July 20, 2016

Director's Letter
Carole Baggerly
Director, GrassrootsHealth

As you know, I am a breast cancer survivor (sometimes I say I'm a breast cancer treatment survivor). While the cancer is gone, the trauma of the treatments will have a detrimental effect on my health for the rest of my life. If only there had been someone with knowledge and information who could have taken me aside when I was in my 30s or 40s or 50s and shared with me the importance of vitamin D. Shortly after my diagnosis, I discovered my vitamin D level was 18 ng/ml. What if I knew then what I know now and had started supplementing and getting more sun at 40, or earlier, what about if my mother had sought out sunlight during her pregnancy? We can never know for sure what may have been different, but our research says that my risk could have been reduced by 50-80%. No one can go back and tell the younger me about vitamin D, but I can help spread the word to others today; and I can fight to make vitamin D a standard of care in all OB offices, pediatrician offices, and general practice.

We can't wait! We have enough studies. We have enough data. This week we will give a summary of some of the data on vitamin D and cancer. There is a lot. If you go to the National Center for Biotechnology Information, where most of the research is housed, and search for "vitamin D" it will report over 68,000 papers on vitamin D. 68,000?? How many do we need? 100,000? 200,000?

Please share this information with those who can make a difference - in their own lives, in their families, in their communities, in their practice.  


Carole Baggerly 
Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research into Practice NOW!
Cancer and Vitamin D - A Review

The Beginning

Almost all vitamin D researchers point to the iconic research of the Garland brothers as the beginning of research on vitamin D and cancer. It centers on the map below, which illustrates both the mean solar radiation in the US (black lines) and the incidence of colon cancer (low is light blue, high is dark red). Dr. Cedric Garland describes this map during his seminar talk, 2010, starting at minute 2:53. You can make your own map using the tool in the sidebar from the National Cancer Institute.

Drawing the initial connection between solar radiation and cancer, and the conclusion that vitamin D is a protective factor against colon cancer in the paper that followed, launched a host of studies - epidemiological, observational, and randomized control - on vitamin D and cancer. 
Annual mean daily solar radiation (gm-cal/cm2) and colon cancer incidence United States

All Cancers
A randomized controlled trial was done at Creighton University and published in 2007 by Joan Lappe, Robert Heaney and others. They conducted a 4 year, population-based, double-blind, randomized placebo-controlled trial with 1179 community-dwelling healthy women over 55 years of age in rural Nebraska. Subjects either received 1400-1500 mg supplemental calcium per day, this same amount of calcium plus 1000 IU vitamin D per day, or simply a placebo. The calcium + D group fared the best and the paper concluded that going from an average of 29 ng/ml at baseline to 38 ng/ml at one year, women in the calcium + D group had a 60% reduced incidence of all cancers compared to women in the placebo group who remained at 29 ng/ml on average.

