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Newsletter: Vitamin D quiz

Posted on: January 18, 2003   by  John Cannell, MD


In the last several years, mainstream scientists at major universities have reported an incredible variety of illnesses are associated with inadequate vitamin D intake. Consider the following stories reported by WebMD.

Lack of Vitamin D Linked to Pain

Don’t Let Vitamin D Level Dip If You Have Bowel Disease

Vitamin D Supplements May Protect Against Diabetes in Kids

Vitamin D May Prevent MS

Vitamin D May Allow for Lower Doses of Steroids

As we are welcoming thousands of new readers from the NIH, CDC and NA, we decided to give a pop quiz.

1. Imagine that Andrew C. von Eschenbach, M.D., the director of the National Cancer Institute (NCI), visited his dermatologist who examined him and diagnosed a small squamous cell cancer on his nose. His dermatologist, who noted that Dr. von Eschenbach had the quaint custom of regularly exposing his body to short courses of noonday sunlight on the roof of the National Library of Medicine, advised Dr. von Eschenbach to totally avoid the sun. As Dr. von Eschenbach has read every scientific article ever written on cancer, his reaction was:

A. He thanked his dermatologist but knowing the prognosis is grim for those who develop squamous cell skin cancers, went home and wrote a will.

B. He immediately arranged to have a complete examination by an internist as Dr. von Eschenbach knows his chances of developing internal squamous cell cancers is much higher after being diagnosed with a squamous cell skin cancer.

C. He knew he must now avoid the sun entirely, so he bought cases of sunblock and lots of clothes that would totally protect his skin. He vowed to never let another ultraviolet ray of sunlight ever strike his unprotected skin.

D. He jumped up, smiled broadly, hugged his dermatologist, arranged to have the skin cancer removed, put some unblock on his face and hands, took of his shirt and changed into shorts for the walk to his car and then drove home to tell his loved ones the good news.

The correct answer is D. Dr. von Eschenbach knows that virtually all squamous cell skin cancers are easily treated and that fewer than 600 Americans die every year from squamous cell skin cancers compared to tens of thousands who may be dying from internal malignancies induced by vitamin D deficiency. Furthermore, he knows the inverse relationship between squamous cell skin cancers and the subsequent development of internal cancers has been known more than sixty years. He also knows that inverse relationship led to one of the first modern theories of cancer (that squamous cell skin cancers conferred immunity against various visceral cancers) which is more parsimoniously explained by sun exposure increasing both squamous cell skin cancers and calcidiol levels. Furthermore, he knows that the inverse association between sun-exposure and several common internal malignancies is robust and has been documented repeatedly. Furthermore, he knows that one of the best things he can do to reduce his chance of getting up to 13 different serious internal cancers is to continue to maintain his healthful levels of serum calcidiol [25(OH) D] by consistent safe sun exposure.

2. As malignant melanoma is caused by chronic sun exposure, the incidence of malignant melanoma increases dramatically with age, is more common on the hands, is more common in those who work outdoors and is less common in those who use sunscreen.

A. True

B. False

False. Malignant melanoma does not increase dramatically with age unlike the skin cancer most clearly associated with chronic sun-exposure, squamous cell skin cancer. Malignant melanoma is most common on relatively less exposed areas (backs in men and upper legs in women), is less common in outdoor workers than indoor ones and evidence to date does not show regular sunscreen use reduces its incidence. Instead of being a cancer of chronic sun-exposure, malignant melanoma is a multifactorial disease, the sun-exposure component of which appears to be best explained by intermittent intense exposure (sunburn) in a vitamin D deficient population. Sunblock which blocks the sun burning (and vitamin D producing) UVB while allowing the more deeply penetrating, and more damaging UVA may have contributed to the rising incidence by allowing users to stay in the sun for hours without burning, while their skin soaked up the highly penetrating UVA radiation. The best sunlight recommendations to prevent malignant melanoma may turn out to be to regularly expose your entire unsunblocked skin to very short periods (1/3 the time it takes for your skin to begin to redden) of direct noonday sunlight during the correct season of the year being careful to never let your skin get red or burn.

3. Pretend that Kenneth, Director of the National Institute of Environmental Health Sciences, was asked if the American Academy of Dermatology (AAD) recommendations to totally avoid sunlight might have helped cause the rising incidence of melanoma and other diseases over the last 20 years by contributing to the current pandemic of vitamin D deficiency. What should his answer be?

