sunlight, gave the Plenary Lecture. Wisely, Dr. Gilchrest overwhelmed the audience with graphic pictures of invasive skin cancer to support her argument that sunlight is evil. Of course, it’s harder to show pictures of invasive colon cancer, breast cancer, prostate cancer, and the 15 other internal cancers caused by sunlight deprivation.”
http://www.vitamindcouncil.org/news-archive/2006/13th-annual-vitamin-d-workshop/

   This study makes it look like the 'theory' needs more defending..

Vitamin D supplementation did not prevent influenza-like illness as diagnosed retrospectively by questionnaires in subjects participating in randomized clinical trials.

CONCLUSION:

Our results do not support the hypothesis that high doses of vitamin D supplementation will have a pronounced effect on influenza-like disease in populations not targeted for high influenza risk. http://www.ncbi.nlm.nih.gov/pubmed/22026455

A review by the Institute of Medicine

IOM Endorses Vitamin D, Calcium Only
for Bone Health, Dispels Deficiency Claims

"And in a blow to a growing number
of claims that vitaminDcan help protect
againstotherconditions—suchascancer,
cardiovascular disease, diabetes,immune
dysfunction, multiple sclerosis, and preeclampsia
in pregnancy, to name just
a few—the IOM committee flatly declared
that “the data just aren’t there”
to recommend that people consume
higheramountsof vitaminDor calcium"

"In evaluating vitamin D’s “purported”
role in preventing numerous diseases,
the IOM committee said the paucity
of randomized clinical trials and
conflicting evidence from observational
studies led it to conclude that the
nutrient’s links to outcomes other than
bone health is “best described as hypotheses
of emerging interest.” Added Ross,
“We describe the biological plausibility
that vitaminDmay have an effect on certain
cancers, for example, and we know
that in animal models there are some
good data. But we were not able to take
the currently available clinical data and
use that information to define DRIs"

http://www.sstans.com/wp-content/uploads/2011/02/12-IOM-JAMA+editorial+1-111.pdf

Vitamin D on Trial

IF WIDESPREAD DEFICIENCY OF VITAmin D is a “silent epidemic” plaguing North America, as some researchers have warned, then a recent Institute of Medicine (IOM) report has just restored us to good health. The majority of persons in the United States and Canada are getting enough vitamin D and calcium to maintain bonehealth, concluded a committee of 14 scientists charged by the US and Canadian governments with updating theDietary Reference Intakes (DRIs) for the 2 interrelated nutrients.And in a blow to a growing number of claims that vitamin D can help protect against other conditions—such as cancer, cardiovascular disease, diabetes, immune dysfunction, multiple sclerosis, and preeclampsia in pregnancy, to name just a few—the IOM committee flatly declared that “the data just aren’t there” to recommend that people consume higher amounts ofvitamin D or calcium.

In  evaluating  vitamin D’s  “purported” role in preventing numerous diseases, the IOM committee said the paucity of randomized clinical trials and conflicting evidence from observational studies led it to conclude that the nutrient’s links to outcomes other than bone health is “best described as hypotheses of emerging interest.” Added Ross, “We describe the biological plausibility that vitamin D may have an effect on certain cancers, for example, and we know that in animal models there are some good data. But we were not able to take the currently available clinical data and use that information to define DRIs.”

Enticing observations

In 2008, epidemiologist JoAnn Manson at Harvard Medical School in Boston received NIH funding to lead the largest vitamin D intervention trial yet. In observational studies, Vitamin D had shown promise for lowering the risk of a wide range of diseases, but Manson felt the field would benefit from a large clinical trial that more rigorously tested the vitamin’s power. This sentiment only grew when she analyzed about 1,000 reports on vitamin D metabolism, intake, and impact on human health as a member of a panel convened by the Institute of Medicine (IOM) in 2009. The panel decided that while the benefit of the nutrient for bones is real, helping to promote bone strength while staving off diseases such as rickets, osteomalacia, and osteoporosis, the evidence of nonskeletal benefits was inconclusive¹—an uncertainty that continues to linger.²

The decision infuriated many scientists—some of whom had documented the correlation between high blood levels of vitamin D and lower rates of colorectal cancer, diabetes, asthma, influenza, multiple sclerosis, and an array of other ailments. And in many cases, researchers can point to ways the vitamin might bring about benefits. The hormone derived from vitamin D, called 1,25-dihydroxyvitamin D3, or calcitriol, can turn on or off hundreds of genes in the body, thereby participating in processes ranging from cell proliferation to immune system regulation. But the IOM panel concluded that without large-scale prevention trials confirming the ultimate result of high levels of vitamin D, it could not say for certain whether insufficiency contributes to cancer or any other nonskeletal disease.