Recently, GrassrootsHealth did a pooled analysis using data from the Lappe trial described above and from our D*action cohort. We found that those with vitamin D serum ≥40 ng/ml had a 67% lower risk of cancer than women with concentrations <20 ng/ml.
Breast Cancer
A hospital-based case control study on Caucasian women in the UK was published in 2005. 179 breast cancer patients and 179 controls were studied for vitamin D level and vitamin D receptor genome type.  The results of the study showed that women with serum concentrations of > 60 ng/ml had an 83% reduction in breast cancer risk compared to women with concentrations < 20 ng/ml.
There are many more studies with breast cancer, all showing between 50-80% risk reduction.  A two-page handout can be found here, our most succinct summary. In addition, we have a breast cancer web page with information solely on vitamin D and breast cancer.
Prostate Cancer
A case control study was done using men from the Health Professionals Follow-up Study, a long-term men's health study sponsored by the Harvard School of Public Health. They followed 1261 men with prostate cancer and 1331 controls from 1995 to 2011 for lethal outcomes, of which there were 114. They found that those in the highest serum level group (median of 36 ng/ml) had a 57% lower risk of lethal prostate cancer compared to those in the lowest serum level group (median of 16 ng/ml).   
Colon Cancer
A pooled-analysis was done using five studies of serum 25(OH)D and colorectal cancer. The conclusion was a 50% reduction in risk for the group with serum levels ≥33 ng/ml, compared to those with serum levels ≤12 ng/ml.
Non-Hodgkin Lymphoma
A case-control study with non-Hodgkin Lymphoma patients (551) and controls (462) was done to collect data on UV exposure in the past 10 years. They found that > 7 hours of sun exposure a week lowered the risk of non-Hodgkin Lymphoma.
Cancer Research Summaries
Dr. Cedric Garland has been researching vitamin D and cancer for over 30 years, serves as a principal investigator for our D*action project and is world renown for his research of vitamin D and cancer. He and his brother Frank had their "aha!" moment when studying the map of colon cancer in the US (above) in the 1970's. Garland pioneered the 'DINOMIT' model which describes 7 steps in the formation of cancer, each with a form of intervention. Vitamin D is known to prevent the first stage or the initiation of cancer, called disjunction in this model. Garland strongly believes in the preventive effect of vitamin D, as you can read below in his editorial. His position is summed up in his paper, Vitamin D for Cancer Prevention: Global Perspective, and this 15 minute video summary.

Dr. Michael Holick, in his paper Cancer, Sunlight and Vitamin D, summarizes key research on vitamin D and cancer; explains how vitamin D is used in the body; how vitamin D can be used for cancer treatment; and the conundrum of sunlight exposure. Production of 1,25(OH)D, the version of vitamin D made in the cells by vitamin D receptors, controls cell replication. This conversion keeps cells in a healthy, normally proliferative state. 
What do Members of our International Panel of Scientists Say about Vitamin D and Cancer?

What about vitamin D?
"The ability of vitamin D to prevent postmenopausal breast cancer and colorectal cancer was discovered by examining a map in 1974, resulting in a publication in 1980 by Garland and Garland of The Johns Hopkins University. There were then a dozen confirmatory observational studies, including research led by Edward D. Gorham, PhD. The effect of vitamin D3 on risk of invasive cancers was further confirmed by an RCT performed by Joan Lappe, Robert Heaney and their colleagues at Creighton University of Omaha in 2007. In the meantime, the number of cancers associated with low UVB levels (and most likely low 25(OH)D) levels, has been substantially expanded by William B. Grant, Ph.D., of the Sunlight and Nutrition Research Center in  San Francisco CA; and Sharif B, Mohr, Ph.D., Rafael Cuomo, MPH and June Kim of UC San Diego. I think that Drs. Lappe and Heaney should be given a Nobel Prize for their experiment in 2007, and am hoping for this.  Due to these studies, there is now no question that vitamin D3 prevents postmenopausal breast cancer and colorectal cancer, along with both types of diabetes, multiple sclerosis and other diseases. The safe upper limit dosages of the National Academy of Sciences (2001) for everyone aged 9 years and older is 4,000 IU/day. It should also be noted that the NOAEL (no adverse effect level) is 10,000 IU/day. 

A reasonable serum 25(OH)D target is now 50-70 ng/ml.  There may be some minor risks of aiming above 40-60 ng/ml, but the Dr. Cedric Garland benefits are so great and the risk is so low that this target is becoming a reasonable choice. Always tell your doctor what you have in mind, and seek his or her advice. He or she can take your personal medical history into account."

Cedric F. Garland, Dr PH FACE
UC San Diego School of Medicine
The Strong Link between Sunlight and Cancer

"The effect of solar UVB exposure on cancer mortality rates is clearly evident in the maps of cancer mortality rates in the United States. Rates for 15 types of cancer are lowest in the southwest, highest in the northeast. The inverse correlation between solar UVB doses in summer and cancer mortality rates is very strong for 15 types of cancer even after adjustment for other cancer risk-modifying factors such as alcohol consumption, diet, and smoking [Grant, 2006].

