Professor Asked to Resign Because He Advocates Moderate Exposure to Sunlight




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"The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease."
- Thomas Edison

Sunlight exposure is correlated with reduced breast cancer risk.

New evidence vitamin D fights cancer.

Read The UV Advantage by Michael Holick.

Vitamin D is essential to prevent cancer and sunlight is your best source. Sunlight is so important to cancer prevention that we have an entire web page devoted to sunlight.

  For information on vitamin D, see the website of the Vitamin D Council.

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Ralph W. Moss, Ph.D. Weekly
Newsletter #134 05/22/04


Science should by definition be open-minded.  As the celebrated eighteenth century German poet and philosopher Goethe said, "As soon as anyone belongs to a narrow creed in science, every unprejudiced and true perception is gone."   This week I begin a two-part series on an important event that has recently been in the news: the firing of a Boston University professor who has written a book that puts forward ideas that run counter to current medical doctrine.

The very fact that doctrine and dogma exist in the world of medicine is cause for concern.  Science-based medicine should be founded on rationality and open-mindedness, not on ideology.  

Unfortunately, the tendency for ideology to supplant open-mindedness has become pervasive in medicine.  For the past thirty years I have studied the world of cancer and its treatment and have written extensively on the many potentially useful treatments that have been dismissed out of hand simply because they challenged the prevailing medical dogma. 

The Moss Reports is a series of more than two hundred detailed reports on different types of cancer.  If you or someone you love has cancer, a Moss Report can offer not just an in-depth analysis of the conventional treatment of that type of cancer, but also a thorough examination of the available alternative and complementary treatments.   You can order a Moss Report through our website, or by calling Diane at 1-800-980-1234 (814-238-3367 from outside the US).


Note: When you finish reading this article you may be moved to take action. At the end of the article I therefore suggest something you can do.

A Boston professor of dermatology has been asked to resign because he advocates moderate exposure to sunlight. Michael F. Holick, MD, PhD, a professor at Boston University, was asked to resign in April from BU's Department of Dermatology because of a book he wrote, in which he describes the importance of sunlight in boosting vitamin D levels. He was also severely criticized for his ties to the indoor tanning industry.

Department chair Barbara Gilchrest, MD, told the Boston Globe that the book "is an embarrassment for this institution and an embarrassment for him." As demanded, Holick resigned his post, but continues to teach and to direct the medical center's Vitamin D, Skin, and Bone Research Laboratory, without a cut in pay.

Holick is a talented, experienced and highly respected researcher.  He is a professor of medicine and physiology, and formerly of dermatology, at Boston University School of Medicine, and (until 2000) chief of endocrinology, metabolism and nutrition. Since 1987 he has also been the program director of the University's General Clinical Research Center.

Department chair Gilchrest's disapproval of Holick stems from the fact that his statements, superficially at least, seem to be at odds with the medical profession's consensus on the damaging effects of sunlight. Dermatologists have been warning the public for years that sunlight, and specifically ultraviolet A (UVA) and ultraviolet B (UVB), is implicated in the causation of melanoma, as well as other less deadly forms of skin cancer.

But the causes of melanoma are still far from established, and there remain many unanswered questions about the exact relationship of sunlight exposure to the development of skin cancers. Exactly how much ultraviolet light constitutes a safe level of exposure is a legitimate topic for scientific debate. For example, according to the American Cancer Society, "We do not yet know exactly what causes melanoma .but we do know that certain risk factors are linked to the disease..Some risk factors, such as smoking, can be controlled. Others, like a person's age or family history, can't be changed. But having a risk factor, or even several, doesn't mean that a person will get the disease"  (ACS 2004).

As to sunlight, the ACS says this: "The best way to lower the risk of melanoma is to avoid too much exposure to the sun and other sources of UV light.. Avoid being outdoors in sunlight too long, especially in the middle of the day when UV light is most intense.."

But this view is not universally held. William B. Grant, Ph.D., who heads the Sunlight, Nutrition and Health Research Center (SUNARC) in San Francisco strongly disputes it. "This is not particularly good advice," he told this newsletter. "There are several papers indicating that occupational exposure to sunlight reduces the risk of melanoma (Kennedy 2003). "It is having fair skin, a high-fat, low fruit and vegetable diet, sunburning, etc., that are more linked to melanoma than total UV exposure."
Reasonable people can certainly differ over this complex question. Such vague terms as "too long" or "too much exposure" leave much room for disagreement. In science, intellectual rigidity is never warranted, especially when it rests on fundamental confusion about the actual causes of a potentially fatal human disease.

Despite scientific uncertainty, the attack on Dr. Holick has taken on a quasi-moralistic tone. Some dermatologists, possibly frustrated at the failure of most of their treatments to reverse advanced melanoma, now regard sun exposure without sunblock as analogous to promiscuous sex without condoms. But ultraviolet sunlight (particularly UVB) is not always and absolutely bad for our health.  It has essential functions, too. In particular, it enables our skin to manufacture vitamin D: without sufficient exposure to sunlight we run the risk of developing the deficiency disease rickets.

