Sunshine, Vitamin D, and Death by Scientific Consensus
The traditional “Top Ten Breakthroughs of the Decade” lists have been appearing in science-related publications. One breakthrough, however, is conspicuously missing from every list I've seen so far. I'm talking about the new understanding of the role and proper dosage of the sunshine vitamin D.
The “scientific consensus” that has held sway for four decades regarding both exposure to the sun and vitamin D has collapsed. What has emerged in place of the old “settled science” is the knowledge that most people in America are seriously vitamin D deficient or insufficient. The same is true for Canada and Europe, and the implications are staggering.
Simply put, unless you are one of the few people with optimal serum D levels, such as lifeguards and roofers in South Florida, you can cut your risks from most major diseases by 50 to 80 percent. All you have to do is get enough D. It also means we can significantly reduce both health care costs and the staggering national deficit by taking a few simple steps.
As a financial writer, I bemoan the fact that no one can patent sunshine. Biotechs with therapies supported by far less evidence have exploded in value. Sirtris, for example, was bought by GlaxoSmithKline for $720 million to acquire IP for certain resveratrol-like substances. If you compare the evidence supporting the benefits of resveratrol vs. sunshine, sunshine leaves resveratrol in the dust.
I do, however, advise all my readers to get and keep their vitamin D levels up. This is simply because the economic benefits of doing so are so profound. Major illnesses have long been the biggest cause of financial crisis, a fact that proponents of nationalized health care have exploited well.
In truth, however, sensible sun exposure and vitamin D3 supplementation would do far more for our national health than the current health care bill. Even better, the benefits to society could be achieved without spending hundreds of billions of dollars. If an “Army of Davids” took it upon itself to spread the word, they could achieve what government is apparently incapable of achieving.
I realize, incidentally, that such bold claims probably inspire skepticism. They should, in fact, and I'm going to make even more bold claims. So allow me to make the necessary disclaimers and move on.
I've come to the conclusions I've written here because my job as a tech investment adviser requires that I survey thousands of the most recent scientific studies. In the last few years, an overwhelming flood of new evidence has been produced supporting the view that the medical and nutritional establishments have been fundamentally wrong about vitamin D's physiological role and optimal dosage.
I'm not, however, going to hyperlink/footnote academic papers for everything I tell you in this article, though those studies exist with multiple redundancies. Nor will I try to explain the biological function of vitamin D, something better left to biologists. I will include a number of links at the end of this article to people and sites with far more credibility. They have journal articles online with voluminous footnotes.
I would encourage you, nevertheless, to verify even their information and act accordingly.
If researchers on the cutting edge are right, the benefits of raising your serum D levels to about 40 ng/ml are enormous. If they are wrong, the risks associated with the recommended therapy are trivial, if not nonexistent, especially if done through supplementation. This is simple Bayesian analysis.
If you do take my advice and perform further research on this subject, you will still encounter holdouts who assert that unprotected exposure to sunshine is always dangerous and that a normal diet supplemented by a daily multiple vitamin provides sufficient vitamin D. Behind the scenes, however, even the NIH is now looking for a face-saving way to change positions on vitamin D without taking too much blame for having resisted those who have urged reassessment for decades.
The stakes are huge, as are the benefits of attaining optimal vitamin D levels. The embarrassment for those who must admit past error, however, may be even greater. The reason is that untold millions have suffered and died prematurely because those who challenged the “settled science” regarding sunshine and vitamin D decades ago were treated like crackpots and demonized.
Now we know that very few people have optimal serum levels of 25-hydroxyvitamin D [25(OH)D], the principal form of vitamin D circulating in the blood. Moreover, those with more melanin manufacture less vitamin D in their skins, so they suffer disproportionately from diseases exacerbated by vitamin D deficiencies.
Dr. Michael Holick, the researcher most responsible for this radical change in thinking, has described the current state of widespread vitamin D deficiency as a “silent epidemic.” In a world inured to over-the-top predictions (polar ice caps will melt in just a few years, and sea levels will rise 20 feet), it is natural to treat the word “epidemic” as hyperbole. A quick Google news search finds the word associated with everything from methamphetamine use to concussions in professional hockey.
