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Vitamin D – Sunlight and Supplementation

Vitamin D - Sunlight and Supplementation

Today’s article is in response to questions coming in from many of my regular readers and clients regarding Vitamin D, Vitamin D deficiency and sun exposure/skin cancer. It is no secret that I am very skeptical of the “Cancer” industry and our pathetically weak government agencies when it comes to believable health data, studies, real science and policy. I am not going to go into criticizing and pointing out the continuing floors and discrepancies rather I am simply going to say that after seeing the latest round of “scare mongering” towards sunlight and skin cancer on commercial television lately, it is not surprising that we are seeing such a high rate of Vitamin D deficiency related health problems surfacing. Now we are being told that “..all your skin exposure to sun adds up and greatly increases your chances of skin cancer.” This type of scare mongering is seeing people become phobic of sun exposure and this is putting their health at greater risk than if they were to get some moderate sun exposure daily. Fact is, we humans need adequate levels of Vitamin D daily for proper functioning and disease prevention and the way we get that naturally is from exposure to sunlight allowing it to be naturally produced by the skin.

What is Safe Sun Exposure For Skin?

In an effort to address the emerging problem of vitamin D deficiency, the ANZBMS (Australian and New Zealand Bone and Mineral Society) is responding to new evidence and updating its 2005 position statement. The update will be published in the MJA in coming months. ANZBMS president Professor Rebecca Mason says that the new statement will offer simpler, more user-friendly advice on limiting sun exposure periods without sun protection, across the population. She points out an increasing number of children are vitamin D deficient, illustrated by a rise in the number of rickets cases. “We are saying most people in the population now need a shot of sun exposure every day,” Professor Mason says. “Get out of the office or the classroom. Clear your head and get some exercise.” In practical terms, this means during summer, just outside the peak ultraviolet radiation B times of 10am to 3pm, the society recommends all Australians go outside mid-morning or mid-afternoon for a brisk walk for six to eight minutes, she says, exposing their arms, face and hands. In winter, it’s the same amount of exposure time for people living in Cairns, but around the middle of the day. In the southern states where UV radiation levels are less intense, Professor Mason says exposure should be for much longer. “If you live in Melbourne, for example, 25 minutes’ exposure a day is recommended, and in Hobart it’s 30 minutes.” Professor Mason hopes general practitioners will pass on this advice to all their patients. She says the advice is cautious, and patients still need to take a balanced approach in their sun exposure, so they are not increasing their risk of skin cancer.

The bottom line is be sensible, sunburn is not sensible, but controlled, normal sun exposure is.

Why is Correct Vitamin D Levels So Important?

In her recent unpublished analysis of 100 healthy people at Westmead, endocrinologist Dr Jenny Gunton, senior research fellow at the Garvan Institute of Medical Research, found 24 of the people tested had vitamin D levels in the range of 25–50 nmol/L. At this range, the serum 25-hydroxy vitamin D level is considered mildly deficient, according to a position statement by the Australian and New Zealand Bone and Mineral Society (ANZBMS), and greater parathyroid hormone secretion and high bone turnover become a concern(1). Dr Gunton, who is also head of the Diabetes and Transcription Factors Group at the Garvan Institute, says the Westmead study shows a major resurgence in vitamin D deficiency “It’s the opposite side of the coin to ‘slip, slop, slap’ Instead of too much sun, we are now getting too little.” And this growing evidence of widespread vitamin D deficiency in the general population will receive even further corroboration, Dr Gunton says, when she publishes the results of a related study in the Medical Journal of Australia this month.

While the bone health benefits of vitamin D are well known, evidence of other physiological implications are emerging. Sun exposure and vitamin D levels have been associated with multiple sclerosis (MS), breast, prostate and colorectal cancer, non-Hodgkin lymphoma, diabetes and also hypertension. A study published in November last year in the American Journal of Hypertension of 413 women aged 24 to 44 found those with vitamin D insufficiency were three times more likely to develop hypertension than those with normal levels.2Then in a study published in February this year, researchers at the Australian National University (ANU) studied the effect of sun exposure on 216 people who had experienced their first symptom of MS.3 The study’s lead author, associate Professor Robyn Lucas from the ANU College of Medicine, Biology and Environment, says researchers discovered UV and vitamin D stimulated T-regulatory cells and reduced levels of pro­inflammatory cytokines, which in turn reduced the risk of MS. Further research could determine if UV exposure and vitamin D could prevent the disease.

More Evidence That Vitamin D is Essential

Apart from the health conditions mentioned above, there is more and more evidence emerging as to the importance of correct Vitamin D levels in therapeutic use for many and varied conditions.