Vitamin D and Internal Cancers

The benefits of sunlight and vitamin D for the development of healthy bones have long been known: a Nobel Prize was awarded for discoveries relating to the importance of vitamin D as early as 1928.

But what has only fairly recently been discovered is that, in addition to its role in bone metabolism, vitamin D may also help prevent a variety of cancers. I wrote about this in my book Cancer Therapy in 1992. I quoted the work of San Diego scientists Drs. Cedric and Frank Garland, who argued that colon cancer could be prevented by sunlight. The Garlands went further, however, showing that "brief, regular exposure to sunlight was probably beneficial in preventing melanoma, while either too little or too much exposure was potentially harmful" (Moss 1992, citing Garland 1990).

The research on the subject of vitamin D and cancer is now voluminous, with over 3,500 PubMed articles on the topic. The US National Institutes of Health has stated that "laboratory, animal, and epidemiologic evidence suggest that vitamin D may be protective against some cancers. Some dietary surveys have associated increased intake of dairy foods with decreased incidence of colon cancer. Another dietary survey associated a higher calcium and vitamin D intake with a lower incidence of colon cancer" (NIH 2004). One randomized trial, published last December, showed that people who had high vitamin D levels benefitted from calcium supplementation: the incidence of premalignant adenomas of the colon was reduced by 29 percent in those who had optimal amounts of both nutrients (Grau 2003).

Vitamin D (and indirectly, therefore, sunlight) might also convey protection against prostate cancer. It is certainly true that more full-scale clinical trials need to be done to test this hypothesis. (PubMed lists 29 such trial articles.) But people are exposed to sunlight every time they step outdoors; the public needs and deserves preliminary recommendations from those with the greatest knowledge.

Dr. Holick's "crime" is that he has provided an answer that is at variance with the positions of the professional dermatology associations. Yet he is well positioned to offer an opinion, as he himself is in the forefront of this research. He is the author of over 200 PubMed articles on the topic of vitamin D, the first of which appeared in 1970. The latest, published this March, suggests the scope and importance of his research: "Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis" (Holick 2004). By contrast, Dr. Gilchrest, although herself well published in dermatology, has only authored two PubMed papers on vitamin D, one of which she co-authored with Dr. Holick.

It is hard to believe that a policy dispute of this sort would warrant such a gross violation of academic freedom and intellectual rights. We do indeed live in parlous times when doctors are removed from high positions for offering carefully reasoned and well intended advice to the general public on preventing cancer!

Mysteries of Sunlight

There is much about sunlight's biological effects that is not known and no one would argue that the case for increasing ultraviolet exposure has yet been conclusively proved.  But neither is it firmly established that blocking sunlight is entirely beneficial.  In fact, the value of physical or chemical sunscreens is itself in dispute.

In February 1998, an epidemiologist at Memorial Sloan-Kettering Cancer Center in New York, Dr. Marianne Berwick, presented a careful analysis of sunscreen use and skin cancer at the annual meeting of the American Association for the Advancement of Science (AAAS). She concluded that sunscreens may not actually protect against skin cancers such as melanoma. In her own words: "We don't really know whether sunscreens prevent skin cancer." Berwick first looked at four studies of squamous cell cancer, a skin cancer that is destructive but not frequently lethal. Two of the studies concluded that sunscreen protected against a precancerous skin condition while two others reported that sunscreen did not shield people from this condition.

She then analyzed two studies of basal cell carcinoma, another generally non-lethal skin cancer. Those two studies found that people who used sunscreen were actually more likely to develop basal cell cancer than people who did not.

Berwick then analyzed ten studies of melanoma, the most deadly form of skin cancer. Melanoma often starts in or near moles on the skin. In five of the ten melanoma studies, people who used sunscreen were also more likely than nonusers to develop melanoma. In three of the studies, there was no association between sunscreen use and melanoma. In the final two studies, people who used sunscreen seemed to be protected (Berwick 1998).

More recently, L.K. Dennis of the University of Iowa reviewed the topic in the Annals of Internal Medicine.  Again, he found that sunblocks offered no protection "No association was seen between melanoma and sunscreen use," he and his colleagues wrote (Dennis 2003).

Dr. Berwick's was a factual presentation. But the dermatology profession's response to her analysis was as unmeasured as its response to Dr. Holick. The American Academy of Dermatology promptly denounced the Memorial Sloan-Kettering researcher's conclusions. In March 1998 the Academy issued a press release calling her message "misleading and confusing."

Roger Ceilley, MD, a Des Moines dermatologist and a past president of the Academy, called Berwick "a numbers cruncher," not a doctor, according to an article in Science News. Incidentally, Dr. Ceilley, has only one PubMed article on the topic of melanoma, dating from 1980 (Elmerts 1980). Dr. Berwick-the Sloan-Kettering "numbers cruncher"-has 81 such publications.