Others argue that the correlational studies provide enough evidence to recommend that people maintain a higher concentration of vitamin D in their blood, and that difficult, expensive, and often inconclusive prevention trials, particularly those for relatively rare or unpredictable diseases, are a waste of time. “The success of the RCT [randomized controlled trial] in evaluating medical treatments has, perhaps, blinded nutritionists, regulators, and editors to the fact that it is a method ill-suited for the evaluation of nutrient effects,” Robert Heaney, an endocrinologist at Creighton University School of Medicine wrote in a 2008 commentary published in The Journal of Nutrition.³

And it seems the public isn’t waiting for clinical trial data. Spurred by headlines about its potential benefits, US consumer sales of vitamin D supplements rocketed from $50 million in 2005 to $550 million in 2010, according to estimates from the Nutrition Business Journal. Enthusiasm for the vitamin echoes among doctors and natural-food advocates, who are pushing for doses higher than the 400 to 600 International Units (IU) that the government currently recommends for maintaining healthy bones.

However, Manson, a refined woman of measured words, is acutely aware of the disappointment that has trailed the hyping of vitamins over the decades. Vitamin E, a fat-soluble antioxidant, gained a reputation for fighting cancer in the 1990s, when observational studies found that people who took supplements had lower rates of the disease.  But the buzz died out in 2008 when a 35,000-person clinical trial on vitamin E and selenium was terminated prematurely after people taking the supplements showed a slightly higher risk of developing prostate cancer than the control group. Similarly, in 1996 two large clinical trials dumbfounded fans of beta-carotene, a substance that humans convert into vitamin A after consuming it in fruits and vegetables. One trial found that it raised the risk of lung cancer and heart disease, and the other ended anticlimactically after 12 years with the conclusion that beta-carotene supplements performed no differently than placebo. “You have to look at these previous randomized trials as cautionary tales,” Manson says, “because they show that time and time again, everyone jumped on the bandwagon and then the randomized trials did not have favorable results, and in fact, the risks outweighed the benefits.”

At the same time, however, this is exactly why large-scale trials are necessary, she says. Though they aren’t perfect, such trials are the only way to discover whether vitamin D causes better health, or simply indicates it. “For example, people who are physically active tend to spend more time outdoors walking, hiking, or playing tennis. They get more sun exposure”—and thus more vitamin D—“but the real benefit might be physical activity,” says Manson. “There are so many potential confounders, and this is just one we know about.”

http://the-scientist.com/2012/03/01/vitamin-d-on-trial/

Really, it IS a puzzle.   Some sort of link between sun exposure and skin cancer is undeniable.   By their location- I can't prove it, of course-  my two primary melanomas may well have resulted from extreme sunburns since I was 15 years old.   But as my oncologist says, the relationship between the sun and skin cancer is "very complex".   There are links of some kind between many other factors, genetic and environmental- and melanoma.   Which factors and how important?   Very poorly understood.   

While we wait for medical science to catch up, everyone wants a Simple Answer.   Human nature gravitates to the most obvious bogeyman- the convention or mantra doctors (and sunscreen manufacturers) have repeated for 30 years:  

"It's the sun!" 

A significant percentage of cases are in no way related to sun exposure.   So, what to do?    Moderation.   Regular, limited sun exposure and avoid tanning beds.  And above all, self-awareness, assiduous skin examination, the best possible prevention.   

Really, it IS a puzzle.   Some sort of link between sun exposure and skin cancer is undeniable.   By their location- I can't prove it, of course-  my two primary melanomas may well have resulted from extreme sunburns since I was 15 years old.   But as my oncologist says, the relationship between the sun and skin cancer is "very complex".   There are links of some kind between many other factors, genetic and environmental- and melanoma.   Which factors and how important?   Very poorly understood.   

While we wait for medical science to catch up, everyone wants a Simple Answer.   Human nature gravitates to the most obvious bogeyman- the convention or mantra doctors (and sunscreen manufacturers) have repeated for 30 years:  

"It's the sun!" 

A significant percentage of cases are in no way related to sun exposure.   So, what to do?    Moderation.   Regular, limited sun exposure and avoid tanning beds.  And above all, self-awareness, assiduous skin examination, the best possible prevention.   

Really, it IS a puzzle.   Some sort of link between sun exposure and skin cancer is undeniable.   By their location- I can't prove it, of course-  my two primary melanomas may well have resulted from extreme sunburns since I was 15 years old.   But as my oncologist says, the relationship between the sun and skin cancer is "very complex".   There are links of some kind between many other factors, genetic and environmental- and melanoma.   Which factors and how important?   Very poorly understood.   

While we wait for medical science to catch up, everyone wants a Simple Answer.   Human nature gravitates to the most obvious bogeyman- the convention or mantra doctors (and sunscreen manufacturers) have repeated for 30 years:  

"It's the sun!" 

A significant percentage of cases are in no way related to sun exposure.   So, what to do?    Moderation.   Regular, limited sun exposure and avoid tanning beds.  And above all, self-awareness, assiduous skin examination, the best possible prevention.