Support Immunity – Winter Vitamin D3 Supplementation – “To our knowledge, no rigorously designed clinical trials have evaluated the relation between vitamin D and physician diagnosed seasonal influenza,” write Mitsuyoshi Urashima, MD, PhD, from Jikei University School of Medicine, Minato-ku, in Tokyo, Japan, and colleagues. “We investigated the effect of vitamin D supplements on the incidence of seasonal influenza A in schoolchildren.” Schoolchildren were randomly assigned to receive vitamin D3 supplements (1200 IU/day) or placebo from December 2008 through March 2009. The main endpoint of the study was the incidence of influenza A, diagnosed by influenza antigen testing (rapid influenza diagnostic test [RIDT]) on a nasopharyngeal swab specimen. In the vitamin D3 group, 18 (10.8%) of 167 children had influenza A, as did 31 (18.6%) of 167 children in the placebo group (relative risk [RR], 0.58; 95% confidence interval [CI], 0.34 – 0.99; P = .04). The association of decreased influenza A incidence with vitamin D supplements was stronger in children who had not been taking other vitamin D supplements (RR, 0.36; 95% CI, 0.17 – 0.79; P = .006) and in those who started nursery school after age 3 years (RR, 0.36; 95% CI, 0.17 – 0.78; P = .005).

Suboptimal Levels of Vitamin D Linked To Asthma – A new hypothesis has emerged linking asthma to suboptimal vitamin D levels. It is estimated that more than two million Australians suffer from asthma The prevalence of asthma in Australia is high by international standards, although the last few years has seen a slight decrease in asthma rates in children and young adults.In asthmatics, low vitamin D levels have been linked to poor asthma control, reduced lung function, reduced glucocorticoid response, and increased exacerbation and subsequent steroid use. Now, research has shown that suboptimal vitamin
D levels are common in adult asthmatics, with the lowest levels found in those individuals with severe and/or uncontrolled asthma. Vitamin D plays a critical role in innate and adaptive immunity. With regards to asthma, vitamin D may assist in its primary prevention, while also decreasing the severity of asthma exacerbations and reducing morbidity. In addition to playing a crucial part in foetal lung and immune development, vitamin D may upregulate antimicrobial proteins that defend against respiratory infections, reduce pro-inflammatory cytokines and have an antiproliferative effect on airway smooth muscle.

Vitamin D May Help To Reduce Rhinitis – Adding an oral vitamin D supplement to regular intranasal corticosteroid dosing can improve symptoms of seasonal allergic rhinitis, according to study results presented at the American Academy of Allergy, Asthma and Immunology 2012 Annual Meeting. The effects are beyond that seen with corticosteroids alone in patients who are not vitamin D deficient.In a double-blind placebo-controlled study, patients 18-45 years of age with seasonal allergic rhinitis received fluticasone propionate 200 µg/day, and were randomised to receive either vitamin D 4000 IU/day for 2 weeks or placebo.According to daily self-rated nasal symptoms, including sneezing, nasal congestion, and drip, subjects in both groups noted significant daytime improvements from baseline.However, subjects in the vitamin D group noted a decreased symptom score of 6.9 points from baseline compared to a 3.7 point drop in the placebo group (P = .04). This deviation of nearly 50% was statistically significant.Recent findings on the function of vitamin D may also explain aspects of the pathophysiology of chronic rhinitis and chronic rhinosinusitis (CRS). Vitamin D has been shown to have an immuno-modulatory effect with a significant impact on immune function, and also regulates the mechanisms that suppress the inflammatory response. Vitamin D has been shown to play an important role in asthma, and the concept of the unified airway model allows the extrapolation of vitamin D as having an important role in chronic rhinitis and CRS.

Vitamin D May Reduce The Risk of Fracture in Girls – Stress fractures are a common injury, often related to sports or physical activity. Essentially, the damage occurs when the bone is not able to withstand the pressure and force it is put under. They can also develop over time from repeated impact that might not initially cause any noticeable injury, but after multiple stress episodes become something of a problem to the bone structure. The scientists looked at more than 6,100 pre-adolescent and adolescent girls (age 9 to 15 at baseline) who were a part of the Growing Up Today Study. Over seven years of follow up nearly four percent of the girls were seen to develop stress fractures, and dairy and calcium intake was not found to be a related cause. Conversely though, vitamin D appears to have been particularly important in maintaining healthy bones, able to withstand high impact events, particularly in those girls involved in an hour or more per day of high stress activity.

The authors noted that : “In contrast, there was no evidence that calcium and dairy intakes were protective against developing a stress fracture or that soda intake was predictive of an increased risk of stress fracture or confounded the association between dairy, calcium or vitamin D intakes and fracture risk.”