"We're going to have millions more cases of skin cancer in the next decade" if people forgo sunscreen, Dr. Ceilley proclaimed (Fackelmann 1998).



The Dermatology Department at Boston University invites the public to send comments, suggestions and concerns. Those wishing to comment on the case of Dr. Holick should click or go here.

I would appreciate receiving a copy of any of your comments and letters and with your permission may print some of them in a future issue.

--Ralph W. Moss, PhD


Ralph W. Moss, Ph.D. Weekly
Newsletter #135 05/30/04


Why would anyone choose to pay for health information, when the Internet has made vast quantities of it accessible, free, to anyone?

Because information alone is not enough.  To be of use, information must be filtered through the lens of understanding, interpreted through experience. Without a knowledgeable guide, information, particularly in the medical field, can quickly create a great deal more confusion than it dispels. 

The Moss Reports are more than sources of information: they represent a comprehensive library of cancer guides. In them, my thirty years of experience in researching cancer treatments have been distilled into a careful assessment of the worth and effectiveness of the conventional and alternative treatments of over two hundred different kinds of cancer.

I recently received the following letter from David R., who bought a Moss Report:

"At first, I thought the price was a bit steep. But the report is excellent. Trying to evaluate the claims of the various alternatives is grasping at wind. I appreciate all of the legwork that you have done to investigate the clinics and the treatment methods. The report was well worth the money, and I have already begun recommending it to other...cancer patients."

If you or someone you love has received a diagnosis of cancer, a Moss Report can provide you with the key to understanding the best that conventional and alternative medicine have to offer.  You can order a Moss Report on your specific cancer type by calling Diane at 1-800-980-1234 (814-238-3367 from outside the US), or by visiting our website. We look forward to helping you.


Note: When you finish reading this article you may be moved to take action. At the end of the article I therefore suggest something that you can do.

Last week I wrote about the firing of Boston University dermatologist, Michael F. Holick, MD, PhD. Dr. Holick was sacked for suggesting, in his book The UV Advantage, that people seek out a few minutes of unblocked sunlight a couple of times per week. The goal is to boost the skin's production of vitamin D, thereby reducing the risk of contracting various diseases, including cancer. The ancient grandmotherly advice to "get a little color in your face" may not be all wrong!

It is commonly believed that exposure to sunlight leads to skin cancer, including deadly melanoma. No one believes this more ardently than leaders of the dermatology profession. For example, a leading dermatologist, Roger Ceilley, MD, has proclaimed, "We're going to have millions more cases of skin cancer in the next decade" if people forgo sunscreen (Fackelmann 1998).

Yet the relationship may not be that simple. There is evidence that a moderate amount of unblocked sunlight is actually beneficial to most people, reducing the risk of many diseases - including, paradoxically, melanoma itself. For example, in often-cited research on US Navy personnel in San Diego, researchers from the University of California School of Medicine found that more melanoma occurred among desk workers than among sailors who worked outdoors (Garland 1990).

Over a ten-year period, 1974-1984, the researchers identified 176 cases of melanoma among active-duty white male Navy personnel. The risk of melanoma was then determined for occupations that were grouped into three categories of sunlight exposure: (1) indoor, (2) outdoor, or (3) indoor and outdoor.

Compared with the US civilian population, Navy personnel in indoor occupations had a higher age-adjusted incidence rate of melanoma (10.6 per 100,000). But persons who worked in occupations that required spending time both indoors and outdoors had the lowest rate.

Another intriguing finding was that incidence rates of melanoma were higher on the trunk of the body than on the more commonly sunlight-exposed head and arms. This alone calls into question the notion that exposure to sunlight equals increased rates of melanoma.

The UC San Diego researchers concluded that there was a protective role for brief, regular exposure to sunlight. They also pointed to laboratory studies showing that vitamin D suppresses the growth of malignant melanoma cells in tissue culture. They suggested that vitamin D could inhibit previously initiated melanomas from becoming clinically apparent (Garland 1990).

But ideas such as these have made some dermatologists very angry indeed. Boni E. Elewski, MD, current president of the American Academy of Dermatology, has argued that even a few minutes of sunlight exposure can be dangerous, and that people can get all the vitamin D they need through supplements. This is a strange recommendation indeed, since orthodox doctors usually urge the laity to shun food supplements. (Incidentally, I can find no published scientific papers by Dr. Elewski on the topic of vitamin D.)

Despite dermatologists' vehement opposition to the idea, it is not at all clear that small amounts of unblocked sun exposure could be a significant cause of melanoma. As even the Skin Cancer Foundation states, "Epidemiologic studies have suggested that intense intermittent exposure resulting in sunburn, especially in childhood, is most likely to lead to melanoma development." (Skin Cancer Foundation 2004) But full-blown intermittent sunburn is not at all the same thing as getting a bit of sun on a winter afternoon in the northern latitudes.