Vitamin D deficiency, however, is not one of these metaphoric “epidemics.” It is an extremely serious public health problem that affects virtually all diseases. To understand this change in thinking, we need to review briefly the history of vitamin D and our understanding of its function.
In the 1890s, the crippling bone-softening children's disease rickets was still widespread in northern states, which has more pollution and a thicker ozone layer than the northwest. Ozone blocks the invisible component of sunshine, ultraviolet B, which produces vitamin D in the skin.
In the early 1900s, it was demonstrated that summer midday sunshine prevented rickets. As a result, there was an effort to educate the public and nearly everybody learned that a little sunshine was good for you. If you're of baby boom age, your mother undoubtedly told you to “go outside and get some sun.” That's why.
Ironically, the beginning of the end of this attitude came in 1923 when a means of producing dietary D was found. UW-Madison biochemistry professor Harry Steenbock discovered that the vitamin D content of milk and other organic substances could be increased with ultraviolet (UV) irradiation. This led to the widespread enrichment of milk and the near elimination of rickets. Slowly, the perception of sunshine as healthy began to fade.
For the most part, scientists lost interest in the biological role of sunshine for higher animals. Dr. Michael Holick was the notable exception. For the last thirty years, Holick has been gathering data, doing research, and studying the role of sunshine and vitamin D.
As a graduate student, Holick first identified the major circulating form of vitamin D in human blood as 25-hydroxyvitamin D. He then isolated and identified the active form of vitamin D as 1,25-dihydroxyvitamin D. He determined the mechanism for how vitamin D is synthesized in the skin, and demonstrated the effects of aging, obesity, latitude, seasonal change, sunscreen use, skin pigmentation, and clothing on this vital cutaneous process. Too often, however, he was treated like a climate change skeptic at an Al Gore fundraiser.
Thanks to his work, we now know that D is not actually a vitamin. It is prohormone, meaning that it is a precursor form of a steroid hormone created by conversion in various organs. This active hormone acts to regulate multiple important biological functions. Every single cell in the body has a D receptor, even stem cells.
When I asked Holick what the source of his epiphany was so long ago, he explained that it was the simple fact that D is a critical nutrient without a natural food source. It is so important biologically that early humans could manufacture D even during famines.
For that reason, he questioned the conventional zero-tolerance approach to sun exposure that has held sway with dermatologists since the 1970s. Holick, a professor of dermatology himself, lost his teaching position when he published his findings. When he wrote a book on the subject, he was targeted by a well-funded PR campaign, aimed at debunking him, by the leading dermatological organization. Supposedly objective journals, including the New England Journal of Medicine, refused to publish his exhaustively documented research -- research now accepted as both accurate and pioneering.
About five years ago, the vitamin D climate began to change. Of late, Holick has finally begun to get the recognition he deserves, and he now serves on multiple prestigious boards as well as advises the NIH. He is, incidentally, professor of medicine, physiology and biophysics at the Boston University School of Medicine. Holick is also director of the General Clinical Research Center, the Vitamin D, Skin and Bone Research Laboratory, and the Biologic Effects of Light Research Center at the Boston University Medical Center.
Holick explains that new breakthroughs in other areas have helped him make his case. With advances in computer processing and the decoding of the human genome, for example, it now appears that a remarkable 2000 genes are influenced by vitamin D.
In retrospect, it's odd that the lessons learned from the northern rickets epidemic were not applied sooner to osteomalacia, which is essentially rickets of the aged. In fact, Dr. Holick and others have demonstrated that osteomalacia is preventable and treatable using vitamin D. Osteoporosis, another bone disease, is also related to lack of vitamin D.
That discovery alone is legitimately worthy of a Nobel prize. In Holick's words, though, it is only the tip of the iceberg. Though Holick began documenting the connection between vitamin D insufficiencies or deficiencies thirty years ago, the scientific floodgates have opened in the last year or two. Word of this massive body of evidence has only really begun to permeate the scientific community in the last few months.
Optimal vitamin D serum blood levels, attained through sunlight or supplementation, dramatically reduce the risk of many diseases other than bone maladies. Many of the most serious are ameliorated by an astonishing 50 to 85 percent. These diseases include cancers, from breast and colon to deadly melanoma skin cancers.