The authors also note that in a stratified analysis, high calcium intake was associated with a greater risk of developing a stress fracture, although they suggest that “unexpected finding” warrants more study. The authors conclude that their findings support the Institute of Medicine’s recent increase in the recommended dietary allowance for vitamin D for adolescents from 400 IU/d to 600 IU/d. Obviously, further studies are needed, especially in regards to showing that boys have the same result, but considering the growing number of children with lactose intolerance, problems and the possible misnomer about dairy products that has been uncovered, Sonneville et. al have certainly come up with some useful and enlightening information.

Vitamin D Inhibits Inflammation – “This study goes beyond previous associations of vitamin D with various health outcomes. It outlines a clear chain of cellular events, from the binding of DNA, through a specific signaling pathway, to the reduction of proteins known to trigger inflammation,” said lead author Elena Goleva, assistant professor of pediatrics at National Jewish Health. “Patients with chronic inflammatory diseases, such as asthma, arthritis and prostate cancer, who are vitamin D deficient, may benefit from vitamin D supplementation to get their serum vitamin D levels above 30 nanograms/milliliter.”

Current national guidelines suggest that people should maintain a minimum blood serum level of 20 ng/ml, although there is much scientific debate about optimum levels. Vitamin D has long been known to contribute to bone health by promoting the absorption of calcium. In recent years, much attention has been paid to its possible immune and inflammatory benefits. Low vitamin D levels have been associated with several diseases including asthma, cancer, diabetes, and arthritis.In the current study researchers examined the specific mechanisms by which vitamin D might act on immune and inflammatory pathways. They incubated human white blood cells with varying levels of vitamin D, then exposed them to lipopolysaccharide (LPS), a molecule associated with bacterial cell walls that is known to promote intense inflammatory responses. Cells incubated with no vitamin D and in solution containing 15 ng/ml of vitamin D produced high levels of cytokines IL-6 and TNF-alpha, major actors in the inflammatory response. Cells incubated in 30 ng/ml vitamin D and above showed significantly reduced response to the LPS. The highest levels of inflammatory inhibition occurred at 50 ng/ml. Through a complex series of experiments, the researchers identified a new location where the vitamin-D receptor appears to bind directly to DNA and activate a gene known as MKP-1. MKP-1 interferes with the inflammatory cascade triggered by LPS, which includes a molecule known as p38, and results in higher levels of IL-6 and TNF-alpha.

“This newly identified DNA-binding site for the vitamin-D receptor, and the specific pathways inhibited by higher levels of vitamin D provide a plausible mechanism for many of the benefits that have been associated with vitamin D,” said Dr. Goleva. ”The fact that we showed a dose-dependent and varying response to levels commonly found in humans also adds weight to the argument for vitamin D’s role in immune and inflammatory conditions.”

Health Experts Are Aware of The Problem

Health-Sign-blue-iconNew figures reveal blood tests for vitamin D deficiency in Victoria rose 10,000 per cent in the past decade. Just over a million tests were ordered in 2010 compared with 9000 in 2000. Doctors are calling for routine testing for pregnant women, as the Federal Budget clamps down on rebates for pathologists. Melbourne University professor Peter Ebeling said there was more awareness about vitamin D deficiency among medical professionals, which may have increased testing. But he said he would be concerned if access to tests was restricted. Recent studies have linked vitamin D deficiency to osteoporosis, auto immune diseases, colon cancer and heart disease. Risk groups include people who spend most of their time inside, including the elderly, those in hospital and shift workers, and people who avoid the sun. Royal Children’s Hospital paediatrician Dr Georgia Paxton said people with naturally very dark skin were at risk of low vitamin D because they needed more exposure to sunlight. “The immediate effects of low vitamin D are bone health and the development of rickets,” Dr Paxton said.Prof Ebeling is calling for mandatory screening of pregnant women to prevent gestational diabetes and to stop their babies being born with soft bones.

The endocrine society releases recommendations for Vitamin D – Representatives of the society said that between 40 and 75 percent of the world’s population is vitamin D deficient. Low levels of the nutrient can contribute to a range of potentially serious medical conditions, including osteoporosis, rickets and skin conditions. Additionally, emerging research has tied deficiencies to an increased risk of developing certain cancers as well as multiple sclerosis.
“Our objective is to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency,” said Michael Hoick, a Boston University researcher who introduced the society’s new recommendations.
In addition to the new guidelines, the group recommended that anyone who had certain risk factors for deficiency seek vitamin D testing.

Who Are At Risk For Vitamin D Deficiency?

Certain groups of people are at risk of Vitamin D deficiencey than others such as metioned above; Risk groups include people who spend most of their time inside, including the elderly, those in hospital and shift workers, and people who avoid the sun. Royal Children’s Hospital paediatrician Dr Georgia Paxton said people with naturally very dark skin were at risk of low vitamin D because they needed more exposure to sunlight. Generally speaking, anyone who has a lack of exposure to sunlight.