Of course too much of a good thing can be dangerous. But the essential point that Holick makes is that by moderately increasing our exposure to sunlight, we can probably decrease our risk of many forms of cancer, as well as diabetes, seasonal affective disorder (SAD), multiple sclerosis, and other illnesses. Interested readers should take a look at the maps of disease distribution and mortality at the website of the SUNARC Foundation of San Francisco.

Click or go to

What these maps clearly show is that, as a general rule, the death rates for breast, colon and ovarian cancer, as well as incidence rates for multiple sclerosis, decrease as one moves south. For example, the breast cancer death rate in the south is about half of what it is in the north and northeast. Dr. William B. Grant, founder of SUNARC, has published a paper in the journal Cancer, in which he argues that these differences are due to sunlight and vitamin D (Grant 2002).

If he is correct, then this is very good news indeed for the "worried well." Brief but regular sunlight exposure could turn out to be a healthful measure that is easy to implement, cost-free and accessible to almost all. And ironically, despite the fervent objections from photophobes in the medical profession, it might even decrease the risk of melanoma.

Growth of Intolerance

Yet the moral climate these days has become polluted by dogmatism, bigotry and petty-mindedness. Science is supposed to be an island of rationality in a sea of intolerance. Yet intolerance is rearing its ugly head here as well.

Astonishingly, advocating even a few minutes of exposure to Old Sol these days is enough to get you black balled by your profession, regardless of prior accomplishments. "Any group, organization, or individual that disseminates information encouraging exposure to UV radiation, whether natural or artificial, is doing a disservice to the public," Elewski menacingly told The Scientist (  Read that sentence over. This is what we've come to in America, circa 2004. One would have to go back to the McCarthy era or to the 1930s-when (to paraphrase the poet W.H. Auden) "intellectual disgrace stared from every human face"-to find an equivalent.

There is much in this current debate on sunlight that is reminiscent of the longstanding feud over dietary fat. First, Dr. Robert Atkins was excoriated by almost the entire medical profession as a fraud and a quack. Then there was a grudging admission that his diet may work sometimes, but for reasons other than those he postulated. Now, after the public in its millions has deserted the orthodox position on weight loss, the medical profession is running full tilt to catch up. Recently I awoke to the following headline: "Longest scientific study yet backs Atkins diet." Two clinical trials conducted at the Philadelphia VA hospital and at Duke University, published in the prestigious Annals of Internal Medicine, have found that subjects on the Atkins diet shed significant amounts of weight without harmful effects on blood fats and sugars (Coghlan 2004).

My purpose here is not to weigh the merits and demerits of the Atkins low-carb diet. Rather it is to point out that all too often science is ruled not so much by cool reason as by pride and prejudice. The reaction to Dr. Holick's research is a case in point.

Demonizing sunlight (and those who advocate moderate exposure) is a manifestation of dogma rather than science. Perhaps a certain narrowness of vision is an inevitable result of professional over-specialization. Dermatologists spend their days looking for melanoma, an insidious and deadly disease.  After a while, they begin to see UV exposure (which is indisputably dangerous when carried to extremes) as the sole source of this evil. Dermatologists are not asked to worry about non-cutaneous forms of cancer, or about diabetes, seasonal affective disorder (SAD), or any of the other illnesses that may be prevented by judicious UV exposure. They just care about skin disease. As the old saying has it, 'to the hammer, everything looks like a nail'. 

A Question of Sponsorship

Much of the animus against Prof. Holick stems from his friendly relationship with the Indoor Tanning Association (ITA), a society that represents people working in that burgeoning industry. Holick is said to have unveiled his new book during a meeting of the ITA, which has also hired a publicist to promote it and has contributed $150,000 to his research.

While his association with the ITA may have been professionally unwise, Holick has denied that his research is influenced by any financial conflict. I have no reason to believe otherwise. It is unlikely that a distinguished and accomplished researcher would compromise his honesty for a few grants. One needs to look at the totality of the man's accomplishments. To me, these all add up to an honest lifelong search for the truth.

Besides, there is something hypocritical in this criticism of Dr. Holick. Of course, it would be better if all research could be independently funded, thereby eliminating the need for researchers to go cap in hand to those who have a vested interest in the outcome of their research. But it certainly seems ironic that leading dermatologists should rebuke Holick so roundly for his ties to the indoor tanning industry when in truth most medical research today is supported by interested parties of one kind or another. Imagine what would happen if all researchers with ties to the pharmaceutical industry were asked to resign.  There would be hardly any top doctors left in America's medical schools and research laboratories. Are dermatologists willing to accept that funding of research from, say, the chemical sunscreen industry should also be prohibited? I haven't heard those sentiments expressed by those who are now harrumphing over Dr. Holick's connections to indoor tanning.