Observational studies also provide strong support for the UVB-vitamin D-cancer hypothesis. Even the International Agency for Cancer Research agrees that vitamin D reduces risk of colorectal cancer [IARC, 2008]. There is a very strong inverse correlation between vitamin D level and incidence of breast cancer based on 11 case-control studies from 7 countries [Grant, 2015].

Since many adverse health outcomes have been linked to low vitamin D levels, the prudent thing to do is maintain levels above 40 ng/mL (100 nmol/L). There are few if any adverse health effects associated with vitamin D levels up to 100 ng/mL [Grant, 2016]."
William B. Grant, PhD
San Francisco
Editor's Letter
Susan Siljander
Marketing Director, GrassrootsHealth

Since cancer is so pervasive in our world, the research on vitamin D is one of the most compelling reasons to test and keep vitamin D serum levels high. If I could prevent breast cancer for myself (which would prevent extreme disruption to my family) and for my children - I would do it. I would do it if it were hard, if it were expensive. But, it is not. Instead it is easy. Just yesterday I moved my swim time with my daughter from 9am to 1pm so we could both get vitamin D and a workout at the same time.

One of my favorite introductions on vitamin D is...

"If you could reduce the chance of your daughter getting breast cancer by 50-80% would you do it?"

"Yes, of course. How?"

"Starting now, even as a young child, test her vitamin D level and keep it within 40-60 ng/ml. Your child can get vitamin D through measured sunlight or supplementation. Your choice. I can text you a web site with more information."

Continue the discussion with friends, neighbors, family. It will be amazing the good you can do with a short discussion. These people, if they listen, may come back to you 2-3 months later and thank you for speaking up.

Have a great week!
Susan Siljander
Marketing Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research Into Practice NOW!
Order Now
Your participation in this project provides information for your answers to D questions and helps fund the GrassrootsHealth projects.

Make Your Own Map
The National Cancer Institute provides an interactive website about cancer mortality. It uses data from 1950-2004 (1970-2004 for blacks) to allow you to create your own map. Where is cancer most prevalent?

Do sunlight and vitamin D reduce the likelihood of colon cancer?
Cedric F. Garland et al.
UC San Diego School of Medicine
Int J Epidemiol
September 1980

Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial.
Joan M. Lappe et al.
Creighton University
American Journal of Clinical Nutrition
June 2007
Read Paper

Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study
Sharon L. McDonnell et al.
April 2016

Plasma 25-hydroxy vitamin D concentrations, vitamin D receptor genotype and breast cancer risk in a UK Caucasian population
Lorraine C. Lowe et al.
St. George's Medical School, London
European Journal of Cancer
May 2005

Vitamin D-related genetic variation, plasma vitamin D, and risk of lethal prostate cancer: a prospective nested case-control study
Irene M. Shui et al.
Harvard School of Public Health
Journal of the National Cancer Institute
April 2012
Read Paper

Optimal Vitamin D Status for Colorectal Cancer Prevention: a quantitative meta analysis
Edward D. Gorham et al.
UC San Diego School of Medicine
American Journal of Preventive Medicine
March 2007
Read Paper

Sun exposure, vitamin D receptor gene polymorphisms and risk of non-Hodgkin lymphoma
Mark P. Purdue et al.
National Cancer Institute
November 2007
Read Paper

Vitamin D for cancer prevention: global perspective
Cedric F. Garland et al.
UC San Diego School of Medicine
Annals of Epidemiology
July 2009
Read Paper

Cancer, sunlight and vitamin D
Michael F. Holick
Boston University School of Medicine
Journal of Clinical & Translational Endocrinology
October 2014

How Vitamin D Reduces Incidence of Cancer: DINOMIT Model
Cedric F. Garland
UC San Diego School of Medicine
June 2009
15 minute video summarizing cancer and vitamin D. It describes the famous map of colon cancer, the first papers on vitamin D and cancer, and Garland's DINOMIT model for cancer. 
How can we prevent 58,000 new breast cancer diagnoses and 49,000 colon cancer diagnoses in the US and Canada yearly?

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