What is The Optimal Level of Vitamin D? Should I Supplement?

For the average adult the normal level is around 50nmol/L. The way to know your Vitamin D levels is through pathology testing. It is a simple test that can be done by your health professional. Should you be found to be deficient in Vitamin D then there are ways to increase your levels. The obvious method is to increase sensible sun exposure on a daily basis. The other measure is through diet and / or supplementation. This is best designed and administered through your natural health practitioner or equivalent to ensure you are getting optimal dosing. In order to get positive therapeutic results, you need to take higher levels of Vitamin D. When you are in a situation like this it is better to obtain some professional advice and guidance for best outcomes to be achieved.

Beware of Misleading Research – Last year some research was released that was of poor standard and was misleading in it’s conclusions that oral Vitamin D supplementation was not effective. World-leading vitamin D expert, Professor Michael F. Holick has called for practitioners to ensure their patients are maintaining good vitamin D status to help reduce the risk of chronic illnesses, following a recent review of vitamin D research that has been misrepresented in media reports. The review of existing data, published in The Lancet, identified 290 prospective cohort studies and 172 randomised trials of major health outcomes and of physiological parameters related to disease risk or inflammatory status. The authors of Vitamin D status and ill health: a systematic review concluded that a number of randomised trials have not confirmed that raising of 25-hydroxyvitamin D (25[OH]D; used as a proxy for an individual’s vitamin D status) concentrations can modify the occurrence or clinical course of chronic health disorders such as breast and colorectal cancer. However, Prof. Holick, a pioneer in vitamin D research, has claimed the review and the media attention surrounding it misleads readers into believing there is new research.

“To look at these meta-analysis and make conclusions on the health benefits of vitamin D is not appropriate. There is really nothing new in this review and it really does misrepresent some very good studies demonstrating associations of vitamin D and chronic illnesses.”

Prof. Holick, endocrinologist and Professor of Medicine, Physiology and Biophysics at Boston University (USA) said despite the review’s large sample size, the problem with many of the reviewed studies was their use of suboptimal doses of vitamin D. According to research, to increase serum vitamin D levels to around 50nmol/L (sub-optimal level), normal healthy adults require 1000IU/day of vitamin D.2 A dose of 4000IU/day of vitamin D is required to increase serum vitamin D to around 75nmol/L (sufficiency). Current Australian recommendations of high dosing in severe deficiency are 10 000 to 50 000IU cholecalciferol, weekly for 6 weeks rather than one large annual dose. Alternative lower dosing schedules of Vitamin D in severe deficiency include: 3000-5000IU daily for at least 6-12 weeks followed by maintenance dosing of 1000IU daily. 50 000IU once per month for 3-6months followed by 1000IU daily maintenance dose.

The short version is that oral supplementation is indeed useful and effective when properly administered in correct dosing amounts that are deemed therapeutic.

So in closing folks I would like to make it clear to you that you do require a sensible amount of daily sunlight exposure to help prevent poor health due to Vitamin D deficiency. If you are someone who has to spend a lot of time indoors, then there are effective and useful diet and supplementation options available to you that can help you. Please do not be “scared off” but the cancer industry in regards to sunlight exposure but please be sensible, sunburn is not sensible! Also do not get your nutritional health research information via commercial media outlets, they love to spin a story for maximum profit only, instead ask your Integrative Medicine Doctor, Naturopath or Clinical Nutrition practitioners when it comes to nutrition, they know best and they know how to help you get the most from it.

Until next time, be well, naturally.


Craig Hitchens – Natural Health Practitioner

 

References:

https://www.bioceuticals.com.au/education/article/vitamin-d-let-the-sun-shine
https://www.bioceuticals.com.au/education/article/vitamin-d3-supplements-in-winter-may-help-support-immunity
https://www.bioceuticals.com.au/education/article/asthma-linked-to-suboptimal-vitamin-d-levels
https://www.bioceuticals.com.au/education/article/vitamin-d-may-improve-rhinitis
https://www.bioceuticals.com.au/education/article/vitamin-d-intake-may-reduce-fracture-risk-in-girls
https://www.bioceuticals.com.au/education/article/we-need-vitamin-d-to-avoid-risks-health-experts-warn
https://www.bioceuticals.com.au/education/article/endocrine-society-releases-new-vitamin-d-recommendations
https://www.bioceuticals.com.au/education/article/vitamin-d-expert-beware-of-misleading-research
https://www.bioceuticals.com.au/education/article/vitamin-d-update
https://www.bioceuticals.com.au/education/article/bioceuticals-statement-vitamin-d-supplementation

 

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