The Case of Dr. Healy

Are we in for a new round of medical McCarthyism? Dr. Holick's case is similar to that of another medical professor who was also recently fired for unorthodox views. Dr. David Healy was removed from his post by the University of Toronto's Centre for Addiction and Mental Health (CAMH), after he wrote a book that was highly critical of the pharmacological approach to mental illness (Kendall 2004).

He stated the following: "Scientific progress in psychiatry has been stalemated because Big Pharma's marketing efforts have overwhelmed the field." This powerful statement points to a far more serious and pervasive problem than Dr. Holick's grant from the tanning lobby.

Signs of Fairness

However, there are still a few encouraging signs of elementary fairness in American medicine. Some vitamin D experts have rallied to Holick's side and have agreed that he should not have been forced to resign. "If he was fired for his opinion, which is based on science, then it would appear to be a violation of the principles of academic freedom," said James Fleet, PhD, who studies nutrition and vitamin D at Purdue University. Whether small amounts of sunlight can boost vitamin D intake without raising the risk of cancer "is an issue worth debating," Fleet has said.

Similarly, Reinhold Vieth, PhD,of the University of Toronto, who has worked with vitamin D since 1974, said that the shunning of Dr. Holick represents a "narrow-minded" approach to health. "It's like a horse with blinkers, and the only thing they [the orthodox dermatologists, ed.] see is melanoma."

Dr. Holick's response has been rather mild-mannered. He has said that he was "disappointed" and "surprised" when asked to step down simply on account of the fact that his opinions differed from those of some of his colleagues. "If you don't follow that party line, then they'll make every effort to squelch everything you have to say," he said.

This year another 1.3 million Americans will develop life-threatening cancers. Nearly 600,000 will die. Dr. William Grant, founder of the SUNARC Foundation, estimates that 47,000 of those deaths will result from internal cancers that could have been prevented by adequate UVB exposure and consequent vitamin D synthesis (Grant, personal communication).

As a recent leading article in Fortune magazine has pointed out, the war on cancer has so far been a failure. 

Click or go here for Fortune reference:

We simply cannot afford to throw away such accomplished and creative scientists as Michael Holick. In my opinion, Dr. Gilchrest and Boston University should reverse this misguided decision, pin a medal on Dr. Holick's labcoat, and get down to the business of finding innovative ways of preventing this terrible disease. The public deserves nothing less.

To order a copy of Dr. Holick's book, The UV Advantage, click or go to:


The Dermatology Department at Boston University invites the public to send comments, suggestions and concerns. Those wishing to comment on the case of Dr. Holick should go here.

I have received copies of dozens of letters so far and urge those of you who have not yet expressed your opinion on this matter to do so now. I would appreciate receiving a copy of any of your comments and letters and with your permission may print some of them in a future issue. Send copies to me at

--Ralph W. Moss, PhD



Allen S. BU advocate of sunlight draws ire. Boston Globe, April 13, 2004. Retrieved May 16, 2004 from:

Coghlan, Andy.  "Longest scientific study yet backs Atkins diet." news service, May 18, 2004. Retrieved May 18, 2004 from:

Dennis LK, Beane Freeman LE, VanBeek MJ. Sunscreen use and the risk for melanoma: a quantitative review. Ann Intern Med. 2003 Dec 16;139(12):966-78.

Elmets CA, Ceilley RI. Amelanotic melanoma presenting as a pyogenic granuloma. Cutis. 1980 Feb;25(2):164-6, 168.

Fackelmann, Kathleen. Melanoma madness. The scientific flap over sunscreens and skin cancer. Science News, Vol. 153, No. 23, June 6, 1998, p. 360 (on the Berwick controversy). Retrieved May 18, 2004 from:

Garland FC. Occupational sunlight expoure and melanoma in the U.S. Navy. Arch Environ Health 1990;45:261-267.

Goldacre MJ, Seagroatt V, Yeates D, Acheson ED. Skin cancer in people with multiple sclerosis: a record linkage study. J Epidemiol Community Health. 2004 Feb;58(2):142-4.

Grant WB. An estimate of premature cancer mortality in the United States due to inadequate doses of solar ultraviolet-B radiation, Cancer. 2002;94:1867-75.

Grau MV, Baron JA, Sandler RS, et al.  Vitamin D, calcium supplementation, and colorectal adenomas: results of a randomized trial. J Natl Cancer Inst. 2003 Dec 3;95(23):1765-71.

Holick, MA.  Vitamin D: Importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. American Journal of Clinical Nutrition, 2004 (March 2):79:362-371.

Kendall, Joshua. Talking back to (Boston Globe online), February 1, 2004. Retrieved May 11, 2004 from:

Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN; Leiden Skin Cancer Study. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol. 2003 Jun;120(6):1087-93.