Yes, that's right. The really nasty skin cancers can be prevented by getting moderate, sensible sunshine or through vitamin D supplementation. Non-melanoma skin cancers do increase somewhat with sun exposure, especially with sun burns. These skin cancers, however, are relatively benign as they tend not to spread into other parts of the body. They are easily detected and removed because they appear on skin exposed to the sun.
Melanoma, on the other hand, is the deadly skin cancer that most people erroneously relate to sunshine. Melanomas, however, do not tend to occur on parts of the body that get direct sunlight. This not only argues against the notion that sunshine directly causes them, it makes them less likely to be detected. The bottom line, which is worth repeating, is that the incidence of truly nasty melanoma skin cancers goes down significantly with sensible exposure to UVB-containing sunshine or with vitamin D3 supplementation. Other effects of vitamin D improve skin tone in general.
This is not the end of the list, though. The big killers and most expensive diseases respond similarly to adequate D. I'm talking about hypertension, cardiovascular disease, and stroke. So do type 1 diabetes, type 2 diabetes (to a lesser extent), rheumatoid arthritis, peripheral vascular disease, multiple sclerosis, dementia, autoimmune diseases, and apparently even viral diseases such as H1N1 and AIDS.
I predict that other diseases will also be linked to vitamin D insufficiencies as more studies are performed. Even conditions such as autism and schizophrenia may be directly related to prenatal or infantile vitamin D deficiency.
Nevertheless, the NIH's current recommended dosage for vitamin D supplementation remains basically unchanged since it was established to prevent rickets. In fact, the maximum safe dosage of vitamin D3, the preferred dietary form, is currently 2000IU. This is extremely unfortunate because it takes about a hundred IU to raise serum blood levels by 1 ng/ml in a healthy adult. To get into the optimal range, 40 to 60 ng/ml, one would therefore have to take 4000 IU daily. It would take even more if you were obese, are taking certain medications, or have one of a number of medical conditions that degrade or prevent the creation of usable D. The evidence, incidentally, is that 10,000IU is entirely safe.
I said above, half-jokingly, that it is too bad sunshine isn't patentable. The reason the statement is somewhat true is that no one has a direct financial interest in pushing back against those who have maligned sunshine. Manufacturers of sunscreen contributed significantly to the impression that the sun's rays were always damaging. This overuse of sunscreen, in fact, has been a major contributor to vitamin D deficiency. Of course, excessive sun exposure is bad. It is clear that sun burns, in particular, are very detrimental to skin health.
In moderation, however, it is a virtual panacea. Holick, incidentally, is a strong proponent of sunscreen use. He recommends using it on face and hands, which are constantly exposed to sunshine and on any part of the body exposed to sun after moderate, “sensible” exposure.
Supplement manufacturers would have an interest in promoting information about vitamin D deficiencies. They, however, are prevented from recommending optimal doses because of current NIH guidelines.
The anti-sunshine movement was bolstered significantly when the environmental movement began to blame thinning of the ozone layer on CFCs. This has never been proven, primarily because natural sources of ozone depleting gases far outweigh the man-made. Fred Singer, atmospheric physicist and professor emeritus of environmental science at the University of Virginia, points out that tropospheric chlorine (volcanoes, ocean spray, etc.) concentration is four to five orders of magnitude greater than than the CFCs that were blamed on ozone thinning.
Regardless, environmental alarmists focused specifically on the ozone layer's blockage of ultraviolet B, the only part of the spectrum that creates vitamin D. UVB may, in fact, contribute to cataract formation, which is why you should wear sunglasses that block ultraviolet light. Environmentalists, however, exploited the connection to create a scenario of widespread blindness.
Al Gore's 1992 book Earth in the Balance concluded that, thanks to the Antarctic ozone hole, "hunters now report finding blind rabbits; fisherman catch blind salmon." The blind rabbits he referred to, incidentally, had previously been explained by Chilean authorities as the result of a pink eye epidemic.
Nevertheless, environmentalist influence over the media was virtually unchallenged at the time. Not only were CFCs regulated, fear of sunshine increased significantly. The cost in both health and money of “solisphobia” has been incredible. Consider this projection: Once the requisite low-cost vitamin D therapies are fully adopted, Americans could save $50 billion annually in direct and indirect costs of disease. This, in turn, would have a real impact on our total health care spending.