A. True

B. False

True. The American Academy of Dermatology press releases and spokesmen (vitamin d +sunshine = bad medicine) are particularly misinformed about vitamin D and appear to be giving information that may greatly increase risks of dying from a multitude of vitamin D deficiency related illness (including hypertension, heart disease, cancer, autoimmune disease, diabetes, depression, and, perhaps, even malignant melanoma). They are also putting AAD members at risk for future malpractice liability should dermatologists recommend their patients terminate sun-exposure without taking steps to ensure adequate
25(OH) D (calcidiol) levels.

4. If Thomas R. Insel, M.D., Director of the National Institutes of Mental Health, is current on the literature on vitamin D and depression — he knows which of the following are true:

A. Vitamin D rapidly increases genetic expression of tyrosine hydroxylase in vitro.

B. Diseases known to be associated with vitamin D deficiency (such as osteoporosis, diabetes, heart disease and hypertension) also have an unexplained significant association with major depression.

C. Two small controlled studies have suggested vitamin D improves mood.

All are true.

5. If Allen M. Spiegel, M.D., Director of the National Institute of Diabetes and Digestive and Kidney Diseases, is current on vitamin D and diabetes, he knows,

A. A recent controlled study showed that even small supplemental doses of vitamin D3 (1332 IU/ day for 30days) significantly increased first phase insulin secretion and reduced insulin resistance by 21% in type 2 diabetics.

B. Young Finnish adults who regularly took the then recommended dose of vitamin D (2000 IU daily) as infants had 1/10 the incidence of type 1 diabetes (RR 0.12) compared to matched controls who received no supplementation as infants.

C. Vitamin D deficiency appears to play a significant role in the etiology of Syndrome X

Again, all are true.

6. Stephen I. Katz, M.D., Ph.D., Director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, recently reviewed all the Framingham studies. He discovered that,

A. Relationship of serum vitamin D levels and osteoarthritis is not mentioned.

B. The risk for progression of osteoarthritis, characterized by loss of joint space and osteophyte formation, is significantly enhanced at serum 25(OH) D (calcidiol) levels below 85nmol/L (34 ng/ml).

B is true. As amazing as it sounds, this well conducted study from Tufts University about an illness (osteoarthritis) most of us will get, appears to have been completely ignored by mainstream medicine.

However, the most amazing vitamin D fact to come out of a major university in the last year came out of the lab of Professor Robert P. Heaney at Creighton University, the vitamin D and calcium expert. Dr. Heaney and his colleagues discovered healthy young men use about 4,000 IU of vitamin D a day (if they can get it). Human serum25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol.

This is twenty times more than the Adequate Intake (AI) currently recommended for people under 50 by the Food and Nutrition Board of the Institute of Medicine of the National Academies! Whoops, off by a factor of ten.


Question 1:
Apperly FL. The relation of solar radiation to cancer mortality in North America. Cancer Res 1941; 1:191-5
Geographic variation in breast cancer mortality in the United States: a hypothesis involving exposure to solar radiation.
Colorectal cancer and solar radiation.

Sunlight, vitamin D, and ovarian cancer mortality rates in US women.
Geographic patterns of prostate cancer mortality. Evidence for a protective effect of ultraviolet radiation.
Vitamin D and breast cancer risk: the NHANES I Epidemiologic follow-up study, 1971-1975 to1992.
National Health and Nutrition Examination Survey.
An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation.
Serum25-hydroxyvitamin D and colon cancer: eight-year prospective study.

Question 2:
Body site distribution of cutaneous malignant melanoma in relationship to patterns of sun exposure.
Site-specific risk of cutaneous malignant melanoma and pattern of sun exposure in New Zealand.
Incidence of cutaneous malignant melanoma in Denmark 1978-1982.Anatomic site distribution, histologic types, and comparison with non-melanoma skin cancer.
Cutaneous melanoma in relation to intermittent and constant sun exposure–the Western Canada Melanoma Study.
Sunscreen use and the risk for melanoma: a quantitative review.
Melanoma and sun exposure: an overview of published studies.

Question 3:
Vitamin D and systemic cancer: is this relevant to malignant melanoma?
Vitamin D in preventive medicine: are we ignoring the evidence?
Vitamin D: A millenium perspective.

Question 4:
Vitamin D increases expression of the tyrosine hydroxylase gene in adrenal medullar cells.
Bone mineral density and depression: a community study in women.
The association of bone mineral density and depression in an older population.
Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment.
Depression as a predictor for coronary heart disease. A review and meta-analysis.
A twin study of depression symptoms, hypertension, and heart disease in middle-aged men.
Vitamin D3enhances mood in healthy subjects during winter.
Vitamin D vs broad-spectrum phototherapy in the treatment of seasonal affective disorder.

Question 5:
The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2diabetic patients.
Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study
Inadequate vitamin D status: does it contribute to the disorders comprising syndrome ‘X’?

Question 6:
Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study.

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