NIH Clinical Center, National Institutes of Health. Facts about dietary supplements: Vitamin D. Retrieved May 11, 2004 from:

Skin Cancer Foundation. The Case Against Indoor Tanning. Retrieved May 18, 2004 from:

SPIS MedWire. Vitamin D may have preventive properties against cancer. The Scientist, August 24, 2000. Retrieved May 16, 2004 from:

Click or go here for my obituary of Dr. Atkins:

Some useful websites:

Indoor Tanning Association's website

James C. Fleet's website

Michael Holick's websites

Reinhold Vieth:

William B. Grant, PhD, Sunlight Nutrition and Health Research Center


The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.




Measuring Your Vitamin D Levels: Your Most Important Blood Test?
By John Cannell, MD and Alex Vasquez, D.C., N.D.

See the original article here

Our children need help. Many of them are suffering from unrecognized and untreated vitamin D deficiency. A recent June 2004 study from Harvard found 24 percent of healthy adolescents had vitamin D levels less than 15 ng/ml and 42 percent had levels less than 20 ng/ml.[1]

Many adults need help, too. Several studies have documented that vitamin D deficiency among adults is an epidemic, not only on a national level, but also worldwide.

However, the problem is much worse than that because a wide variety of diseases and unhealthy conditions are associated with vitamin D levels less than about 40 ng/ml--more than 70 percent of adolescents in the above study had 25(OH)D levels less than 40 ng/ml. Remember that 25(OH)D blood levels are technically difficult to perform and significant variation occurs from lab to lab and from the past literature to present literature. However, as Reinhold Vieth has pointed out, one must proceed with the literature, and the variation, as that is all that is available.

So how do we know what our vitamin D blood levels {25(OH)D} should be?

  1. The most commonly used rationale for optimum vitamin D levels is the level that maximally suppresses parathormone (PTH) levels. PTH is the emergency hormone the body uses to maintain calcium blood levels and high levels are associated with a number of chronic illnesses, not just osteoporosis. Therefore, the thought is the lower your PTH the better. A study shows 25(OH)D was highly inversely correlated with PTH and at concentrations of 25(OH)D below 36 ng/ml (90 nmol/l), an increase in PTH was observed. The data from elderly adults indicates even higher 25(OH)D levels are needed as suppression of PTH does not plateau until 25(OH)D is 44 ng/ml.
  2. When vitamin D levels fall below 35 ng/ml, calcium absorption in the intestine falls with it. That is, calcium absorption is maximized by keeping vitamin D levels above 35 ng/ml.
  3. Deaths from cardiovascular disease are more common in the winter, more common at higher latitudes and more common at lower altitudes, observations that are all consistent with vitamin D deficiency contributing heart disease. People with 25(OH)D levels above 35 ng/ml were half as likely to have a heart attack than those whose level was less than 35 ng/ml.
  4. One-hour glucose and area under the glucose curve during a standard 75-g oral glucose tolerance test are inversely associated with the serum concentration of 25(OH)D. Extrapolation of recent graphic data for healthy young adults showed that improvements in 60-minute, 90-minute and 120-minute postprandial glucose levels and insulin sensitivity appeared to plateau when subjects reached vitamin D levels above 35 ng/ml.
  5. Framingham data showed osteoarthritis of the knee progressed more rapidly in those with vitamin D levels lower than 36 ng/ml (90 nmol/L). Another study found that osteoarthritis of the hip progressed more rapidly in those with vitamin D levels lower than 30 ng/ml (75 nmol/L).
  6. In an eight-year prospective study of 25,000 subjects, colon cancer was reduced by 80 percent in those with vitamin D levels above 33 ng/ml.
  7. Hollis and Wagner have reported that lactating women need 4,000 IU of vitamin D3 a day to maintain both their and their infants vitamin D levels. Such supplementation is associated with vitamin D levels of about 40 ng/ml. (Hollis and Wagner have answered an old and puzzling question, "Why is almost all human breast milk deficient in vitamin D?" Answer: "Because almost all the mothers are deficient in vitamin D.")
  8. A study published in July 2004 showed that people over the age of 50 with higher vitamin D levels have less evidence of periodontal disease. There is a significant inverse relationship between periodontal disease and vitamin D levels. Those with levels greater than 34 ng/ml had the least risk.

The Optimal Level for Vitamin D

Perhaps the most compelling reason to keep our vitamin D levels above 40 ng/ml is a naturalistic one. Humans have spent about 2 million years on the Earth, almost all that time we were naked in equatorial Africa. Vitamin D levels of American lifeguards (almost naked in the sun) and humans living in high agricultural societies near the equator (Brazil) both have vitamin D levels in excess of 40 ng/ml.

Therefore, the normal human vitamin D level is above 40 ng/ml and any argument to accept lower levels would have to be based on compelling new research. So far, nothing--not one article in the literature--gives any reason to accept anything less than 40 ng/ml in children and adults.