The impact on average lifespans is somewhat difficult to calculate because the numbers include both infant mortality and aging-related statistics, both of which are affected differently by vitamin D deficiencies. My opinion, however, based on discussions with experts, is that adults who treat the big killers with sufficient vitamin D could see average increases in life expectancies of 6 to 8 years.
For people with more melanin and therefore darker skin, the benefits would be even greater because they currently suffer far more from diseases caused by vitamin D deficiencies. African Americans and Latinos are descendants of people whose melanin counts developed to protect them from excessive sunshine near the equator, where UVB contents are much higher. African Americans in the Northeast are particularly deficient and, as a result, have much higher rates of diseases that are exacerbated by vitamin D deficiency.
This fact has obvious political ramifications as the usual suspects have attributed to institutional racism the differences between white and black life expectancies. The research now shows that the primary factor is the ability to manufacture vitamin D, which is particularly impacted at northern latitudes. On the other hand, the fact that people with darker skins generally choose not to tan may have played a major contributing role in health differentials.
On a flight to speak at an investment conference in Canada last year, I had a pile of academic papers spread out on my tray and the seat next to me. A black woman on the flight and I started talking and she asked me what I was reading. When I told her they were papers related primarily to new technologies that would significantly extend our lives in the coming decade, she grew interested.
Finally, she asked me what I believed the most important thing she could do now for her health. I told her to take vitamin D and work on her tan a bit. The silence that ensued was followed by laughter and the statement that, never in her life had anyone ever encouraged her to get sunshine. In fact, she had spent her life avoiding it, and her behavior was typical of her friends and family. This is a problem, though it can be ameliorated with supplementation.
Holick says that from Los Angeles south, UVB is present in sunshine year round though it is blocked by clouds. Even the palest among us will be unable to get sufficient UVB from sunshine in more northern latitudes. In Boston, for example, UVB is blocked by the angle of the sun November through February. Edmonton, Canada, has no UVB mid-October through mid-April. Young people can store enough D during summer months to make it through the winter. Older people cannot.
Many of the benefits of D, incidentally, appear rapidly. Holick and others who prescribe D in clinical situations report that patients often experience dramatic improvements in quality of life within months. Not only do hypertension and bone density respond quickly, the neuromuscular impact of D is such that many of those who experience body pains and muscular weakness are relieved quickly when their serum blood levels are adjusted. Depression, irritable bowel syndrome, and various other maladies can respond extremely quickly to the sunshine vitamin.
Before giving you the links I promised, I'd like to make a few general observations. One is that, in every age, much of the mainstream scientific establishment has considered itself to have achieved a final understanding of core scientific issues. It is also true that, in retrospect, it has never been the case. Science, rightly, is a process of discovery, not a set of established facts.
Recall one recent example of this authoritarian fatuousness: The government dietary establishment's long insistence that “fats are bad.” My nutritional scientist wife told me decades ago that this was untrue. It took many years, however, before the importance of omega-3 fats was generally recognized. Remember when eggs, coffee, alcohol, and chocolate were bad for you?
Moreover, change and scientific progress continue to accelerate at an unbelievable pace. The next decade will see accelerating breakthroughs in world-changing technologies. They include stem cell sciences, misunderstood and mischaracterized by conservatives and liberals alike, as well as RNA interference, cellular engineering, nanoviricides and other life-extending technologies.
In the meantime, we need to always exercise skepticism toward “authorities” who tell us to simply trust their judgment regarding sunshine, diet, climate change, or anything else. It will become increasingly critical that we do our own research in the years to come as government has expanded into every aspect of sciences. At the same time, the sheer mass of legitimate discoveries is making it harder and harder for anyone to keep up.
The single best source of the latest information about vitamin D and sunshine, unfortunately, will not be published until April. It is Holick's forthcoming book, The Vitamin D Solution: A 3-Step Strategy to Cure Our Most Common Health Problem. In keeping with the conventions of my profession, I should tell you that I have no personal financial interest in promoting Dr.Holick's book.
In the meantime, his website will provide you with far more information than is included in this article. Another useful site is D*Action's Grassroots Health. This activist group includes leading scientists dedicated to increasing understanding of vitamin D.