There is a wide variety of evidence that tells us we should keep our vitamin D level above 40 ng/ml. Based on our extensive review of the research, which will soon be published in Alternative Therapies in Health and Medicine, we have proposed that optimal vitamin D levels are between 40-65 ng/mL--these levels are high enough to reduce the risk for disease, yet are low enough to avoid complications and adverse effects. (Dr. Mercola believes the range should be 40-55 to avoid toxicity risk).

Treatment and testing needs to be supervised by a doctor, and 25(OH)D needs to be performed along with measurement of serum calcium to ensure that treatment is safe and effective.

Our conclusion in our review article is that, "Until proven otherwise, the balance of the research clearly indicates that oral supplementation in the range of 1,000 IU per day for infants, 2,000 IU per day for children and 4,000 IU per day for adults is safe and reasonable to meet physiologic requirements, to promote optimal health, and to reduce the risk of many serious diseases."

Dr. Mercola has shown with his clinical experience that microemulsified vitamin D in the product "Bio-D-Mulsion" (400 IU per drop) has been the most effective form of supplementation for optimizing blood levels of vitamin D. The new "Bio-D-Forte" will provide 2,000 IU of vitamin D per microemulsified drop for more convenient dosing in children and adults.

Measuring your vitamin D levels with 25(OH)D may be the single most important blood test you, and your children, can have. Vitamin D supplementation (or prudent sun exposure) is crucial for significantly reducing the risk for many illness including:

Testing for and treating vitamin D deficiency must be considered a crucial component of health promotion and preventive health care.

Dr. Mercola's Comment:

Many thanks to Drs. Cannell and Vasquez for contributing this revealing article. If you are a health care professional I would strongly urge you to consider subscribing to Dr. Cannell's excellent vitamin D newsletter. The top vitamin D scientists in the world write it, and it is sent to the top scientists in the world with the intention of sparking the important changes that need to occur in the U.S. recommendations. I have learned quite a bit about vitamin D already, but it seems that every issue Dr. Cannel surprises me with new and exciting information about the health benefits of vitamin D.

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[1] Hypovitaminosis D in healthy schoolchildren

[2] Hypovitaminosis D in medical inpatients. Vitamin D insufficiency in a population of healthy western Canadians. High prevalence of vitamin D insufficiency in healthy elderly people living at home in Argentina.



Daily Dose

July 2, 2004

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The sun also rises over the medical establishment

I've often wondered - and more than once in print - how the human race ever managed to survive and thrive if what the mainstream says about sunlight is really true. To hear them tell it, natural sunlight is only slightly less harmful to our health than nuclear fallout! How did we ever last eight million years as an evolving species?

But as usual, my pokings and proddings on the subject have gone all but ignored by conventional medicine. Why? Because of commercial pressures, most likely. After all, how much sunscreen would you buy if they all of a sudden said that getting out in the sun every day was actually GOOD for you?

Every once in a while, though, a mainstream doctor will slip up (or even skip ranks) and agree with me about something...

Such was the case in a New York Times article in which a Boston University Medical Center dermatologist named Dr. Michael Holick re-affirmed what I've said all along - that sunlight is good for you because it aids in the body's production of vitamin D! An expert on Vitamin D with over 30 years of research on the subject under his belt, Dr. Holick cites a deficiency of this vital nutrient as a major factor in osteoporosis, diabetes, and cancers of the skin, breast, prostate, and ovaries...

If this all sounds familiar, it's because it's what I've been telling you - and the medical establishment - about the benefits of vitamin D for years now! Anyway...

In the interview, Dr. Holick also mentions that vitamin D plays a vital role in regulating cell growth - and on our immune systems and cardiovascular health. But what are really interesting are his studies on regional sun exposure and vitamin D levels. In one such study, Dr. Holick discovered that 36 percent of young Boston-area adults were vitamin D deficient at the end of wintertime (not too surprising, right)...

But get this: They were still 11 percent vitamin D deficient at the END of summer!

Remember: these figures represented the youngest, most active adults (aged 18 to 29), the hiking, biking, roller-blading, and running demographic. Can you imagine what those figures must be like for older adults with indoor jobs or a less outdoorsy lifestyle? Not good. But this condition is so easy - and fun - to remedy.

My recommendation is that you get outside a little every day - especially if you live north of the Mason-Dixon line. Go ahead, play some golf or tennis, do a little gardening, or take a stroll. It'll do you so much good on so many levels, believe me. Of course, supplemental vitamin D isn't a bad idea if you're sure that what you're taking is of good quality, and highly absorbable.       

Off to catch some rays,

William Campbell Douglass II, MD

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Let the Sun Shine
Health Sciences Institute e-Alert

Thursday July 08, 2004


Dear Reader,

If you have type 2 diabetes, or if you've been diagnosed with a pre-diabetic condition, you may be deficient in one vitamin that could help make a big difference in your health.

I'm not talking about vitamin C or vitamin E, although both of these vitamins have been shown to be essential in helping prevent kidney disease in diabetics (see the e-Alert "Take 2" 7/28/03).

According to new research from the American Journal of Clinical Nutrition, vitamin D may play a key role in glucose metabolism. But how do you know if you're vitamin D deficient? And what are the best sources?

My "what" level?

Off hand, do you know what your 25-hydroxyvitamin D level is?

Neither do I. But the next time my doctor draws blood I'm going to ask him to make a note of the level of this marker (also known as 25(OH)D), because it's the best way to tell if you're getting enough vitamin D.

Researchers at the University of California-Los Angeles School of Medicine (UCLA) recently examined the relation of 25(OH)D to insulin sensitivity in a group of 126 adults with normal glucose-tolerance. After determining the subjects' 25(OH)D levels, the UCLA team gauged the responsiveness of the pancreas to glucose using a technique called hyperglycemic clamp.

Compared to subjects with the highest vitamin D levels, those with the lowest levels had symptoms of type 2 diabetes, including weaker pancreatic function and greater insulin resistance. In addition, 30 percent of the subjects with low vitamin D levels had one or more of the symptoms associated with metabolic syndrome x (MSX). Only 11 percent of those with normal vitamin D levels showed similar symptoms.

In the e-Alert "X Marks the Spot" (4/15/04), I told you about the primary MSX indicators:
* Excessive abdominal fat 
* Elevated blood pressure (130/85 or higher) 
* Low HDL cholesterol level (Less than 50 in women, less than 40 in men) 
* Elevated Triglyceride level 
* Elevated C-reactive protein level 
* Fasting glucose level that indicates insulin resistance/glucose intolerance

A combination of just three or more of these symptoms creates an elevated risk of heart disease and type 2 diabetes.

Light of day 

The best dietary sources of vitamin D are eggs, liver, fish liver oils, and oily fish such as salmon, sardines, trout, and tuna. But by far, the best source of vitamin D is through sun exposure. When your skin is exposed to ultraviolet light, your body responds by manufacturing vitamin D.

Of course, the idea of sun exposure runs against the current popular "wisdom" that you should completely avoid sunlight unless covered scalp to ankles with sunblock. But as Dr. Jonathan V. Wright, M.D., has pointed out in his Nutrition & Healing newsletter, sun exposure is not only good, it's essential. The damage that can set the stage for skin cancer comes when exposure is extreme and results in sunburned skin.

Unfortunately, the amount of sun needed to prompt the body to create vitamin D is only available in most of the U.S. during the summer months. For the remainder of the year - and for those who live in extreme northern and southern latitudes - the most accessible source of vitamin D is from fish oil supplements.

Good values

As I mentioned above, the first step in determining if your vitamin D intake is sufficient is to assess blood serum levels of 25(OH)D. According to natural medical physician Dr. Joseph Mercola, the optimal 25(OH)D value is 115-128 millimicromolar (nmol/L). A value below 50 is considered a serious deficiency that increases the risk of chronic diseases, including breast and prostate cancer.

By some estimates, as much as 40 percent of the population is vitamin D deficient, with a relatively small percentage qualifying in the optimal 25(OH)D range. So how can you make sure you're getting enough D? In addition to sun exposure and dietary sources, fish oil supplements provide a convenient way to boost 25(OH)D.

In a 1999 issue of the American Journal of Clinical Nutrition, Reinhold Vieth, M.D., of the University of Toronto laid out some guidelines for supplementing above the vitamin D recommended dietary allowance of 200 IU per day. Dr. Vieth wrote that in order for 25(OH)D to exceed 100 nmol/L, a daily vitamin D intake of 4,000 IU is necessary. And Dr. Vieth notes that, except for people who have a hypersensitivity to vitamin D, there are no adverse effects with 25(OH)D levels under 140 nmol/L. But to reach that upper level you'd need to take 10,000 IU per day.

But before you begin taking fish oil supplements, there are two important details to keep in mind:

* If you get regular, daily sun exposure during the summer, chances are you don't need a D supplement during those three months of the year
* Choose a fish oil supplement that's "molecularly distilled" to insure that toxins are kept to a minimum

And, as always, talk to your doctor or health care provider before starting any new dietary supplement regimen. 

To Your Good Health,

Jenny Thompson
Health Sciences Institute

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"Hypovitaminosis D is Associated with Insulin Resistance and Beta Cell Dysfunction" American Journal of Clinical Nutrition, Vol. 79, No. 5, May 2004,
"Low Vitamin D Linked to Insulin Resistance" David Douglas, Reuters Health, 6/29/04,
"Test Values and Treatment for Vitamin D Deficiency" Dr. Joseph Mercola, 2/23/02,
"Vitamin D supplementation, 25-Hydroxyvitamin D Concentrations, and Safety" Reinhold Vieth, M.D., American Journal of Clinical Nutrition, Vol. 69, No. 5, May 1999,
"Is the Government too Lax in Advice on Tuna Consumption?" Consumer Reports, July 2004,

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e-Alerts and products or you're an HSI member and would like
to search past articles, visit

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